Thursday,

August 5, 2004

Part II

Department of 

Health and Human 

Services

Centers for Medicare and Medicaid 

Services 

42 CFR Parts 405, 410, 411, et al. 

Medicare Program; Revisions to Payment 

Policies Under the Physician Fee 

Schedule for Calendar Year 2005; 

Proposed Rule

47488 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 405, 410, 411, 414, 418, 

424, 484, and 486

[CMS–1429–P] 

RIN 0938–AM90

Medicare Program; Revisions to 

Payment Policies Under the Physician 

Fee Schedule for Calendar Year 2005

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Proposed rule.

SUMMARY: This proposed rule would 

refine the resource-based practice 

expense relative value units (RVUs) and 

make other changes to Medicare Part B 

payment policy. The proposed policy 

changes concern: supplemental survey 

data for practice expense, updated 

geographic practice cost indices for 

physician work and practice expense, 

updated malpractice RVUs, revised 

requirements for supervision of therapy 

assistants, revised payment rules for low 

osmolar contrast media, changes to 

payment policies for physicians and 

practitioners managing dialysis patients, 

clarification of care plan oversight 

requirements, revised requirements for 

supervision of diagnostic psychological 

testing services, clarifications to the 

policies affecting therapy services, 

revised requirements for assignment of 

Medicare claims, addition to the list of 

telehealth services, and several coding 

issues. 

We are proposing these changes to 

ensure that our payment systems are 

updated to reflect changes in medical 

practice and the relative value of 

services. We solicit comments on these 

proposed policy changes. 

This proposed rule also addresses the 

following provisions of the Medicare 

Prescription Drug, Improvement, and 

Modernization Act of 2003 (MMA): 

coverage of an initial preventive 

physical examination; coverage of 

cardiovascular screening blood tests; 

coverage of diabetes screening tests; 

incentive payment improvements for 

physicians in shortage areas; payment 

for covered outpatient drugs and 

biologicals; payment for renal dialysis 

services; coverage of routine costs 

associated with certain clinical trials of 

category A devices as defined by the 

Food and Drug Administration; hospice 

consultation service; indexing the Part B 

deductible to inflation; extension of 

coverage of intravenous immune 

globulin (IVIG) for the treatment in the 

home of primary immune deficiency 

diseases; revisions to reassignment 

provisions; clinical conditions for 

payment of covered items of durable 

medical equipment; and payment for 

diagnostic mammograms.

In addition, we discuss physicians’ 

services associated with drug 

administration services and payment for 

set-up of portable x-ray equipment.

DATES: To be assured consideration, 

comments must be received at one of 

the addresses provided below, no later 

than 5 p.m. on September 24, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–1429–P. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

You may submit comments in one of 

three ways (no duplicates, please): 

1. Electronically. You may submit 

electronic comments on specific issues 

in this regulation to http://

www.cms.hhs.gov/regulations/

ecomments. (Attachments should be in 

Microsoft Word, WordPerfect, or Excel; 

however, we prefer Microsoft Word.) 

2. By mail. You may mail written 

comments (one original and two copies) 

to the following address ONLY:

Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–

1429–P, P.O. Box 8012, Baltimore, 

MD 21244–8012.

Please allow sufficient time for mailed 

comments to be received before the 

close of the comment period. 

3. By hand or courier. If you prefer, 

you may deliver (by hand or courier) 

your written comments (one original 

and two copies) before the close of the 

comment period to one of the following 

addresses. If you intend to deliver your 

comments to the Baltimore address, 

please call telephone number (410) 786–

7197 in advance to schedule your 

arrival with one of our staff members.

Room 445–G, Hubert H. Humphrey 

Building, 200 Independence Avenue, 

SW., Washington, DC 20201; or 7500 

Security Boulevard, Baltimore, MD 

21244–1850.

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal Government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available for persons wishing to retain 

a proof of filing by stamping in and 

retaining an extra copy of the comments 

being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

received after the comment period. 

Submission of comments on 

paperwork requirements. You may 

submit comments on this document’s 

paperwork requirements by mailing 

your comments to the addresses 

provided at the end of the ‘‘Collection 

of Information Requirements’’ section in 

this document. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:

Pam West (410) 786–2302 (for issues 

related to Practice Expense, 

Respiratory Therapy Coding, and 

Therapy Supervision). 

Rick Ensor (410) 786–5617 (for issues 

related to Geographic Practice Cost 

Index (GPCI) and malpractice RVUs). 

Craig Dobyski (410) 786–4584 (for issues 

related to list of telehealth services or 

payments for physicians and 

practitioners managing dialysis 

patients). 

Bill Larson or Tiffany Sanders (410) 

786–7176 (for issues related to 

coverage of an initial preventive 

physical examination). 

Cathleen Scally (410) 786–5714 (for 

issues related to payment of an initial 

preventive physical examination). 

Joyce Eng (410) 786–7176 (for issues 

related to coverage of cardiovascular 

screening tests). 

Betty Shaw (410) 786–7176 (for issues 

related to coverage of diabetes 

screening tests). 

Anita Greenberg (410) 786–0548 (for 

issues related to payment of 

cardiovascular and diabetes screening 

tests). 

David Worgo (410) 786–5919, (for issues 

related to incentive payment 

improvements for physicians 

practicing in shortage areas). 

Angela Mason or Jennifer Fan (410) 

786–0548 (for issues related to 

payment for covered outpatient drugs 

and biologicals). 

David Walczak (410) 786–4475 (for 

issues related to reassignment 

provisions). 

Henry Richter (410) 786–4562 (for 

issues related to payments for ESRD 

facilities). 

Steve Berkowitz (410) 786–7176 (for 

issues related to coverage of routine 

costs associated with certain clinical 

trials of category A devices). 

Terri Deutsch (410) 786–9462 (for issues 

related to hospice consultation 

services).

Karen Daily (410) 786–7176 (for issues 

related to clinical conditions for 

payment of covered items of durable 

medical equipment). 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47489

Dorothy Shannon (410) 786–3396 (for 

issues related to outpatient therapy 

services performed ‘‘incident to’’

physicians’ services). 

Roberta Epps (410) 786–5919 (for issues 

related to low osmolar contrast media 

or supervision of diagnostic 

psychological testing services). 

Gail Addis (410) 786–4522 (for issues 

related to care plan oversight). 

Diane Milstead (410) 786–3355 or 

Gaysha Brooks (410) 786–9649 (for all 

other issues).

SUPPLEMENTARY INFORMATION: 

Submitting Comments: We welcome 

comments from the public on all issues 

set forth in this rule to assist us in fully 

considering issues and developing 

policies. You can assist us by 

referencing the file code CMS–1429-P 

and the specific ‘‘issue identifier’’ that 

precedes the section on which you 

choose to comment. 

Inspection of Public Comments:

Comments received timely will be 

available for public inspection as they 

are processed, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

a.m. to 4 p.m. To schedule an 

appointment to view public comments, 

phone (410) 786–7197. 

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 the date of the issue requested 

and enclose a check or money order 

payable to the Superintendent of 

Documents, or enclose your Visa or 

Master Card number and expiration 

date. Credit card orders can also be 

placed by calling the order desk at (202) 

512–1800 (or toll-free at 1–888–293–

6498) or by faxing to (202) 512–2250. 

The cost for each copy is $10. As an 

alternative, you can view and 

photocopy the Federal Register

document at most libraries designated 

as Federal Depository Libraries and at 

many other public and academic 

libraries throughout the country that 

receive the Federal Register. 

This Federal Register document is 

also available from the Federal Register

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. The web site address is: http://

www.access.gpo.gov/nara/index.html. 

Information on the physician fee 

schedule can be found on the CMS 

homepage. You can access this data by 

using the following directions: 

1. Go to the CMS homepage (http://

www.cms.hhs.gov). 

2. Place your cursor over the word 

‘‘Professionals’’ in the blue area near the 

top of the page. Select ‘‘physicians’’

from the drop-down menu. 

3. Under ‘‘Policies/Regulations’’ select 

‘‘Physician Fee Schedule.’’

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 is not exclusively in 

section VII.

Table of Contents 

I. Background 

A. Legislative History 

B. Published Changes to the Fee Schedule 

II. Provisions of the Proposed Regulation 

Related to the Physician Fee Schedule 

A. Resource-Based Practice Expense 

Relative Value Units (RVUs)

B. Geographic Practice Cost Indices (GPCIs) 

C. Malpractice Work RVUs 

D. Coding Issues 

III. Provisions Related to the Medicare 

Modernization Act of 2003

A. Section 611—Preventive Physical 

Examination 

B. Section 613—Diabetes Screening 

C. Section 612—Cardiovascular Screening 

D. Section 413—Incentive Payment for 

Physician Scarcity 

E. Section 303—Payment for Covered 

Outpatient Drugs and Biologicals 

F. Section 952—Revision to Reassignment 

Provisions 

G. Section 642—Extension of Coverage of 

IVIG for the Treatment in the Home of 

Primary Immune Deficiency Diseases 

H. Section 623—Payment for Renal 

Dialysis Services 

I. Section 731—Coverage of Routine Costs 

for Category A Clinical Trials 

J. Section 629—Part B Deductible 

K. Section 512—Hospice Consultation 

Service 

L. Section 302—Clinical Conditions for 

Coverage of Durable Medical Equipment 

(DME) 

M. Section 614—Payment for Certain 

Mammography Services 

N. Section 305—Payment for Inhalation 

Drugs 

IV. Other Issues 

A. Provisions Related to Therapy Services 

1. Outpatient Therapy Services Performed 

‘‘Incident to’’ Physicians’’ Services 

2. Supervision Requirements for Therapy 

Assistants in Private Practice 

3. Other Technical Revisions 

B. Low Osmolar Contrast Media 

C. Payments for Physicians and 

Practitioners Managing Dialysis Patients 

D. Technical Revision—§ 411.404

E. Supervision of Clinical Psychological 

Testing 

F. Care Plan Oversight 

G. Assignment of Medicare Claims—

Payment to the Supplier 

V. Collection of Information Requirements 

VI. Response to Comments 

VII. Regulatory Impact Analysis 

Addendum A—Explanation and Use of 

Addendum B. 

Addendum B—2005 Relative Value Units 

and Related Information Used in 

Determining Medicare Payments for 

2005. 

Addendum C—Codes for Which We 

Received PEAC Recommendations on 

Practice Expense Direct Cost Inputs. 

Addendum D—Proposed Changes to Practice 

Expense Equipment Description and 

Pricing. 

Addendum E—Revised 2005 Office Rental 

Index Versus Current Office Rental Index 

by 2004 Fee Schedule Area 

Addendum F—Current Geographic Practice 

Cost Indices by Medicare Carrier and 

Locality 

Addendum G—Proposed 2005 Geographic 

Practice Cost Indices by Medicare Carrier 

and Locality 

Addendum H—Proposed 2006 Geographic 

Practice Cost Indices by Medicare Carrier 

and Locality 

Addendum I—Comparison of Current 2004 

Geographic Adjustment Factors (GAFs) 

to Proposed 2005 GAFS 

Addendum J—Comparison of Current 2004 

GAFs to Proposed 2006 GAFs

In addition, because of the many 

organizations and terms to which we 

refer by acronym in this proposed rule, 

we are listing these acronyms and their 

corresponding terms in alphabetical 

order below:

ACC American College of Cardiology 

ACR American College of Radiology 

AMA American Medical Association 

APA American Psychological Association 

ASP Average Sales Price 

ATA American Telemedicine Association 

BBA Balanced Budget Act of 1997

BBRA Balanced Budget Refinement Act of 

1999

BIPA Benefits Improvement and Protection 

Act of 2000

BLS Bureau of Labor Statistics 

CAH Critical Access Hospital 

CF Conversion factor 

CFR Code of Federal Regulations 

CMS Centers for Medicare & Medicaid 

Services 

CNS Clinical Nurse Specialist 

CPT [Physicians’] Current Procedural 

Terminology [4th Edition, 2002, 

copyrighted by the American Medical 

Association] 

CPEP Clinical Practice Expert Panel 

CY Calendar Year 

E/M Evaluation and management 

ESRD End-Stage Renal Disease 

FMR Fair market rental 

FY Fiscal Year 

GAF Geographic adjustment factor 

GPCI Geographic practice cost index 

HCPCS Healthcare Common Procedure 

Coding System 

HHA Home health agency

HHS [Department of] Health and Human 

Services 

47490 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

HOCM High osmolar contrast media 

HPSA Health Professional Shortage Area 

HRSA Health Resources and Services 

Administration 

IDTFs Independent Diagnostic Testing 

Facilities 

IPPS Inpatient prospective payment system 

IOM Internet Only Manual 

ISO Insurance Services Office 

LOCM Low osmolar contrast media 

MCM Medicare Carrier Manual 

MCP Monthly Capitation Payment 

MedPAC Medicare Payment Advisory 

Commission 

MEI Medicare Economic Index 

MGMA Medical Group Management 

Association 

MMA Medicare Prescription Drug, 

Improvement, and Modernization Act of 

2003

MPFS Medicare Physician Fee Schedule 

MSA Metropolitan Statistical Area 

NAMCS National Ambulatory Medical Care 

Survey 

NP Nurse Practitioner 

OBRA Omnibus Budget Reconciliation Act 

OMB Office of Management and Budget 

OPPS Outpatient prospective payment 

system 

PA Physician Assistant 

PC Professional component 

PCF Patient compensation fund 

PEAC Practice Expense Advisory 

Committee 

PET Positron Emission Tomography 

PHSA Public Health Services Act 

PPS Prospective payment system 

PSA Physician Scarcity Area 

RN Registered Nurse 

RUC [AMA’s Specialty Society] Relative 

[Value] Update Committee 

RUCA Rural-Urban Commuting Area 

RVU Relative value unit 

SCHIP State Child Health Insurance 

Program 

SGR Sustainable growth rate 

SLP Speech language pathology 

SMS [AMA’s] Socioeconomic Monitoring 

System 

TC Technical component 

USPSTF U.S. Preventive Services Task 

Force

I. Background 

A. Legislative History 

Since January 1, 1992, Medicare has 

paid for physicians’ services under 

section 1848 of the Social Security Act 

(the Act), ‘‘Payment for Physicians’

Services.’’ 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 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. If adjustments to RVUs cause 

expenditures to change by more than 

$20 million, we must make adjustments 

to ensure that they do not increase or 

decrease by more than $20 million. 

B. Published Changes to the Fee 

Schedule 

The July 2000 and August 2003 

proposed rules ((65 FR 44177) and (68 

FR 49030), respectively), include a 

summary of the final physician fee 

schedule rules published through 

February 2003. 

In the November 7, 2003 final rule, we 

refined the resource-based practice 

expense RVUs and made other changes 

to Medicare Part B payment policy. The 

specific policy changes concerned: The 

Medicare Economic Index; practice 

expense for professional component 

services; definition of diabetes for 

diabetes self-management training; 

supplemental survey data for practice 

expense; geographic practice cost 

indices; and several coding issues. In 

addition, this rule updated the codes 

subject to the physician self-referral 

prohibition. We also made revisions to 

the sustainable growth rate, the 

anesthesia conversion factor and 

finalized the CY 2003 interim RVUs and 

issued interim RVUs for new and 

revised procedure codes for CY 2004. 

As required by the statute, we 

announced that the physician fee 

schedule update for CY 2004 would be 

¥4.5 percent; the initial estimate of the 

sustainable growth rate for CY 2004 was 

7.4 percent; and the conversion factor 

for CY 2004 was $35.1339. 

Subsequent to the November 7, 2003 

final rule, the Congress enacted the 

MMA (Pub. L. 108–17). On January 7, 

2004, an interim final rule was 

published to implement provisions of 

the MMA applicable in 2004 to 

Medicare payment for covered drugs 

and physician fee schedule services. 

These provisions included—

• Revising the current payment 

methodology for Part B covered drugs 

and biologicals that are not paid on a 

cost or prospective payment basis; 

• Making changes to Medicare 

payment for furnishing or administering 

drugs and biologicals; 

• Revising the geographic practice 

cost indices;

• Changing the physician fee 

schedule conversion factor. The 2004 

physician fee schedule conversion 

factor is $37.3374; and 

• Extending the ‘‘opt-out’’ provisions 

of section 1802(b)(5)(3) of the Act to 

dentists, podiatrists, and optometrists. 

The information contained in the 

January 7, 2004 interim final rule 

concerning payment under the 

physician fee schedule superceded 

information contained in the November 

7, 2003 final rule to the extent that the 

two are inconsistent. 

II. Provisions of the Proposed Rule 

This proposed rule would affect the 

regulations set forth at Part 405, Federal 

Health Insurance for the Aged and 

Disabled; Part 410, Supplementary 

Medical Insurance (SMI) Benefits; Part 

411, Exclusions from Medicare and 

Limitations on Medicare Payment; Part 

414, Payment for Part B Medical and 

Other Health Services; Part 418, Hospice 

Care; Part 424, Conditions for Medicare 

Payment; Part 484, Home Health 

Services; and Part 486, Conditions for 

Coverage of Specialized Services 

Furnished by Suppliers. 

A. Resource-Based Practice Expense 

Relative Value Units 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Practice Expense’’ at the beginning of 

your comments.] 

1. Resource-Based Practice Expense 

Legislation 

Section 121 of the Social Security Act 

Amendments of 1994 (Pub. L. 103–432), 

enacted on October 31, 1994, amended 

section 1848(c)(2)(C)(ii) of the Social 

Security Act and required us to develop 

a methodology for a resource-based 

system for determining practice expense 

RVUs for each physician’s service 

beginning in 1998. Until that time, 

physicians’ practice expenses were 

established based on historical allowed 

charges. 

In developing the methodology, we 

were to consider the staff, equipment, 

and supplies used in providing medical 

and surgical services in various settings. 

The legislation specifically required 

that, in implementing the new system of 

practice expense RVUs, we apply the 

same budget-neutrality provisions that 

we apply to other adjustments under the 

physician fee schedule. 

Section 4505(a) of the Balanced 

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

33), enacted on August 5, 1997, 

amended section 1848(c)(2)(C)(ii) of the 

Act and delayed the effective date of the 

resource-based practice expense RVU 

system until January 1, 1999. In 

addition, section 4505(b) of the BBA 

provided for a 4-year transition period 

from charge-based practice expense 

RVUs to resource-based RVUs. 

Further legislation affecting resourcebased practice expense RVUs was 

included in the Medicare, Medicaid and 

State Child Health Insurance Program 

(SCHIP) Balanced Budget Refinement 

Act of 1999 (BBRA) (Pub. L. 106–113) 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47491

enacted on November 29, 1999. Section 

212 of the BBRA amended section 

1848(c)(2)(C)(ii) of the Act by directing 

us to establish a process under which 

we accept and use, to the maximum 

extent practicable and consistent with 

sound data practices, data collected or 

developed by entities and organizations. 

These data would supplement the data 

we normally collect in determining the 

practice expense component of the 

physician fee schedule for payments in 

CY 2001 and CY 2002. (The 1999 and 

2003 final rules (64 FR 59380 and 68 FR 

63196, respectively, extended the period 

during which we would accept 

supplemental data.) 

2. Current Methodology for Computing 

the Practice Expense Relative Value 

Unit System 

In the November 2, 1998 final rule (63 

FR 58910), effective with services 

furnished on or after January 1, 1999, 

we established at 42 CFR 414.22(b)(5) a 

new methodology for computing 

resource-based practice expense RVUs 

that used the two significant sources of 

actual practice expense data we have 

available—the Clinical Practice Expert 

Panel (CPEP) data and the American 

Medical Association’s (AMA) 

Socioeconomic Monitoring System 

(SMS) data. The CPEP data were 

collected from panels of physicians, 

practice administrators, and 

nonphysicians (for example registered 

nurses) nominated by physician 

specialty societies and other groups. 

The CPEP panels identified the direct 

inputs required for each physician 

service in both the office setting and 

out-of-office setting. The AMA’s SMS 

data provided aggregate specialtyspecific information on hours worked 

and practice expenses. The 

methodology was based on an 

assumption that current aggregate 

specialty practice costs are a reasonable 

way to establish initial estimates of 

relative resource costs for physicians’

services across specialties. The 

methodology allocated these aggregate 

specialty practice costs to specific 

procedures and, thus, can be seen as a 

‘‘top-down’’ approach. 

Also in the November 2, 1998 final 

rule, in response to comments, we 

discussed the establishment of the 

Practice Expense Advisory Committee 

(PEAC) of the AMA’s Specialty Society 

Relative Value Update Committee 

(RUC), which would review codespecific CPEP data during the 

refinement period. This committee 

would include representatives from all 

major specialty societies and would 

make recommendations to us on 

suggested changes to the CPEP data. 

As directed by the BBRA, we also 

established a process (see 65 FR 65380) 

under which we would accept and use, 

to the maximum extent practicable and 

consistent with sound data practices, 

data collected by entities and 

organizations to supplement the data we 

normally collect in determining the 

practice expense component of the 

physician fee schedule. 

a. Major Steps 

A brief discussion of the major steps 

involved in the determination of the 

practice expense RVUs follows.

(Please see the November 1, 2001 final 

rule (66 FR 55249) for a more detailed 

explanation of the top-down 

methodology.) 

• Step 1—Determine the specialty 

specific practice expense per hour of 

physician direct patient care. We used 

the AMA’s SMS survey of actual 

aggregate cost data by specialty to 

determine the practice expenses per 

hour for each specialty. We calculated 

the practice expenses per hour for the 

specialty by dividing the aggregate 

practice expenses for the specialty by 

the total number of hours spent in 

patient care activities.

• Step 2—Create a specialty-specific 

practice expense pool of practice 

expense costs for treating Medicare 

patients. To calculate the total number 

of hours spent treating Medicare 

patients for each specialty, we used the 

physician time assigned to each 

procedure code and the Medicare 

utilization data. The primary sources for 

the physician time data were surveys 

submitted to the AMA’s RUC and 

surveys done by Harvard for the 

establishment of the work RVUs. We 

then multiplied the physician time 

assigned per procedure code by the 

number of times that code was billed by 

each specialty, and summed the 

products for each code, by specialty, to 

get the total physician hours spent 

treating Medicare patients for that 

specialty. We then calculated the 

specialty specific practice expense pools 

by multiplying the specialty practice 

expenses per hour (from step 1) by the 

total Medicare physician hours for the 

specialty. 

• Step 3—Allocate the specialty 

specific practice expense pool to the 

specific services (procedure codes) 

performed by each specialty. For each 

specialty, we divided the practice 

expense pool into two groups based on 

whether direct or indirect costs were 

involved and used a different allocation 

basis for each group. 

(i) Direct costs—For direct costs 

(which include clinical labor, medical 

supplies, and medical equipment), we 

used the procedure-specific CPEP data 

on the staff time, supplies, and 

equipment as the allocation basis. For 

the separate practice expense pool for 

services without physician work RVUs, 

we have used, on an interim basis, 1998 

practice expense RVUs to allocate the 

direct cost pools. 

(ii) Indirect costs—To allocate the cost 

pools for indirect costs, including 

administrative labor, office expenses, 

and all other expenses, we used the total 

direct costs, or the 1998 practice 

expense RVUs, in combination with the 

physician fee schedule work RVUs. We 

converted the work RVUs to dollars 

using the Medicare CF (expressed in 

1995 dollars for consistency with the 

SMS survey years). 

• Step 4—The direct and indirect 

costs are then added together to attain 

the practice expense for each procedure, 

by specialty. For procedures performed 

by more than one specialty, the final 

practice expense allocation was a 

weighted average of practice expense 

allocations for the specialties that 

perform the procedure, based on the 

frequency with which each specialty 

performs the procedure on Medicare 

patients. 

b. Other Methodological Issues 

i. Nonphysician Work Pool 

As an interim measure, until we could 

further analyze the effect of the topdown methodology on the Medicare 

payment for services with physician 

work RVUs equal to zero (including the 

technical components of radiology 

services and other diagnostic tests), we 

created a separate practice expense 

pool. We first used the average clinical 

staff time from the CPEP data and the 

‘‘all physicians’’ practice expense per 

hour to create the pool. In the December 

2002 final rule, we changed this policy 

and now use the total clinical staff time 

and the weighted average specialty–

specific practice expense per hour for 

specialties with services in this pool. In 

the next step, we used the adjusted 1998 

practice expense RVUs to allocate this 

pool to each service. Also, for all 

radiology services that are assigned 

physician work RVUs, we used the 

adjusted 1998 practice expense RVUs 

for radiology services as an interim 

measure to allocate the direct practice 

expense cost pool for radiology. 

A specialty society may request that 

its services be removed from the 

nonphysician workpool. We have 

removed services from the nonphysician 

work pool if the requesting specialty 

predominates utilization of the service.

47492 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ii. Crosswalks for Specialties Without 

Practice Expense Survey Data 

Since many specialties identified in 

our claims data did not correspond 

exactly to the specialties included in the 

SMS survey data, it was necessary to 

crosswalk these specialties to the most 

appropriate SMS specialty. 

iii. Physical Therapy Services 

Because we believe that most physical 

therapy services furnished in 

physicians’ offices are performed by 

physical therapists, we crosswalked all 

utilization for therapy services in the 

CPT 97000 series to the physical and 

occupational therapy practice expense 

pool. 

3. Practice Expense Proposals for 

Calendar Year 2005 

a. Supplemental Practice Expense 

Surveys 

i. Survey Criteria and Submission Dates 

As required by the BBRA, we 

established criteria to evaluate survey 

data collected by organizations to 

supplement the SMS survey data 

normally used in the calculation of the 

practice expense component of the 

physician fee schedule. By regulation 

(see 68 FR 63200), we provided that, 

beginning this year, supplemental 

survey data must be submitted by March 

1 to be considered for use in computing 

practice expense RVUs for the following 

year. This allows us to publish our 

decisions regarding survey data in the 

proposed rule and provides the 

opportunity for public comment on 

these results before implementation. 

To continue to ensure the maximum 

opportunity for specialties to submit 

supplemental practice expense data, we 

extended until 2005 the period that we 

would accept survey data that meet the 

criteria set forth in the November 2000 

final rule. We will no longer accept 

supplemental practice expense data 

after that point. The deadline for 

submission of supplemental data to be 

considered in CY 2006 is March 1, 2005. 

ii. Survey by the College of American 

Pathologists (CAP) 

In the June 28, 2002 Federal Register 

(67 FR 43849), we proposed a technical 

change to the practice expense 

methodology that calculated the 

technical component as the difference 

between the global and professional 

component RVUs for services not 

included in the nonphysician work 

pool. In the December 31, 2002 final 

rule (67 FR 79979), we established a 1- 

year moratorium on the technical 

change for pathology services to allow 

CAP to do a survey of independent 

laboratories. Consistent with last year’s 

rules, CAP submitted its supplemental 

survey by August 1, 2003 for use in 

determining the 2004 practice expense 

RVUs. Our contractor, The Lewin 

Group, evaluated the data and 

recommended that we accept the survey 

to supplement the data on PE. However, 

because we changed the survey deadline 

to March 1, CAP requested that we 

delay incorporation of the survey data 

until this year’s proposed rule. CAP also 

requested that we extend the 

moratorium on calculating the technical 

component as the difference between 

the global and professional component 

RVUs for pathology services for one 

additional year to allow us to evaluate 

in a proposed rule the combined effects 

of the use of the new survey data along 

with other proposed technical changes. 

In the November 7, 2003 final rule, in 

response to the CAP comment, we 

agreed to extend the moratorium by an 

additional year. In this proposed rule, 

we propose to incorporate the CAP 

survey data into the practice expense 

methodology and to end the moratorium 

on calculating the technical component 

as the difference between the global and 

professional component RVUs for 

pathology services. We propose to use 

the following practice expense per hour 

figures for specialty 69—Independent 

Laboratory. 

TABLE 1.—PRACTICE EXPENSE PER HOUR FIGURES FOR SPECIALTY 69—INDEPENDENT LABORATORY

Specialty Clinical staff Admin. staff Office expense 

Medical 

supplies 

Medical 

equipment Other Total 

Independent Laboratory ........................... $39.7 $37.5 $40.1 $19.3 $11.1 $16.1 $163.8 

iii. Submission of Supplemental 

Surveys 

We received surveys from the 

American College of Cardiology (ACC), 

the American College of Radiology 

(ACR), and the American Society for 

Therapeutic Radiation Oncology 

(ASTRO). Our contractor, The Lewin 

Group, evaluated the data and made 

recommendations to us regarding use of 

the data in a report on May 26, 2004. We 

have made The Lewin Group report 

available on the CMS Web site at 

http://www.cms.hhs.gov/physicians/ 

pfs/. The Lewin Group is recommending 

that we accept the data from ACC and 

ACR but indicated that the survey from 

ASTRO does not meet the precision 

criteria we have established for 

supplemental surveys. As a result, The 

Lewin Group is not recommending that 

we use the ASTRO survey results at this 

time. We agree with this 

recommendation and are proposing not 

using the ASTRO survey data at this 

time. 

Many of the procedures that are 

performed by radiology, cardiology, and 

radiation oncology are affected by the 

nonphysician work pool calculations. 

We created the nonphysician work pool 

as an interim measure because of a 

concern that the top-down methodology 

was having a large adverse impact on 

payment for services that do not have 

physician work RVUs. As we stated in 

the December 31, 2002 final rule (67 FR 

79979), we believe a relatively low 

practice expense per hour explains the 

adverse impact on diagnostic and other 

services that would occur from 

eliminating the nonphysician work 

pool. The ACR, ACC, and ASTRO began 

undertaking surveys in 2003 following 

our analysis of options for eliminating 

the nonphysician work pool in the 

December 31, 2002 final rule. CMS’

interest is in using the supplemental 

survey data to eliminate the 

nonphysician work pool and use a 

single methodology to establish 

payments for all physician fee schedule 

services. 

We appreciate the efforts of these 

three specialties to undertake surveys 

and assist CMS in finding a permanent 

resolution of issues related to the 

nonphysician work pool. While the 

radiology survey data do meet the 

criteria we have established for use of 

supplemental surveys, the ACR has 

written to us asking that we not use the 

data until we have a stable and global 

solution that is workable for all 

specialties that are currently paid using 

the nonphysician work pool. The ACC 

also requested that we use the 

supplemental survey for services that 

are in the cardiology pool. However, 

ACC also indicated if CMS determines 

that it would only be appropriate to use 

the survey data if cardiology services are 

removed from the nonphysician work 

pool or if the nonphysician work pool 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47493

is eliminated, we should delay using the 

data until the issues involved can be 

discussed further. 

At this time, we are not proposing to 

eliminate the nonphysician work pool 

or to remove selected radiology and 

cardiology codes from it. Since our 

interest is in using supplemental data in 

conjunction with pricing all services 

under the top-down methodology, we 

agree with the request from ACR to 

delay use of its supplemental survey 

until issues related to the nonphysician 

work pool can be addressed. 

Furthermore, we believe the high 

practice expense per hour for cardiology 

from the supplemental survey results 

from the inclusion of practices that do 

very high cost office-based cardiology 

services. Because the RVUs for these 

office-based cardiology services are 

currently determined using the 

nonphysician work pool methodology, 

we believe the ACC supplemental 

survey data should only be used in 

conjunction with removing cardiology 

services from the nonphysician work 

pool. For this reason, we are also 

delaying use of the ACC survey data as 

we continue to analyze elimination of 

the nonphysician work pool in 

conjunction with using supplemental 

survey data. As we complete our 

analysis, we look forward to working 

with the medical community to find a 

permanent resolution of this issue.

b. Practice Expense Advisory Committee 

(PEAC) Recommendations on CPEP 

Inputs for 2005

Since 1999, the PEAC, an advisory 

committee of the RUC, has been 

providing us with recommendations for 

refining the direct practice expense 

inputs (clinical staff, supplies, and 

equipment) for existing CPT codes. As 

we did last year, we are including our 

proposals regarding the PEAC 

recommendations in the proposed rule, 

to enable specialty groups to assess the 

impact of the proposed changes on their 

services and to make comments on them 

before the final rule. 

These PEAC recommendations are the 

result of meetings held in March and 

August 2003 and January and March 

2004, and account for over 2,200 codes 

from many specialties. (A list of these 

codes can be found in Addendum C.) 

The PEAC held its last meeting in 

March 2004, and these are the last 

recommendations we will be receiving 

from the committee. The AMA 

established the PEAC to assist the RUC 

in refining the direct input data used in 

calculating the practice expense RVUs 

for established codes. Since its 

inception, the PEAC has provided 

recommendations on over 7,600 codes, 

which leaves only a few hundred 

physician fee schedule codes that we 

believe are still unrefined. The PEAC 

has also recommended standard times 

for many clinical staff activities and has 

established several supply and 

equipment packages that can be applied 

across wide ranges of codes. This has 

helped us ensure that the CPEP inputs 

have been assigned equitably across 

procedures performed by different 

specialties. The work of the PEAC has, 

therefore, contributed greatly to the 

refinement of the practice expense 

inputs, and we appreciate the 5 years of 

hard work by the specialty societies and 

the AMA that helped make the PEAC so 

successful. Future practice expense 

issues, including the refinement of the 

remaining codes not addressed by the 

PEAC, will be handled by the RUC. We 

anticipate the RUC will formulate the 

specific process at a future meeting, 

possibly as soon as October 2004. If 

possible, additional information on this 

process will be included in the final fee 

schedule rule. 

We have reviewed the PEACsubmitted recommendations and 

propose to adopt nearly all of them. We 

have worked with the PEAC staff to 

correct any typographical errors and to 

make certain that the recommendations 

are in line with previously accepted 

standards. In addition, in order to 

prevent rank order anomalies, we 

reviewed those codes that are currently 

unrefined or that were refined early in 

the PEAC process to apply some of the 

major PEAC-agreed standards. For the 

unrefined 10-day global services, we are 

proposing to substitute for the original 

CPEP times the PEAC-agreed standard 

post-service office visit clinical staff 

times used for all 90-day and refined 10-

day global services. We also are 

proposing to eliminate the discharge 

management clinical staff time from all 

but the 10 and 90-day global codes, 

substituting one post-service phone call 

if not already in the earlier data. Lastly, 

we are proposing to delete any extra 

clinical staff time for post-visit phone 

calls because that time is already 

included in the time allotted for the 

visits. 

The complete PEAC 

recommendations and the revised 

practice expense database can be found 

on our web site. (See the 

‘‘Supplementary Information’’ section of 

this proposed rule for directions on 

accessing our website.) 

We disagree with the PEAC 

recommendation for clinical labor time 

for CPT 99183, Hyperbaric oxygen 

(HBO) therapy. During last year’s 

rulemaking, we assigned, on an interim 

basis, 135 minutes of total clinical labor. 

The PEAC however, recommended 42 

minutes of total clinical labor time, 

which allows for 20 minutes for the 

HBO chamber treatment (intra) time. We 

believe that 90 minutes is a more 

appropriate estimation of the clinical 

staff time actually needed for the intra 

time because, according to our data, a 

typical HBO treatment session billed 

under the outpatient prospective 

payment system is 90 minutes and the 

clinical staff is in constant attendance. 

Therefore, we are proposing a total 

clinical labor time of 112 minutes for 

this service. 

The PEAC recommendations for CPT 

codes 91011 and 91052 included a 

supply input for methacholine chloride 

as the injected stimulant for these two 

services. In discussions with 

representatives from the 

gastroenterology specialty subsequent to 

receipt of the PEAC recommendations, 

we learned this is incorrect, since an 

injected form of methacholine chloride 

is not currently available. For CPT 

91011, esophageal motility study, we 

are proposing to include edrophonium, 

1 ml, as the drug typically used in this 

procedure. For CPT 91052, gastric 

analysis study, we were unable to 

identify the single drug that is most 

typically used with this procedure. We 

have added the edrophonium to the list 

of supplies where we need information 

from the specialty in order to price 

appropriately (see Table 3). We are also 

requesting that commenters, particularly 

the specialty organizations, provide us 

with information on the drug that is 

most typically used for CPT 91052, 

including drug dosage and price, so that 

it can be included in the practice 

expense database.

In last year’s final rule, we indicated 

that we would not go forward with the 

2003 PEAC recommendations on eight 

E/M codes for nursing home services, 

CPT codes 99301 through 99316 and on 

two E/M codes for home visits, CPT 

codes 99348 and 99350, to allow the 

PEAC to reconsider the clinical staff 

time for these codes based on the 

specific input from the representatives 

of the nursing home and home visit 

specialties. This year’s PEAC 

recommendations for the E/M nursing 

home services included the views of the 

long-term care physicians and represent 

an overall decrease in clinical labor 

inputs for these codes. However, the 

home care physicians subsequently 

withdrew these codes from further 

PEAC consideration, which leaves the 

2003 PEAC recommendation for these 

services unchanged. Therefore, we are 

proposing to adopt the direct practice 

expense input recommendations from 

47494 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

the March 2003 PEAC meeting for CPT 

codes 99348 and 99350. 

c. Repricing of Clinical Practice Expense 

Inputs—Equipment 

We use the practice expense inputs 

(the clinical staff, supplies, and 

equipment assigned to each procedure) 

to allocate the specialty-specific practice 

expense cost pools to the procedures 

performed by each specialty. The costs 

of the original equipment inputs 

assigned by the CPEP panels were 

determined in 1997 by our contractor, 

Abt Associates, based primarily on list 

prices from equipment suppliers. 

Subsequent to the CPEP panels, 

equipment has also been added to the 

CPEP data, with the costs of the inputs 

provided by the relevant specialty 

society. We only include equipment 

with costs equal to or exceeding $500 in 

our practice expense database because 

the cost per use for equipment costing 

less than $500 would be negligible. We 

also considered the useful life of the 

equipment in establishing an equipment 

cost per minute of use. This was 

discussed in our proposed rule 

published June 18, 1997 (62 FR 33164). 

The primary source of this information 

was the ‘‘Estimated Useful Lives of 

Depreciable Hospital Assets’’ (1993 

edition) from the American Hospital 

Association (AHA). 

We proposed updates and revisions to 

the clinical staff salary data and supply 

inputs and finalized these in the rules 

published November 1, 2001 (66 FR 

55255) and November 7, 2003 (68 FR 

63196), respectively. We also indicated 

that, in future rulemaking, we would be 

proposing updates to the equipment 

inputs that are used in the CPEP 

database. 

We contracted with a consultant to 

assist us in obtaining the current price 

for each equipment item in our CPEP 

database. The consultant has been able 

to determine the current prices for most 

of the equipment inputs and, to ensure 

that accurate information was obtained, 

has submitted documentation from 

vendor catalogs or websites for nearly 

600 equipment items. 

Our contractor also clarified the 

specific composition of each of the 

various packaged and standardized 

rooms or ophthalmology ‘‘lanes’’

currently identified in the equipment 

practice expense database (for example, 

‘‘mammography room’’ or ‘‘exam lane’’). 

We are proposing to delete the current 

‘‘room’’ designation for the 

radiopharmaceutical receiving area and, 

in its place, list separately the 

equipment necessary for each procedure 

as individual line items because there 

does not appear to be a standard 

configuration for such a room across the 

nuclear medicine codes. 

Although individual equipment items 

valued under $500 are not included in 

the equipment database, we do include 

instrument packs or surgical trays that 

are maintained, stored, and used as a 

unit, where the aggregate cost of 

individual items equals or exceeds 

$500. We have adopted the PEAC 

recommendation based on consensus 

among specialties to establish two 

generic instrument packages rather than 

list a myriad of different packages for 

each specialty. The basic instrument 

pack, assigned a value of $500, includes 

instrument aggregate costs ranging from 

$500 to $1,499. The medium pack was 

assigned $1,500, for instrument 

packages priced at or above $1,500. We 

are proposing to replace all surgical 

packs and trays in the practice expense 

database with the appropriate 

standardized packs described above. 

Our consultant worked closely with 

the specialty societies to obtain accurate 

information to identify equipment and 

applicable prices. The useful life for 

each equipment item has also been 

reviewed and updated as necessary. 

This update is primarily based on the 

AHA’s ‘‘Estimated Useful Lives of 

Depreciable Hospital Assets’’ (1998 

edition) by direct association with a 

listed item in the publication or by 

crosswalking from a reasonably similar 

item. We understand that AHA will 

publish updated guidelines this 

summer, and we plan to reflect any 

updates in our final rule. 

Addendum D lists the proposed new 

prices for equipment items, instrument 

packs, and rooms/lanes, as well as new 

descriptions when needed. A more 

detailed spreadsheet can be found on 

our website, http://www.cms.hhs.gov/

physicians/pfs. This spreadsheet 

contains additional information 

regarding the sources used to price each 

equipment item. 

Additionally, there are specific 

equipment items for which a source has 

not yet been identified or for which 

pricing information has not yet been 

found and documented. These are 

included in Table 2 below. In this table, 

we have identified the equipment code 

(if assigned), the existing description for 

the equipment item and current price, 

the procedures or specialties associated 

with the item, as well as the proposed 

new description and standardized life 

for the equipment’s use, where this 

could be identified. We have also 

identified equipment for deletion from 

the database, such as equipment items 

less than $500 and items that have 

become obsolete. We are requesting that 

commenters, particularly the relevant 

specialty groups, provide us with the 

needed pricing information, including 

appropriate documentation. Whenever 

possible, commenters should provide 

multiple sources of documentation so 

that a typical price can be determined. 

If we are not able to obtain any verified 

pricing information for an item, we may 

eliminate it from the database.

TABLE 2.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS

Code 2005 description Price Primary specialties associated with item 

*CPT code(s) associated with item Status of item 

Ambulatory blood pressure 

monitor.

3,000.00 Cardiology ......................... 93784, 93786, 93788 See Note A. 

Biofeedback equipment ..... ........................ Psychology ........................ 90875 ........................ See Note A. 

CAD processor unit (mammography).210,000.00 Radiology ........................... 76082, 76083, 76085 See Note A (Need system 

components). 

E53005 ......... Camera system, cardiac, 

nuclear.

675,000.00 Anesthesia, IM, cardiology 78414 ........................ See Note A. 

E53026 ......... Collimator, cardiofocal set 29,990.00 Radiology ........................... 78206, 78607, 78647, 

78803, 78807.

See Note A. 

E71013 ......... Computer and VDT and 

software.

9,000.00 Ophthalmology, optometry 92060, 92065 ............ See Notes A and C. 

Computer software, MR/

PET/CT fusion.

60,000.00 Radiation oncology ............ 77301 ........................ See Note A. 

E51022 ......... Computer system, record 

and verify.

60,000.00 Radiation oncology ............ 77418 ........................ See Note A. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47495

TABLE 2.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS—Continued

Code 2005 description Price Primary specialties associated with item 

*CPT code(s) associated with item Status of item 

E51050 ......... Computer workstation, 3D 

teletherapy treatment 

planning.

221,500.00 Radiation oncology ............ 77300, 77305, 77310, 

77315, 77321, 

77331.

See Note A. 

Computer workstation, 

MRA post processing.

........................ Radiology ........................... 71555, 72159, 72198, 

73225, 73725, 

74185.

See Note A. 

Computer, server ............... ........................ Radiation oncology ............ 77301 ........................ See Note A. (Need system 

components). 

Cortical bipolar-biphasic 

stimulating equipment.

........................ Neurosurgery, neurology ... 95961, 95962 ............ See Note A. 

CPAP/BiPAP remote clinical unit......................... Pulmonary disease, neurology.95811 ........................ See Note A. 

Cryo-thermal unit ............... ........................ Anesthesia ......................... 64620 ........................ See Notes A and C. 

E53034 ......... Densitometry unit, whole 

body, DPA.

65,000.00 Radiology ........................... 78351 ........................ See Notes A and C. 

E53032 ......... Densitometry unit, whole 

body, SPA.

22,500.00 Radiology ........................... 78350 ........................ See Notes A and C. 

E53036 ......... Detector (Probe) ................ 14,000.00 Radiology, cardiology ........ 78455 ........................ See Notes A and C. 

Dialysis access flow monitor.10,000.00 Nephrology ........................ 90940 ........................ See Note A. 

Diathermy, microwave ....... ........................ Anesthesia, GP, podiatry .. 97020 ........................ See Notes A and C. 

DNA image analyzer 

(ACIS).

200,000.00 Lab, pathology ................... 88358, 88361 ............ See Note A. 

Drill, ophthalmology ........... ........................ Ophthalmology .................. 65125 ........................ See Note A. 

E55035 ......... ECG signal averaging system.8,250.00 Cardiology, IM ................... 93278 ........................ See Note A. 

EEG monitor, digital, portable......................... 95953 ................................. Neurology ................. See Note A. 

E54008 ......... EEG recorder, ambulatory 6,940.00 Neurology .......................... 95950 ........................ See Note A. 

E54009 ......... EEG review station, ambulatory.44,950.00 Neurology .......................... 95950 ........................ See Note A. 

Electroconvulsive therapy 

machine.

........................ Psychiatry .......................... 90870 ........................ See Note A. 

Electromagnetic therapy 

machine.

25,000.00 Physical therapy ................ G0329 ....................... See Note A. 

E54012 ......... EMG botox ........................ 1,500.00 Critical care, pulmonary, 

ophthalmology.

92265 ........................ See Note A. 

E52002 ......... Fetal monitor software ....... 35,000.00 Ob-gyn, radiology .............. 76818, 76819 ............ See Note A. 

Film alternator (motorized 

film viewbox).

27,500.00 Radiology ........................... 329 codes ................. See Note B. 

Generator, constant current.950.00 Neurology, NP ................... 95923 ........................ See Note A. 

E51072 ......... HDR Afterload System, 

Nucletron—Oldelft.

375,000.00 Radiation oncology ............ 77781–84 .................. See Note A. 

Hyperbaric chamber .......... 125,000.00 FP, IM, EM ........................ 99183 ........................ See Note A. 

Hyperthermia system, 

ultrasound, external.

360,000.00 Radiation oncology ............ 77600 ........................ See Note A. 

Hyperthermia system, 

ultrasound, intracavitary.

250,000.00 Radiation oncology ............ 77620 ........................ See Note A. 

Hysteroscopy ablation system.19,500.00 Ob-gyn ............................... 58563 ........................ See Note A. 

E13652 ......... image analyzer (CAS system).92,000.00 Pathology, neurology ......... 88355, 88356 ............ See Note A. 

IMRT physics tools ............ 55,485.00 Radiation oncology ............ 77301, 77418 ............ See Note A. 

E91008 ......... IVAC Injection Automatic 

Pump.

2,500.00 Radiology ........................... 78206, 78607, 78647, 

78803, 78807.

See Note A. 

Mammography reporting 

software.

........................ Radiology ........................... 76090, 76091, 76092 See Note A. 

E12002 ......... Neurobehavioral status instrument-average.717.00 Psychology, IM .................. 96115, 96117 ............ See Note A. 

Orthovoltage radiotherapy 

system.

140,000.00 Radiation oncology ............ 77401 ........................ See Note A. 

OSHA ventilated hood ....... 5,000.00 Radiation oncology ............ 77334 ........................ See Note B. 

E91011 ......... Plasma pheresis machine 

w/UV light source.

37,900.00 Radiology, dermatology ..... 36481, 36510, 36522 See Note A. 

E55013 ......... Programmer, pacemaker ... 10,000.00 Cardiology, cardiothoracic 

surgery, general surgery.

33200–01, 33206–08, 

33212–18, 33220, 

33222, 33240, 

33245–46, 33249, 

33282.

See Note A. 

47496 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 2.—EQUIPMENT ITEMS NEEDING SPECIALTY INPUT FOR PRICING AND PROPOSED DELETIONS—Continued

Code 2005 description Price Primary specialties associated with item 

*CPT code(s) associated with item Status of item 

Pulse oxymetry recording 

software (prolonged 

monitoring).

3,660.00 Pulmonary disease, IM ...... 94762 ........................ See Note A. 

Radiation treatment vault .. 550,670.00 Radiation oncology ............ 774XX ....................... See Note B. 

Radiation virtual simulation 

system.

........................ Radiation oncology ............ 77280, 77285, 77290, 

77402–16.

See Note A. 

Remote monitoring service 

(neurodiagnostics).

9,500.00 Neurology .......................... 95955 ........................ See Note A. 

E54010 ......... Review master ................... 23,500.00 Pulmonary disease, neurology.95805, 95807–11, 

95816, 95822, 

95955–56.

See Note A. 

E51004 ......... Room, basic radiology ....... 150,000.00 Radiology ........................... 103 codes ................. See Note A. 

E51016 ......... Room, mammography ....... 130,000.00 Radiology ........................... 19030, 19290–91, 

19295, 76086–92, 

76096.

See Note A. 

E51005 ......... Room, radiographicfluoroscopic.475,000.00 ............................................ 123 codes ................. See Note A. 

Source, 10 Ci Ir 192 .......... 22,000.00 Radiation oncology ............ 77781–84 .................. See Note A. 

Strontium-90 applicator ..... 8,599.00 Radiation oncology ............ 77789 ........................ See Note A. 

Table, cystoscopy .............. ........................ urology ............................... 52204–24, 52265-75 

52310–17, 52327–

32.

See Note A. 

E52001 ......... Ultrasound color doppler, 

transducers and vaginal 

probe.

155,000.00 Ob-gyn ............................... 59070, 59074, 

76818–19.

See Note A. 

E52007 ......... Ultrasound, echocardiography digital acquisition 

(Novo Microsonics, 

TomTec).

29,900.00 Ob-gyn, cardiology, pediatrics.76825–28, 93303-12, 

93314, 93320, 

93325, 93350.

See Note A. 

Vacuum cart ...................... ........................ Anesthesia ......................... 64620 ........................ See Notes A and C. 

E13635 ......... Video camera .................... 1,000.00 Radiation oncology ............ 77418 ........................ See Note A. 

Water chiller (radiation 

treatment).

28,000.00 Radiation oncology ............ 77402–16 .................. See Note B. 

E51076 ......... Well counter ...................... ........................ Radiology ........................... 78160–72, 78282 ...... See Note A. 

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Notes:

A. Additional information required. Need detailed description (including system components as specified), source, and current pricing information. 

B. Proposed deletion as indirect expense. 

C. Item may no longer be available. 

In addition to reviewing and updating 

the cost information for equipment 

items in the database, our contractor 

also recommended the following 

revisions to provide uniformity and 

consistency in the CPEP equipment 

database. All of the following 

recommendations are noted in 

Addendum D: 

Assignment of equipment categories.

In the original CPEP data, a number was 

assigned to each item of equipment. The 

contractor has recommended that each 

equipment item also be assigned a 

‘‘category’’ to allow for easier 

identification and sorting of items. We 

agree and are proposing that equipment 

be assigned to one of the following six 

categories: documentation, laboratory, 

scopes, radiology, furniture, roomslanes, and other equipment. 

These categories could also be used to 

establish a new numbering system for 

equipment that would more clearly 

identify them for practice expense 

purposes. We would assign a letter to 

each category and use this in 

conjunction with a number (000 through 

999) to identify each item of equipment. 

This would enable specialty groups to 

identify more easily whether an item of 

equipment has already been included in 

the practice expense database and 

would help avoid duplication of 

references to the same item of 

equipment under different descriptions. 

If we proceed in the final rule with this 

proposed method for categorizing 

equipment, we will assign new 

identifying numbers to each equipment 

input item and these will be available 

on our website. 

Consolidation/standardization of item 

descriptions.

When items appear to be duplicative, 

we are proposing to combine the items. 

For example, for two cervical endoscopy 

procedures, our contractor identified 

that the price of the LEEP system 

includes a smoke evacuation system but 

that system is also listed separately. We 

propose to merge these two line items 

and reflect both prices in the price of 

the LEEP system. All proposed changes 

are specifically referenced in 

Addendum D. 

We welcome any comments on the 

proposed pricing and all other proposed 

revisions. To help us evaluate the 

information provided, comments should 

include documentation from more than 

one source, where available, such as 

information from a vendor catalog or 

website or from a current invoice. 

d. Miscellaneous Practice Expense 

Issues 

i. Pricing for Seldinger Needle 

We received comments from a 

specialty organization on our November 

7, 2003 rule stating that the $72.90 price 

assigned to the Seldinger needle, which 

is used in certain radiological 

procedures, is too high. The 

organization estimated that the cost is 

actually closer to $7.00; however, 

documentation was not provided to 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47497

support this price estimate. Our 

contractor was able to confirm pricing 

information from two sources, including 

a price of $3.50 from a hospital supplier 

and a price of $6.85 from a cardiology 

supplier. Based on this pricing 

variability, we are proposing to average 

the two prices of this supply item to 

reflect a cost of $5.175. If a commenter 

disagrees with this proposed change in 

price, the comment should provide 

documentation to support the 

recommended price, as well as the 

specific type of needle that is most 

commonly used. 

ii. Hysteroscopic Endometrial Ablation 

We received requests from a 

manufacturer and physicians to price 

CPT code 56853, Hysteroscopy with 

endometrial ablation, in the office 

setting so that physicians providing this 

service in the nonfacility setting could 

receive an appropriate payment. (This 

service is currently valued only in the 

facility setting.) We have worked with 

the specialty society, the American 

College of Obstetricians and 

Gynecologists, to identify the required 

resources based on the typical practice. 

We propose to assign on an interim 

basis, the following direct practice 

expense inputs in the nonfacility setting 

for this service. 

• Clinical Staff: RN/LPN/MTA—72 

minutes (18 pre-service and 54 service) 

• Supplies: PEAC multispecialty visit 

supply package, Post-op incision care 

kit, pelvic exam package, irrigation 

tubing, sterile impervious gown, 

surgical cap, shoe cover, surgical mask 

with face shield, 3x3 sterile gauze (20), 

cotton tip applicator, cotton balls (4), 

irrigation 0.9 percent sodium chloride 

500–1000ml(3), maxi-pad, mini-pad, 3-

pack betadine swab (4), Monsel’s 

solution (10ml), lidocaine jelly 

(1000ml), disposable speculum, spinal 

needle, 18–24g needle, 20 ml syringe, 

bupivicaine 0.25 percent (10ml), 1 

percent xylocaine (20ml), cidex (10ml), 

Polaroid film–type 667 (2), endosheath, 

and hysteroscopic ablation device kit. 

• Equipment: power table, fiberoptic 

exam light, endoscopic-rigid 

hysteroscope, endoscopy video system, 

and hysteroscopic ablation system. 

We will request that the RUC review 

these inputs along with inputs of other 

codes still in need of refinement. iii. 

Photopheresis 

We received a request from a supplier 

to review the direct practice expense 

inputs currently in our database for the 

photopheresis service, CPT code 36522. 

These inputs are based on the original 

CPEP panel recommendations and the 

supplier does not believe they are 

reflective of the resources now being 

used. This service was not reviewed by 

the PEAC during the refinement 

process, and we agree that the direct 

inputs need to be revised for this 

service. We propose to assign, on an 

interim basis, the following nonfacility 

practice expense inputs, and we will 

request that the RUC review them as 

part of the practice expense refinement 

process. 

• Clinical Staff: RN—223 minutes 

(treatment is for approximately 4 hours) 

• Supplies: multispecialty visit 

supply package, photopheresis 

procedural kit, blood filter (filter iv set), 

IV blood administration set, 0.9 percent 

irrigation sodium chloride 500–1000 ml 

(2), heparin 1,000 units-ml (10), 

povidone solution-betadine, 

methoxsalen (UVADEX) sterile solution10 ml vial, 1 percent-2 percent 

lidocaine-xylocaine, paper surgical tape 

(12), 2x3 underpad (chux), nonsterile 

drapesheet 40 inches x 60 inches, 

nonsterile Kling bandage, bandage strip, 

3x3 sterile gauze, 4x4 sterile gauze, 

alcohol swab pad (3), impervious staff 

gown, 19–25 g butterfly needle, 14–24g 

angiocatheter, 18–27 g needle, 20 ml 

syringe, 10–12 ml syringe, 1 ml syringe, 

22–26 g syringe needle-3 ml. 

• Equipment: plasma pheresis 

machine with ultraviolet light source, 

medical recliner. 

iv. Pricing of New Supply Items 

As part of last year’s rulemaking 

process, we reviewed and updated the 

prices for supply items in our practice 

expense database. During subsequent 

meetings of both the PEAC and the RUC, 

supply items were added that were not 

included in the supply pricing update. 

The following table, Proposed Practice 

Expense Supply Item Additions for 

2005, lists these additional supply items 

and the proposed associated prices that 

we will use in the practice expense 

calculation.

TABLE 3.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2004 

Supply description Unit price * Unit * CPT code(s) associated with item Supply category 

Acrylic tray-base material ................. 1.775 oz ...................... 21421, 21452 .................................... Lab. 

Adapter, luer lock .............................. 1.249 Item .................. 36515 ................................................ Hypodermic, IV. 

Adapter, spike (for syringe) .............. 4.558 Item .................. 36515 ................................................ Hypodermic, IV. 

Adhesive, conductive (silver, liquid) 3.000 gm ..................... 88349 ................................................ Lab. 

Adhesive, cyanoacrylate (2ml 

uou).doc.

28.988 Item .................. 65286 ................................................ Pharmacy, Rx. 

Airway adapter .................................. 12.500 Item .................. 94770 ................................................ Accessory, Procedure. 

Albuterol inhal soln (3ml vial) ........... 0.436 Item .................. 95070 ................................................ Pharmacy, Rx. 

Alcohol ethyl 100% ........................... 0.028 ml ...................... 88348 ................................................ Lab. 

Applicator, cotton-tipped, sterile, 6in 0.056 Item .................. 127 codes ......................................... Wound Care, Dressings. 

Applicator, wood, 6.5in ..................... 0.008 Item .................. 99348–49 .......................................... Lab. 

Bag system, 1000ml (for 

angiography waste fluids).

8.925 Item .................. 93501, 93505–10 .............................. Accessory, Procedure. 

Balanced salt soln (BSS) (15ml uou) 1.600 Item .................. 59 codes ........................................... Pharmacy, Rx. 

Battery, AA ........................................ 0.450 Item .................. 95250 ................................................ Office Supply, Grocery. 

Blade, surgical, super-sharp ............. 4.167 Item .................. 14 codes ........................................... Cutters, Closures, Cautery. 

Blade, urethrotome ........................... 85.030 Item .................. 52270 ................................................ Cutters, Closures, Cautery. 

Blood collection tube holder ............. 0.163 Item .................. 78110–11, 78120–22, 78130, 78191, 

78725.

Hypodermic, IV. 

Blood collection tube needle ............. 0.142 Item .................. 36514–16, 78110–11, 78120–22, 

78130, 78191, 78725.

Hypodermic, IV. 

Blood pressure recording form, average.0.310 Item .................. 93784, 93786, 93788 ....................... Office Supply, Grocery. 

Brush, protected airway specimen ... 13.000 Item .................. 31623, 31717 .................................... Accessory, Procedure. 

Bur, surgical, sterile (drill) ................. 4.792 Item .................. 28289 ................................................ Accessory, Procedure. 

Canned air (Dust-Off) ....................... 1.021 oz ...................... 88348 ................................................ Office Supply, Grocery. 

Cannula, anterior chamber, 18–27g 2.688 Item .................. 65815, 66020, 66030, 66250 ........... Accessory, Procedure. 

47498 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 3.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2004—Continued

Supply description Unit price * Unit * CPT code(s) associated with item Supply category 

Catheter percutaneous fastener 

(Percu-Stay).

12.745 Item .................. 32201, 44901, 47525, 47530, 

48511, 49021, 49041, 49061, 

49423, 49424, 50021, 58823.

Accessory, Procedure. 

Catheter, (Glide) ............................... 62.000 Item .................. 36218, 36248 .................................... Accessory, Procedure. 

Catheter, (SIM2F1) ........................... 17.000 Item .................. 36011–15, 36215–17, 36245–47 ..... Accessory, Procedure. 

Catheter, angiographic ...................... 16.200 Item .................. 93508, 93510, 93526 ....................... Hypodermic, IV. 

Catheter, balloon inflation device ..... 24.900 Item .................. 35470–76 .......................................... Accessory, Procedure. 

Catheter, balloon ureteral (Dowd) .... 65.000 Item .................. 52330 ................................................ Accessory, Procedure. 

Catheter, balloon, low profile PTA .... 431.500 Item .................. 35470, 35471, 35474 ....................... Accessory, Procedure. 

Catheter, balloon, PTA ..................... 243.500 Item .................. 35472–73, 35475–76 ........................ Accessory, Procedure. 

Catheter, curved ............................... 17.775 Item .................. 36218 ................................................ Accessory, Produce. 

Catheter, hyperthermia, closed-end ........................ Item .................. 77600–20 .......................................... Hypodermic, IV. 

Catheter, hyperthermia, open-end .... ........................ Item .................. 77600 ................................................ Hypodermic, IV. 

Catheter, microcatheter (selective 

3rd order).

337.880 Item .................. 36217, 36247 .................................... Accessory, Procedure. 

Catheter, Swan Ganz ....................... 65.000 Item .................. 93501, 93526 .................................... Accessory, Procedure. 

Catheter, ureteral, acorn tip .............. 9.550 Item .................. 52007, 52010, 52327, 52330 ........... Accessory, Procedure. 

Clamp, circumcision .......................... 7.500 Item .................. 54150 ................................................ Cutters, Closures, Cautery. 

Collagen, dermal implant (2.5ml uou) 

(Contigen).

317.000 Item .................. 52327, 52330 .................................... Pharmacy, Rx. 

Conformer, sterile, acrylic ................. 20.000 Item .................. 68340 ................................................ Accessory, Procedure. 

Contact lens (hard) care kit .............. 7.950 Item .................. 92325–26 .......................................... Pharmacy, NonRx. 

Contact lens (hard) extra strength 

cleaning solution.

0.158 ml ...................... 92325–26 .......................................... Pharmacy, NonRx. 

Contact lends (RGP) polishing soln 

(Silo2 Care).

0.077 ml ...................... 92325 ................................................ Pharmacy, NonRx. 

Container, 2000ml, transfer pack ..... 7.120 Item .................. 36515 ................................................ Accessory, Procedure. 

Container, 600ml, transfer pack ....... 3.360 Item .................. 36515 ................................................ Accessory Procedure. 

Cotton balls, sterile ........................... 0.022 Item .................. 115 codes ......................................... Wound Care, Dressings. 

Cup, sterile, 12–16 oz ....................... 0.760 Item .................. 32201, 44901, 48511, 49021, 

49041, 49061, 50021, 58823, 

93501, 93505, 93508, 93510, 

93526.

Lab. 

Cup, sterile, 8 oz ............................... 0.542 Item .................. 32201, 44901, 48511, 49021, 

49041, 49061, 50021, 58823.

Lab. 

Cuvette, whole blood oximeter ......... 115.000 Item .................. 93501, 93526 .................................... Hypodermic, IV. 

Diamond knife cleaning rod .............. 1.000 Item .................. 99348 ................................................ Lab. 

Drainage catheter, all purpose ......... 88.430 Item .................. 44901, 47525, 47530, 48511, 

49021, 49041, 49061, 49423, 

50021, 50398, 58823.

Accessory, Procedure. 

Drainage catheter, chest ................... 88.890 Item .................. 32201 ................................................ Accessory, Procedure. 

Drainage pouch, nephrostomy-biliary 13.250 Item .................. 32201, 44901, 47525, 47530, 

48511, 49021, 49041, 49061, 

49423, 50021, 50398, 58823.

Accessory, Procedure. 

Drape, sterile, incise, ophthalmic ...... 4,900 ...................... 67025, 67028, 67110, 67120 ........... Gown, Drape. 

Drape, sterile, split-sheet .................. 10,243 Item .................. 212 codes ......................................... Gown, Drape. 

Drape, sterile, table 44 in x 76 in ..... 5.250 Item .................. 93501–10, 93526 .............................. Gown, Drape. 

Electrode, Bugbee ............................ 115.000 Item .................. 52204, 52214, 52224, 52265, 

52275, 55200, 55250.

Accessory, Procedure. 

Electrode, EEG (single) .................... 1.638 Item .................. 95961, 95816 .................................... Accessory, Procedure. 

Electrode, EGG (single) .................... 2.917 Item .................. 91132, 95925–27, 95930 ................. Accessory, Procedure. 

Endoscopic deflecting brush ............. 73.500 Item .................. 52007 ................................................ Accessory, Procedure. 

Film, x-ray, laser print ....................... 1.437 Item .................. 146 codes ......................................... Office Supply, Grocery. 

Floxin 0.3% otic soln ......................... 2.354 ml ...................... 69145, 69620 .................................... Pharmacy, Rx. 

Forceps, endomyocardial biopsy ...... 250.000 Item .................. 93505 ................................................ Accessory, Procedure. 

Forceps, Kelly ................................... 2.335 Item .................. 93501–10, 93526 .............................. Accessory, Procedure. 

Gas, nitrogen .................................... 2.708 cu ft .................. 88348–49 .......................................... Lab. 

Glass knife boat ................................ 0.200 Item .................. 88348 ................................................ Lab. 

Grid storage box (holds 50 grids) ..... 3.750 Item .................. 88348 ................................................ Lab. 

Guidewire bowl w-lid, sterile ............. 3.000 Item .................. 93501–10, 93526 .............................. Accessory, Procedure. 

Guidewire, cerebral (Bentson) .......... 14.500 Item .................. 36011–15, 36215–17, 36245–47 ..... Accessory, Procedure. 

Guidewire, low profile (SpartaCore) 101.250 Item .................. 35470–71, 35474 .............................. Accessory, Procedure. 

Guidewire, steerable (Hi-Torque) ..... 90.000 Item .................. 35470–76, 37203 .............................. Accessory, Procedure. 

Guidewire, steerable (Transcend) .... 180.000 Item .................. 36217, 32647 .................................... Accessory, Procedure. 

Guidewire, torque .............................. 41.000 Item .................. 35470–76 .......................................... Accessory, Procedure. 

Heparin 5,000 units-mi inj ................. 0.509 ml ...................... 36514–15 .......................................... Pharmacy, Rx. 

Hyaluronic acid viscoelastic inj 

(Amvisc, 0.5ml uou.

61.000 Item .................. 65286, 65815, 66250 ....................... Pharmacy, Rx. 

Hysteroscope ablation device ........... 1,146.000 Item .................. 58563 ................................................ Accessory, Procedure. 

Jessner’s soln ................................... 0.240 ml ...................... 15788–89, 15792–93 ........................ Pharmacy, Rx. 

Kenalog 40 inj ................................... 1.830 ml ...................... 31830 ................................................ Pharmacy, Rx. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47499

TABLE 3.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2004—Continued

Supply description Unit price * Unit * CPT code(s) associated with item Supply category 

Kit, AccuStick II Introducer system 

with RO Marker.

82.620 Kit ..................... 26 codes ........................................... Kit, Pack, Tray. 

Kit, apheresis treatment .................... 140.000 Kit ..................... 36515 ................................................ Kit, Pack, Tray. 

Kit, barium enema ............................. 9.466 Kit ..................... 75270, 74283 .................................... Kit, Pack, Tray. 

Kit, BCR/ABL DNA probe ................. 42.650 Kit ..................... 88365 ................................................ Kit, Pack, Tray. 

Kit, slit catheter (for compartment 

pressure monitor).

73.750 Kit ..................... 20950 ................................................ Kit, Pack, Tray. 

Kit, vasotomy .................................... ........................ Kit ..................... 55200, 55250 .................................... Kit, Pack, Tray. 

Lacrimal duct stent-tube set ............. 74.000 Item .................. 68815 ................................................ Accessory, Procedure. 

Lead citrate ....................................... 0.510 gm .................... 88348 ................................................ Lab. 

Manifold (for angiography) ................ 6.682 Item .................. 93501, 93508, 93510, 93526 ........... Accessory, procedure.

Marker, gold, for radiosurgery-radiotherapy.29.667 Item .................. 77761–63 .......................................... Accessory, Procedure. 

Mask, CPR (RespAide) ..................... 16.950 Item .................. 92950 ................................................ Accessory, Procedure. 

Methoxsalen, sterile solution 

(UVADEX), 10ml vial.

49.500 ml ...................... 36522 ................................................ Pharmacy, Rx. 

Microsponge, cellulose (10 pack 

uou).

3.620 Item .................. 22 codes ........................................... Wound Care, Dressings. 

Mount, carbon spectro-pure (for 

SEM).

0.500 Item .................. 88349 ................................................ Lab. 

Nasal tip, olive .................................. 0.340 Item .................. 92512 ................................................ Accessory, Procedure. 

Nebulizer medication cup ................. 0.140 Item .................. 95070 ................................................ Accessory, Procedure. 

Needle, arterial, percutaneous .......... 3.150 Item .................. 93501, 93505, 93508, 93510, 93526 Hypodermic, IV. 

Needle, bone biopsy ......................... 65.000 Item .................. 20225 ................................................ Hypodermic, IV. 

Needle, flexi, hyperthermia ............... 12.000 Item .................. 77600–20 .......................................... Hypodermic, IV. 

Needle, micropigmentation (tattoo) ... 12.000 Item .................. 11920–21 .......................................... Hypodermic, IV. 

Needle, OSHA compliant 

(SafetyGlide).

0.454 Item .................. 37 codes ........................................... Hypodermic, IV. 

Needle, retrobulbar (Atkinson) .......... 1.825 Item .................. 67120, 67141 .................................... Hypodermic, IV. 

Omnipaque 350mg (125ml uou) ....... 29.530 Item .................. 93508, 93510, 93526 ....................... Pharmacy, Rx. 

Omnipaque 350mg (50ml uou) ......... 12.498 Item .................. 42550, 70370 .................................... Pharmacy, Rx. 

Osmometer sample tip and cleaner 0.534 Item .................. 88348 ................................................ Lab. 

Osmometer std, 50 mOsm-kg, 2ml 

amp.

17.000 ml ...................... 88348 ................................................ Lab. 

Osmometer std, 850 mOsm-kg, 2ml 

amp.

17.000 ml ...................... 88348 ................................................ Lab. 

Pack, drapes, ortho, large ................ 40.646 Pack ................. 102 codes ......................................... Kit, Pack, Tray. 

Pack, drapes, ortho, small ................ 1.128 Pack ................. 37 codes ........................................... Kit, Pack, Tray. 

Pack, ophthalmology visit (w-dilation) 1.997 Pack ................. 65272–73, 65280–85, 65290, 

65810–015, 65855–60, 66130, 

66625–35, 67031, 68130.

Kit, Pack, Tray. 

Pack, protective, ortho, large ............ 9.182 Pack ................. 99 codes ........................................... Kit, Pack, Tray. 

Pack, protective, ortho, small ........... 4.441 Pack ................. 38 codes ........................................... Kit, Pack, Tray. 

Paper, weighing (glassine) ............... 0.021 Item .................. 88348 ................................................ Lab. 

Phenol, liquified, USP ....................... 0.135 ml ...................... 15788–93 .......................................... Pharmacy, Rx. 

Photo-Flo soln ................................... 0.021 ml ...................... 88348 ................................................ Office Supply, Grocery. 

Pipette bulb ....................................... 0.271 Item .................. 88348–49 .......................................... Lab. 

Pipette 9inch ..................................... 0.054 Item .................. 88348–89 .......................................... Lab. 

Plasma antibody adsorption column 

(Prosorba).

1,150.000 Item .................. 36515 ................................................ Accessory, Procedure. 

Plasma LDL adsorption column 

(Liposorber).

1,300.000 Item .................. 36516 ................................................ Accessory, Procedure. 

Plasma leukocyte filter ...................... 49.719 Item .................. 36515 ................................................ Accessory, Procedure. 

Plasma separator (Liposorber) ......... 100.000 Item .................. 36516 ................................................ Accessory, Procedure. 

Plate, surgical, mini-compression, 4 

hole.

226.000 Item .................. 21208 ................................................ Accessory, Procedure. 

Plate, surgical, mini-i, 16mm ............ 147.000 Item .................. 21210 ................................................ Accessory, Procedure. 

Plate, surgical, reconstruction, left, 5 

x 16 hole.

719.000 Item .................. 21125–27, 21215 .............................. Accessory, Procedure. 

Plate, surgical, reconstruction, template, 5 x 16 hole.50.000 Item .................. 21125–27, 21215 .............................. Accessory, Procedure. 

Plate, surgical, rigid comminuted 

fracture.

389,000 item ................... 21461, 21462 .................................... Accessory, Procedure. 

Plate, surgical, rigid comminuted 

fracture, template.

29.000 Item .................. 21461, 21462 .................................... Accessory, Procedure. 

Pressure bag ..................................... ........................ Item .................. 93501, 93508–10, 93526 ................. Hypodermic, IV. 

Prosthesis, voice button (Blom-Singer).48.000 Item .................. 31611 ................................................ Accessory, Procedure. 

Scalpel, safety, surgical, with blade 

(#10–20).

2.143 Item .................. 54150, 54160, 54162 ....................... Cutters, Closures, Cautery. 

Screw, surgical, auto-drive, 2.0mm x 

4mm.

37.000 Item .................. 2120 .................................................. Accessory, Procedure. 

47500 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 3.—PROPOSED PRACTICE EXPENSE SUPPLY ITEM ADDITIONS FOR 2004—Continued

Supply description Unit price * Unit * CPT code(s) associated with item Supply category 

Screw, surgical, Carroll-Girard, 9cm 

x 3.75in.

92.000 Item .................. 21401 ................................................ Accessory, Procedure. 

Screw, surgical, lag, 2.4mm x 26mm 66.000 Item .................. 21461–62 .......................................... Accessory, Procedure. 

Screw, surgical, locking, 2.4mm x 

16mm.

74.000 Item .................. 21127, 21208, 21215 ....................... Accessory, Procedure. 

Screw, surgical, self-tapping, 1.5–2.0 

mm.

27.000 Item .................. 21100, 21452 .................................... Accessory, Procedure. 

Screw, surgical, standard, 2.4mm x 

14mm.

42.000 Item .................. 21125 ................................................ Accessory, Procedure. 

Screw, surgical, standard, 2.7mm x 

12mm.

47.000 Item .................. 21125–27, 21208, 21215, 21461–62 Accessory, Procedure. 

Sea salt ............................................. 0.004 gm ..................... 15810–11 .......................................... Office Supply, Grocery. 

Sensor, manometry ........................... 25.000 Item .................. 91010–12, 91122 .............................. Accessory, Procedure. 

Sheath, peel away ............................ 68.990 Item .................. 47530 ................................................ Accessory, Procedure. 

Skin refrigerant-anesthetic spray 

(Frigiderm).

5.000 oz ...................... 15780–86, 15788–93 ........................ Pharmacy, Rx. 

Sodium acetate ................................. 0.064 gm ..................... 88348 ................................................ Lab. 

Sodium barbital ................................. 0.315 gm .................... 88348 ................................................ Lab. 

Specimen block storage box ............ 0.625 Item .................. 88348 ................................................ Lab. 

Splint, finger (metal-foam) ................ 1.655 Item .................. 26700–05, 26720–25, 26740–42, 

26750–55, 26770–75.

Wound Care, Dressings. 

Sucrose, reagent ............................... 0.037 gm .................... 88348 ................................................ Lab. 

Suture device for vessel closure 

(Perclose A–T).

225.000 Item .................. 35470–75 .......................................... Accessory, Procedure. 

Suture, monocryl, 3–0 to 6–0, p, ps 9.887 Item .................. 15050, 15200, 15220, 15240, 15260 Cutters, Closures, Cautery. 

Suture, nylon, 8–0 to 9–0 ................. 15.320 Item .................. 65270–72, 65275, 65420–26, 66130, 

66250, 68115–30, 68320, 68330, 

68340, 68360.

Cutters, Closures, Cautery. 

Suture, plain, gut, 2–0 to 6–0 ........... 4.262 Item .................. 41872 ................................................ Cutters, Closures, Cautery. 

Suture, polyester, 0 to 3–0 

(Mersilene).

3.895 Item .................. 40840–45 .......................................... Cutters, Closures, Cautery. 

Suture, vicryl, 7–0 ............................. 21.773 Item .................. 67120 ................................................ Cutters, Closures, Cautery. 

Syringe 12ml, coronary control ......... 7.000 Item .................. 93508–10, 93526 .............................. Hypodermic, IV. 

Syringe filter ...................................... 2.040 Item .................. 88348 ................................................ Hypodermic, IV. 

Tape, foam, elastic, 2in (Microfoam) 0.003 Inch ................... 21120–23, 21315, 21355–56, 

31820–25.

Wound Care, Dressings. 

Toluidine Blue O (for microscopy) .... 0.580 gm .................... 88348 ................................................ Lab. 

Towel clamp, plastic ......................... 0.556 Item .................. 93501–10, 93526 .............................. Accessory, Procedure. 

Tracheostomy collar-neckband ......... 3.235 Item .................. 31580–84, 31588, 31610 ................. Wound Care, Dressings. 

Tracheostomy dressing ..................... 3.240 Item .................. 31580–84, 31588, 31610 ................. Wound Care, Dressings. 

Tracheostomy tube ........................... 20.934 Item .................. 31370–82, 31580–84, 31588, 31610, 

31613–14, 31750, 41140, 41145.

Accessory, Procedure. 

Transducer, pressure monitoring (for 

angiography).

9.520 Item .................. 93501, 93508, 93510, 93526 ........... Accessory, Procedure. 

Tray, bronchogram ............................ ........................ Tray .................. 31708 ................................................ Kit, Pack, Tray. 

Tray, central line dressing change ... 2.430 Tray .................. 36514–16 .......................................... Kit, Pack, Tray. 

Tray, circumcision ............................. 25.173 Tray .................. 54150, 54160–62 .............................. Kit, Pack, Tray. 

Tray, surgical skin prep, sterile ......... 6.765 Tray .................. 134 codes ......................................... Kit, Pack, Tray. 

Trichloroacetic acid 90% (sat soln) .. 0.855 ml ...................... 46900 ................................................ Pharmacy, Rx. 

Tubing set (Liposorber) ..................... 50.000 Item .................. 36516 ................................................ Hypodermic, IV. 

Tubing set, blood warmer ................. 7.396 Item .................. 36514–16 .......................................... Hypodermic, IV. 

Tubing set, plasma exchange ........... 173.333 Item .................. 36514 ................................................ Hypodermic, IV. 

Tubing set, plasma transfer .............. 1.680 Item .................. 36515 ................................................ Hypodermic, IV. 

Tubing set, Y-type blood recipient .... 5.750 Item .................. 36515 ................................................ Hypodermic, IV. 

Tubing, pressure injection line 

(angiography).

3.170 Item .................. 93508, 93510, 93526 ....................... Accessory, Procedure. 

Tubing, sterile, connecting (fluid administration).1.950 Item .................. 93510, 93526 .................................... Accessory, Procedure. 

Tubing, sterile, non-vented (fluid administration)......................... Item .................. 93501, 93508, 93510, 93526 ........... Accessory, Procedure. 

Tubing, suction, non-latex (2ft) with 

Frazier tip (1).

7.557 Item .................. 99 codes ........................................... Accessory, Procedure. 

Underpad 2ft x 2ft (lab bench) .......... 0.377 Item .................. 88348–49 .......................................... Lab. 

Vial, specimen-sample, 4ml .............. 0.550 Item .................. 88348–49 .......................................... Lab. 

Wax sheet ......................................... 0.285 Item .................. 88348 ................................................ Lab. 

* CPT codes and descriptions only are copyright. 

2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47501

We have identified certain supply 

items for which we were unable to 

verify the pricing information (see Table 

4, Supply Items Needing Specialty Input 

for Pricing). Therefore, we are 

requesting commenters, particularly 

specialty organizations, to provide 

pricing information on items in this 

table along with documentation to 

support the recommended price. In 

addition, we are seeking information on 

the specific contents of the listed kits, 

so that we do not duplicate any supply 

items.

TABLE 4.—SUPPLY ITEMS NEEDING SPECIALTY INPUT FOR PRICING

Code 2005 Description Unit Unit price Primary specialties associated with item 

*CPT code(s) associated with item Status

of item 

SL008 ........... Antibodies—detection ....... Slide ............ 30.90 Lab, pathology .................. 88365 ....................... See Note A. 

Blood pressure recording 

form, average.

Item ............. 0.31 Cardiology ........................ 93784, 93786, 93788 See Note A. 

Catheter, hyperthermia, 

closed-end.

Item ............. ........................ Radiation oncology ........... 77600–20 ................. See Note A. 

Catheter, hyperthermia, 

open-end.

Item ............. ........................ Radiation oncology ........... 77600 ....................... See Note A. 

Edrophonium .................... ml ................ 4.67 Gastroenterology .............. 91011 ....................... See Note A 

Hysteroscope, ablation device.Item ............. 1,146.00 Ob-gyn .............................. 58563 ....................... See Note A 

Kit, BCR/ABL DNA probe Kit ................ 42.65 Pathology .......................... 88365 ....................... See Note A. 

SA013 .......... Kit, detection ..................... Slide ............ 8.50 Pathology, neurology ........ 88355, 88356 ........... See Note A. 

SA024 .......... Kit, photopheresis procedure.Kit ................ 809.00 Dermatology, ob-gyn ........ 36522 ....................... See Note A. 

Kit, vasotomy .................... Kit ................ ........................ Urology ............................. 55200, 55250 ........... See Note A. 

Methoxsalen, sterile solution (UVADEX) 10 ml 

vial.

ml ................ 49.50 Dermatology, radiation oncology.36522 ....................... See Note A. 

Pressure bag .................... Item ............. ........................ Cardiology ........................ 93501, 93508, 

93510, 93526.

See Note A. 

SL114 ........... Primary antibodies ............ Slide ............ 3.52 Pathology, neurology ........ 88355, 88356, 88358 See Note A. 

Tray, bronchogram ........... Tray ............. ........................ Pulmonary disease ........... 31708 ....................... See Note A. 

Tubing, sterile, non-vented 

(fluid administration).

Item ............. ........................ Cardiology ........................ 93501, 93508, 

93510, 93526.

See Note A. 

*CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS apply. 

Note A. Additional information required. Need detailed description (including kit contents), source, and current pricing information. 

v. Addition of Supply Item to CPT 

88365, Tissue In Situ Hybridization 

We received a request from a 

pathology society to add a DNA probe 

to the CPEP database for CPT 88365, 

tissue in situ hybridization. The society 

specified that 1.5 DNA probes are 

typically used in this service and the 

cost of one probe is $42.65. 

Documentation supporting this price 

was also provided. We are proposing to 

add, on an interim basis, this supply to 

the practice expense database with the 

understanding that the inclusion of the 

item will be subject to forthcoming RUC 

review. 

vi. Ophthalmology Equipment 

In the CPEP equipment data for many 

of the ophthalmology procedures, there 

is a duplication of time assigned to the 

screening lane and exam lane. In a 

majority of these identified procedures, 

the same timeframe was assigned to 

both the screening and exam lanes. 

While some of the procedures had not 

been refined by the PEAC, others were 

refined early on in the PEAC process 

before the PEAC agreed to assign only 

one equipment lane to each procedure 

because a patient can be in only one 

room at a time. In cases where both the 

screening and exam lanes are included, 

we are proposing to adjust the lane 

assignment by defaulting to the exam 

lane and, thus, we will delete the 

screening lane from these procedures. 

For all of the above services where a 

lane change was made, time values were 

assigned to the exam lane in accordance 

with our established standard 

procedure. We are asking commenters, 

in particular, organizations representing 

ophthalmology, to review these 

proposed changes and submit specific 

comments on the appropriateness of the 

exam lane default. 

vii. Other Practice Expense Issues 

Parathyroid Imaging, CPT 78070 

We received comments from the RUC 

and the specialty society representing 

nuclear medicine that the practice 

expenses for CPT 78070, parathyroid 

imaging, which is valued in the 

nonphysician work pool, are too low. 

Because this procedure involves 

multiple imaging sessions, the 

organizations have requested that a 

different crosswalk of charge-based 

RVUs be used to more appropriately 

value the practice expenses involved 

with CPT 78070. We agree and are 

proposing to crosswalk the charge-based 

RVUs from CPT 78306, whole body 

imaging, to this procedure. 

B. Geographic Practice Cost Indices 

(GPCIs) 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘GPCI’’ at the beginning of your 

comments.] 

1. Background 

The Social Security Act (the Act) 

requires that payments vary among 

physician fee schedule areas according 

to the extent that resource costs vary as 

measured by the Geographic Practice 

Cost Indices (GPCIs). In general, the fee 

schedule areas that existed under the 

prior reasonable charge system were 

retained under the physician fee 

schedule from calendar years 1992 to 

1996. We implemented a 

comprehensive revision in the 

physician fee schedule payment areas 

(localities) in 1997, reducing the 

number of localities from 210 to 89. A 

detailed discussion of physician fee 

schedule areas can be found in the July 

2, 1996 proposed rule (61 FR 34615) and 

the November 22, 1996 final rule (61 FR 

59494). 

47502 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

We are required by section 

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

separate GPCIs to measure resource cost 

differences among localities compared 

to the national average for each of the 

three fee schedule components. While 

requiring that the practice expense and 

malpractice GPCIs reflect the full 

relative cost differences, section 

1848(e)(1)(A)(iii) of the Act requires that 

the physician work GPCIs reflect only 

one-quarter of the relative cost 

differences compared to the national 

average. 

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

requires us to review and, if necessary, 

to 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 onehalf of any adjustment if more than 1 

year has elapsed since the last GPCI 

revision. The GPCIs were first 

implemented in 1992. The first review 

and revision was implemented in 1995, 

the second review was implemented in 

1998, and the third review was 

implemented in 2001. This constitutes 

the fourth review of the work and 

practice expense GPCIs. 

The malpractice GPCIs were reviewed 

and revised as part of the November 7, 

2003 (68 FR 63196) physician fee 

schedule final rule. At the time of the 

publication of the November 2003 final 

rule, the U.S. Census data upon which 

the work and practice expense GPCIs 

are based were not yet available. 

Section 412 of MMA amends section 

1848(e)(1) of the Act and establishes a 

floor of 1.0 for the work GPCI for any 

locality where the GPCI would 

otherwise fall below 1.0. This 1.0 work 

GPCI floor will be used for purposes of 

payment for services furnished on or 

after January 1, 2004 and before January 

1, 2007. In addition, section 602 of 

MMA further amended section 

1848(e)(1) of the Act for purposes of 

payment for services furnished in 

Alaska under the physician fee schedule 

on or after January 1, 2004 and before 

January 1, 2006, and sets the work, 

practice expense, and malpractice 

expense GPCIs at 1.67 if any GPCI 

would otherwise be less than 1.67.

Based on these MMA provisions, we 

revised the addenda published in the 

November 7, 2003 final rule (68 FR 

63196) that reflected both the 

transitional 2004 and 2005 malpractice 

GPCIs, as well as the work and practice 

expense GPCIs that were not updated 

(Addendum D and Addendum E, 

respectively) in an interim final rule 

with comment period entitled, 

‘‘Changes to Medicare Payment for 

Drugs and Physician Fee Schedule 

Payments for Calendar Year 2004,’’

published January 7, 2004 (69 FR 1084). 

Due to the MMA provisions, no locality 

in these revised addenda has a work 

GPCI of less than 1.00. Additionally, the 

work, practice expense, and malpractice 

GPCIs for Alaska are set at 1.67. 

We are proposing to revise the work 

and practice expense GPCIs beginning 

in 2005 based on updated U.S. Census 

data and Department of Housing and 

Urban Development fair market rent 

data. 

2. Development of the Geographic 

Practice Cost Indices 

The GPCIs were developed by a joint 

effort of the Urban Institute and the 

Center for Health Economics Research 

under contract to us. Indices were 

developed that measured the relative 

physician resource cost differences 

among areas compared to the national 

average in a ‘‘market basket’’ of goods. 

The market basket consists of the 

resources involved with operating a 

private medical practice. The resource 

inputs are—

• Physician work or net income (used 

to construct the physician work GPCI); 

• Employee wages, office rents, 

medical equipment, supplies, and other 

miscellaneous expenses used to 

comprise the practice expense GPCI; 

and 

• Professional liability insurance 

premiums (used to construct the 

malpractice GPCI). 

The resource inputs and their 

respective weights for the resource costs 

associated with the work, practice 

expense, and malpractice expense 

associated with providing a physician 

service, were obtained from the 2003 

AMA Physician Socioeconomic 

Characteristics publication (2003 Patient 

Care Physician Survey data) which 

measures physicians’ earnings and 

overall practice expenses for 2000. 

The weights for the 2004 GPCIs, as 

well as the proposed 2005 through 2007 

GPCI revisions, are from the 2003 AMA 

survey and were used in the Medicare 

Economic Index (MEI) revision 

discussed in the November 2003 

physician fee schedule final rule (68 FR 

63245). Table 5 below shows the 

weights of the resource inputs, as 

defined by the MEI, those used for the 

original GPCIs, as well as the weights 

for the first, second, and third GPCI 

revisions. The MEI weights associated 

with the first and second GPCI updates 

(1995–2000 GPCIs) were not revised. In 

addition, the MEI weights for the 

proposed fourth GPCI revision are also 

shown.

TABLE 5.—HISTORICAL VIEW OF MEI WEIGHTS

Input component 

Percentage of practice cost indices 

1992–1994

GPCIs 

1995–2000

GPCIs 

2001–2003

GPCIs 

2004–2006

GPCI 

Physician Work ................................................................................................................ 54.2 54.2 54.5 52.5 

Practice Expense ............................................................................................................. 40.2 41.0 42.3 43.7 

Employee Wages ............................................................................................................. 15.7 16.3 16.8 18.7 

Rent ................................................................................................................................. 11.1 10.3 11.6 12.2 

Miscellaneous .................................................................................................................. 13.4 14.4 13.9 12.8 

Malpractice ....................................................................................................................... 5.6 4.8 3.2 3.9 

Total .......................................................................................................................... 100.0 100.0 100.0 100.0 

a. Work Geographic Practice Cost 

Indices 

As in previous GPCI updates, the 

median hourly earnings component is 

based on a 20 percent sample of U.S. 

Census data from workers in seven 

professional occupations. The actual 

reported earnings of physicians were 

not used to establish the GPCIs because 

Medicare payments (which are based on 

the GPCIs) are in part determinants of 

the earnings. Including physician wages 

in the physician work GPCI could, in 

effect, make the index dependent upon 

Medicare payments. Based upon 

analysis performed by Health 

Economics Research, we believe that in 

the majority of instances, the earnings of 

physicians will vary among areas to the 

same degree that the earnings of other 

professionals vary. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47503 

Data from the 2000 decennial U.S. 

Census by county of seven professional 

occupations (architecture and 

engineering; computer, mathematical, 

and natural sciences; social scientist, 

social workers, lawyers; education, 

library, training; registered nurses; 

pharmacists; writers, artists, editors) 

were utilized in the development of the 

proposed work GPCIs. 

TABLE 6.—SPECIFIC OCCUPATION

CATEGORIES USED IN DEVELOPMENT

OF PHYSICIAN WORK GPCI 

Categories 

Census 2000 

occupation 

code 

Architecture and Engineering 130–156 

Computer, Mathematical, and 

Natural Sciences ................. 100–124 

160–176 

Social Scientists, Social Workers, Lawyers ........................ 180–215 

Education, Training, and Library .................................... 220–255 

Registered Nurses .................. 313 

Pharmacists ............................ 305 

Writers, Artists, and Editors .... 260–296 

The Census Bureau has very specific 

criteria that tabulations must meet in 

order to be released to the public. To 

maximize the accuracy and availability 

of the data collection, the nonphysician 

professional wage data were aggregated 

into three geographic area categories: 

1. By Individual Counties—The 

tabulations were requested for each 

county in a Consolidated Metropolitan 

Statistical Area (CMSA). 

2. By Metropolitan Statistical Area 

(MSA)—The tabulations were requested 

by MSA for all counties that fall within 

an MSA. 

3. By Rest of State—The tabulations 

were requested by rest of State for 

counties that are not in a CMSA or 

MSA. 

The nonphysician professional wage 

data were subsequently assigned to each 

respective county within the MSA or 

Rest of State aggregations (or, in the case 

of CMSAs, the data were already at the 

county level), and a median wage by 

county was calculated for each 

occupational category. These median 

wages were then weighted by the total 

RVUs associated with a given county to 

ultimately arrive at locality-specific 

work GPCIs. This geographic 

aggregation of Census data is the same 

methodology that was utilized in 

previous updates to the GPCIs. 

The work GPCIs reflect one-fourth of 

the relative cost differences, as required 

by statute, with the exception of those 

areas where MMA requires that the 

GPCI be set at no lower than 1.00 and 

that the Alaska GPCIs be set at 1.67. 

b. Practice Expense GPCIs 

As in the past, we are proposing that 

the practice expense GPCI would be 

comprised of several factors that 

represent the major expenses incurred 

in operating a physician practice. The 

factors and the data sources we propose 

to use are detailed below. The impact of 

each individual factor on the calculation 

of the practice expense GPCI is based on 

the relative weight for that factor 

consistent with the calculation of the 

MEI. 

Employee Wage Indices—The 

employee wage index is based on 

special tabulations of 2000 census data, 

which are generated from the Long 

Form Questionnaire. These special 

tabulations provided by the Census 

Bureau are designed to capture the 

median wage by county of the 

professional labor force. The Employee 

Wage Index uses the median wages of 

four labor categories that are most 

commonly present in a physician’s 

private practice (administrative support, 

registered nurses, licensed practical 

nurses, and health technicians). Median 

wages for these occupations were 

provided by the U.S. Census Bureau 

using the same set of geographic 

aggregation rules discussed previously 

in the physician work GPCI section. 

TABLE 7.—SPECIFIC OCCUPATIONS

USED IN CREATING EMPLOYEE

WAGE INDEX UPDATE

Categories Census 2000 

occupation code 

Administrative Support .... 500–593 

Registered Nurses ........... 313 

Licensed Practical Nurses 350 

Health Technicians .......... 330, 332, 341, 

351–354, 365 

Office Rent Indices— Since no 

national data are readily available for 

physician office rents, some proxy must 

be used for this portion of the practice 

expense index. To construct the practice 

expense GPCIs, we need data that are 

widely and consistently available across 

all fee schedule areas. Although we 

searched for alternative commercial 

rental data that were both widely and 

consistently available across all fee 

schedule areas, we were unable to 

identify any reliable sources of 

commercial rental data. 

As with the current practice expense 

GPCIs, the Department of Housing and 

Urban Development (HUD) Fair Market 

Rental (FMR) data for the residential 

rents were again used as the proxy for 

physician office rents. The proposed 

2005 through 2007 practice expense 

GPCIs reflect the final fiscal year 2004 

HUD FMR data. See Addendum E for a 

more detailed illustration of the actual 

office rent indices. 

We believe that the FMR data remain 

the best available source for 

constructing the office rent index. The 

FMR data are available for all areas, are 

updated annually, and retain 

consistency from area-to-area and from 

year-to-year. Additionally, physicians 

frequently locate their offices in areas 

that are residential, rather than 

commercial, in nature. Residential rates 

may, in fact, be a better measure of the 

differences among areas in the 

physician office market than a general 

commercial rental index. In developing 

FMRs for metropolitan areas, HUD 

assumes that all counties within an 

MSA have the same rent. However, we 

believe that the rents in the New York 

City MSA vary too widely and propose 

that the FMR for this metropolitan area 

should be adjusted to account for this 

variation. For the New York City MSA, 

we used median gross rent from the 

2000 Census to adjust the individual 

rents within counties in this MSA. 

A reduction in an area’s rent index 

does not necessarily mean that rents 

have gone down in that area since the 

last GPCI update. Since the GPCIs 

measure area costs compared to the 

national average, a decrease in an area’s 

rent index means that that area’s rental 

costs are lower relative to the national 

average rental costs. Addendum E 

illustrates the changes in the rental 

index based upon the new FMR data. 

Medical Equipment, Supplies, and 

other Miscellaneous Expenses—The 

GPCIs assume that items such as 

medical equipment and supplies have a 

national market and that input prices do 

not vary among geographic areas. We 

were again unable to find any data 

sources that demonstrated price 

differences by geographic areas. As 

mentioned in previous updates, some 

price differences might exist, but these 

differences are more likely to be based 

on volume discounts rather than on 

geographic areas. The medical 

equipment, supplies, and miscellaneous 

expense portion of the practice expense 

geographic index will continue to be 

1.000 for all areas in the proposed 

GPCIs, except for Alaska which will 

have an overall practice expense GPCI 

set at 1.67 for 2004 and 2005. 

c. Malpractice Expense GPCIs 

The malpractice GPCIs were reviewed 

and revised as part of the November 7, 

2003 (68 FR 63196) physician fee 

schedule final rule. Please refer to that 

47504 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

final rule for a detailed discussion of the 

update to the malpractice GPCIs. 

4. Calculation and Effect of the 

Proposed 2005 Through 2007 Work and 

Practice Expense GPCIs 

All three of the indices for a specific 

fee schedule locality are based on the 

indices for the individual counties 

within the respective fee schedule 

localities. As has been done in the past, 

fee schedule RVUs would again be used 

to weight the county indices (to reflect 

volumes of services within counties) 

when mapping to fee schedule areas and 

in constructing the national average 

indices. However, we propose to use 

more recent data, 2002 versus 1998 

RVUs, in the county, locality, and 

national mapping in the proposed 

GPCIs. The payment effect associated 

with the use of these revised RVUs 

would generally be negligible, in most 

cases resulting in changes at the third 

decimal point, if at all. 

Fee schedule payments are the 

product of the RVUs, the GPCIs, and the 

conversion factor. Updating the GPCIs 

changes the relative position of fee 

schedule areas compared to the national 

average. Since the changes represented 

by the proposed GPCIs could result in 

total payments either greater than or less 

than what would have been paid if the 

GPCIs were not updated, it would be 

necessary to apply scaling factors to the 

proposed GPCIs to ensure budget 

neutrality (prior to applying the 

provisions of MMA that change the 

work GPCIs to a minimum of 1.0 and 

increase the Alaska GPCIs to 1.67 

because these provisions are exempted 

from budget neutrality). We determined 

that the proposed work and practice 

expense GPCIs would have resulted in 

slightly higher total national payments. 

Since the law requires that each 

individual component of the fee 

schedule—work, practice expense, and 

malpractice expense—is separately 

adjusted by its respective GPCI, we 

propose to scale each of the GPCIs 

separately. To ensure budget neutrality 

prior to applying the MMA provisions, 

it would be necessary to—

• Decrease the proposed work GPCI 

by 0.9965; 

• Decrease the proposed practice 

expense GPCI by 0.9930; and

• Increase the malpractice GPCIs that 

were published in the November 7, 2003 

final rule by 1.0021. 

As all geographic payment areas 

would receive the same percentage 

adjustments, the adjustments do not 

change the new relative positions 

among areas indicated by the proposed 

GPCIs. After the appropriate scaling 

factors are applied, the MMA provision 

setting a 1.0 floor would be applied to 

all work GPCIs falling below 1.0. 

Additionally, the GPCIs for Alaska 

would all be set to 1.67 in accordance 

with MMA. 

The locality specific effect of these 

proposed revisions to the work and 

practice expense GPCIs, as well as the 

revisions to the malpractice GPCIs 

published in the November 7, 2003 final 

rule, and the MMA provisions enacted 

December 8, 2003, are shown in 

Addendum F through Addendum H. 

Addendum F reflects the current GPCIs 

that were effective on January 1, 2004. 

Addendum F can be utilized as a 

baseline for purposes of comparison to 

the proposed GPCIs. Addendum H 

illustrates the proposed fully 

implemented 2006 GPCIs. Addendum G 

illustrates the proposed transitional 

2005 GPCIs, which are one-half of the 

effect of the proposed fully 

implemented GPCI revisions as required 

by section 1848(e)(1)(C) of the Act. 

Because the three GPCIs have 

different weights, the overall effect of 

the proposed changes cannot be 

achieved by summing the individual 

effects of the revisions on the work, 

practice expense, and malpractice 

expense GPCIs. The overall effect of all 

three revised GPCI components on an 

area can be estimated by a comparison 

of the area’s geographic adjustment 

factors (GAFs). The GAF for a specific 

payment area is the weighted composite 

of the three separate components. The 

GAF illustrates an estimate of the 

general effect on total payments across 

a specific fee schedule locality. The 

effects on individual physicians would 

vary depending on each physician’s mix 

and volume of services. 

To illustrate a comparison of the 

overall effect of the current and 

proposed GPCIs, Addendum J contains 

a comparison of the current 2004 GAFs 

to the proposed fully-implemented 2006 

GAFs. Addendum I contains a 

comparison of the proposed transitional 

GAFs (2005) to the current 2004 GAFs. 

Both Addenda I and J are sorted in 

descending order of change. As 

Addendum J shows, no fee schedule 

area would experience a total decrease 

in its respective GAF by more than 3.5 

percent, or increase by more than 7 

percent, if the proposed GPCI revisions 

are fully implemented in 2006. The 

majority of payment areas would change 

by considerably less than these 

amounts. Nearly 75 percent of payment 

areas would change by less than 2 

percent with the majority of these 

payment areas changing by less than 1 

percent. Consequently, as illustrated by 

Addendum I, no fee schedule area 

would experience a total decrease in its 

respective GAF of more than 1.6 

percent, or an increase of more than 3.5 

percent, in the transition year (2005). 

The GPCIs measure relative cost 

differences among payment areas 

compared to the national average. The 

national average cost is represented by 

a value of about 1.000. A proposed GPCI 

revision showing a decrease from the 

current value does not necessarily mean 

that absolute costs in a payment area 

have decreased, only that the average 

costs of a payment area have decreased 

as compared to the national average 

costs. 

5. Payment Localities 

In the August 15, 2003 proposed rule, 

we requested comments on the 

composition of the current 89 Medicare 

physician payment localities to which 

the GPCIs are applied. In the November 

7, 2003 final rule, we indicated that we 

received comments from various parties 

requesting that specific counties be 

removed from their current locality. We 

further indicated that we are continuing 

to examine alternatives for reconfiguring 

the current locality structure. 

While we have considered 

alternatives, we have not yet been able 

to come up with a policy and criteria 

that would satisfactorily apply to all 

situations. Any policy that we would 

propose would have to apply to all 

States and payment localities. For 

example, if we were to establish a policy 

that if adjacent county geographic 

indices exceeded a threshold amount, 

the lower county could be moved to the 

higher county or a separate locality 

could be created, that approach would 

cause redistributions within a State. 

Locality changes are budget-neutral 

with respect to the aggregate amount of 

Medicare money in a State. That is, 

reconfigurations of localities within a 

State do not result in any more 

Medicare money for the State in the 

aggregate, but only redistributions of 

money within a State. Since there will 

be both winners and losers in any 

locality reconfiguration, the State 

medical associations should be the 

impetus behind these changes. Since 

1996, we have moved to Statewide areas 

in several States after receiving 

resolutions from State medical societies 

including support from physicians in 

losing areas, and after going through 

Notice and Comment rulemaking. The 

support of State medical associations 

has been the basis for previous changes 

to Statewide areas, and continues to be 

equally important in our consideration 

of other future locality changes. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47505

C. Malpractice Relative Value Units 

(RVUs) 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Malpractice RVUs’’ at the beginning of 

your comments.]

1. History of Relative Value Unit System 

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

requires that each service paid under 

the physician fee schedule be comprised 

of three components: work, practice 

expense, and malpractice. 

From 1992 to 1999, malpractice RVUs 

were charge-based, using weighted 

specialty-specific malpractice expense 

percentages and 1991 average allowed 

charges. Malpractice RVUs for new 

codes after 1991 were extrapolated from 

similar existing codes or as a percentage 

of the corresponding work RVU. Section 

4505(f) of the BBA required us to 

implement resource-based malpractice 

RVUs for services furnished beginning 

in 2000. With the implementation of 

resource-based malpractice RVUs in 

2000 and the full implementation of 

resource-based practice expense RVUs 

in 2002, all physician fee schedule 

RVUs were resource-based, eliminating 

the last vestiges of charged-based 

payment. 

2. Proposed Methodology for the 

Revision of Resource-based Malpractice 

RVUs 

The methodology used in calculating 

the proposed resource-based 

malpractice RVUs is the same 

methodology that was used in the initial 

development of resource-based RVUs, 

the only difference being the use of 

more current data. The proposed 

resource-based malpractice expense 

RVUs are based upon: 

• Actual 2001 and 2002 malpractice 

premium data; 

• Projected 2003 premium data; and 

• 2002 Medicare payment data on 

allowed services and charges. 

As was done in the initial 

development of resource-based 

malpractice expense RVUs in the 

November 2, 1999 final rule, we are 

proposing to revise resource-based 

malpractice expense RVUs using 

specialty-specific malpractice premium 

data because they represent the actual 

malpractice expense to the physician. In 

addition, malpractice premium data are 

widely available. We propose to use 

actual 2001 and 2002 malpractice 

premium data and projected 2003 

malpractice premium data for three 

reasons: 

• These are the most current data 

available. 

• These data capture the highly 

publicized and most recent trends in the 

specialty-specific costs of professional 

liability insurance. 

• These are the same malpractice 

premium data that were utilized in the 

development of revised malpractice 

GPCIs in the November 7, 2003 final 

rule. 

We were unable to obtain a nationally 

representative sample of 2003 

malpractice premium data for two 

reasons: (1) The premium data that we 

collected from the private insurance 

companies had to ‘‘match’’ the market 

share data that were provided by the 

respective State Departments of 

Insurance. Because none of the State 

Departments of Insurance had 2003 

market share information at the time of 

this data collection, 2003 premium data 

were not usable; and (2) the majority of 

private insurers were not amicable to 

releasing premium data to us. In the 

majority of instances, the private 

insurance companies would release 

their premium data only to the State 

Departments of Insurance. 

Discussions with the industry lead us 

to conclude that the primary 

determinants of malpractice liability 

costs remain physician specialty, level 

of surgical involvement, and the 

physician’s malpractice history. 

Malpractice premium data were 

collected for the top 20 Medicare 

physician specialties measured by total 

payments. Premiums were for a $1 

million/$3 million mature claims-made 

policy (a policy covering claims made, 

rather than services provided during the 

policy term). We attempted to collect 

premium data from all 50 States, 

Washington, DC, and Puerto Rico. Data 

were collected from commercial and 

physician-owned insurers and from 

joint underwriting associations (JUAs). 

A JUA is a State governmentadministered risk pooling insurance 

arrangement in areas where commercial 

insurers have left the market. 

Adjustments were made to reflect 

mandatory patient compensation funds 

(PCFs) (funds to pay for any claim 

beyond the statutory amount, thereby 

limiting an individual physician’s 

liability in cases of a large suit) 

surcharges in States where PCF 

participation is mandatory. The 

premium data collected represent at 

least 50 percent of physician 

malpractice premiums paid in each 

State. 

For 2001, we were able to collect 

premium data from 48 States (for 

purposes of this discussion, State counts 

include Washington, DC and Puerto 

Rico). We were unable to obtain 

premium data from Kentucky, New 

Hampshire, New Mexico, and 

Washington DC. To calculate a proxy for 

the malpractice premium data for these 

four areas in 2001, we began with the 

most current malpractice premium data 

collected for these areas, 1996 through 

1998 (the last premium data collection 

that was undertaken). An average 

premium price was calculated (using 

1996 through 1998 data) for all States 

except Kentucky, New Hampshire, New 

Mexico, and Washington, DC. Similarly, 

an average premium price was 

calculated for the 1999 through 2001 

period for all States except Kentucky, 

New Hampshire, New Mexico, and 

Washington, DC. The percentage change 

in these premium prices was calculated 

as the percent difference between the 

1999 to 2001 calculated average 

premium price and the 1996 to 1998 

calculated average premium price. This 

percentage change was then applied to 

the weighted average 1996 to 1998 

malpractice premium price for these 

four areas to arrive at a comparable 1999 

to 2001 average premium price.

For 2002, we were able to obtain 

malpractice premium data from 33 

States. Many State Departments of 

Insurance had not yet obtained 

premium data from the primary insurers 

within their State at the time of this data 

collection. For those States for which 

we were unable to obtain malpractice 

premium data, we calculated a national 

average rate of growth for 2002 and 

applied this national rate of growth to 

the weighted average premium for 2001 

to obtain an average premium for 2002 

for each county for which we were 

unable to obtain malpractice premium 

data for 2002. 

We projected premium values for 

2003 based on the average of historical 

year-to-year changes for each locality 

(when locality level data were available) 

or by State (when only Statewide 

premium data projections were 

available). First, we calculated the 

percentage changes in the premiums 

from the 1999 through 2000, 2000 

through 2001, and 2001 through 2002 

periods for each payment locality. Next, 

we calculated the geometric mean of 

these three percentages and applied the 

mean to the 2002 premium to obtain the 

forecasted 2003 malpractice premium. 

We used the geometric mean to 

calculate the forecasted 2003 premium 

data because the geometric mean is 

commonly used to derive the mean of a 

series of values that represent rates of 

change. Because the geometric mean is 

based on the logarithmic scale, it is less 

impacted by outlying data. 

Malpractice insurers generally use 

five-digit codes developed by the 

Insurance Services Office (ISO), an 

advisory body serving property and 

casualty insurers, to classify physician 

47506 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

specialties into different risk classes for 

premium rating purposes. ISO codes 

classify physicians not only by 

specialty, but in many cases also by 

whether or not the specialty performs 

surgical procedures. A given specialty 

could thus have two ISO codes, one for 

use in rating a member of that specialty 

who performs surgical procedures and 

another for rating a member who does 

not perform surgery. Medicare uses its 

own system of specialty classification 

for payment and data purposes. It was 

therefore necessary to map Medicare 

specialties to ISO codes and insurer risk 

classes. Different insurers, while using 

ISO codes, have their own risk class 

categories. To ensure consistency, we 

used the risk classes of St. Paul 

Companies, one of the oldest and largest 

malpractice insurers. Table 8 crosswalks 

Medicare specialties to ISO codes and to 

the St. Paul risk classes used.

TABLE 8.—CROSSWALK OF MEDICARE SPECIALTIES TO IOS CODES AND TO THE ST. PAUL RISK CLASSES USED

Medicare code Medicare description 

ISO code Risk class 

St. Paul’s description 

Surgery Other Surgery Other 

1 ...................... General practice ........................................ 80117 80420 4 1 Family/Gen. Practitioners—No Obstetrical. 

2 ...................... General surgery ......................................... 80143 80143 5 5 Surgery, General. 

3 ...................... Allergy/Immunology ................................... 80254 80254 1A 1A Allergy. 

4 ...................... Otolaryngology .......................................... 80159 80265 3 1 Otarhinolaryngology. 

5 ...................... Anesthesiology .......................................... 80151 80151 5A 5A Anesthesiology. 

6 ...................... Cardiology ................................................. 80281 80255 2 1 Cardiovascular Disease. 

7 ...................... Dermatology .............................................. 80472 80256 5 1A Dermatology. 

8 ...................... Family practice .......................................... 80117 80420 4 1 Family/Gen. Practitioners—No Obstetrical. 

10 .................... Gastroenterology ....................................... 80104 80241 3 1 Gastroenterology. 

11 .................... Internal medicine ....................................... 80284 80257 2 1 Internal medicine. 

13 .................... Neurology .................................................. 80288 80261 2 2 Neurology. 

14 .................... Neurosurgery ............................................. 80152 80152 8 8 Surgery, Neurology. 

16 .................... Obstetrics/Gynecology .............................. 80167 80244 4 1 Gynecology. 

18 .................... Ophthalmology .......................................... 80114 80263 2 1 Ophthalmology. 

20 .................... Orthopedic surgery .................................... 80501 80501 5 5 Surgery, Orthopedic—excluding 

Spinal Surgery. 

20 .................... Orthopedic surgery .................................... 80154 80154 6 6 Surgery, Orthopedic—including 

Spinal Surgery. 

22 .................... Pathology ................................................... 80292 80266 2 1A Pathology. 

24 .................... Plastic and reconstructive surgery ............ 80156 80156 5 5 Surgery, Plastic. 

25 .................... Physical medicine and rehab .................... 80235 80235 1 1 Physical medicine and rehab. 

26 .................... Psychiatry* ................................................. 80492, 

80431

80249 2 1A Psychiatry. 

28 .................... Colorectal surgery ..................................... 80115 80115 3 3 Surgery, Colon and Rectal. 

29 .................... Pulmonary Disease ................................... 80269 80269 1 1 Pulmonary Disease. 

30 .................... Diagnostic radiology ** .............................. 80280 80253 2 2 Radiology. 

33 .................... Thoracic surgery ........................................ 80144 80144 6 6 Surgery, Thoracic. 

34 .................... Urology ...................................................... 80145 80145 2 2 Surgery, Urological. 

36 .................... Nuclear medicine ....................................... 80262 80262 1 1 Nuclear medicine. 

37 .................... Pediatric medicine ..................................... 80293 80267 2 1 Pediatrics. 

38 .................... Geriatric medicine*** ................................. 80276 80243 2 1 Geriatrics. 

39 .................... Nephrology*** ............................................ 80287 80260 2 1 Nephrology. 

40 .................... Hand surgery ............................................. 80169 80169 5 5 Surgery, Hand. 

44 .................... Infectious disease ...................................... 80279 80246 2 1 Infectious disease. 

46 .................... Endocrinology*** ........................................ 80272 80238 2 1 Endocrinology. 

65 .................... Physical therapist (independent) ............... 80235 80235 1 1 Physical medicine and rehab. 

66 .................... Rheumatology ........................................... 80252 80252 1 1 Rheumatology. 

67 .................... Occupational therapist (independent) ....... 80235 80235 1 1 Occupational Medicine. 

77 .................... Vascular surgery ....................................... 80146 80146 6 6 Surgery, Vascular. 

78 .................... Cardiac surgery ......................................... 80141 80141 6 6 Surgery, Cardiac. 

82 .................... Hematology ............................................... 80278 80245 2 1 Hematology. 

83 .................... Hematology/oncology ................................ 80473 80473 1 1 Oncology. 

84 .................... Preventive medicine .................................. 80231 80231 1 1 General Preventive Medicine. 

92 .................... Radiation Oncology**** ............................. 80425 80425 2 2 Radiation Therapy. 

93 .................... Emergency medicine ................................. 80157 80102 5 4 Emergency Medicine. 

98 .................... Gynecologist/oncologist ............................. 80167 80244 4 1 Gynecology. 

Note: For specialties with multiple risk classifications depending on the level of surgical involvement, the highest level of surgery for each specialty was selected for the ‘‘surgery’’ ISO and risk class; and the lowest level of surgery was selected for the ‘‘nonsurgery’’ ISO and risk class. 

Note: If a specialty has only one risk classification, the same classification was used for both surgery and nonsurgery. 

* The ISO codes for surgery for Psychiatry represents Psychiatry—shock therapy. 

** St. Paul’s is the only one of the five companies that has a ‘‘major invasive’’ procedures ISO Code for Radiology; therefore, the ‘‘minor 

invasive procedures’’ ISO Code is being used as the highest level of surgery. 

*** St. Paul’s is the only one of the five companies that has a ‘‘major surgery’’ ISO Code for Geriatrics, Nephrology, and Endocrinology; therefore, the minor surgery’’ ISO Code is being used as the highest level of surgery. 

**** Medical Protective’s Description was used, as St. Paul’s does not provide specific medical malpractice insurance for Radiation Therapy. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47507

Some physician specialties, 

nonphysician practitioners, and other 

entities (for example, independent 

diagnostic testing facilities) paid under 

the physician fee schedule could not be 

assigned an ISO code. We crosswalked 

these specialties to similar physician 

specialties assigned an ISO code and a 

risk class. The unassigned specialties 

and the specialty to which they were 

assigned are shown in Table 9.

TABLE 9.—CROSSWALK OF SPECIALTIES TO SIMILAR PHYSICIAN SPECIALTIES ASSIGNED AN ISO CODE AND A RISK CLASS

Medicare code Unassigned Medicare specialty Crosswalk specialty 

12 ............................................... Osteopathic Manipulative Therapy ................................................................. Family Practice. 

32 ............................................... Anesthesiologist Assistant .............................................................................. Anesthesiology. 

35 ............................................... Chiropractic ..................................................................................................... Physical medicine and rehab. 

41 ............................................... Optometry ........................................................................................................ Ophthalmology. 

43 ............................................... Certified Registered Nurse Assistant .............................................................. All Physicians. 

47 ............................................... Physiological Laboratory (independent) .......................................................... All Physicians. 

48 ............................................... Podiatry ........................................................................................................... All Physicians. 

50 ............................................... Nurse Practitioner ........................................................................................... All Physicians. 

62 ............................................... Psychologist .................................................................................................... Psychiatry. 

68 ............................................... Clinical Psychologist ....................................................................................... Psychiatry. 

69 ............................................... Clinical Laboratory .......................................................................................... All Physicians. 

70 ............................................... Multi-Specialty Clinic or Group Practice ......................................................... All Physicians. 

74 ............................................... Radiation Therapy Center ............................................................................... Radiation Oncology. 

76 ............................................... Peripheral Vascular Disease ........................................................................... Vascular Surgery. 

79 ............................................... Addiction Medicine .......................................................................................... Psychiatry. 

80 ............................................... Licensed Clinical Social Worker ..................................................................... Psychiatry. 

81 ............................................... Critical Care (Intensivists) ............................................................................... All Physicians. 

85 ............................................... Maxillofacial Surgery ....................................................................................... Plastic Surgery. 

86 ............................................... Neuropsychiatry .............................................................................................. Psychiatry. 

89 ............................................... Certified Clinical Nurse Specialist ................................................................... All Physicians. 

90 ............................................... Medical Oncology ............................................................................................ Internal Medicine. 

91 ............................................... Surgical Oncology ........................................................................................... General Surgery. 

94 ............................................... Interventional Radiology .................................................................................. Radiology. 

96 ............................................... Optician ........................................................................................................... Ophthalmology. 

97 ............................................... Physician Assistant ......................................................................................... All Physicians. 

In the development of the proposed 

resource-based malpractice RVU 

methodology, we considered two 

malpractice premium-based alternatives 

for resource-based malpractice RVUs, 

the dominant specialty approach and 

the specialty-weighted approach. 

Dominant Specialty Approach 

The dominant specialty approach 

bases the malpractice RVUs upon the 

risk factor of only the dominant 

specialty performing a given service as 

long as the dominant specialty 

accounted for at least 51 percent of the 

total utilization for a given service. 

When 51 percent of the total utilization 

does not comprise the dominant 

specialty, this approach uses a modified 

specialty-weighted approach. In this 

modified specialty-weighted approach, 

two or more specialties are collectively 

defined as the dominant specialty. 

Starting with the specialty with the 

largest percentage of allowed services, 

the modified specialty-weighted 

approach successively adds the next 

highest specialty in terms of percentage 

of allowed services until a 50 percent 

threshold is achieved. The next step is 

to sum the risk factors of those 

specialties (weighted by utilization) in 

order to achieve at least 50 percent of 

the total utilization of a given service 

and then use the factors in the 

calculation of the final malpractice 

RVU. 

The dominant specialty approach 

produces modest increases for some 

specialties and modest decreases for 

other specialties. The largest increase 

for any given specialty, over the 

specialty-weighted approach, is less 

than 1.5 percent of total RVUs, while 

the largest decrease for any given 

specialty is less than 0.5 percent of total 

RVUs. 

Specialty-Weighted Approach 

The approach that we adopted in the 

November 1999 final rule and are 

proposing to use in this proposed rule, 

bases the final malpractice RVUs upon 

a weighted average of the risk factors of 

all specialties performing a given 

service. The specialty-weighted 

approach ensures that all specialties 

performing a given service are 

accounted for in the calculation of the 

final malpractice RVU. Our proposed 

methodology is as follows: 

(1) Compute a national average 

premium for each specialty. Insurance 

rating area malpractice premiums for 

each specialty were mapped to the 

county level. The specialty premium for 

each county is then multiplied by the 

total county RVUs (as defined by 

Medicare claims data), which had been 

divided by the malpractice GPCI 

applicable to each county to standardize 

the relative values for geographic 

variations. If the malpractice RVUs were 

not normalized for geographic variation, 

the locality cost differences (as reflected 

by the GPCIs) would be counted twice. 

The product of the malpractice 

premiums and standardized RVUs is 

then summed across specialties for each 

county. This calculation is then divided 

by the total RVUs for all counties, for 

each specialty, to yield a national 

average premium for each specialty. 

Table 10 shows the national average 

premiums for the years 1999 through 

2003 for the 20 specialties for which we 

collected premium data. As stated 

previously, we used an average of the 3 

most current years, 2001 to projected 

2003 malpractice premiums, in our 

calculation of the proposed malpractice 

RVUs.

47508 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 10.—NATIONAL AVERAGE PREMIUMS FOR THE YEARS 1999 THROUGH 2003 FOR THE 20 SPECIALTIES FOR WHICH

WE COLLECTED PREMIUM DATA

ISO Specialty 2001

average 

2002

average 

2003

average 

1996–1998

average 

2001–2003

average 1

Annual

trend 2

(percent) 

Specialty

MGPCI 3

Normalized 

2001–2003

premium 4

Risk

factor 5

80269 ......... Pulmonary disease ............... 12,574 13,456 14,541 9,508 13,524 7.30 1.027 13,168 2.14 

80280 ......... Diagnostic radiology ............. 15,807 16,783 17,997 12,372 16,862 6.39 0.997 16,913 2.75 

80284 ......... Internal medicine .................. 14,395 15,714 16,985 11,836 15,698 5.81 1.028 15,270 2.48

80274 ......... Gastroenterology .................. 14,347 15,398 16,643 11,745 15,463 5.65 1.017 15,204 2.47 

80143 ......... General surgery .................... 33,163 36,004 39,059 27,825 36,075 5.33 0.957 37,696 6.13 

80423 ......... General practice ................... 13,325 14,479 15,731 11,234 14,512 5.25 0.943 15,389 2.50 

80288 ......... Neurology ............................. 16,206 17,330 18,629 13,726 17,388 4.84 1.032 16,849 2.74 

80114 ......... Ophthalmology ..................... 13,064 14,103 15,317 11,209 14,161 4.79 0.997 14,204 2.31 

80152 ......... Neurosurgery ........................ 64,724 70,125 76,060 57,701 70,303 4.03 0.952 73,848 12.00 

80281 ......... Cardiology ............................ 14,798 15,836 17,085 13,204 15,906 3.79 1.021 15,579 2.53

80145 ......... Urology ................................. 18,701 20,253 21,931 16,958 20,295 3.66 0.999 20,315 3.30 

80159 ......... Otolaryngology ..................... 21,720 23,127 24,794 19,990 23,214 3.04 0.997 23,284 3.78 

80154 ......... Orthopedic w/spinal .............. 40,384 43,758 47,321 38,584 43,821 2.58 0.955 45,886 7.46 

80144 ......... Thoracic surgery ................... 39,538 43,200 47,249 38,812 43,329 2.23 1.020 42,479 6.91 

80282 ......... Dermatology ......................... 11,046 11,549 12,375 10,650 11,657 1.82 1.020 11,428 1.86 

80260 ......... Nephrology 6 ......................... 8,408 9,290 10,142 n/a 9,280 n/a 0.999 9,289 1.51 

80146 ......... Vascular surgery .................. 39,391 42,660 46,211 n/a 42,754 n/a 1.014 42,164 6.85 

80141 ......... Cardiac surgery .................... 37,802 40,498 43,722 n/a 40,674 n/a 0.921 44,163 7.18 

80425 ......... Radiation oncology ............... 13,800 14,755 15,976 n/a 14,844 n/a 0.995 14,918 2.43 

80102 ......... Emergency medicine ............ 20,671 22,672 24,733 n/a 22,692 n/a 0.974 23,298 3.79 

1A simple average of figures for 2001, 2002, and 2003. 

2Percent annualized average growth rate between 1996–1998 and 2001–2003. 3An average of locality malpractice GPCIs using specialty-specific malpractice RVUs as weights. 

4 2001–2003 premium divided by specialty MGPCI. 5 (Normalized 2001–2003 Premium, .9289) × 1.51. 6 Nephrology is set to 1.51 to be consistent with the risk factor taken from the rating manuals. n/a signifies that the premium data were not available. 

(2) Calculate a risk factor for each 

specialty. Differences among specialties 

in malpractice premiums are a direct 

reflection of the malpractice risk 

associated with the services performed 

by a given specialty. The relative 

differences in national average 

premiums between various specialties 

can be expressed as a specialty risk 

factor. These risk factors are an index 

calculated by dividing the national 

average premium for each specialty by 

the national average premium for the 

specialty with the lowest average 

premium, nephrology. Table 11 shows 

the risk factors, surgical and 

nonsurgical, by specialty.

TABLE 11.—RISK FACTORS, SURGICAL AND NONSURGICAL, BY SPECIALTY

Medicare code Medicare description Nonsurgical

risk factor 

Surgical

risk factor 

01 .................................. General practice ........................................................................................................... 1.79 4.26 

02 .................................. General surgery ........................................................................................................... 6.13 6.13 

03 .................................. Allergy/Immunology ...................................................................................................... 1.00 1.00 

04 .................................. Otolaryngology ............................................................................................................. 1.45 3.78 

05 .................................. Anesthesiology ............................................................................................................. 2.84 2.84 

06 .................................. Cardiology .................................................................................................................... 1.45 2.53 

07 .................................. Dermatology ................................................................................................................. 1.00 3.90 

08 .................................. Family practice ............................................................................................................. 1.79 4.26 

10 .................................. Gastroenterology .......................................................................................................... 2.05 3.49 

11 .................................. Internal medicine .......................................................................................................... 2.05 2.48 

12 .................................. Osteopathic Manipulative Therapy .............................................................................. 1.79 4.26 

13 .................................. Neurology ..................................................................................................................... 2.52 2.74 

14 .................................. Neurosurgery ................................................................................................................ 12.00 12.00 

16 .................................. Obstetrics/Gynecology ................................................................................................. 2.15 5.63 

18 .................................. Ophthalmology ............................................................................................................. 1.24 2.31 

20 .................................. Orthopedic surgery w/o Spinal ..................................................................................... 8.06 8.06 

20 .................................. Orthopedic surgery with Spinal .................................................................................... 7.46 7.46 

22 .................................. Pathology ..................................................................................................................... 1.72 2.09 

24 .................................. Plastic Surgery ............................................................................................................. 6.92 6.92 

25 .................................. Physical Med & Rehab ................................................................................................ 1.26 1.26 

26 .................................. Psychiatry ..................................................................................................................... 1.11 3.08 

28 .................................. Colorectal surgery ........................................................................................................ 4.08 4.08 

29 .................................. Pulmonary disease ....................................................................................................... 2.14 2.14 

30 .................................. Diagnostic radiology ..................................................................................................... 2.07 2.75 

32 .................................. Anesthesiologist Assistant ........................................................................................... 2.84 2.84 

33 .................................. Thoracic surgery .......................................................................................................... 6.91 6.91 

34 .................................. Urology ......................................................................................................................... 3.30 3.30 

35 .................................. Chiropractic .................................................................................................................. 1.26 1.26 

36 .................................. Nuclear medicine ......................................................................................................... 1.66 1.66 

37 .................................. Pediatric medicine ........................................................................................................ 1.76 2.42 

38 .................................. Geriatric medicine ........................................................................................................ 1.35 2.17 

39 .................................. Nephrology ................................................................................................................... 1.51 1.96 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47509

TABLE 11.—RISK FACTORS, SURGICAL AND NONSURGICAL, BY SPECIALTY—Continued

Medicare code Medicare description Nonsurgical

risk factor 

Surgical

risk factor 

40 .................................. Hand surgery ................................................................................................................ 4.71 4.71 

41 .................................. Optometry ..................................................................................................................... 1.24 2.31 

43 .................................. Certified Registered Nurse Assistant ........................................................................... 3.04 3.71 

44 .................................. Infectious disease ........................................................................................................ 1.55 2.09 

46 .................................. Endocrinology ............................................................................................................... 2.03 2.09 

47 .................................. Physiological Laboratory (independent) ....................................................................... 3.04 3.71 

48 .................................. Podiatry ........................................................................................................................ 3.04 3.71 

50 .................................. Nurse Practitioner ........................................................................................................ 3.04 3.71 

62 .................................. Psychologist ................................................................................................................. 1.11 3.08 

65 .................................. Physical therapist (independent) .................................................................................. 1.26 1.26 

66 .................................. Rheumatology .............................................................................................................. 2.11 2.11 

67 .................................. Occupational therapist ................................................................................................. 1.11 1.11 

68 .................................. Clinical Psychologist .................................................................................................... 1.11 3.08 

69 .................................. Clinical Laboratory ....................................................................................................... 3.04 3.71 

70 .................................. Multi-Specialty Clinic or Group Practice ...................................................................... 3.04 3.71 

74 .................................. Radiation Therapy Center ............................................................................................ 2.43 2.43 

76 .................................. Peripheral Vascular Disease ........................................................................................ 6.85 6.85 

77 .................................. Vascular surgery .......................................................................................................... 6.85 6.85 

78 .................................. Cardiac surgery ............................................................................................................ 7.18 7.18 

79 .................................. Addiction Medicine ....................................................................................................... 1.11 3.08 

80 .................................. Licensed Clinical Social Worker .................................................................................. 1.11 3.08 

81 .................................. Critical Care (Intensivists) ............................................................................................ 3.04 3.71 

82 .................................. Hematology .................................................................................................................. 1.77 2.26 

83 .................................. Hematology/oncology ................................................................................................... 2.05 2.11 

84 .................................. Preventive medicine ..................................................................................................... 1.26 1.26 

85 .................................. Maxillofacial Surgery .................................................................................................... 6.92 6.92 

86 .................................. Neuropsychiatry ........................................................................................................... 1.11 3.08 

89 .................................. Certified Clinical Nurse Specialist ................................................................................ 3.04 3.71 

90 .................................. Medical Oncology ......................................................................................................... 2.05 2.48 

91 .................................. Surgical Oncology ........................................................................................................ 6.13 6.13 

92 .................................. *Radiation oncology/therapy ........................................................................................ 2.43 2.43 

93 .................................. Emergency medicine .................................................................................................... 3.79 4.55 

94 .................................. Interventional Radiology ............................................................................................... 2.07 2.75 

96 .................................. Optician ........................................................................................................................ 1.24 2.31 

97 .................................. Physician Assistant ...................................................................................................... 3.04 3.71 

98 .................................. Gynecologist/oncologist ............................................................................................... 2.15 5.63 

Note: If a specialty has only one risk classification, the same classification was used for both surgery and nonsurgery. 

Note: For specialties with multiple risk classifications depending on the level of surgical involvement, the highest level of surgery was selected 

for surgery risk factor and the lowest level of surgery was selected for nonsurgery risk factor. 

(3) Calculate malpractice RVUs for 

each code. Resource-based malpractice 

RVUs were calculated for each 

procedure. The first step was to identify 

the percentage of services performed by 

each specialty for each respective 

procedure code. This percentage was 

then multiplied by each respective 

specialty’s risk factor as calculated in 

Step 2. The products for all specialties 

for the procedure were then summed, 

yielding a specialty-weighted 

malpractice RVU reflecting the weighted 

malpractice costs across all specialties 

for that procedure. This number was 

then multiplied by the procedure’s work 

RVUs to account for differences in riskof-service. Since we were unable to find 

an acceptable source of data to be used 

in determining risk-of-service, work 

RVUs were used. We would welcome 

any suggestions for alternative data 

sources to be used in determining riskof-service. 

As mentioned above, certain 

specialties may have more than one ISO 

rating class and risk factor. The surgical 

risk factor for a specialty was used for 

surgical services and the nonsurgical 

risk factor for evaluation and 

management services. Also, for 

obstetrics/gynecology, the lower 

gynecology risk factor was used for all 

codes except those obviously surgical 

services, in which case the higher, 

surgical risk factor was used. 

Certain codes have no physician work 

RVUs. The overwhelming majority of 

these codes are the technical 

components (TCs) of diagnostic tests, 

such as x-rays and cardiac 

catheterization, which have a distinctly 

separate technical component (the 

taking of an x-ray by a technician) and 

professional component (the 

interpretation of the x-ray by a 

physician). Examples of other codes 

with no work RVUs are audiology tests 

and injections. These services are 

usually furnished by nonphysicians, in 

this example, audiologists and nurses, 

respectively. In many cases, the 

nonphysician or entity furnishing the 

TC is distinct and separate from the 

physician ordering and interpreting the 

test. We believe it is appropriate for the 

malpractice RVUs assigned to TCs to be 

based on the malpractice costs of the 

nonphysician or entity, not the 

professional liability of the physician. 

Our proposed methodology, however, 

would result in zero malpractice RVUs 

for codes with no physician work, since 

we propose the use of physician work 

RVUs to adjust for risk-of-service. We 

believe that zero malpractice RVUs 

would be inappropriate because 

nonphysician health practitioners and 

entities such as independent diagnostic 

testing facilities (IDTFs) also have 

malpractice liability and carry 

malpractice insurance. Therefore, we 

are proposing to retain the current 

charge-based malpractice RVUs for all 

services with zero work RVUs. We are 

open to comments and suggestions for 

constructing resource-based malpractice 

RVUs for codes with no physician work. 

47510 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

(4) Rescale for budget neutrality. The 

law requires that changes to fee 

schedule RVUs be budget neutral. The 

current resource-based malpractice 

RVUs and the proposed resource-based 

malpractice RVUs were constructed 

using entirely different malpractice 

premium data. Thus, the last step is to 

adjust for budget neutrality by rescaling 

the proposed malpractice RVUs so that 

the total proposed resource-based 

malpractice RVUs equal the total 

current resource-based malpractice 

RVUs. The proposed resource-based 

malpractice RVUs for each procedure 

were multiplied by the frequency count 

for that procedure to determine the total 

resource-based malpractice RVUs for 

each procedure. This was summed for 

all procedures to determine the total fee 

schedule proposed resource-based 

malpractice RVUs. This was compared 

to the total current resource-based 

malpractice RVUs, using the same 

calculation and cases. The total current 

and proposed malpractice RVUs were 

equal, and therefore budget neutral. 

Thus, no adjustments were needed to 

ensure that expenditures remained 

constant for the malpractice RVU 

portion of the physician fee schedule 

payment.

The proposed resource-based 

malpractice RVUs are shown in 

Addendum B. These values have been 

adjusted for budget neutrality on the 

basis of the most recent available data. 

The values do not reflect the final 

budget-neutrality adjustment, which we 

will make in the final rule based upon 

the more current Medicare claims data. 

We do not believe, however, that the 

values will change significantly as a 

result of the final budget-neutrality 

adjustment. 

Because of the differences in the sizes 

of the three fee schedule components, 

implementation of the proposed 

resource-based malpractice RVUs will 

have a smaller payment effect than the 

previous implementation of resourcebased practice expense RVUs. On 

average, work represents about 52.5 

percent of the total payment for a 

procedure, practice expense about 43.6 

percent of the total payment, and 

malpractice expense about 3.9 percent 

of the total payment. Thus, a 20 percent 

change in practice expense or work 

RVUs would yield a change in payment 

of about 8 to 11 percent. In contrast, a 

corresponding 20 percent change in 

malpractice values would yield a 

change in payment of only about 0.6 

percent. Estimates of the effects on 

payment by specialty and selected highvolume procedures can be found in the 

impact section of this rule. 

We are requesting comments on our 

proposed methodology and resourcebased malpractice RVUs. 

D. Coding Issues 

1. Change in Global Period for CPT Code 

77427, Radiation Treatment 

Management, Five Treatments 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CODING-GLOBAL PERIOD’’ at the 

beginning of your comments.] 

This code was included in the 

November 2, 1999 physician fee 

schedule final rule and was effective for 

services beginning January 1, 2000. In 

that rule, and subsequent rules, we have 

applied a global indicator of ‘‘xxx’’ to 

this code, meaning that the global 

concept does not apply. It has been 

brought to our attention that this global 

indicator is incorrect. The global 

indicator should be 090 since the RUC 

valuation of this service reflected a 

global period of 90 days and we 

accepted this valuation. Therefore, we 

would correct the global indicator for 

this service to reflect a global period of 

90 days (090). 

2. Requests for Adding Services to the 

List of Medicare Telehealth Services 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CODING—TELEHEALTH’’ at the 

beginning of your comments.] 

a. Background 

Section 1834(m) of the Act defines 

telehealth services as professional 

consultations, office and other 

outpatient visits, and office psychiatry 

services identified as of July 1, 2000 by 

CPT codes 99241 through 99275, 99201 

through 99215, 90804 through 90809, 

and 90862. In addition, the statute 

required us to establish a process for 

adding services to or deleting services 

from the list of telehealth services on an 

annual basis. In the CY 2003 final rule, 

we established a process for adding or 

deleting services to the list of Medicare 

telehealth services. This process 

provides the public an opportunity on 

an ongoing basis to submit requests for 

adding a service. For more information 

on submitting a request for addition to 

the list of Medicare telehealth services, 

visit our Web site at www.cms.hhs.gov/

physicians/telehealth. 

b. Submitted Requests for Addition to 

the List of Telehealth Services 

Requests for adding services to the list 

of Medicare telehealth services must be 

submitted and received no later than 

December 31st of each calendar year to 

be considered for the next proposed 

rule. For example, requests submitted in 

CY 2003 are considered for the CY 2005 

proposed rule. 

We received the following public 

requests for addition in CY 2003: 

Inpatient hospital care, emergency 

department visits, hospital observation 

services, inpatient psychotherapy, 

monthly management of patients with 

end-stage renal disease (ESRD), speech 

and audiologist services, case 

management, and care plan oversight. 

Requests for additions submitted in 

CY 2003 are discussed below. 

Inpatient hospital care, emergency 

department visits, hospital observation 

services, and inpatient psychotherapy

The American Telemedicine 

Association (ATA) and an individual 

practitioner submitted a request to add 

initial and subsequent inpatient hospital 

care as represented by CPT codes 99221 

through 99223 and 99231 through 

99233; hospital observation services 

(CPT codes 99217, 99218 through 

99220); and individual psychotherapy 

furnished in an inpatient, partial 

hospitalization, or residential care 

facility setting (as defined by CPT codes 

90816 through 90822). The requestors 

argue that the addition of hospital 

observation services, inpatient hospital 

care, and inpatient psychotherapy will 

reduce transfers from remote facilities to 

tertiary care facilities, decrease length of 

stay, improve diagnostic accuracy, plan 

of care strategies and patient outcomes, 

and also stabilize local health care 

systems. The requestors emphasize that 

adding individual psychotherapy in the 

inpatient and partial hospitalization 

setting is crucial for providing access to 

mental health services for the rural 

population. Additionally, the requestors 

believe that no current Medicare 

telehealth service can be billed when a 

patient is in observation status or is 

admitted as an inpatient. They also 

noted that the current psychiatry 

services paid for as telehealth services 

are not appropriate for mental health 

patients in the hospital, partial hospital, 

or residential facility settings.

The University of Kansas Medical 

Center requested that we add emergency 

department visits as defined by CPT 

codes 99281 through 99285 as telehealth 

services. The requestor stated that, for 

many rural hospitals, the attending 

physician in emergency cases is a local 

primary care or family physician who 

may not have sufficient experience with 

the complexities of emergent care. The 

requestor believes that adding 

emergency department visits will 

provide quicker access to an expert 

trauma or emergency physician and that 

the time saved could be life-saving for 

the patient. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47511

CMS Review 

As discussed in the June 28, 2002 

Federal Register (67 FR 43862), we 

assign requests to one of two categories 

for review. Category 1 is comprised of 

services, which are similar in nature to 

an office or other outpatient visit, 

consultation, or office psychiatry. We 

review category 1 services to ensure that 

the roles of, and interaction among, the 

patient, physician, or practitioner at the 

distant site and telepresenter (if 

necessary) are similar to the current 

telehealth services. 

Category 2 services would include 

services that are not similar to an office 

or other outpatient visit, consultation, or 

office psychiatry. Because of the 

potential acuity of the patient in the 

hospital setting, we consider inpatient 

hospital care, emergency department 

visits, hospital observation services, and 

inpatient psychotherapy to fall into the 

second category of requests. As 

discussed on our website, for category 2 

services, requestors must provide 

evidence indicating that the use of a 

telecommunications system produces 

similar diagnostic findings or 

therapeutic interventions as would faceto-face delivery of the same service. 

For inpatient hospital care, hospital 

observation services, and inpatient 

psychotherapy, the requestors did not 

submit evidence indicating that the use 

of a telecommunications system does 

not affect the diagnosis or treatment 

plan as compared to the face-to-face 

delivery of the service. The requestors 

instead submitted various studies and 

articles regarding: the psychiatric 

diagnostic interview examination; 

school-based pediatric acute care to 

children; child and adolescent 

psychotherapy in clinics and schools; 

the use of telehealth technology to 

simplify case management and prior 

authorization; consultation on 

neurology cases; and nursing care to 

reduce hospitalization for heart failure. 

These data are not directly relevant to 

the services that the requesters wanted 

to have added. They do not address 

whether the use of a 

telecommunications system produces 

similar diagnoses or therapeutic 

interventions by physicians or 

practitioners, as would the face-to-face 

delivery of inpatient hospital care, 

hospital observation services, and 

inpatient psychotherapy. With respect 

to emergency department visits, the 

requestor submitted a comparison study 

between emergency department 

telemedicine and face-to-face emergency 

department visits. However, this study 

did not take into account complex 

emergent care. Study participants were 

pre-selected based on cases with limited 

clinical intervention, for example, 

animal bites with no skin laceration or 

puncture wounds, insect bites without 

evidence of wheezing or airway 

compromise, sore throat, first degree 

burns—less than 5 percent, and 

nonurgent medical problems requiring a 

referral. 

In the absence of sufficient, welldesigned comparison studies showing 

that the use of a telecommunications 

system produces similar diagnoses or 

therapeutic interventions as would the 

face-to-face delivery of the requested 

services, we are proposing not to add 

these services to the list of telehealth 

services.

We believe that the current list of 

Medicare telehealth services is 

appropriate for hospital inpatients, 

emergency room cases, and patients 

designated as observation status. If 

guidance or advice is needed in these 

settings, a consultation could be 

requested from an appropriate source. 

End Stage Renal Disease—Monthly 

Management of Patients on Dialysis 

The ATA and an individual 

practitioner submitted a request that we 

add the monthly management of 

patients on dialysis, as represented by 

HCPCS codes G0308 through G0319, to 

the list of Medicare telehealth services. 

Under these codes, Medicare pays an 

increased monthly capitated payment 

amount for additional visits during the 

month (up to four). The requestors 

noted the shortage of nephrologists and 

the difficulty they have in visiting faceto-face with all patients on dialysis. 

Additionally, the requestors stated that 

many States, including Alaska, Hawaii, 

Montana, and Wisconsin, have remote 

community-based dialysis centers with 

underserved populations located a 

considerable distance from a 

nephrologist. To address this issue, 

consultations and patient care 

conferences are currently being 

provided using a telecommunications 

system to manage patients on dialysis 

located in communities that do not have 

a nephrologist, including communities 

in Texas, where dialysis consultations 

and assessments using 

telecommunications are paid under the 

State’s Medicaid program. Given the 

claims of a shortage of nephrologists 

and the new face-to-face visit 

requirements for physicians managing 

patients on dialysis, the requestors 

believe that permitting the management 

of dialysis patients through telehealth 

services is crucial. 

CMS Review 

The MCP G codes represent a range of 

services provided during a month, 

including a complete assessment of the 

patient and subsequent visits to monitor 

the patient’s condition. We believe the 

types of services provided as part of the 

subsequent visits included in the codes 

are similar to the office and other 

outpatient visits currently on the list of 

Medicare telehealth services. Therefore, 

we believe these services would meet 

the criteria set forth in Category 1 of the 

process for adding services described 

above. However, we do not believe the 

complete assessment aspect of the MCP 

G codes is similar to existing telehealth 

services. For example, one aspect of a 

complete assessment would involve 

examination of the vascular access site. 

This is a specific clinical examination 

that is not similar to other services on 

the list. 

Therefore, we consider the request for 

addition of the complete assessment to 

the list of telehealth services to be a 

Category 2 request, requiring 

comparative analyses. In submitting 

their requests for addition to the list of 

Medicare telehealth services, the 

requestors included summaries of many 

studies related to renal dialysis patient 

monitoring. However, we do not believe 

the requestor provided comparative 

analyses illustrating that the use of a 

telecommunications system is an 

adequate substitute for the clinical 

examination of the vascular access site. 

We do not believe that the use of a 

telecommunications system is an 

adequate method for conducting a 

complete assessment of the ESRD 

beneficiary. We believe that a clinical 

examination of the vascular access site 

can be adequately performed only with 

a face-to-face, ‘‘hands on’’ examination 

of the patient. 

However, we do believe the 

subsequent visits meet the criteria for 

approving a Category 1 request. That is, 

we believe the roles and interactions 

between the patient and the physician 

(or practitioner) are similar to those of 

office and other outpatient visits 

currently on the telehealth list. This 

presents a unique scenario, wherein a 

portion of the services represented by 

the MCP G codes are eligible to add to 

the list, but one service (the complete 

assessment) is not. To address this 

issue, we propose to add the ESRDrelated services with 2 or 3 visits per 

month and ESRD-related services with 4 

or more visits per month as described by 

G0308, G0309, G0311, G0312, G0314, 

G0315, G0317, G0318 to the list of 

Medicare telehealth services. However, 

the complete assessment of the ESRD 

47512 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

beneficiary would not be permitted 

through the use of a 

telecommunications system. A 

comprehensive visit including a clinical 

examination of the vascular access site 

must be furnished face-to-face ‘‘hands 

on’’ by a physician, clinical nurse 

specialist, nurse practitioner, or 

physician’s assistant. An interactive 

telecommunications system may be 

used for providing additional visits 

required under the 2-to-3 visit MCP and 

the 4-or-more visit MCP. 

As noted previously, the MCP G codes 

are unique in that they reflect the 

ongoing care provided to ESRD patients 

by the physician or practitioner, on a 

monthly basis. These codes also reflect 

a range of services, from a monthly 

comprehensive assessment to 

monitoring the patient’s overall 

condition and addressing individual 

issues and concerns as they arise during 

the month. We believe these codes are 

distinguishable from other codes by the 

scope of services and the ongoing nature 

of the services provided. Therefore, we 

believe that it would be appropriate to 

permit the use of a telecommunications 

system for providing some of the visits 

required under the ESRD MCP and to 

add these codes to the list of Medicare 

telehealth services. 

The MCP physician, for example, the 

physician or practitioner who provided 

the complete assessment, and other 

practitioners within the same group 

practice or employed by the same 

employer/entity, may furnish ESRDrelated visits through a 

telecommunications system. However, 

the physician or practitioner who 

performs the complete assessment and 

establishes the plan of care should bill 

for the MCP in any given month. 

Clinical Criteria—The complete 

assessment visit must be conducted 

face-to-face. For subsequent visits, the 

physician or practitioner at the distant 

site is required, at a minimum, to use an 

interactive audio and video 

telecommunications system that allows 

the physician or practitioner to provide 

medical management services for a 

maintenance dialysis beneficiary. For 

example, an ESRD visit conducted via 

telecommunications system must permit 

the physician or practitioner at the 

distant site to perform an assessment of 

whether the dialysis is working 

effectively and whether the patient is 

tolerating the procedure well 

(physiologically and psychologically). 

During this assessment, the physician or 

practitioner at the distant site must be 

able to determine whether alteration in 

any aspect of the beneficiary’s 

prescription is indicated, due to such 

changes as the estimate of the patient’s 

dry weight. 

Clarification on originating sites—The 

statute currently defines a telehealth 

originating site as a physician’s or 

practitioner’s office, hospital, critical 

access hospital, rural health clinic, or 

Federally-qualified health center. ESRD 

facilities are not originating sites 

(dialysis facilities are not defined in the 

statute as originating sites). Subsequent 

visits (other than the comprehensive 

assessment) in any of the statutorilycovered settings could be provided via 

telecommunications equipment, 

including a physician’s satellite office 

within a dialysis center. Adding dialysis 

facilities to the list of Medicare 

telehealth originating sites would 

require a legislative change. 

Speech and Audiologist Services

The American Speech-Language 

Hearing Association (ASHA) requested 

that we add 36 audiology services (CPT 

code range 92541 through 92596) and 30 

speech language pathology (SLP) 

services (CPT code range 31575 through 

97703) to the list of Medicare telehealth 

services. The ASHA believes the 

cognitive nature of these services makes 

them well-suited for telehealth and 

noted several telehealth programs that 

have been successful at providing SLP 

and audiology services. For example, 

existing telehealth networks were cited 

as successfully providing diagnosis, 

treatment, and management 

recommendations for patients with 

speech language and hearing disorders. 

CMS Review 

Speech language pathologists and 

audiologists are not permitted under 

current law to provide and receive 

payment for Medicare telehealth 

services at the distant site. The statute 

permits only a physician, as defined by 

section 1861(r) of the Act or a 

practitioner as described in section 

1842(b)(18)(C) of the Act (clinical nurse 

specialist, nurse practitioner, physician 

assistant, nurse midwife, clinical 

psychologist, and clinical social 

worker), to furnish Medicare telehealth 

services. We are exploring this issue as 

part of a report to Congress (required by 

section 223(d) of BIPA) on additional 

sites and settings, geographic areas, and 

practitioners that may be reimbursed for 

the provision of telehealth services. At 

this time, we are not adding speech and 

audiology services to the list of 

Medicare telehealth services. 

Case Management and Care Plan 

Oversight (Team Conferences and 

Physician Supervision) 

Two requests were submitted asking 

that we add medical team conferences 

as identified by CPT codes 99361 and 

99362 and physician supervision (CPT 

codes 99374 and 99375) as telehealth 

services. Requestors stated that for these 

services, the use of a 

telecommunications system provides 

interdisciplinary medical teams serving 

remote underserved populations better 

access to the clinical expertise and 

decision making of specialty physicians. 

The requestors note that the current list 

of Medicare telehealth services, for 

example, consultations or office visits, 

cannot be used for case management 

and care plan oversight services because 

the patient is not typically present. 

CMS Review 

Medical team conferences and 

monthly physician supervision are 

already covered Medicare services and 

do not require a face-to-face encounter 

with the beneficiary. Under the 

Medicare program, the use of a 

telecommunications system in 

furnishing a telehealth service is a 

substitution for the face-to-face 

requirements of a service. Since medical 

team conferences and monthly 

physician supervision do not require a 

face-to-face encounter with the patient, 

we cannot add these services to the list 

of Medicare telehealth services. 

Review Summary 

For the reasons stated above, we 

propose to add ESRD-related services as 

described by G0308, G0309, G0311, 

G0312, G0314, G0315, G0317 and G0318 

to the list of Medicare telehealth 

services. 

Moreover, we would add the term 

‘‘ESRD-related visits’’ to the definition 

of Medicare telehealth services at CFR 

410.78 and 414.65 as appropriate. 

We do not propose to add any 

additional services discussed above to 

the list of Medicare telehealth services 

for CY 2005.

3. National Pricing of G0238 and G0239 

Respiratory Therapy Service Codes 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CODING—RESPIRATORY THERAPY’’

at the beginning of your comments.] 

In the 2001 final rule, we created 

three G codes for respiratory therapy 

services: G0237 Therapeutic 

procedures to increase strength or 

endurance of respiratory muscles, faceto-face, one-on-one, each 15 minutes 

(includes monitoring), G0238 

Therapeutic procedures to improve 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47513

respiratory function, other than ones 

described by G0237, one-on-one, faceto-face, per 15 minutes (includes 

monitoring) and G0239 Therapeutic 

procedures to improve respiratory 

function or increase strength or 

endurance of respiratory muscles, two 

or more individuals (includes 

monitoring).

We assigned RVUs to one of the codes 

(G0237), and indicated that the other 

two codes (G0238 and G0239) would be 

carrier-priced. Since the services 

represented by these codes are 

frequently being performed in 

comprehensive outpatient rehabilitation 

facilities, and paid under the physician 

fee schedule through fiscal 

intermediaries, there has been some 

uncertainty surrounding the payment 

for the carrier-priced services. We 

believe assigning RVUs to G0238 and 

G0239 would alleviate some of this 

uncertainty. Since these services are 

typically performed by respiratory 

therapists, no physician work was 

assigned to G0237, and we are not 

proposing work RVUs for either G0238 

or G0239. 

Therefore, we are proposing to value 

these services using the nonphysician 

workpool. 

We propose practice expense RVUS 

for G0238 equal to those for G0237. 

While these codes represent two 

different types of activities (G0237 

involves therapeutic procedures 

specifically targeted at improving the 

strength and endurance of respiratory 

muscles such as pursed-lip breathing, 

diaphragmatic breathing, and paced 

breathing, and G0238 involves other 

activities such as teaching patients 

strategies for performing tasks with less 

respiratory effort and the performance of 

graded activity programs to increase 

endurance and strength of upper and 

lower extremities), we believe that the 

practice expense involved is 

substantially the same for both services 

and thus, propose to crosswalk the 

practice expense RVUs for G0237 to 

G0238. 

G0239 represents situations in which 

two or more individuals are receiving 

services simultaneously (such as those 

described above in G0237 or G0238) 

during the same time period. Although 

the practitioner must be in constant 

attendance, he or she need not be 

providing one-on-one patient contact. 

For G0239, we believe a typical group 

session to be 30 minutes in length and 

to consist of 3 patients. Therefore, for 

the practice expense RVUs for G0239, 

we will use the practice expense RVUs 

of G0237 reduced by one-third to 

account for the fact that the service is 

being provided to more than one patient 

simultaneously and each patient in a 

group can be billed for the services of 

G0239. 

We also propose a malpractice RVU of 

0.02, the malpractice RVU assigned to 

G0237, for these two G codes. 

4. Bone Marrow Aspiration and Biopsy 

Through the Same Incision on the Same 

Date of Service 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CODING—BONE MARROW 

ASPIRATION’’ at the beginning of your 

comments.] 

In the physician fee schedule final 

rule published on June 28, 2002 (67 FR 

43864), we proposed creation of a new 

G-code that reflects a bone marrow 

biopsy and aspiration procedure 

performed on the same date, at the same 

encounter, through the same incision. 

While some commenters were 

supportive of this proposal, other 

commenters felt that creation of a Gcode was unnecessary and that any 

concerns with respect to payment could 

be addressed through application of the 

multiple procedure payment rules. In a 

final rule published on December 31, 

2002 (67 FR 79992), we agreed that the 

code should go through the CPT process 

and did not make our proposal final. 

To date, CPT has not addressed the 

issue. Therefore, we are proposing to 

create a G-code for this service in 2005. 

We believe that there is minimal 

incremental work associated with 

performing the second procedure 

through the same incision during a 

single encounter and are proposing an 

add-on G-code to reflect the additional 

physician work and practice expense. 

As we had stated in our previous 

proposal, if the two procedures, 

aspiration and biopsy, are performed at 

different sites (for example, contralateral 

iliac crests, sternum/iliac crest or two 

separate incisions on the same iliac 

crest), the –59 modifier, which denotes 

a distinct procedural service, would be 

appropriate to use and Medicare’s 

multiple procedure rules would apply. 

In this instance, the CPT codes for 

aspiration and biopsy would each be 

used.

G0XX1: Bone Marrow Aspiration 

Performed With Bone Marrow Biopsy 

Through Same Incision on Same Date 

of Service, Add-On 

The code would be used when a bone 

marrow aspiration and a bone marrow 

biopsy are performed on the same day 

through a single incision. The physician 

would use the CPT code for bone 

marrow biopsy (38221) and G0XX1 for 

the second procedure (bone marrow 

aspiration). 

Based on our estimation that the time 

associated with this G-code is 

approximately 5 minutes and based on 

a comparison to CPT code 38220 which 

has 34 minutes of intraservice time and 

a work RVU of 1.08 work, we are 

proposing 0.16 work RVUs for this 

proposed G-code. The proposed 

malpractice RVUs are 0.04 which are 

the current malpractice RVUS assigned 

to CPT code 38220. We are proposing 

the following practice expense inputs:

—Clinical staff time: Registered nurse—

5 minutes 

Lab technician—2 minutes 

—Equipment: Exam table

We are also proposing a ZZZ global 

period for this add-on code since this 

code is related to another service and is 

included in the global period of the 

other service. 

5. Q Code for the Set-Up of Portable XRay Equipment 

The Q-code for the set-up of portable 

x-ray equipment, Q0092, is currently 

paid under the physician fee schedule 

and is assigned an RVU of 0.33. In 2004, 

this produces a national payment of 

$12.32. This set-up code encompasses 

only a portion of the resources required 

to provide a portable x-ray service to 

patients. In 2003, portable x-ray 

suppliers received total Medicare 

payments of approximately $208 

million. More than half of these 

payments (approximately $116 million) 

were for portable x-ray transportation 

(codes R0070 and R0075). The portable 

x-ray set-up code (Q0092) generated 

approximately $19 million in payments. 

The remainder of the Medicare 

payments for portable x-ray services 

(approximately $73 million) were for 

the actual x-ray services themselves. 

Between 2002 and 2004, the Medicare 

carriers increased the average amount 

paid for portable x-ray transportation 

across the country from about $89 to 

$112, an increase of about 25 percent 

(transportation is carrier-priced). 

Nonetheless, the Conference Report 

accompanying the Consolidated 

Appropriations Bill, HR 2673 (Pub. L. 

108–199, enacted January 23, 2004), 

urged the Secretary to review and 

update the RVUs for Q0092 utilizing 

existing data. 

In 2002, the National Association of 

Portable X-ray Providers had requested 

that we use their cost data to develop 

practice expense RVUs for the physician 

fee schedule services they provide. We 

asked the Lewin Group to evaluate the 

data using the same standards of review 

applied to other specialty survey data. 

The Lewin Group found that the data as 

presented were not adequately detailed 

47514 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

to calculate a practice expense per hour 

based on the current practice expense 

methodology. Therefore, we did not use 

the data. However, in response to 

ongoing requests from the portable x-ray 

industry that we reexamine payments 

for this code, we have reevaluated this 

code. 

This code is currently priced in the 

nonphysician work pool. Removing this 

code from the nonphysician work pool 

has an overall negative impact on 

payments to portable x-ray suppliers (as 

a result of decreases to radiology codes 

that remain in the nonphysician work 

pool) and has a negative impact on 

many of the codes remaining in the 

nonphysician workpool. An alternative 

to national pricing of portable x-ray setup would be to require Medicare 

carriers to develop local pricing as they 

do currently for portable x-ray 

transportation. In 2002, we received a 

comment from a supplier of portable xrays stating that the practice costs 

associated with set-up of portable x-ray 

equipment are not included in the 

Socioeconomic Monitoring System 

(SMS) and that there are sufficient 

differences among geographic regions in 

the performance of this procedure that 

warrant reclassifying this service as 

carrier-priced. We are interested in 

public comments on whether we should 

pursue national pricing for portable xray set-up outside of the nonphysician 

work pool or local carrier pricing for 

2005 or whether we should continue to 

price the service in the nonphysician 

workpool. 

6. Venous Mapping for Hemodialysis 

We are proposing to create a new Gcode (G0XX3: Venous mapping for 

hemodialysis access placement (Service 

to be performed by operating surgeon 

for preoperative venous mapping prior 

to creation of a hemodialysis access 

conduit using an autogenous graft). 

Autogenous grafts have longer patency 

rates, a lower incidence of infection and 

greater durability than prosthetic grafts. 

Use of autogenous grafts can also result 

in a decrease in hospitalizations and 

morbidity related to vascular access 

complications. Creation of this G-code 

will enable us to distinguish between 

CPT code 93971 (Duplex scan of 

extremity veins including responses to 

compression and other maneuvers; 

unilateral or limited study) and G0XX3. 

This new code will allow us to track use 

of venous mapping for quality 

improvement purposes. 

This G code would only be billed by 

the operating surgeon in conjunction 

with the following CPT codes: 36819, 

36821, 36825, and 36832. Because CPT 

code 93971 and the new G-code would 

be used to describe a similar service, we 

would propose that we not permit 

payment for CPT code 93971 when this 

G-code is billed, unless code 93971 

were being performed for a separately 

identifiable clinical indication in a 

different anatomic region. 

The physician work, practice expense 

and professional liability expense for 

this new G code would be the same as 

those for CPT code 93971. Thus, we 

propose to crosswalk the RVUs for the 

new G-code from those of CPT code 

93971. We would also assign this new 

G-code a global period of ‘‘XXX’’, which 

means that the global concept does not 

apply. 

III. Provisions of the Medicare 

Modernization Act of 2003

A. Section 611—Initial Preventive 

Physical Examination 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 611’’ at the beginning of your 

comments.]

1. Coverage of Initial Preventive 

Physical Examinations 

Section 611 of the MMA provides for 

coverage under Part B of an initial 

preventive physical examination for 

new beneficiaries, effective for services 

furnished on or after January 1, 2005, 

subject to certain eligibility and other 

limitations. 

Previously, Medicare law had not 

allowed for payment for routine 

physical examinations or checkups. 

Section 1862(a)(7) of the Act states that 

routine physical checkups are excluded 

services. This exclusion is described in 

§ 411.15(a) (Particular services excluded 

from coverage). In addition, we have 

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

Act to exclude coverage for preventive 

physical examinations. This section 

provides that items and services must be 

reasonable and necessary for the 

diagnosis or treatment of illness or 

injury or to improve the functioning of 

a malformed body member as stated in 

§ 411.15(k). Since preventive services 

are not provided for diagnosis or 

treatment of illness, injury, or 

malformation, we determined that these 

services are not reasonable and 

necessary within the meaning of the 

statute. 

To conform the regulations to the 

MMA, we are specifying an exception to 

the list of examples of routine physical 

examinations excluded from coverage in 

§ 411.15(a)(1) and § 411.15(k)(11) for 

initial preventive physical examinations 

that meet the eligibility limitation and 

the conditions for coverage that we are 

specifying under § 410.16—Initial 

Preventive Physical Examinations. 

Coverage of initial preventive 

physical examinations is provided 

under Medicare Part B only. The MMA 

permits payment for one initial 

preventive physical examination within 

the first 6 months after the effective date 

of the beneficiary’s first Part B coverage 

period, but only if that coverage period 

begins on or after January 1, 2005. 

We are proposing to add § 410.16(b), 

Condition for Coverage of Initial 

Preventive Physical Examinations, and 

§ 410.16(c), Limitation on Coverage of 

Initial Preventive Physical 

Examinations, to provide for coverage of 

the various initial preventive physical 

examination services specified in the 

statute. 

We are proposing to define several 

terms, as described specifically in 

§ 410.16, that would be used in 

implementing the statutory provisions, 

including definitions of the following 

terms—

(1) Eligible beneficiary; 

(2) An initial preventive physical 

examination; 

(3) Medical history; 

(4) Physician; 

(5) Qualified nonphysician 

practitioner. 

(6) Social history; 

(7) Review of the individual’s 

functional ability and level of safety; 

Section 611 of the MMA defines an 

‘‘initial preventive physical 

examination’’ to mean physicians’ and 

certain qualified nonphysician 

practitioners’ services consisting of—

(1) A physical examination (including 

measurement of height, weight, blood 

pressure, and an electrocardiogram, but 

excluding clinical laboratory tests) with 

the goal of health promotion and disease 

detection; and 

(2) Education, counseling, and referral 

with respect to screening and other 

covered preventive benefits separately 

authorized under Medicare Part B. 

Specifically, section 611(b) of the 

MMA provides that the education, 

counseling, and referral of the 

individual by the physician or other 

qualified nonphysician practitioner 

should be with respect to the following 

statutory screening and other preventive 

services authorized under Medicare Part 

B: 

(1) Pneumococcal, influenza, and 

hepatitis B vaccine and their 

administration. 

(2) Screening mammography. 

(3) Screening pap smear and 

screening pelvic exam services. 

(4) Prostate cancer screening services. 

(5) Colorectal cancer screening tests. 

(6) Diabetes outpatient selfmanagement training services; 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47515

(7) Bone mass measurements. 

(8) Screening for glaucoma. 

(9) Medical nutrition therapy services 

for individuals with diabetes or renal 

disease. 

(10) Cardiovascular screening blood 

tests. 

(11) Diabetes screening tests. 

Based on the language of the statute, 

our review of the medical literature, 

current clinical practice guidelines, and 

United States Preventive Services Task 

Force recommendations, we are 

proposing to interpret the term, ‘‘initial 

preventive physical examination,’’ for 

purposes of this new benefit to include 

all of the following: 

(1) Review of the individual’s 

comprehensive medical and social 

history, as those terms are defined in 

paragraph (a) of proposed § 410.16. 

(2) Review of the individual’s 

potential (risk factors) for depression 

(including past experiences with 

depression or other mood disorders) 

based on the use of an appropriate 

screening instrument which the 

physician or other qualified 

nonphysician practitioner may select 

from various available standardized 

screening tests for this purpose, unless 

the appropriate screening instrument is 

defined through the national coverage 

determination (NCD) process. 

(3) Review of the individual’s 

functional ability and level of safety, as 

described in paragraph (a) of proposed 

§ 410.16, (that is, at a minimum, a 

review of the following areas: hearing 

impairment, activities of daily living, 

falls risk, and home safety), based on the 

use of an appropriate screening 

instrument, which the physician or 

other qualified nonphysician 

practitioner may select from various 

available standardized screening tests 

for this purpose, unless the appropriate 

screening instrument is further defined 

through the NCD process. 

(4) An examination to include 

measurement of the individual’s height, 

weight, blood pressure, a visual acuity 

screen, and other factors as deemed 

appropriate by the physician or 

qualified nonphysician practitioner, 

based on the individual’s 

comprehensive medical and social 

history and current clinical standards. 

(5) Performance and interpretation of 

an electrocardiogram. 

(6) Education, counseling, and 

referral, as appropriate, based on the 

results of the previous five elements of 

the initial preventive physical 

examination. 

(7) Education, counseling, and 

referral, including a written plan 

provided to the individual for obtaining 

the appropriate screening and other 

preventive services, which are 

separately covered under Medicare Part 

B benefits; that is, pneumococcal, 

influenza, and hepatitis B vaccines and 

their administration, screening 

mammography, screening pap smear 

and screening pelvic exams, prostate 

cancer screening tests, diabetes 

outpatient self-management training 

services, bone mass measurements, 

screening for glaucoma, medical 

nutrition therapy services, 

cardiovascular screening blood tests, 

and diabetes screening tests. 

We are requesting public comments 

on the definition of the term ‘‘initial 

preventive physical examination.’’ For 

example, we have chosen not to define 

the term, ‘‘appropriate screening 

instrument,’’ for screening individuals 

for depression, functional ability, and 

level of safety, as specified in the 

proposed rule, because we anticipate 

that the examining physician or 

qualified nonphysician practitioner will 

want to use the test of his or her choice, 

based on current clinical practice 

guidelines. We believe that any 

standardized screening test for 

depression, functional ability, and level 

of safety recognized by the American 

Academy of Family Physicians, the 

American College of PhysiciansAmerican Society of Internal Medicine, 

the American College of Preventive 

Medicine, the American Geriatrics 

Society, the American Psychiatric 

Association, or the United States 

Preventive Services Task Force, or other 

recognized medical professional group, 

would be acceptable for purposes of 

meeting the ‘‘appropriate screening 

instrument’’ provision. We ask that 

commenters making specific 

recommendations on this or any related 

issue provide documentation from the 

medical literature, current clinical 

practice guidelines, or the United States 

Preventive Services Task Force 

recommendations.

We recognize that the NCD process 

could be used to define more 

specifically the type or types of 

appropriate screening instruments for 

depression, functional ability, or level of 

safety and propose to include in 

§ 410.16(a) in elements (2) and (3) of the 

definition of an initial preventive 

physical examination a reference that 

would allow us to define these 

screening instruments more specifically 

through the national coverage 

determination (‘‘NCD’’) process. The 

NCD process would include an 

opportunity for public comment on the 

medical and scientific issues related to 

the coverage of the new tests that may 

be brought to our attention in the future. 

Use of an NCD to establish a change in 

the scope of benefits is authorized by 

section 1871(a)(2) of the Act. 

2. Payment for Initial Preventive 

Physical Examination 

There is no current CPT code that 

contains the specific elements included 

in the initial preventive examination. 

Therefore, we are proposing to establish 

the following new HCPCS code, G0XX2, 

Initial preventive physical examination,

to be used for billing for the initial 

preventive examination. As required by 

the statute, this code includes an 

electrocardiogram, but does not include 

the other previously mentioned 

preventive services that are currently 

separately covered and paid under the 

Medicare Part B screening benefits. 

When these other preventive services 

are performed, they should be identified 

using the existing appropriate codes. 

a. Basis for Payment 

Payment for this new HCPCS code 

will be based on the following: 

1. Work RVUs—We are proposing a 

work value of 1.51 RVUs for G0XX2. 

This value is based on our 

determination that this new service has 

equivalent resources and work intensity 

to those contained in CPT E/M code 

99203, new patient, office or other 

outpatient visit, and CPT code 93000 

electrocardiogram, complete. CPT code 

99203 has a work RVU of 1.34 and 

requires a detailed history, detailed 

examination, and medical decision 

making of low complexity, which we 

believe to be representative of the 

elements contained in the initial 

preventive health examination. CPT 

code 93000, which is for a routine ECG 

with the interpretation and report, has 

a work RVU of 0.17. 

2. Malpractice RVUs—For the 

malpractice component of G0XX2, we 

are proposing malpractice RVUs of 0.13 

in the nonfacility setting based on the 

malpractice RVUs currently assigned to 

CPT code 99203 (0.10) and CPT code 

93000 (0.03). In the facility setting, we 

are proposing malpractice RVUs of 0.11 

based on the current malpractice RVUs 

assigned to CPT code 99203 (0.10) and 

93010 (an EKG interpretation with a 

value of 0.01). 

3. Practice Expense RVUs—For the 

practice expense component of G0XX2, 

we are proposing practice expense 

RVUs of 1.65 in the nonfacility setting 

based on the practice RVUs assigned to 

CPT code 99203 (1.14) and CPT code 

93000 (0.51). In the facility setting, we 

are proposing practice expense RVUs of 

0.54 based on the practice RVUs 

assigned to CPT code 99203 (0.48) and 

93010 (0.06). 

47516 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

b. Evaluation and Management (E/M) 

Service 

Since some of the components for a 

medically necessary E/M visit are 

reflected in this new HCPCS code, we 

are also proposing, when it is 

appropriate, to allow a medically 

necessary E/M service no greater than a 

level 2 to be reported at the same visit 

as the initial preventive physical 

examination. That portion of the visit 

must be medically necessary to treat the 

patient’s illness or injury or to improve 

the function of a malformed body 

member and should be reported with 

modifier –25. The physician or qualified 

nonphysician practitioner could also 

bill for the screening and other 

preventive services currently covered 

and paid by Medicare Part B under 

separate provisions of section 1861 of 

the Act, if provided during this initial 

preventive physical examination. 

c. Coinsurance and Part B Deductible 

MMA did not make any provision for 

the waiver of the Medicare coinsurance 

and Part B deductible for the initial 

preventive physical examination. 

Payment for this service would be 

applied to the required deductible, 

which is $110 for CY 2005, if the 

deductible has not been met, and the 

usual coinsurance provisions would 

apply. 

B. Section 613—Diabetes Screening 

Tests 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 613’’ at the beginning of your 

comments.] 

Section 613 of the MMA adds section 

1861(yy) to the Act and mandates 

coverage of diabetes screening tests. 

The term ‘‘diabetes screening tests’’ is 

defined in section 613 as testing 

furnished to an individual at risk for 

diabetes including a fasting plasma 

glucose test and such other tests, and 

modifications to tests, as the Secretary 

determines appropriate, in consultation 

with appropriate organizations. In 

compliance with this directive, we 

consulted with the American Diabetes 

Association, the American Association 

of Clinical Endocrinologists, and the 

National Institute for Diabetes and 

Digestive and Kidney Diseases.

1. Coverage 

We are proposing in § 410.18 that 

Medicare cover—

• A fasting plasma glucose test; and 

• Post-glucose challenge tests; either 

an oral glucose tolerance test with a 

glucose challenge of 75 grams of glucose 

for nonpregnant adults, or a 2-hour postglucose challenge test alone. 

We would not include a random 

serum or plasma glucose for persons 

with symptoms of uncontrolled diabetes 

such as excessive thirst or frequent 

urination in this benefit because it is 

already covered as a diagnostic service. 

This language is not intended to exclude 

other post-glucose challenge tests that 

may be developed in the future, 

including panels that may be created to 

include new diabetes and lipid 

screening tests. We also would include 

language that would allow Medicare to 

cover other diabetes screening tests, 

subject to a NCD process. We are 

requesting comments regarding the 

specific tests, definitions, and eligibility 

criteria. The comments that we receive 

will also be used to create the list of 

billing codes for covered tests and 

diagnosis codes that would be 

published in instructions for Medicare 

contractors. 

The statutory provision describes an 

‘‘individual at risk for diabetes’’ as 

having any of the following risk factors: 

1. Hypertension. 

2. Dyslipidemia. 

3. Obesity, defined as a body mass 

index greater than or equal to 30 kg/m2. 

4. Previous identification of an 

elevated impaired fasting glucose. 

5. Previous identification of impaired 

glucose tolerance. 

6. A risk factor consisting of at least 

two of the following characteristics: 

(a) Overweight, defined as a body 

mass index greater than 25 kg/m2, but 

less than 30. 

(b) A family history of diabetes. 

(c) A history of gestational diabetes 

mellitus or delivery of a baby weighing 

greater than 9 pounds. 

(d) 65 years of age or older. 

The statutory language directs the 

Secretary to establish standards 

regarding the frequency of diabetes 

screening tests that will be covered and 

limits the frequency to no more than 

twice within the 12-month period 

following the date of the most recent 

diabetes screening test of that 

individual. 

We are proposing that Medicare 

beneficiaries diagnosed with ‘‘prediabetes’’ be eligible for the maximum 

frequency allowed by the statute, that is, 

2 screening tests per 12 month period. 

We propose to define ‘‘pre-diabetes’’ as 

a previous fasting glucose level of 100–

125 mg/dL, or a 2-hour post-glucose 

challenge of 140–199 mg/dL. This 

definition of ‘‘pre-diabetes’’ was 

developed with the assistance of the 

American Association of Clinical 

Endocrinologists and complements the 

definition of diabetes that we published 

November 7, 2003 (68 FR 63195). We 

are specifically asking for comments 

regarding our new definition of ‘‘prediabetes.’’ We are also requesting 

suggestions for the definition of ‘‘a 

family history of diabetes.’’

For individuals not meeting the ‘‘prediabetes’’ criteria, we are proposing that 

one diabetes screening test be covered 

per individual per year. 

2. Payment 

We are proposing to pay for the 

screening diabetes tests at the same 

amounts paid for these tests when 

performed to diagnose an individual 

with signs and symptoms of diabetes. 

We would pay for these tests under the 

clinical laboratory fee schedule. We 

propose to pay for these tests under CPT 

code 82947 Glucose; quantitative, blood 

(except reagent strip) and CPT code 

82951 Glucose; tolerance test (GTT), 

three specimens (includes glucose). To 

indicate that the purpose of the test is 

for diabetes screening, we would require 

that the laboratory include a screening 

diagnosis code in the diagnosis section 

of the claim. We propose V77.1 Special 

screening for diabetes mellitus as the 

applicable ICD–9—CM code for this 

purpose. Because laboratories are 

required and accustomed to submitting 

diagnosis codes when requesting 

payment for testing, we believe 

including a screening diagnosis code is 

appropriate for this benefit. 

C. Section 612—Cardiovascular 

Screening Blood Tests 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 612’’ at the beginning of your 

comments.] 

Section 612 of the MMA provides for 

Medicare coverage of cardiovascular 

screening blood tests for the early 

detection of cardiovascular disease or 

abnormalities associated with an 

elevated risk for that disease effective on 

or after January 1, 2005. 

1. Coverage 

The Act requires coverage of tests for 

cholesterol and other lipid or 

trigylcerides levels for this purpose. It 

also authorizes the Secretary to approve 

coverage of other screening tests for 

other indications associated with 

cardiovascular disease or an elevated 

risk for that disease, including 

indications measured by noninvasive 

testing, if the United States Preventive 

Services Task Force (USPSTF) 

recommended a blood test for that 

indication. 

We invited comments about the types 

of tests from the American College of 

Physicians/ American Society of 

Internal Medicine, the American College 

of Cardiology, American Academy of 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47517 

Family Physicians, American Heart 

Association, College of American 

Pathologists, American Society for 

Clinical Laboratory Science, American 

Society for Clinical Pathologists, 

American Association for Clinical 

Chemistry, and the American Clinical 

Laboratory Association. Comments were 

received from the American Heart 

Association, American Academy of 

Family Physicians, the American 

Association for Clinical Chemistry, 

American Society for Clinical 

Laboratory Science, the National Kidney 

Foundation, and the Vascular Disease 

Foundation, regarding the coverage of a 

number of cardiovascular screening 

tests in addition to the required blood 

lipid tests; for example, high sensitivity 

C-Reactive Protein (CRP), homocysteine, 

or Beta Naturetic Protein (BNP), 

electrocardiograms, Doppler and 

noninvasive vascular tests, and a skin 

reflectance test. 

We also reviewed the following 2001 

recommendations of the USPSTF 

regarding screening for lipid disorders 

that are associated with cardiovascular 

disease: 

a. Clinicians should routinely screen 

men aged 35 years and older and 

women aged 45 years and older for lipid 

disorders and treat abnormal lipids in 

people who are at increased risk. 

b. Clinicians should routinely screen 

younger adults (men aged 20 to 35 and 

women aged 20 to 45) for lipid disorders 

if they have other risk factors for 

coronary heart disease. 

c. No recommendation was made for 

or against routine screening for lipid 

disorders in younger adults (men aged 

20 to 35 or women aged 20 to 45) in the 

absence of known risk factors for 

coronary heart disease. 

d. Screening for lipid disorders 

should include measurement of total 

cholesterol (TC) and high-density 

lipoprotein cholesterol (HDL–C). 

e. Evidence is insufficient to 

recommend for or against trigylcerides 

measurement as a part of routine 

screening for lipid disorders. 

Based on the statutory language and 

our review of the scientific literature, 

expert opinion, and the USPSTF 

recommendations, we are proposing 

coverage of the following three 

screening blood tests for conditions 

associated with cardiovascular disease: 

(1) A total cholesterol test. 

(2) A cholesterol test for high density 

lipoproteins. 

(3) A triglycerides test. 

These tests should be performed as 

part of a panel and should be done after 

a 12-hour fast. We are also proposing 

coverage of each of these tests once 

every 5 years. The statute provides that 

the Secretary shall establish frequency 

standards for the coverage of 

cardiovascular screening blood tests, 

provided the frequency is no more often 

than once every 2 years. However, the 

scientific literature shows that 

cholesterol levels are fairly stable and 

do not fluctuate drastically for those 

older than age 65. The USPSTF clinical 

considerations indicate that, while 

screening may be appropriate in older 

people, repeated screening is less 

important because lipid levels are less 

likely to increase after age 65. Under the 

USPSTF recommendations, routine 

measurement of total cholesterol and 

HDL cholesterol every 5 years is 

recommended by the National 

Cholesterol Education program Adult 

Treatment Panel II (ATP II), sponsored 

by the National Institutes of Health, and 

endorsed by the American Heart 

Association. In addition, the most recent 

Report of the Adult Treatment Panel 

(ATP III) includes similar 

recommendations. In all adults aged 20 

years or older, a fasting lipoprotein 

profile (total cholesterol, LDL 

cholesterol, high density lipoprotein 

(HDL) cholesterol, and triglyceride) 

should be obtained once every 5 years. 

Since the LDL cholesterol can be 

calculated, the remaining tests, which 

are part of the lipid panel, are the tests 

we are proposing for coverage under 

this new benefit at a 5-year screening 

interval. We do not believe the evidence 

justifies or the statute allows for 

coverage of other cardiovascular 

screening blood tests at this time. 

To facilitate our consideration of 

future coverage of other new types of 

cardiovascular screening blood tests, we 

have decided to add a provision to this 

proposed regulation that, in addition to 

the specific cardiovascular screening 

blood tests proposed for coverage in this 

proposed rule, would provide that other 

types of these tests may be covered 

under this new screening benefit, if we 

determine that this is appropriate 

through a National Coverage 

Determination (NCD). This provision 

would allow us to conduct a more 

timely assessment of other new types of 

cardiovascular screening blood tests that 

may have been approved for marketing 

by the Food and Drug Administration 

and recommended by the USPSTF than 

is possible under the standard 

rulemaking process. We intend to use 

the NCD process, which includes an 

opportunity for public comments, for 

evaluating the medical and scientific 

issues relating to the coverage of 

additional tests that may be brought to 

our attention in the future. Use of an 

NCD to establish a change in the scope 

of benefits is authorized by section 

1871(a)(2) of the Act. These proposed 

coverage requirements are set forth in 

new section § 410.17. 

2. Payment 

Section 612 of the MMA provides for 

Medicare coverage of cardiovascular 

screening blood tests for the early 

detection of cardiovascular disease or 

abnormalities associated with an 

elevated risk for cardiovascular disease. 

The coverage is effective on or after 

January 1, 2005. We are proposing to 

pay for the screening cardiovascular 

disease tests at the same amounts paid 

for these tests when they are performed 

to diagnose an individual with signs 

and symptoms of cardiovascular 

disease. Medicare would pay for the 

tests under the clinical laboratory fee 

schedule. We propose to use the 

following CPT codes: 

• 82465 Cholesterol, serum or whole 

blood, total. 

• 83718 Lipoprotein, direct 

measurement; high density cholesterol 

(HDL cholesterol). 

• 84478 Triglycerides. 

• 80061 Lipid Panel. 

To indicate that the purpose of the 

test is for cardiovascular screening, we 

propose that the laboratory include in 

the diagnosis section of the claim the 

diagnosis code that provides the highest 

degree of accuracy and completeness in 

describing the diagnosis. We propose 

that the applicable ICD–9–CM codes for 

cardiovascular screening blood tests be 

selected from the following: 

• V81.0 Special screening for 

ischemic heart disease. 

• V81.1 Special screening for 

Hypertension. 

• V81.2 Special screening for other 

and unspecified cardiovascular 

conditions. 

Because laboratories are required and 

accustomed to submitting diagnosis 

codes when requesting payment for 

testing, we believe including a screening 

diagnosis code for this purpose will not 

be unduly burdensome to them. 

D. Section 413—Physician Scarcity 

Areas and Health Professional Shortage 

Areas Incentive Payments 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 413’’ at the beginning of your 

comments.] 

1. Background 

Section 4043 of the Omnibus Budget 

Reconciliation Act (OBRA) of 1987 

added section 1833(m) to the Act to 

provide incentive payments to 

physicians who furnish services to 

47518 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

Medicare beneficiaries in Health 

Professional Shortage Areas (HPSAs). 

Under section 1833(m) of the Act, a 5 

percent payment was added, beginning 

January 1, 1989, to the amounts 

otherwise payable under the physician 

fee schedule to doctors who furnish 

covered services to Medicare patients in 

designated HPSAs. Section 6102 of 

OBRA 1989 further amended section 

1833 of the Act to raise the amount of 

this incentive payment from 5 percent 

to 10 percent for services furnished after 

December 31, 1990. The OBRA 1989 

amendment also increased eligible 

service areas to include both rural and 

urban HPSAs. The Congress established 

the HPSA incentive payments as 

incentives to attract new physicians to 

medically underserved communities 

and to encourage physicians in those 

areas to remain there. 

Eligibility for receiving the 10 percent 

incentive payment is based on whether 

the specific location at which the 

service is furnished is within an area 

that is designated (under section 

332(a)(1)(A) of the Public Health Service 

Act (PHS)) as a HPSA. The Health 

Resources and Services Administration 

of the Department of Health and Human 

Services (HRSA) is responsible for 

designating shortage areas. HRSA 

designates several types of HPSAs. 

Some HPSAs are areas with shortages of 

primary care physicians, dentists, or 

psychiatrists. These shortage 

designations are referred to as 

geographic-based HPSAs. Also, there are 

HPSA designations based on 

underserved populations within an area, 

which are referred to as populationbased HPSAs.

Section 1833(m) of the Act provides 

incentive payments for physicians who 

furnish services in areas designated as 

HPSAs under section 332(a)(1)(A) of the 

PHS Act. These include all three types 

of geographic-based HPSAs (primary 

medical care, dental, and mental 

health). Consequently, physicians, 

including psychiatrists, furnishing 

services in a primary medical care 

HPSA are eligible to receive bonus 

payments. Medicare HPSA bonus 

payments apply to all physicians who 

perform covered services within a 

primary medical care HPSA, regardless 

of specialty. In addition, psychiatrists 

furnishing services in mental health 

HPSAs are eligible to receive incentive 

payments. We do not recognize dental 

HPSAs for the Medicare HPSA payment 

program because Medicare does not 

cover general dental services for its 

beneficiaries. 

Since the inception of the Medicare 

HPSA incentive payment program, 

physicians have been responsible for 

indicating their eligibility for the 

incentive payment on the Medicare 

billing form. To facilitate the 

verification of eligibility, physicians 

have been notified by their Medicare 

carriers when changes (withdrawals, 

revisions, or replacements) occur in 

HPSA designations. Using this 

information from carriers, physicians 

have been required to verify their 

eligibility and correctly code their 

Medicare claims using modifiers (QB for 

rural HPSAs and QU for urban HPSAs) 

to receive incentive payments. 

2. New Legislation 

a. Physician Scarcity Areas 

Section 413(a) of the MMA, provides 

a new 5 percent incentive payment to 

physicians furnishing services in 

physician scarcity areas. The MMA adds 

a new section 1833(u) of the Act which 

provides for paying primary care 

physicians furnishing services in a 

primary care scarcity county and 

specialty physicians furnishing services 

in a specialist care scarcity county, an 

additional amount equal to 5 percent of 

the amount paid for these services. 

Eligible physicians furnishing services 

in an area qualified as a physician 

scarcity area (PSA) and HPSA would be 

entitled to receive both incentive 

payments, that is, a 15 percent bonus 

payment. Eligibility for receiving both 

incentive payments is time limited 

(January 1, 2005 to January 1, 2008) 

because the 5 percent PSA bonus is 

scheduled to sunset on December 31, 

2007.

The Congress created the new 5 

percent incentive payment program to 

make it easier to recruit and retain both 

primary and specialist care physicians 

for furnishing services to Medicare 

beneficiaries in PSAs. 

The two measures of physician 

scarcity are defined by the statute as 

follows: 

1. The primary care scarcity areas are 

determined by the ratio of primary care 

physicians to Medicare beneficiaries. 

2. The specialist care scarcity areas 

are determined by the ratio of specialty 

care physicians to Medicare 

beneficiaries. 

i. Primary Care 

Consistent with section 1833(u) of the 

Act, we would identify eligible primary 

care scarcity counties by ranking each 

county by its ratio of primary care 

physicians to Medicare beneficiaries. 

From the list of primary care scarcity 

counties, only those counties with the 

lowest primary care ratios that represent 

20 percent of the total number of 

Medicare beneficiaries residing in the 

counties will be considered eligible for 

the 5 percent incentive payment. For 

calculating the ratios, section 1833(u)(6) 

of the Act, as added by the MMA, 

defines a primary care physician as a 

general practitioner, family practice 

practitioner, general internist, 

obstetrician, or gynecologist. All other 

physicians will be considered 

specialists for purposes of the 5 percent 

incentive payment. Section 1833(u) of 

the Act, as added by the MMA, 

specifically defines ‘‘physician’’ as one 

described in section 1861(r)(1) of the 

Act. This statutory provision does not 

include dentists, podiatrists, 

optometrists, and chiropractors. 

ii. Specialist Care 

To identify eligible specialist care 

scarcity areas, we would rank each 

county by its ratio of specialty 

physicians to Medicare beneficiaries. 

From the list of specialist care scarcity 

counties, only those counties with the 

lowest ratios that represent 20 percent 

of the total number of Medicare 

beneficiaries residing in the counties 

will be considered eligible for the 5 

percent incentive payment. 

iii. The Goldsmith Modification 

For purposes of counties identified as 

having a shortage of primary care or 

specialty care physicians, section 

1833(u)(5) of the Act also requires that, 

to the extent feasible, we treat a rural 

census tract of a metropolitan statistical 

area (as determined under the most 

recent modification of the Goldsmith 

Modification) as an equivalent area. The 

Goldsmith modification evolved from 

an outreach grant program sponsored by 

the Office of Rural Health Policy of 

HRSA. This program was created to 

establish an operational definition of 

rural populations lacking easy access to 

health services in Large Area 

Metropolitan Counties (LAMCs). Dr. 

Harold F. Goldsmith and his associates 

created a methodology for identifying 

rural census tracts located within a large 

metropolitan county of at least 1,225 

square miles. Using a combination of 

data on population density and 

commuting patterns, census tracts were 

identified as being so isolated by 

distance or physical features that they 

are more rural than urban in character. 

iv. Rural-Urban Commuting Area 

The original Goldsmith Modification 

was developed using data from the 1980 

census. In order to more accurately 

reflect current demographic and 

geographic characteristics of the nation, 

the Office of Rural Health Policy, in 

partnership with the Department of 

Agriculture’s Economic Research 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47519

Service and the University of 

Washington, developed the Rural-Urban 

Commuting Area codes (RUCAs). Rather 

than being limited to LAMCs, RUCAs 

use urbanization, population density, 

and daily commuting data to categorize 

every census tract in the country. 

RUCAs are the updated version of the 

Goldsmith Modification and are used to 

identify rural census tracts in all 

metropolitan counties. 

Once all the full county PSAs are 

determined, we would identify, 

consistent with section 1833(u)(4)(C)of 

the Act, eligible PSAs by their 5-digit 

zip code area for the purpose of 

automatically providing the 5 percent 

incentive payment to eligible 

physicians. The zip code of the place of 

service is the only data element reported 

on the Medicare claim form that would 

allow automation. For zip codes that 

cross county boundaries, the statute 

specifically requires the use of the 

dominant county of the postal zip code 

(as determined by the U.S. Postal 

Service) if the Secretary uses the 5-digit 

postal zip code to identify areas eligible 

to receive the 5 percent payment. The 

statute also requires us to publish a list 

of eligible areas as part of the proposed 

and final physician fee schedule rules 

for the years for which PSAs are 

identified or revised and to post a list 

of PSAs on the CMS Website. Lastly, the 

statute provides no administrative or 

judicial review under sections 1869 or 

1878 of the Act or otherwise, regarding 

the identification of a county or area, 

the assignment of a specialty of any 

physician, the assignment of a physician 

to a county, or the assignment of a 

postal ZIP Code to a county or other 

area. 

b. Improvement to Medicare HPSA 

Incentive Payment Program 

In addition to the creation of the 5 

percent PSA incentive payment, section 

413 of MMA amended section 1833(m) 

of the Act to mandate that we automate 

payment of the 10 percent HPSA 

incentive payment to eligible physicians 

for full county HPSAs without a 

requirement for the physician to 

identify the HPSA involved. When 

automation is not feasible, consistent 

with section 1833(m) of the Act as 

amended by section 413(b) of MMA, we 

plan to post a list of HPSAs on our 

website. When automation is not 

feasible, the billing of modifiers would 

still be required. 

The statute provides for no 

administrative or judicial review of the 

identification of a county or area, the 

assignment of the individual physician’s 

specialty, the assignment of a physician 

to a county or the assignment of a zip 

code to a county or area.

3. Provisions Related to Physician 

Scarcity Areas and HPSA Incentive 

Payment Program 

a. Determination of Physician Scarcity 

Areas 

As the statute prescribes, PSAs for 

primary care would be determined by 

the ratio of primary care physicians to 

the Medicare beneficiaries residing in 

that county or area. A primary care 

physician is defined by statute as a 

general practitioner, family practice 

practitioner, general internist, 

obstetrician, or gynecologist. The 

physician definition for determining 

primary care PSAs will be based on 

HRSA’s physician designations for 

primary medical care HPSAs, which 

include all of the above physicians. In 

other words, the PSA definition for 

primary care will be identical to 

HRSA’s, except for pediatricians. 

Furthermore, the statute provides that 

the primary care ratio include only 

primary care doctors in the active 

practice of medicine. Physicians whose 

practice is exclusively for the Federal 

Government or who provide only 

administrative services would not be 

included in the physician tally. PSAs 

for specialty care would be determined 

by the ratio of physicians who are not 

primary care physicians to the Medicare 

beneficiaries residing in that county or 

area. The specialist care PSA ratio 

would include all physicians other than 

primary care physicians as defined in 

the statute. To the extent feasible, we 

also plan to include rural census tracts 

of metropolitan statistical areas (as 

determined under the most recent 

modification of the Goldsmith 

Modification), as identified at the zip 

code level, with sufficiently low 

physician-to-Medicare population ratios 

as equivalent to qualified full county 

scarcity areas. The calculation of 

physician scarcity ratios is being made 

by the North Carolina Rural Research 

and Policy Analysis Center using the 

most current Medicare beneficiary and 

physician data available. At this time, 

the North Carolina Rural Research and 

Policy Analysis Center can only 

determine physician scarcity for 

Goldsmith areas at the zip code level 

due to the fact that Medicare beneficiary 

data is currently unavailable at the 

census tract level. 

As previously discussed, section 

1833(u) of the Act requires the 

automation of incentive payments for all 

PSAs, which we can only achieve by 

assigning zip codes to eligible areas. We 

propose the identification of qualified 

PSAs by zip code for automatic payment 

as follows: 

• For zip codes that fall within a full 

county PSA, the bonus would be paid 

automatically.

• For full county PSAs, the dominant 

county of the 5-digit zip code, as 

determined by the U.S. Postal Service, 

would be used when the zip code area 

is not entirely located within the 

county. In some cases, a service may be 

provided in a county that is considered 

to be a PSA, but the zip code is not 

considered to be dominant for that area, 

which would not permit automation of 

the bonus payment. In order to receive 

the bonus for those areas, physicians 

would need to include a new physician 

scarcity modifier on the claim. We plan 

to establish and implement the new 

modifier through the Medicare Claims 

Processing Manual. 

• For partial county PSAs (Goldsmith 

Modification), all zip code areas that are 

entirely located within the qualified 

Goldsmith area and all zip code areas 

that are partially located within a 

qualified Goldsmith area as long as the 

majority (51 percent) of the population 

located within the zip code area resides 

in the qualified Goldsmith area would 

be able to receive automatic payment. 

Due to the complex nature of 

processing available physician and 

Medicare beneficiary data into a usable 

format to identify counties and areas 

with the lowest ratios, we cannot make 

available a list of PSAs within this 

proposed rule. We are working closely 

with HRSA and its contractors to 

publish these lists in the physician fee 

schedule final rule. 

b. Incentive Payments for Physician 

Scarcity Areas 

Similar to the Medicare HPSA bonus 

payment program, eligibility for 

receiving the 5 percent bonus payment 

would be based on whether the specific 

location at which the service is 

furnished is within an area that is 

designated as a PSA. Furthermore, the 

statute requires us to restrict eligibility 

for receiving the incentive payments for 

physicians’ services furnished within 

primary care PSAs to general 

practitioners, family practice 

practitioners, general internists, 

obstetricians, or gynecologists. Also 

prescribed by statute, dentists, 

podiatrists, optometrists, and 

chiropractors are not eligible to receive 

incentive payments for PSAs. Section 

1833(u) of the Act specifically defines a 

physician as one described in section 

1861(r)(1) of the Act, which does not 

include dentists, podiatrists, 

optometrists, and chiropractors. 

47520 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

To conform our regulations to the 

statute, we are proposing to add 

§ 414.66 to provide a 5 percent incentive 

payment to eligible physicians 

furnishing covered services in eligible 

PSAs. We propose to add § 414.66(a)(1) 

to specify that primary care physicians 

furnishing services in primary care 

PSAs are entitled to an additional 5 

percent incentive payment above the 

amount paid under the physician fee 

schedule for their professional services 

furnished on or after January 1, 2005, 

and before January 1, 2008. The new 

incentive payment would apply to the 

professional services performed by 

physicians, including evaluation and 

management, surgery, consultation, and 

home, office and institutional visits. The 

technical component of physicians’

services is not eligible because this 

component is not included in the 

definition of physicians’ services at 

section 1861(q) of the Act as applied by 

the MMA. We are also proposing to add 

§ 414.66(b) to specify that physicians, 

other than primary care physicians, 

dentists, podiatrists, optometrists, and 

chiropractors, furnishing services in 

specialist care PSAs are entitled to an 

additional 5 percent payment above the 

amount paid under the physician fee 

schedule for their professional services 

furnished on or after January 1, 2005, 

and before January 1, 2008.

c. Improvement to Medicare HPSA 

Incentive Payment Program 

As of January 1, 2005, most 

physicians eligible for the 10 percent 

HPSA incentive payment would no 

longer be required to determine whether 

their service areas are eligible for 

incentive payments and to modify their 

claims to receive those payments. The 

MMA requires us to automate bonus 

payments for physicians’ services 

furnished in full county HPSAs. 

Automation of full county HPSA 

incentive payments involves the same 

issues of automation as PSA incentive 

payments: the zip code of the place of 

service is the only data element reported 

on the claim form that would allow 

automation. Similarly, zip codes need to 

be cross-walked to full county HPSAs. 

The statute allows use of the same 

method of automation of incentive 

payments for full county HPSAs as for 

full county PSAs. We are proposing the 

identification of HPSAs by zip code for 

automatic payment as follows: 

• For zip codes that fall entirely 

within a full or partial county HPSA, 

the bonus would be paid automatically. 

• When the zip code area is not 

entirely located within the full county 

HPSA, only the dominant county of the 

5-digit zip code as determined by the 

U.S. Postal Service would be used for 

automatically paying the HPSA 

incentive payment. 

• For all other zip code areas that are 

not entirely, but are to some extent, 

located within a designated HPSA (full 

county or partial), we would require 

physicians furnishing services in these 

areas to bill for the incentive payments 

by using the appropriate modifier on 

their Medicare claims. We propose to 

post on our website, prior to January 1, 

2005, a list of zip codes that fully fall 

within a designated HPSA and a list of 

zip codes that partially fall within a 

designated HPSA, so that physicians 

can determine whether they would need 

to bill using a modifier. 

Determination of zip codes eligible for 

automatic HPSA bonus payment would 

be made on an annual basis, and there 

would not be any mid-year updates. We 

would effectuate mid-year revisions 

made to designations by HRSA the 

following year for automatic bonus 

payment purposes. 

d. Medicare HPSA Incentive Payments 

The Medicare HPSA Incentive 

Payment program, which the Congress 

established under OBRA 1987, was 

implemented through the Medicare 

Claims Processing Manual. This 

proposed rule would create § 414.67 to 

conform the regulations to the law, as 

amended by OBRA 1987 and 1989. 

We propose in § 414.67 to provide a 

10 percent incentive payment to eligible 

physicians furnishing covered services 

in eligible HPSAs. Section 414.67(a) 

would specify that physicians, 

regardless of specialty, furnishing 

services in a primary medical care 

HPSA are entitled to a 10 percent 

incentive payment above the amount 

paid for their professional services 

under the physician fee schedule. We 

would also create § 414.67(c) to specify 

that psychiatrists furnishing services in 

a mental health HPSA are entitled to a 

10 percent incentive payment above the 

amount paid for their professional 

services under the physician fee 

schedule. Psychiatrists furnishing 

services in mental health HPSAs that do 

not overlap with primary care HPSAs 

are the only physicians eligible to 

receive the 10 percent incentive 

payment in those areas. In other words, 

these stand-alone mental health HPSAs 

are eligible areas for psychiatrists only 

to receive incentive payments. 

E. Section 303—Payment Reform for 

Covered Outpatient Drugs and 

Biologicals 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 303’’ at the beginning of your 

comments.] 

1. Average Sales Price (ASP) Payment 

Methodology 

a. Background 

Medicare Part B covers a limited 

number of prescription drugs and 

biologicals. For the purposes of this 

proposed rule, the term ‘‘drugs’’ will 

hereafter refer to both drugs and 

biologicals. Medicare Part B covered 

drugs generally fall into the following 

three categories: 

• Drugs furnished incident to a 

physician’s service. 

• Durable medical equipment (DME) 

drugs. 

• Drugs specifically covered by 

statute (for example, 

immunosuppressive drugs). 

Section 303(c) of the MMA revises the 

payment methodology for Part B 

covered drugs that are not paid on a cost 

or prospective payment basis. In 

particular, section 303(c) of the MMA 

amends Title XVIII of the Act by adding 

section 1847A. Beginning in 2005, 

section 1847A of the Act establishes a 

new ASP drug payment system. In 2005, 

almost all Medicare Part B drugs not 

paid on a cost or prospective payment 

basis will be paid under this system.

The new ASP drug payment system is 

based on data submitted to us quarterly 

by manufacturers. For calendar quarters 

beginning on or after January 1, 2004, 

the statute requires manufacturers to 

report their ASP data to us for almost all 

Medicare Part B drugs not paid on a cost 

or prospective payment basis. 

Manufacturers’ submissions are due to 

us not later than 30 days after the last 

day of each calendar quarter. 

For further information on the 

submission of manufacturers’ ASP data, 

see the interim final rule titled 

‘‘Manufacturer Submission of 

Manufacturer’s Average Sales Price 

(ASP) Data for Medicare Part B Drugs 

and Biologicals’ published in the 

Federal Register on April 6, 2004 (69 FR 

17935). It is accessible on the CMS Web 

site at http://www.cms.hhs.gov/ 

providers/drugs/default.asp.

The methodology for developing 

Medicare drug payment allowances 

based on the manufacturer’s submitted 

ASP data is described in this proposed 

rule and reflected in proposed revisions 

to the regulations at § 405.517 and new 

Subpart K in part 414. 

b. Provisions of the Proposed Rule 

i. The ASP Methodology 

Beginning in 2005, section 1847A of 

the Act establishes an ASP payment 

system for certain drugs and biologicals 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47521

not paid on a cost or prospective 

payment basis furnished on or after 

January 1, 2005. The most notable 

exceptions are described below in 

sections III.E.1.c through III.E.1.e. 

ii. Calculation of ASP 

As described in section 

1847A(b)(3)(A) of the Act for multiple 

source drugs and section 1847A(b)(4)(A) 

for single source drugs, the ASP for all 

drug products included within the same 

billing and payment code [or HCPCS 

code] is the volume-weighted average of 

the manufacturer’s average sales prices 

reported to us across all the NDCs 

assigned to the HCPCS code. 

Specifically, section 1847A(b)(3)(A) of 

the Act and section 1847A(b)(4)(A) of 

the Act require that this amount be 

determined by—

• Computing the sum of the products 

(for each National Drug Code assigned 

to those drug products) of the 

manufacturer’s average sales price and 

the total number of units sold; and

• Dividing that sum by the sum of the 

total number of units sold for all NDCs 

assigned to those drug products. 

Note that in the following 

discussions, the term ‘‘manufacturer’s 

ASP’’ refers to the ASP data submitted 

to us by manufacturers at the NDC level 

and the term ‘‘ASP’’ used in isolation 

refers to the weighted average sales 

price for all drug products included 

within the HCPCS [billing and payment] 

code. 

Section 1847A(b)(5) of the Act 

requires that the ASP be determined 

without regard to any special packaging, 

labeling, or identifiers on the dosage 

form or product or package. 

iii. Medicare Payment Allowances for 

Multiple Source Drugs 

Section 1847A(b)(1)(A) of the Act 

requires that the Medicare payment 

allowance for a multiple source drug 

included within the same HCPCS code 

be equal to 106 percent of the ASP for 

the HCPCS code. This payment 

allowance is subject to applicable 

deductible and coinsurance. The 

payment limit is also subject to the two 

limitations described below in section 

III.E.1.b.v of this preamble concerning 

widely available market prices and 

average manufacturer prices in the 

Medicaid drug rebate program. As 

described in section 1847A(e) of the 

Act, the payment limit may also be 

adjusted in response to a public health 

emergency under section 319 of the 

Public Health Service Act in which 

there is a documented inability to access 

drugs and a concomitant increase in the 

price of the drug which is not reflected 

in the manufacturer’s average sales 

price. 

iv. Medicare Payment Allowances for 

Single Source Drugs 

Section 1847A(b)(1)(B) of the Act 

requires that the Medicare payment 

allowance for a single source drug 

HCPCS code be equal to the lesser of 

106 percent of the average sales price for 

the HCPCS code or 106 percent of the 

wholesale acquisition cost of the HCPCS 

code. This payment allowance is subject 

to applicable deductible and 

coinsurance. The payment limit is also 

subject to the two limitations described 

below in section III.E.1.b.v concerning 

widely available market prices and 

average manufacturer prices in the 

Medicaid drug rebate program. As 

described in section 1847A(e) of the 

Act, the payment limit may also be 

adjusted in response to a public health 

emergency under section 319 of the 

Public Health Service Act. 

It has been brought to our attention 

that some physicians have concerns 

about their ability to purchase drugs at 

the Medicare payment amount of 106 

percent of the ASP as these physicians 

believe that they are small purchasers of 

the Medicare Part B drugs subject to this 

proposed rule and do not have access to 

the average discounts. It is our 

understanding that many physicians are 

members of purchasing groups, which 

do obtain discounts on drugs. We 

encourage physicians to consider 

participating in such groups in order to 

achieve advantageous prices. We are 

interested in comments regarding the 

extent to which physicians can become 

members of such buying groups and the 

possible effects of doing so. 

v. Limitations on ASP 

Section 1847A(d)(1) of the Act states 

that ‘‘The Inspector General of the 

Department of Health and Human 

Services shall conduct studies, which 

may include surveys, to determine the 

widely available market prices of drugs 

and biologicals to which this section 

applies, as the Inspector General, in 

consultation with the Secretary, 

determines to be appropriate.’’ Section 

1847A(d)(2) of the Act states that 

‘‘Based upon such studies and other 

data for drugs and biologicals, the 

Inspector General shall compare the 

average sales price under this section for 

drugs and biologicals with—

• The widely available market price 

for such drugs and biologicals (if any); 

and 

• The average manufacturer price (as 

determined under section 1927(k)(1)) for 

such drugs and biologicals.’’

Section 1847A(d)(3) of the Act states 

that ‘‘The Secretary may disregard the 

average sales price for a drug or 

biological that exceeds the widely 

available market price or the average 

manufacturer price for such drug or 

biological by the applicable threshold 

percentage (as defined in subparagraph 

(B)).’’ Section 1847A(d)(3)(B) states that 

‘‘the term ‘applicable threshold 

percentage’ means—

• In 2005, in the case of an average 

sales price for a drug or biological that 

exceeds widely available market price 

or the average manufacturer price, 5 

percent; and 

• In 2006 and subsequent years, the 

percentage applied under this 

subparagraph subject to such 

adjustment as the Secretary may specify 

for the widely available market price or 

the average manufacturer price, or 

both.’’

Section 1847A(d)(3)(C) of the Act 

states that ‘‘If the Inspector General 

finds that the average sales price for a 

drug or biological exceeds such widely 

available market price or average 

manufacturer price for such drug or 

biological by the applicable threshold 

percentage, the Inspector General shall 

inform the Secretary (at such times as 

the Secretary may specify to carry out 

this subparagraph) and the Secretary 

shall, effective as of the next quarter, 

substitute for the amount of payment 

otherwise determined under this section 

for such drug or biological the lesser 

of—

• The widely available market price 

for the drug or biological (if any); or 

• 103 percent of the average 

manufacturer price (as determined 

under section 1927(k)(1)) for the drug or 

biological.’’

vi. Payment Methodology in Cases 

Where the Average Sales Price During 

the First Quarter of Sales Is Unavailable 

Section 1847A(c)(4) of the Act states 

that ‘‘In the case of a drug or biological 

during an initial period (not to exceed 

a full calendar quarter) in which data on 

the prices for sales for the drug or 

biological is not sufficiently available 

from the manufacturer to compute an 

average sales price for the drug or 

biological, the Secretary may determine 

the amount payable under this section 

for the drug or biological based on—

• The wholesale acquisition cost; or 

• The methodologies in effect under 

this part on November 1, 2003, to 

determine payment amounts for drugs 

or biologicals.’’

47522 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

c. Payment for Influenza, 

Pneumococcal, and Hepatitis B 

Vaccines 

Section 1841(o)(1)(A)(iv) of the Act 

requires that influenza, pneumococcal, 

and hepatitis B vaccines described in 

subparagraph (A) or (B) of section 

1861(s)(10) of the Act be paid based on 

95 percent of the average wholesale 

price (AWP) of the drug. These AWP 

payments, which will be updated 

quarterly, have not been revised by the 

ASP provisions. 

d. Payment for Drugs Furnished During 

2005 in Connection With the Furnishing 

of Renal Dialysis Services if Separately 

Billed by Renal Dialysis Facilities. 

Section 1881(b)(13)(A)(ii) of the Act 

indicates that payment for a drug 

furnished during 2005 in connection 

with the furnishing of renal dialysis 

services, if separately billed by renal 

dialysis facilities, will be based on the 

acquisition cost of the drug as 

determined by the Inspector General 

(IG) report to the Secretary required by 

section 623(c) of the MMA or, insofar as 

the IG has not determined the 

acquisition cost with respect to a drug, 

the Secretary shall determine the 

payment amount for the drug. In the 

report, ‘‘Medicare Reimbursement for 

Existing End-Stage Renal Disease 

Drugs,’’ the IG found that, on average, in 

2003 the four largest chains had drug 

acquisition costs that were 6 percent 

lower than the ASP of 10 of the top 

drugs, including erythropoietin. A 

sample of the remaining independent 

facilities had acquisition costs that were 

4 percent above the ASP. Based on this 

information, the overall weighted 

average drug acquisition cost for renal 

dialysis facilities is 3 percent lower than 

the ASP. Therefore, payment for a drug 

or biological furnished during 2005 in 

connection with renal dialysis services 

and separately billed by renal dialysis 

facilities will be based on the ASP of the 

drug minus 3 percent. This will be 

updated quarterly based on the ASP 

reported to us by drug manufacturers. 

e. Payment for Infusion Drugs Furnished 

Through an Item of DME 

In 2005, section 1841(o)(1)(D)(i) of the 

Act requires an infusion drug furnished 

through an item of DME covered under 

section 1861(n) of the Act be paid 95 

percent of the average wholesale price 

for that drug in effect on October 1, 

2003.

2. Provisions for Appropriate Reporting 

and Billing for Physicians’ Services 

Associated With the Administration of 

Covered Outpatient Drugs 

Section 1848(c)(2)(J) of the Act (as 

added by section 303(a) of the MMA) 

requires the Secretary to promptly 

evaluate existing drug administration 

codes for physicians’ services to ensure 

accurate reporting and billing for those 

services, taking into account levels of 

complexity of the administration and 

resource consumption. According to 

section 1848(c)(2)(B)(iv) of the Act (also 

as amended by section 303(a) of the 

MMA), any changes in expenditures in 

2005 or 2006 resulting from this review 

are exempt from the budget neutrality 

requirement of section 1848(c)(2)(B)(ii) 

of the Act. The statute further indicates 

that the Secretary shall use existing 

processes for the consideration of 

coding changes and, to the extent 

changes are made, shall use those 

processes to establish relative values for 

those services. The Secretary is also 

required to consult with physician 

specialties affected by the provisions 

that change Medicare payments for 

drugs and drug administration. 

In the January 7, 2004 interim final 

rule with comment (69 FR 1094), we 

indicated that the Physicians Regulatory 

Issues Team (PRIT) will review 

Medicare payment policy for drug 

administration and that we plan to 

consult with the AMA’s CPT Editorial 

Panel and physician specialties affected 

by changes in payment for drugs and 

drug administration. We requested that 

the CPT Editorial Panel review all codes 

related to the administration of drugs 

and consider whether any revisions or 

additional codes are needed. At its 

February 2004 meeting, the CPT 

Editorial Panel established a workgroup, 

with representatives from affected 

specialties, to make recommendations 

on drug administration coding to the 

full Panel. In addition, the workgroup 

will be reviewing issues related to drug 

administration that were identified in 

the public comments on the January 7, 

2004 Physician Fee Schedule rule. 

These comments raised the following 

two major issues: 

1. Can the current coding distinction 

between chemotherapy and 

nonchemotherapy infusions allow for 

recognition of the resources needed to 

administer drugs with high toxicity or 

potential for serious side effects for 

diagnoses other than cancer? If not, are 

code revisions or new codes needed? 

2. Does the current coding for 

chemotherapy administration capture 

all the support services provided by 

oncology practices for chemotherapy 

patients? If not, are code revisions or 

new codes such as a cancer management 

code needed? 

There were also a number of specific 

comments on individual codes raised by 

some specialties such as urology and 

ophthalmology. On June 21, 2004, the 

workgroup held a public meeting to 

receive input and comments about drug 

administration code changes under 

consideration. The workgroup is 

expected to report to the full CPT 

Editorial Panel on all these issues at its 

August 2004 meeting. Once we review 

the CPT Editorial Panel’s work on this 

issue, we will consider whether it is 

necessary for us to make coding changes 

effective January 1, 2005 through the 

use of G codes, since the 2005 CPT book 

will already have been published. While 

the CPT Editorial Panel’s work on this 

issue is important to us, we finally 

determine coding policy for Medicare; 

we also would welcome public 

comments on these issues. We would 

also welcome comments concerning any 

alternative methods of allocating 

practice expenses to the drug 

administration codes. (See section 

II.A.2. of this proposed rule for a 

discussion of allocation of practice 

expenses.) If coding changes are to be 

made for next year, we would announce 

them in the physician fee schedule final 

rule effective January 1, 2005.

We also plan to analyze any shift or 

change in utilization patterns once the 

payment changes for drugs and drug 

administration required by MMA go 

into effect. While we do not believe the 

changes will result in access problems, 

we plan to continue studying this issue. 

We also note that the MMA requires the 

Medicare Payment Advisory 

Commission (MedPAC) to study items 

and services furnished by oncologists 

and drug administration services 

furnished by other specialties. 

3. Blood Clotting Factor—Section 

303(e)(1)—Items and Services Relating 

to Furnishing of Blood Clotting Factors 

For clotting factors furnished on or 

after January 1, 2005, we propose to 

establish a separate payment of $0.05 

per unit to hemophilia treatment centers 

and homecare companies for the items 

and services associated with the 

furnishing of blood clotting factor. 

Section 303(e)(1) of the MMA requires 

the Secretary, after review of the January 

2003 report to the Congress by the 

Comptroller General of the United 

States, to establish a separate payment 

to hemophilia treatment centers and 

homecare companies for the items and 

services associated with the furnishing 

of blood clotting factor. In the proposed 

rule, Payment Reform for Part B Drugs 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47523

(68 FR 50440), published in the Federal 

Register on August 20, 2003, we 

indicated that we are proposing to 

create a payment of $0.05 per unit of 

clotting factor provided to Medicare 

beneficiaries by hemophilia treatment 

centers and homecare companies to 

appropriately pay for the administrative 

costs associated with furnishing the 

clotting factor. We did not propose the 

creation of separate payment for 

furnishing the clotting factor for 

individuals or entities other than 

hemophilia treatment centers and 

homecare companies. 

We received comments from 

hemophilia organizations and specialty 

pharmacy providers of blood clotting 

factor. Most comments questioned our 

position to create a separate payment of 

$0.05 per unit, stating that this amount 

would jeopardize the ability of these 

facilities to adequately supply the 

clotting factor. Commenters were 

concerned that the $0.05 amount was 

too low and would cause many entities 

to discontinue providing the clotting 

factors and severely impact 

beneficiaries’ access to clotting factor. 

Based on a review of the General 

Accounting Office (GAO) report and 

data received from various clotting 

factor providers, we believe a separate 

payment amount of $0.05 per unit 

would cover the administrative costs 

associated with supplying the clotting 

factor. As outlined in the MMA, any 

separate payment amount established 

may include the mixing and delivery of 

factors, including special inventory 

management and storage requirements, 

as well as ancillary supplies and patient 

training necessary for the selfadministration of these factors. The 

MMA states that, in determining the 

separate payment, the total amount of 

payments and these separate payments 

shall not exceed the total amount of 

payments that would have been made 

for the factors if the amendments in 

section 303 of the MMA had not been 

enacted. As indicated in the GAO 

report, ‘‘[w]hen Medicare’s payment for 

clotting factor more closely reflects 

acquisition costs, we recommend that 

the Administrator establish a separate 

payment for providers based on the 

costs of delivering clotting factor to 

Medicare beneficiaries. Effective 

January 1, 2005, payment for blood 

clotting factors will more closely reflect 

acquisition costs as payment will be 

based on the average sales price as 

reported by drug manufacturers plus 6 

percent.’’

Therefore, in the absence of 

additional data, we believe that a 

separate payment amount of $0.05 per 

unit for the cost of delivering clotting 

factor is an appropriate amount 

beginning CY 2005 and we are 

proposing revisions to § 410.63 to reflect 

this amount. However, we are also 

seeking updated data and comments on 

the GAO report, as well as information 

on the fixed and variable costs of 

furnishing clotting factor. We recognize 

that there may be alternatives to a fee, 

which varies entirely based on the 

number of units of clotting factor 

furnished. We will closely examine all 

data and information submitted in order 

to make a final determination with 

respect to the appropriateness of the 

$0.05 per unit amount. That information 

will enable us to effectively determine 

the appropriateness of the $0.05 per unit 

amount. 

4. Supplying Fee 

Section 1842(o)(6) of the Act, as 

added by section 303(e)(2) of the MMA, 

requires the Secretary to pay a 

supplying fee (less applicable 

deductible and coinsurance) to 

pharmacies for certain Medicare Part B 

drugs and biologicals, as determined 

appropriate by the Secretary. The types 

of Medicare Part B drugs and biologicals 

eligible for a supplying fee are 

immunosuppressive drugs described in 

section 1861(s)(2)(J) of the Act, oral 

anticancer chemotherapeutic drugs 

described in section 1861(s)(2)(Q) of the 

Act, and oral anti-emetic drugs used as 

part of an anticancer chemotherapeutic 

regimen described in section 

1861(s)(2)(T) of the Act. As discussed in 

the interim final rule published on 

January 7, 2004 (69 FR 1084), we 

considered this fee to be bundled into 

the current payment for these drugs for 

2004 where payment is based on the 

Average Wholesale Price (AWP). 

We propose to establish a separately 

billable supplying fee, effective January 

1, 2005, when Medicare implements a 

different payment system for these 

drugs. We believe that a separately 

billable supplying fee of $10 per 

prescription is an appropriate level, 

beginning CY 2005. We received data 

suggesting various amounts for the 

supplying fee. Retail chain pharmacies 

suggested a supplying fee of $12 to $15 

per prescription. These pharmacies 

stated that on average it cost between 

$10 to $12 to dispense a prescription to 

a Medicare beneficiary. However, when 

supplying immunosuppressive and oral 

anti-cancer drugs to Medicare 

beneficiaries, they argued that costs 

increase due to factors such as 

coordination of benefits activities. The 

specialty pharmacies that exclusively or 

largely furnish immunosuppressive 

drugs submitted data indicating that 

they believe a supplying fee of $44 

(weighted average) to $56 (unweighted 

average) was appropriate. Pharmacies 

have pointed to the additional Medicare 

billing requirements as additional costs 

they had to incur, in the form of extra 

staff and time required to fulfill the 

billing requirements. We believe that a 

supplying fee of $10 per prescription is 

appropriate, especially when combined 

with the savings the pharmacy will 

experience with the clarification and 

elimination of the billing and shipping 

requirements, as described below.

We point out that if we were to 

establish a supplying fee of $44, then we 

expect that Medicare would be spending 

more money in 2005 on the supplying 

fees and immunosuppressive drugs than 

Medicare would have paid for 

immunosuppressive drugs in 2005 

under the former system at 95 percent 

of AWP, when the supplying fee was 

bundled into payment for the drug. 

Our goal is to assure that each 

beneficiary who needs covered oral 

drugs has access to those medications. 

We seek comments about the 

appropriateness of our proposed 

supplying fee amount as well as the 

components of a supplying fee that 

would assure beneficiary access to oral 

drugs. We believe that a supplying fee 

is intended to cover a pharmacy’s 

activities to get oral drugs to 

beneficiaries. We seek data and 

information on the additional services 

these pharmacies provide to Medicare 

beneficiaries, the extent to which oral 

drugs can be furnished without these 

additional services and the extent to 

which such services are covered under 

Medicare. We seek comment about 

whether the supplying fee should be 

somewhat higher during the initial 

month following a Medicare 

beneficiary’s transplant to the extent 

that additional resources are required 

for example, due to more frequent 

changes in prescriptions for 

immunosuppressive drugs. 

5. Billing Requirements 

We propose to clarify or eliminate the 

following billing requirements in an 

effort to reduce a pharmacy’s costs of 

supplying covered immunosuppressive 

and oral drugs to Medicare 

beneficiaries: 

• Original signed order. We wish to 

clarify Medicare’s policy regarding the 

necessity of an original signed order 

prior to the filling of a prescription. 

According to the Medicare Program 

Integrity Manual (section 5.1 of Chapter 

5), which addresses the ordering 

requirement for durable medical 

equipment, prosthetics, orthotics and 

supplies (DMEPOS), including drugs, 

most DMEPOS items can be dispensed 

47524 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

based on a verbal order from a 

physician. A written order must be 

obtained before submitting a claim, but 

that written order may be faxed, 

photocopied, electronic, or pen and ink. 

The order for the drug must specify the 

name of the drug, the concentration (if 

applicable), the dosage, and the 

frequency of administration. We hope 

that clarification of this requirement 

would reduce a pharmacy’s costs of 

supplying covered immunosuppressive 

and oral drugs to Medicare beneficiaries 

to the extent that pharmacies are 

currently applying an original signed 

prescription requirement. 

• Assignment of Benefits Form. 

Currently, pharmacies must obtain a 

completed Assignment of Benefits form 

in order to receive payment from 

Medicare. Other payors do not impose 

this requirement. This requirement 

increases a pharmacy’s cost of 

supplying covered drugs to Medicare 

beneficiaries. Section 1842(o)(3) of the 

Act requires that payment for drugs 

under Part B of Medicare can only be 

made on an assignment related basis. 

However, § 424.55(a) implies that if a 

beneficiary does not sign an assignment 

of benefits form, then Medicare will not 

make payment to the supplier. It has 

been pointed out that this requirement 

increases costs to suppliers that are not 

reimbursed by Medicare. We believe 

that it is not necessary for an assignment 

of benefit form to be filled out for drugs 

covered under Part B since payment for 

them can only be made on an 

assignment-related basis. We propose to 

eliminate use of the Assignment of 

Benefits form for Part B covered oral 

drugs as a means of reducing a 

pharmacy’s costs of supplying such 

drugs to Medicare beneficiaries. 

(Additional discussion on assignment of 

Medicare claims is in section IV.G of 

this preamble.) 

• DMERC Information Form (DIF). 

The DIF is a form created by the DMERC 

Medical Directors that contains 

information regarding the dates of the 

beneficiary’s transplant and other 

diagnosis information. Pharmacies must 

have a completed DIF in order to receive 

payment. This requirement increases a 

pharmacy’s cost of supplying covered 

drugs to Medicare beneficiaries. The DIF 

is a one-time requirement that was 

established to facilitate implementation 

of the immunosuppressive drug benefit 

when Medicare covered the drugs for 

different periods of time to distinguish 

between transplant and non-transplant 

uses for immunosuppressive drugs. 

Since section 1861(s)(2)(J) of the Act no 

longer imposes limits on the period of 

time for coverage of immunosuppressive 

drugs, we believe that the information 

on transplant diagnosis can be captured 

through other means (for example, 

diagnosis codes on the Part B claim 

form). In light of this statutory revision, 

we have had discussions with the 

DMERCs about their elimination of the 

use of this form when billing DMERC 

drugs. The DMERCs plan to eliminate 

the use of this form effective October 1, 

2004. We believe that a pharmacy’s 

costs of supplying Part B covered oral 

drugs to Medicare beneficiaries would 

be reduced with this change.

6. Shipping Time Frame 

It has been suggested that Medicare 

guidelines for refill prescriptions 

allowed too short of a window between 

shipping the next month’s prescription 

and the end of the current month. It has 

been argued that, as a result, a pharmacy 

‘‘effectively’’ had to ship the product to 

a beneficiary using an overnight 

delivery service. 

As indicated in section III.N of this 

preamble, on January 2, 2004, we 

revised the guidelines (effective 

February 2, 2004) regarding the time 

frame for subsequent deliveries of refills 

of DMEPOS products to occur no sooner 

than ‘‘approximately 5 days prior to the 

end of the usage for the current 

product’’ (see section 4.26.1 of Chapter 

4—Benefit Integrity of the Medicare 

Program Integrity Manual). This change 

allows shipping of refills on 

‘‘approximately’’ the 25th day of the 

month in the case of a month’s supply. 

We emphasize the word 

‘‘approximately’; while we believe that 

normal ground service shipping would 

allow delivery in 5 days, if there were 

circumstances where ground service 

could not occur in 5 days, the guideline 

would still be met if the shipment 

occurs in 6 or 7 days. (‘‘Days’’ refers to 

business days or shipping days 

applicable to the shipper, that is, a 6-

day week in the case of the U.S. Postal 

Service.) We believe that this change 

eliminates the need for suppliers to use 

overnight shipping methods and allows 

shipping of drugs by less expensive 

ground service. 

F. Section 952—Revisions to 

Reassignment Provisions—Section 952 

of the MMA 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 952’’ at the beginning of your 

comments.] 

Section 1842(b)(6) of the Act requires 

that payment may only be made to the 

physician or other person who 

furnished a service, or to the beneficiary 

for whom services were furnished, 

unless certain specified exceptions are 

met. Prior to the enactment of section 

952 of the MMA, Medicare did not 

permit the reassignment of payments for 

services provided by an independent 

contractor physician or nonphysician 

practitioner unless the services were 

performed on the premises of the 

facility or health care delivery system 

that submitted the bill. Therefore, if the 

services were furnished offsite, 

reassignment was prohibited (see 

section 1842(b)(6)(A)(ii) of the Act). 

Section 1842(b)(6)(A)(ii) of the Act, as 

amended by section 952 of the MMA, 

allows a physician or nonphysician 

practitioner to reassign payment for 

Medicare-covered services, regardless of 

the site of service, as long as there is a 

contractual arrangement between the 

physician and nonphysician 

practitioner and the entity through 

which the entity submits the bill for 

those services. Thus, the services may 

be provided on or off the premises of the 

entity receiving the reassigned 

payments. The MMA Conference 

Agreement states that entities that retain 

independent contractors may enroll in 

the Medicare program. We note that the 

expanded exception created by section 

952 applies to those situations when an 

entity seeks to obtain the medical 

services of a physician or nonphysician 

practitioner. 

Section 952 states that reassignment is 

permissible if the contractual 

arrangement between the entity that 

submits the bill for the service and the 

physician or nonphysician practitioner 

who performs the service ‘‘meets such 

program integrity and other safeguards 

as the Secretary may determine to be 

appropriate.’’ The Conference 

Agreement supports appropriate 

program integrity efforts for entities 

with independent contractors that bill 

the Medicare program, including joint 

and several liability (that is, both the 

entity accepting reassignment and the 

physician or nonphysician practitioner 

providing a service are both liable for 

any Medicare overpayments). The 

Conference Agreement also 

recommends that physician or 

nonphysician practitioners have 

unrestricted access to the billings 

submitted on their behalf by entities 

with which they contract. We 

incorporated these recommended 

safeguards in a change to the Medicare 

Manual, implementing section 952 of 

the MMA that was published on 

February 27, 2004. We are proposing to 

revise § 424.71 and § 424.80 to reflect 

these safeguards, as well as the 

expanded exception established by 

section 952. 

Given the myriad relationships and 

financial arrangements potentially 

permitted by section 952, the purpose of 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47525

joint and several liability is to encourage 

both parties to the contractual 

arrangement to exercise oversight of 

billings submitted to the Medicare 

program by holding them each fully 

accountable. Since physician or 

nonphysician practitioners will be 

subject to liability for claims that are 

submitted to the Medicare program by 

entities to which they have reassigned 

payments, it follows that a physician or 

nonphysician practitioners should have 

access to the billings submitted on their 

behalf. 

We note that section 952 of the MMA 

revises only the statutory reassignment 

exceptions relevant to services provided 

in facilities and clinics (section 

1842(b)(6)(A)(ii) of the Act). 

Arrangements involving reassignment 

must not violate any other applicable 

Medicare laws or regulations governing 

billing or claims submission, including, 

but not limited to, those regarding 

‘‘incident to’’ services, payment for 

purchased diagnostic tests, and payment 

for purchased test interpretations. 

In addition, physician group practices 

should be mindful that compliance with 

the in-office ancillary services exception 

to the physician self-referral prohibition 

requires that a physician who is engaged 

by a group practice on an independent 

contractor basis must provide services 

to the group practice’s patients in the 

group’s facilities. As noted in the Phase 

I physician self-referral final rule (66 FR 

887), ‘‘[w]e consider an independent 

contractor physician to be ‘‘in the group 

practice’’ if (1) he or she has a 

contractual arrangement to provide 

services to the group’s patients in the 

group practice’s facilities, (2) the 

contract contains compensation terms 

that are the same as those that apply to 

group members under section 

1877(h)(4)(iv) of the Act or the contract 

fits in the personal services exception, 

and (3) the contract complies with the 

reassignment rules * * * .’’ See also 66 

FR 886. This test is codified at § 411.351 

in the definition of ‘‘physician in the 

group practice.’’

We are aware that the changes in the 

reassignment rules based on section 952 

of the MMA may create new fraud and 

abuse vulnerabilities, which may not 

become apparent until the program has 

experience with the new contractual 

arrangements addressed in section 952 

of the MMA. Parties should be mindful 

that contractual arrangements involving 

reassignment may not be used to 

camouflage inappropriate fee-splitting 

arrangements or payments for referrals. 

We are soliciting public comment on 

potential program vulnerabilities and on 

possible additional program integrity 

safeguards to guard against such 

vulnerabilities. We intend to monitor 

reassignment arrangements for potential 

program abuse. 

G. Section 642—Extension of Coverage 

of IVIG for the Treatment of Primary 

Immune Deficiency Diseases in the 

Home 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 642’’ at the beginning of your 

comments.]

Beginning for dates of service on or 

after January 1, 2004, Medicare pays for 

intravenous immune globulin 

administered in the home. This benefit 

is for the drug and not for the items or 

services related to the administration of 

the drug when administered in the 

home, if deemed medically appropriate. 

Manual instructions implementing this 

MMA provision have been issued and 

can be found at http://

www.cms.hhs.gov/manuals/pm_trans/

R6BP.pdf and http://www.cms.hhs.gov/

manuals/pm_trans/R74CP.pdf. We are 

also proposing to revise § 410.10 to 

address this statutory change. 

H. Section 623—Payment for Renal 

Dialysis Services 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 623’’ at the beginning of your 

comments.] 

1. Background 

We are proposing changes affecting 

payments to ESRD facilities that result 

from enactment of the MMA and would 

be effective January 1, 2005. Section 

1881(b) of the Act, as amended by 

section 623 of the MMA, directed the 

Secretary to revise the current 

composite rate payment system. The 

statute has several major provisions that 

require the development of revised 

composite payment rates, as follows: 

• An update of 1.6 percent. 

• An add-on to the composite rate for 

the difference between current 

payments for separately billable drugs 

and biologicals and payments based on 

the revised drug pricing methodology 

using acquisition costs. 

• Case-mix adjustments for a limited 

number of patient characteristics. 

• Application of a budget neutrality 

adjustment. The statute also allows the 

Secretary to adjust the payment rates by 

a geographic index as the Secretary 

determines to be appropriate which 

would be phased-in over a multiyear 

period. 

By January 1, 2005, we plan to 

implement the proposed revisions 

affecting the composite payment rate 

which would include the following:

• An increase of 1.6 percent to the 

basic composite payment rate. 

• Proposed revisions to the pricing of 

separately billable drugs and 

biologicals. 

• A drug add-on to the composite rate 

to reflect the difference between current 

payments for separately billable drugs 

and biologicals, and payment based on 

the revised drug pricing methodology 

using acquisition costs. 

We propose to implement the patient 

characteristics adjustments and the 

related budget neutrality adjustments by 

April 1, 2005. (See detailed discussion 

later in this section.) 

2. Legislative History 

Section 2991 of the Social Security 

Amendments of 1972 (Pub. L. 92–603), 

established Medicare’s End Stage Renal 

Disease (ESRD) Program. This law 

extended Medicare coverage to 

individuals who have permanent kidney 

failure, require either dialysis or 

transplantation, and meet certain other 

eligibility requirements. The End Stage 

Renal Disease Program Amendments of 

1978 (Pub. L. 95–292) added section 

1881(b)(2)(B) to title XVIII of the Act. 

That legislation provided for the 

establishment of a prospective 

reimbursement methodology for the 

payment of dialysis treatments provided 

by renal dialysis facilities. Further 

changes to the ESRD payment system 

were made by section 2145 of Pub. L. 

97–35, which amended section 1881 of 

the Act, requiring the development of a 

prospective reimbursement system for 

outpatient maintenance dialysis that 

promotes home dialysis. The payment 

system required either the 

reimbursement of home dialysis and infacility dialysis under ‘‘composite’’

rates, or the use of some other more 

efficient method determined to promote 

home dialysis more effectively. 

On February 12, 1982, we published 

a proposed rule on reimbursement for 

outpatient maintenance dialysis services 

(47 FR 6556) and we published the final 

rule on May 13, 1983 (48 FR 21254). 

This regulation implemented section 

1881 of the Act, as amended by section 

2145 of Pub. L. 97–35, and provided 

that each ESRD facility will receive a 

fixed composite payment rate per 

dialysis treatment, adjusted for 

geographic differences in area wage 

levels. Payment for in-facility and home 

dialysis treatments was established 

using a composite payment rate 

reflecting the costs of both modalities. 

Separate composite payment rates were 

established for hospital-based and 

independent dialysis facilities. The 

regulation also included a process under 

which facilities could obtain exceptions 

47526 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

to their composite payment rates under 

specified circumstances. 

The average composite payment rate 

per treatment, effective on August 1, 

1983, was $123 for independent ESRD 

facilities and $127 for hospital-based 

facilities. The composite rate was 

designed to provide payment for a 

package of goods and services needed to 

furnish dialysis treatments that 

included certain routinely provided 

drugs, laboratory tests, supplies, and 

equipment. Unless specifically included 

in the composite payment rate, other 

injectable drugs and laboratory tests 

medically necessary for the care of the 

dialysis patient are separately billable. 

Prior to January 1, 2004, drugs not 

paid on a cost or prospective payment 

basis were paid based on the lower of 

the actual charge or 95 percent of the 

AWP (section 1842(o)(1) of the Act, as 

added by section 4556 of the BBA of 

1997 (Pub. L. 105–33)). Sections 303 

through 305 of the MMA make revisions 

to payment methodology for Part B 

covered drugs that are not paid on a cost 

or prospective payment basis. For CY 

2004, the MMA provides that drugs not 

paid on a cost or prospective payment 

basis will be paid at 85 percent of the 

AWP determined as of April 1, 2003. 

However, there are several exceptions to 

this general rule, including payment of 

ESRD drugs and biologicals. In CY 2004, 

drugs and biologicals furnished in 

connection with the furnishing of renal 

dialysis services if separately billed by 

renal dialysis facilities are paid at 95 

percent of AWP. We note that hospitalbased ESRD facilities are paid 

reasonable costs for separately billable 

drugs, except for Erythropoietin/

Epoietin (EPO). 

EPO is an anti-anemia drug 

administered to certain patients with 

ESRD. Medicare Part B pays for EPO 

and its administration if it is furnished 

by an approved ESRD facility as part of 

an outpatient dialysis service or by a 

supplier of home dialysis equipment 

and supplies to ESRD patients in their 

homes as part of home dialysis services. 

Most dialysis is furnished to ESRD 

patients on an outpatient basis or is selfadministered in the home. 

Section 1881(b)(11) of the Act 

expressly excludes payment for EPO 

furnished to ESRD patients from the 

composite rate for dialysis services. The 

costs of EPO are, therefore, billed 

separately by an ESRD facility or by a 

supplier of home dialysis equipment 

and supplies and are paid in addition to 

the facility’s composite rate. Any EPOrelated costs, such as the cost of its 

administration or overhead costs 

associated with its storage, however, are 

subsumed in the facility’s composite 

rate. 

Section 413.174(f)(3) requires that we 

prospectively determine the EPO 

amount pursuant to section 

1881(b)(11)(B)(ii) of the Act. Section 

4201(c) of the Omnibus Budget 

Reconciliation Act of 1990 (OBRA 90) 

(Pub. L. 101–508), however, amended 

section 1881(b)(11) of the Act to 

establish a new EPO payment 

methodology. OBRA 90 directed, 

effective January 1, 1991, that payment 

for EPO furnished to ESRD patients by 

Medicare-approved dialysis facilities or 

suppliers of home dialysis equipment 

and supplies for home use be made on 

a per-unit basis. OBRA 90 also 

established a maximum payment 

amount of $11 per 1,000 unit doses 

rounded to the nearest 100 units. 

Subsequently, section 13556(a)(2) of 

OBRA 93 was enacted, which further 

amended section 1881(11)(b)(B)(ii) of 

the Act to reduce the maximum 

payment level to $10 per 1,000 units 

effective January 1, 1994. Although we 

have the authority to revise the rate, we 

continue to pay at the rate of $10 per 

1,000 units.

Section 9335(a) of Pub. L. 99–509 

required the Secretary to reduce the 

initially established composite payment 

rates by $2.00 per treatment effective 

October 1, 1986. This reduction was 

partially reversed as a result of the 

enactment of section 4201(a)(2) of Pub. 

L. 101–508, which increased the 

composite payment rates in effect as of 

September 30, 1990 by $1.00 per 

treatment, but effectively froze the 

methodology for their calculation, 

including the data and definitions used, 

as of that date. Section 222 of Pub. L. 

106–113, provided for a 1.2 percent 

increase to the payment rates effective 

January 1, 2000, and also provided for 

another 1.2 percent increase effective 

January 1, 2001. Section 422(a)(1) of 

Pub. L. 106–554, raised the amount of 

the January 1, 2001 payment increase by 

another 1.2 percent for a total increase 

of 2.4 percent effective January 1, 2001. 

Section 422 of Pub. L. 106–554 also 

directed the Secretary to develop a 

Prospective Payment System (PPS) that 

expanded the bundle of routine services 

reflected in the composite rate to 

include separately billable laboratory 

tests and drugs ‘‘to the maximum extent 

feasible’’. In addition, section 422(a) of 

Pub. L. 106–554 prohibited the granting 

of new composite rate payment 

exceptions for services furnished after 

December 31, 2000. Because a bundled 

ESRD payment system must be 

periodically updated, section 422(b) of 

Pub. L. 106–554 also required the 

development of an ESRD market basket 

to account for changes in price inflation, 

with discretionary consideration of 

other factors known to affect costs. 

Section 422(c) of Pub. L. 106–554 

mandated the submission of a report to 

the Congress on the bundled payment 

system and ESRD market basket. 

On May 12, 2003, the Secretary 

submitted the required report to the 

Congress. The report explained the 

major issues that must be addressed 

before a bundled ESRD PPS can be 

implemented, presented an ESRD 

composite rate market basket, and 

discussed the results from the first 

phase of our sponsored research to 

develop a bundled payment system. The 

report presented the following three 

major findings that are relevant to our 

efforts to revise the composite rate 

payment system: 

• Current data sources are adequate 

for proceeding to develop a bundled 

ESRD PPS. 

• Case-mix may be an important 

variable for risk adjusting payments, 

based on preliminary analysis. 

• Current data provide a sound basis 

for monitoring patient outcomes in a 

revised ESRD payment system. 

3. Summary of Section 623 of MMA 

The following provisions in section 

623 of the MMA, effective January 1, 

2005, affect the composite payment rate 

methodology, as well as the pricing 

methodology for separately billable 

drugs and biologicals furnished by 

ESRD facilities: 

a. Section 623(a)—The last sentence 

of section 1881(b)(7) of the Act, as 

amended by MMA, provides for an 

increase in the current composite 

payment rate of 1.6 percent. 

b. Section 623(d)(1)—Section 

1881(b)(13) of the Act, as added by 

MMA section 623(d)(1), provides for a 

revision to the current AWP pricing of 

separately billable drugs and 

biologicals; payment will be based on 

acquisition costs as determined by the 

OIG’s study mandated under section 

623(c) of the MMA. Insofar, as the OIG 

has not determined the acquisition 

costs, with respect to a drug or 

biological, the Secretary shall determine 

the payment amount for such drug or 

biological. 

c. Section 623(d)(1)—Section 

1881(b)(12) of the Act, as added by 

MMA section 623(d)(1), also requires 

the establishment of a basic case-mix 

adjusted composite payment rate that 

applies certain adjustments to the 

composite payment rate as follows: 

• Adjustments for a limited number 

of patient characteristics. 

• An adjustment that reflects the 

difference between current payments for 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47527

separately billed drugs and biologicals 

and the revised pricing based on 

acquisition costs or other method as 

determined by the Secretary. 

• A geographic adjustment, if the 

Secretary determines such an 

adjustment is appropriate with the 

possibility of a phase-in. 

• A budget neutrality adjustment, so 

that aggregate payments under the basic 

case-mix adjusted composite payment 

rates for 2005 equal the aggregate 

payments that would have been made 

for the same period if section 

1881(b)(12) of the Act did not apply. 

4. Provisions of the Proposed Rule 

a. Composite Rate Increase 

The current composite payment rates 

applicable to urban and rural hospitalbased and independent ESRD facilities 

were effective January 1, 2002. The 

current wage-adjusted rates for each 

urban and rural area were published in 

Tables III and IV of Program 

Memorandum A–01–19 issued February 

1, 2001 and are applicable through the 

end of 2004. Section 623(a)(3) of the 

MMA requires that the composite rates 

in effect on December 31, 2004 be 

increased by 1.6 percent. We are 

publishing revised wage-adjusted 

composite rates that reflect the 

statutorily required 1.6 percent increase. 

Those rates are set forth in Tables I and 

II at the end of this section. These tables 

reflect the updated hospital-based and 

independent facility composite rate of 

$132.40 and $128.35, respectively, 

adjusted by the current wage index. The 

rates will be effective January 1, 2005. 

The rates shown in the tables do not 

include any of the basic case-mix 

adjustments required under section 623 

of the MMA. 

b. Revised Pricing Methodology for 

Separately Billable Drugs and 

Biologicals Furnished by ESRD 

Facilities 

Section 623(d) of the MMA requires 

the Secretary to establish a basic casemix adjusted PPS for dialysis services 

that are furnished beginning on January 

1, 2005 by providers of services and 

renal dialysis facilities to individuals in 

a facility and to individuals at home. 

This system will include services 

comprising the composite rate as well as 

the difference between payment 

amounts for separately billed drugs and 

biologicals (including erythropoietin) 

furnished by ESRD facilities and 

acquisition costs of such drugs and 

biologicals as determined by the OIG 

reports from the studies mandated by 

section 623(c) of the MMA. 

For 2004, the payment amounts for 

separately billed drugs and biologicals 

(other than erythropoietin) furnished by 

ESRD facilities are determined by 95 

percent of AWP. For 2005, the payment 

amounts for separately billed drugs and 

biologicals (including erythropoietin) 

furnished by ESRD facilities are 

described in section III.E of the NRPM. 

Insofar as the acquisition cost has not 

been determined by the OIG, then the 

Secretary shall determine the payment 

amount of the drug and biological. 

For 2005 and subsequent years, the 

payment amounts for separately billed 

drugs and biologicals (including 

erythropoietin) furnished by ESRD 

facilities will be the acquisition cost or 

the amount that is derived from the ASP 

methodology in section 1847A of the 

Act, as the Secretary may specify. 

See section III.E.1.d. of this proposed 

rule for further explanation of payment 

for separately billable drugs and 

biologicals furnished by renal dialysis 

facilities.

c. Composite Rate Adjustment to 

Account for Changes in Pricing of 

Separately Billable Drugs and 

Biologicals 

Section 1881(b)(12) of the Act, as 

added by section 623(d) of the MMA, 

contains two provisions that specify 

how the drug add-on adjustment is to be 

handled in the revised ESRD payment 

system. First, subparagraph (B)(ii) of 

such section requires an adjustment to 

the composite payment rates to account 

for the difference between payment 

amounts for separately billed drugs 

(including erythropoietin) under the 

current payment system and acquisition 

costs as determined by the OIG. Second, 

subparagraph (E)(i) requires that the 

drug add-on adjustment be budgetneutral, that is, that it be designed to 

result in the same aggregate amount of 

expenditures as would have been made 

without the statutory policy change. 

We need to determine the composite 

rate adjustment for drug add-on amount 

that simultaneously deals with both 

statutory requirements. That is, the 

aggregate amount of the composite rate 

adjustment for drug add-on amount 

needs to equal the aggregate amount of 

the drug spread (the difference between 

drug payments under the old system 

and acquisition costs). 

In order to ensure that we satisfy both 

constraints, it is necessary to consider 

the proposed drug pricing in developing 

the adjustment to the composite rates. 

As discussed in section III.E.1.d. of this 

proposed rule, we are proposing to pay 

for separately billable ESRD drugs using 

ASP minus 3 percent based on the 

average relationship of acquisition costs 

to average sales prices from the drug 

manufacturers as outlined in the OIG 

report. We have developed the proposed 

drug add-on adjustment using the ASP 

minus 3 percent drug prices. Section 2 

below discusses the details of the 

calculation of the drug add-on 

adjustment. An alternative approach 

would be to use the 2003 acquisition 

prices from the OIG report, calculate the 

aggregate difference between such 

prices and payments for drugs under the 

AWP system, update this difference to 

2005 and then apply the budget 

neutrality adjustment. Because the same 

budget-neutrality adjustment would be 

used in both calculations, we believe 

that the drug add-on adjustment for the 

drug spread would be the same with 

both approaches. Therefore, we are 

proposing to use the ASP minus 3 

percent prices as the basis for 

developing the drug add-on adjustment 

to the composite rate.

1. Options for Applying the Drug AddOn Adjustment to the Composite 

Payment Rate 

Currently, separately billable ESRD 

drugs are paid differently to hospitalbased and independent ESRD facilities. 

EPO is currently the only drug for 

which payment is uniform across ESRD 

facilities; EPO is paid at the current rate 

of $10 per 1000 units. All other 

separately billed ESRD drugs provided 

by independent ESRD facilities are 

currently paid 95 percent of AWP 

prices. However, hospital based ESRD 

facilities are paid their reasonable cost 

for the other separately billed drugs they 

provide. Because they are paid on cost, 

hospital-based facilities have not made 

the profits from drug payment that 

independent facilities have enjoyed. 

The statutory language describing the 

add-on adjustment to the composite rate 

does not specifically differentiate 

between hospital-based and 

independent facility composite rate 

adjustments. However, the drug add-on 

provision is included with the other 

provisions related to the basic case-mix 

adjusted composite rate system; thus, it 

could be argued that the drug add-on 

provision was intended to address ESRD 

industry concerns about the inadequacy 

of the composite payment rate. We 

believe these concerns apply equally to 

hospital-based facilities and 

independent facilities. Therefore, we are 

proposing a single adjustment to the 

composite payment rates for both 

hospital based and independent 

facilities. 

An alternative option would be to 

develop a separate adjustment for 

hospital-based facilities for EPO and one 

for independent facilities for all of their 

separately billed drugs. The IG’s report 

provided the acquisition costs we are 

47528 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

using; it did not provide different 

acquisition costs for hospital-based and 

independent facilities. We believe that it 

would not be appropriate for us to use 

these data to create two separate 

adjustments. The following discussion 

outlines the development of the drug 

add-on adjustment under both options—

a single factor and separate factors. 

2. Computation of Drug Add-On 

Adjustment to the ESRD Composite 

Payment Rate 

i. Data 

To develop the drug add-on 

adjustment we used historical total 

aggregate payments for separately billed 

ESRD drugs for half of 2000 and all of 

2001 and 2002. For EPO, these 

payments were broken down according 

to type of ESRD facility (hospital-based 

versus independent). We also used the 

number of dialysis treatments 

performed by these two types of 

facilities over the same period. 

ii. ASP Minus 3 Percent 

We updated the ASP minus 3 percent 

prices, for the first quarter of 2004, to 

represent 2005 prices. We used the 

projected annual price growth factor for 

National Health Expenditure 

prescription drugs of 3.39 percent.

TABLE 12 

Drugs 

First quarter 

2004 average 

sales price 

first minus 3 

percent 

Quarter 2005 

average sales 

price minus 3 

percent 

Epogen ..................................................................................................................................................................... $8.74 $9.04 

Calcitriol ................................................................................................................................................................... 0.66 0.68 

Doxercalciferol ......................................................................................................................................................... 2.55 2.64 

Iron_dextran ............................................................................................................................................................. 9.22 9.54 

Iron_sucrose ............................................................................................................................................................ 0.34 0.35 

Levocarnitine ............................................................................................................................................................ 7.15 7.39 

Paricalcitol ................................................................................................................................................................ 3.86 3.99 

Sodium_ferric_glut ................................................................................................................................................... 4.15 4.29 

Alteplase, Recombinant ........................................................................................................................................... 27.74 28.68 

Vancomycin ............................................................................................................................................................. 3.40 3.52 

iii. Current Medicare Reimbursement 

We updated the first quarter 2004 

Medicare payment amounts (95 percent 

of AWP), based on the January 2004 

Single Drug Pricer, for drugs other than 

EPO, to estimate 2005 payment amounts 

by using an estimated AWP growth of 3 

percent. These growth factors are based 

on historical trends of AWPs. We did 

not increase the price for Epogen since 

payment was maintained at $10.00 per 

thousand units prior to MMA.

TABLE 13 

Drugs 

Current medicare 

reimbursement 

prices for 2005 

Epogen ............................. $10.00 

Calcitriol ............................ 1.42 

Doxercalciferol .................. 5.67 

Iron_dextran ...................... 18.45 

Iron_sucrose ..................... 0.68 

Levocarnitine .................... 35.23 

Paricalcitol ........................ 5.49 

Sodium_ferric_glut ............ 8.42 

Alteplase, Recombinant .... 37.80 

Vancomycin ...................... 7.24 

iv. Dialysis Treatments 

We updated the number of dialysis 

treatments by actuarial projected growth 

in the number of ESRD beneficiaries. 

Since Medicare covers a maximum of 

three treatments per week, utilization 

growth is limited, and therefore any 

increase in the number of treatments 

should be due to enrollment. In 2005, 

we project there will be a total of 36.5 

million treatments performed (5.1 

million treatments will be performed by 

hospital-based facilities and 31.4 

million treatments by independent 

facilities). 

v. Drug Payments 

We updated the total aggregate 

Epogen drug payments for each 

hospital-based and independent 

facilities using historical trend factors. 

For 2003 through 2005, the 2002 

payment level was increased each year 

by trend factors of 2.8 percent for 

hospital-based facilities and by 9.4 

percent for independent facilities. 

Using drug growth factors for drugs 

paid for by Medicare Part B carriers, 

which were calculated from historical 

data, we updated the aggregate spending 

for separately billable drugs, other than 

EPO, for independent facilities. We used 

24.7 percent for 2003, 23.3 percent for 

2004, and 21.4 percent for 2005 as 

factors because historical growth of 

ESRD drugs is similar to that for drugs 

paid for by Part B carriers. These factors 

are projected to approach the level of 

National Health Expenditure 

prescription drug growth. For 2005, we 

estimate that spending will reach $185 

million for Epogen provided in hospitalbased facilities, and $2,664 million for 

drugs provided in independent facilities 

($1,568 million for Epogen and $1,096 

million for other drugs).

vi. Add-On Calculation and Budget 

Neutrality 

For each of the ten drugs, we 

calculated the percent by which ASP 

minus 3 percent prices are projected to 

be less than reimbursement amounts 

under the current system for 2005. For 

Epogen, this amount is 10 percent. We 

applied this 10 percent figure to the 

total aggregate drug payments for 

Epogen in hospital-based facilities, 

resulting in a difference of $18 million. 

We then calculated a weighted average 

of the percentages by which ASP minus 

3 percent would be below current 

Medicare reimbursement prices for the 

top 10 ESRD drugs. We weighted these 

percentages by using the 2002 Medicare 

reimbursement values contained in the 

OIG report for the ten drugs. This 

procedure resulted in a weighted 

average of 19 percent. Since these ten 

drugs represented 98 percent of drugs 

payments, we applied the weighted 

average to 100 percent or all of aggregate 

drug spending projections for 

independent facilities, producing a 

projected difference of $516 million. 

Combining the 2005 figures of $18 

million and $516 million, for a total of 

$534 million and then distributing this 

over a total projected 36.5 million 

treatments would result in a single addon to the per treatment composite rate 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47529 

of 11.3 percent. By making this 

adjustment to the composite rate, we 

estimate that the aggregate payments to 

ESRD facilities would be budget neutral 

with respect to drug payments. 

Alternatively, we could produce 

separate drug add-on adjustments for 

hospital-based and independent 

facilities using the same methodology. 

Under this option, we could distribute 

the $18 million difference in EPO 

payments to hospital-based facilities 

based on data projecting 5.1 million 

treatments resulting in a hospital-based 

facility drug add-on adjustment of 2.7 

percent. We would distribute the $516 

million difference in drug payments 

(including EPO) to independent 

facilities using projected treatments of 

31.4 million, resulting in a drug add-on 

adjustment of 12.8 percent for 

independent facilities. 

Drug prices used in the computation 

of the proposed drug add-on adjustment 

to the ESRD composite payment rate, 

may be revised based on later data and 

will be reflected in the final rule. 

3. Composite Rate Effect of Proposed 

Drug Add-On Adjustment 

We used a single drug add-on 

adjustment for both hospital-based and 

independent ESRD facilities, the 

proposed adjustment to the composite 

rate would be 1.113. Separate 

adjustments would provide a 1.128 

adjustment for independent facilities 

and 1.027 for hospital-based facilities. 

The following table illustrates the effect 

on the composite payment rates under 

the two potential drug add-on options. 

(Case-mix budget neutrality adjustments 

are not reflected in this table). 

TABLE 14 

Facility type CY 2005 

base rate 

Separate 

add-on 

Single addon 

Independent ............................................................................................................................................. $128.35 $144.78 $142.85 

Hospital Based ......................................................................................................................................... 132.41 135.99 147.37 

Under the single add-on, the 

proportionately higher rate for hospitalbased facilities would be consistent 

with section 1881(b)(7) which requires 

that our payment methods differentiate 

between hospital-based facilities and 

others. Separate add-on adjustments 

would result in a significantly higher 

composite payment rate for independent 

facilities, than hospital-based facilities, 

that is, $8.79 higher per treatment. 

d. Patient Characteristic Adjustments 

1. Statutory Authority 

The current ESRD composite payment 

rates do not adjust for variation in 

patient characteristics or case mix. 

Section 1881(b)(12)(A) of the Act, as 

added by section 623(d)(1) of the MMA, 

requires that the outpatient dialysis 

services included in the composite rate 

be case-mix adjusted. Specifically, the 

statute states that ‘‘The Secretary shall 

establish a basic case-mix adjusted 

prospective payment system for dialysis 

services furnished by providers of 

services and renal dialysis facilities in a 

year to individuals in a facility and to 

individuals at home. The case-mix 

under the system would be for a limited 

number of patient characteristics.’’ In 

the following sections, we describe the 

development of the methodology for the 

proposed patient characteristic case-mix 

adjusters required under the MMA. 

2. Background 

Case-mix measures utilizing patient 

characteristics have been used in a 

number of prospective payment 

systems. Use of a case-mix measure 

permits targeting of greater payments to 

facilities that treat more costly resourceintensive patients. However, the 

legislative mandate to establish a casemix adjustment for services included in 

the composite rate based on a limited 

number of patient characteristics 

presents a unique challenge. 

The composite rate represents 

payment for a fixed bundle of routine 

services provided to ESRD patients as 

part of a dialysis treatment. Generally, 

the items and services needed to 

provide a dialysis treatment do not vary 

significantly across patients. Moreover, 

the bills for composite payment rate 

services furnished to ESRD patients, 

which are generally submitted monthly, 

do not identify the specific items and 

services provided on a case-by-case 

basis. In addition, the Medicare cost 

reports identify only aggregate costs for 

composite rate services at the facility 

level. Therefore, any case-mix 

adjustment based on patient 

characteristics obtained from the bills 

for outpatient ESRD services and 

applied to the composite rate will reflect 

only variation in composite rate costs at 

the facility level. 

Earlier research by Hirth (1999) and 

Dor (1992) found that if case-mix 

adjustments applied only to composite 

rate items and services the adjustments 

played a limited role in predicting 

variation in costs per treatment because 

case-mix and dialysis treatment patterns 

are very similar across facilities. 

However, more recent analyses 

conducted under our contract with the 

University of Michigan, Kidney, 

Epidemiology and Cost Center (KECC) 

found that patient level case-mix 

adjustment would be more relevant in a 

bundled payment system that includes 

both composite rate and separately 

billable items and services. KECC’s 

research studies relied on an extensive 

set of variables to define patient casemix. These variables included patient 

characteristics, a large number of 

specific comorbidities and clinical 

measures (including primary diagnosis) 

and other (non-Medicare) insurance 

coverage, as well as the duration of 

ESRD. We relied on linear regression 

analyses used in the studies to assess 

the relationship of patient 

characteristics and comorbidity 

measures to per session cost and 

Medicare payments to facilities. These 

studies relied on data from our 

administrative files. 

We are continuing and expanding the 

research project in support of the 

development of a fully bundled casemix adjusted system. We are continuing 

to explore alternative models and 

options with more detailed analysis of 

patient characteristics as part of the 

legislatively mandated report to the 

Congress in the fall of 2005. 

Despite the difficulty in developing a 

patient characteristic case-mix 

adjustment, we were able to develop 

case-mix adjustment factors for a 

limited number of patient 

characteristics, consistent with the 

legislative mandate. As expected, these 

adjusters are only modest predictors of 

variation in average costs for composite 

services. In developing the proposed 

patient characteristic adjustments, we 

used our available administrative data. 

Because facilities do not list individual 

composite rate items and services on the 

dialysis bill, billing data do not identify 

resources used by each patient. In 

47530 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

addition, facilities can underreport or 

not report comorbid conditions. 

Therefore, these bills are not useful for 

deriving average facility input costs. 

Since there are not any current 

requirements to list comorbid 

conditions on the dialysis bill, we used 

a combination of data sources to 

determine co-morbidities for ESRD 

patients on maintenance dialysis. These 

include the Medicare claims history file 

as well as the CMS Form 2728 (ESRD 

Medical Evidence Report) which 

provides information on the cause of 

ESRD and lists 20 possible comorbidities present at the onset of a 

patient’s ESRD. The Form 2728 is 

completed only at the initiation of 

dialysis treatment. It is not updated to 

reflect more recent medical conditions. 

Nonetheless, we found selected 

variables from the Form 2728 to be valid 

predictors of cost per treatment for the 

proposed case-mix adjustment, and the 

Form 2728 was also useful in 

developing our proposed case-mix 

adjustments. As discussed below, the 

Form 2728 variables were supplemented 

by additional information we obtained 

from billing records. 

3. Development of the Proposed 

Adjustments for Patient Characteristics

We are proposing a methodology to 

establish a basic case-mix adjusted 

composite rate system using a limited 

number of patient characteristic 

variables developed from existing our 

administrative files. We analyzed a 

number of patient level variables 

including age, gender, alcohol and drug 

dependence, inability to ambulate/

transfer, current smoker, number of 

years since ESRD onset, weight, height, 

mean BUN, and mean creatinine 

clearance, as well as a number of 

comorbidities. 

As a means to estimate how average 

cost variations among facilities are 

influenced by selected patient 

characteristics, extensive analyses were 

performed to develop a proposed ‘‘basic 

case-mix adjusted PPS, for a limited 

number of patient characteristics,’’ as 

specified in the statute. We analyzed the 

average cost per dialysis session 

(including both hemodialysis and 

Method I peritoneal dialysis converted 

to equivalent 3 times per week 

hemodialysis sessions) from national 

data gathered for the years 2000, 2001, 

and 2002. 

A stepwise regression was used to 

select a limited set of variables that were 

predictive of average facility cost per 

treatment. We used data pooled over a 

three-year period because we found the 

regression coefficients to reflect a 

consistent pattern over three years. We 

used data pooled over a three-year 

period to minimize the potential for 

volatility in the regressive coefficients. 

The analysis controlled for selected 

variables that influence facility costs, 

but are not case-mix related. These 

variables included wage index, the 

natural log of the number of dialysis 

sessions provided annually by the 

facility, type of facility, chain affiliation, 

and percentage of patients with urea 

reduction ratio (URR) as a measure of 

dialysis dose equal to or greater than 65 

percent. The proposed model is based 

not only on the predictive power of 

these measures, but also upon 

objectivity (for example, discrete 

variables: age/gender), clinical 

plausibility, and practicality (that is, 

availability) of data collection. The 

variables used were assessed for their 

clinical plausibility by clinicians from 

the University of Michigan and CMS. 

Physicians assessed a proposed list to 

determine relationship of the proposed 

comorbidities to ESRD patients, and 

clinical practice/patterns. 

In addition to exploring a number of 

potential case-mix variables, we 

examined two methods, that is, linear 

and log linear models of the composite 

rate costs. We selected the log linear 

model in order to yield patient specific 

case-mix adjustments which can be 

multiplied by a dialysis facility’s 

otherwise applicable composite rate 

payment. In this proposed rule, we 

provide a detailed example of the 

calculation of the proposed case-mix 

adjusted composite rate payments. 

4. Proposed Patient Characteristic 

Adjustments 

As discussed in the background 

section above, the basic case-mix system 

is constrained by the composite rate and 

the data available for these adjustments. 

While we analyzed a number of 

variables, four patient characteristic 

variables were found to be modest 

predictors of cost variation among ESRD 

facilities. These patient characteristic 

variables include gender, age, and two 

comorbidities (AIDs and PVD) (See table 

3 for specific ICD 9 codes for these 

comorbidities). Each of the gender 

categories was also divided into three 

age categories so that one adjustment 

factor could be developed to encompass 

both gender and age. The proposed 

patient characteristic adjustments are 

discussed below. 

i. Gender and Age 

We are proposing adjustments for 

both gender and age. We found that 

gender and age were strong predictors of 

facility cost variations. In addition, data 

on gender and age are readily available, 

and are objective measures. After 

examining a number of options for age, 

we are proposing under 65, 65–79, and 

over 80 as the three categories for age. 

We attempted to develop a case-mix 

adjuster specific to the under 18 age 

group. However, the population in that 

age group that was included in the data 

used to develop the case-mix 

adjustments was too small, and was 

generally concentrated in a very small 

number of facilities. 

While we recognize that pediatric 

patients are more costly to treat, those 

patients are generally treated in 

specialized pediatric facilities. As 

provided in MMA, those facilities can 

request adjustments to their composite 

payment rates through the exceptions 

process. This process will enable 

pediatric facilities to obtain payments 

that specifically recognize the higher 

cost associated with treating these 

patients. In developing the age 

adjustments, data for those patients 

were grouped into the under 65 age 

category. We note that adjustments for 

both gender and age are consistent with 

the MA risk adjustment models for 

ESRD patients. 

ii. Proposed Comorbidity Adjustments 

As discussed above, the effect of the 

costs of dialysis for a number of 

conditions were analyzed. These 

included several comorbidities that did 

not have a statistically significant 

relationship to facility costs. In other 

cases, the lack of data precluded 

inclusion of a comorbid condition in the 

proposed patient characteristic 

adjustments. That is, we are unable to 

propose any adjustments based on data 

that cannot be routinely reported, (for 

example, some data elements that are 

reported only on the Form 2728). For 

the reasons discussed above, the Form 

2728 is not an appropriate source of 

information since it is not updated after 

a patient enters the ESRD program. Two 

variables not currently available on the 

Medicare bill are weight and height. 

Weight and height are used to compute 

a patient’s body mass index (BMI). Our 

analysis indicates that patients with 

extremely low or high BMI are costly to 

treat. Since BMI is directly related to a 

patient’s dialysis prescription, we 

believe this factor could be an important 

measure of resource consumption 

related to the composite payment rate. 

We also believe that the length of time 

a patient is dialyzed could directly 

affect composite rate costs. We are 

currently exploring the feasibility of 

developing a mechanism to collect these 

data on the ESRD bill. In addition, we 

are soliciting comments on other data 

elements that could be added to the bill 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47531

that could be relevant predictors of 

composite rate costs.

We also examined whether having 

cancer was predictive of higher resource 

used. We examined all cancers reported 

within the last 3 to 10 years as reported 

on our claims history file or the Form 

2728. While a patient’s history of cancer 

was associated with higher costs, we 

found this measure to be too broad to be 

clinically meaningful. We will continue 

to evaluate this condition as a potential 

variable for refinement purposes. As 

ESRD facilities begin reporting patient 

comorbidities, we expect that we will be 

in a better position to identify the 

specific cancer diagnoses that may be 

related to increased composite rate 

costs. 

We also explored whether diabetes as 

a comorbidity is predictive of high 

resource use. We found that the 

predictive power of diabetes was 

dependent on whether PVD was part of 

the model. PVD was always statistically 

significant, when accounted for, while 

most measures of diabetes were not 

strongly associated with facility costs. 

Therefore, we are proposing a case-mix 

adjustment for PVD diagnoses. We 

believe this adjustment appropriately 

addresses the higher costs associated 

with sicker diabetic patients. We note 

that about 73 percent of diabetes 

patients included in our data also had 

PVD. Another comorbid condition that 

was found to be a significant predictor 

of facility cost is AIDs. This diagnosis is 

currently coded as part of the claims 

data. 

Another Form 2728 variable we 

examined was the presence of a 

substance (alcohol and drugs) 

dependence diagnosis. While the 

presence of substance abuse was found 

to be predictive of higher facility level 

costs, we are not proposing an 

adjustment for this comorbidity at this 

time since the substance abuse 

diagnosis is underreported on the 

claims. We are soliciting comments on 

the variables included in the proposed 

patient characteristic adjustment as well 

as recommendations for the inclusion of 

other potential variables that may affect 

the costs of dialysis. 

In summary, we are proposing to use 

a limited number of patient 

characteristics that do explain variation 

in reported costs for composite rate 

services consistent with the legislative 

requirement. The proposed adjustment 

factors are as follows:

TABLE 15 

Female ..... age <65 years ............ 1.11 

age 65–79 years ......... 1.00 

age >79 years ............ 1.16 

TABLE 15—Continued

Male ......... age <65 years ............ 1.21 

age 65–79 years ......... 1.17 

age >79 years ............ 1.23 

AIDS ........ ..................................... 1.15 

PVD ......... ..................................... 1.07 

While the magnitude of some of the 

patient specific case-mix adjustments 

appears to be significant, facility 

variation in the case-mix is limited. This 

is because of the overall similarity of the 

distribution of patients among the eight 

case-mix classification categories across 

facility classification groups. This is 

reflected by the average case-mix 

adjustment based on 2002 data for the 

various types of ESRD facilities shown 

in the table below.

TABLE 16 

Facility type 

Average case 

mix adjustment 

All .......................................... 1.1919 

Independent .......................... 1.1917 

Hospital Based ..................... 1.1936 

Urban .................................... 1.1931 

Rural ..................................... 1.1865 

Small (<5k treatments/yr.) .... 1.1911 

Medium (5–10k treatments/

yr.) ..................................... 1.1910 

Large (>10k treatments/yr.) .. 1.1924 

Non-profit .............................. 1.1924 

For-profit ............................... 1.1918 

As illustrated from this table, 

regardless of the type of provider, the 

average case-mix adjustments for patient 

characteristics do not vary significantly. 

We are continuing research to develop 

a more fully bundled proposed model 

that is not constrained by the existing 

composite rate. We will continue to 

study the predictive value of 

comorbidities and facility and patient 

level variables as part of the ongoing 

research. In addition, we are aware that 

by limiting the number of variables for 

the patient characteristics adjustment 

applicable to the composite payment 

rate, we are limiting the predictive 

power of the model. We are planning to 

consider additional variables to refine 

and update the proposed patient 

characteristics. Once we have 

implemented this basic case-mix 

system, we will continue to analyze 

comorbidities (on the reported claims 

file) and will consider expanding the 

list of variables used in the patient 

classification adjustment. In addition, 

we will be working with our fiscal 

intermediaries to improve the reporting 

of comorbidities on claims.

5. Technical Description of Model Used 

To Develop the Proposed Patient 

Characteristic Adjustments 

Both facility and patient level 

variables were used for the development 

of the proposed case-mix adjustment. 

Facility costs are based on Medicare 

allowable costs reported by facilities for 

dialysis and related services for which 

they are reimbursed through the 

composite rate. The sources of the cost 

data are the Medicare Independent 

Renal Dialysis Facility Cost Reports 

(Form CMS 265–94) and the Medicare 

Hospital Cost Reports (Form CMS 2552–

96). We used the most current set of 

facility cost reports available (cost 

reports updated through December 2003 

and made publicly available in March 

2004). 

All cost reports spanning any part of 

calendar years 2000, 2001 or 2002 were 

included in the development of the case 

mix adjusters. While for most facilities, 

especially independent facilities, a 

single cost report encompasses the 

entire calendar year; data for some 

facilities, most notably those whose 

reporting period spans two calendar 

years (for example, October through 

September rather than January through 

December) were pro-rated to calculate 

the average treatment cost during a 

calendar year. The resulting numbers of 

cost reports used in the analyses are 

shown in the table below by facility 

type and year. Note that currently there 

are fewer cost reports available for 

analysis in 2002 because many facilities 

have not yet submitted cost reports for 

that year. The final version of this 

regulation will contain the most recent 

data available.

TABLE 17 

2000 2001 2002 

Independent facilities ............ 3,027 3,034 2,508 

Hospital-based 

facilities ......... 477 466 456 

The average treatment cost per 

dialysis session for each facility was 

calculated by dividing the total reported 

cost for dialysis and related services by 

the total number of dialysis treatments. 

The source of the reported cost for 

independent facilities was Worksheet B 

from Form CMS 265–94 and, for 

hospital-based facilities, Worksheet I–2 

(Form CMS 2552–96). The source for the 

total number of dialysis treatments for 

independent facilities was worksheet 

Form CMS265–94 and, for hospitalbased facilities, worksheet I–4 (Form 

CMS 2552–96). Note that, for CMS Form 

2552–96 and CMS Form 265–94, values 

47532 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

in the fields for renal dialysis and home 

program dialysis were used in the cost 

and treatment calculations. For the CMS 

Form 265–94 and the CMS Form 2552–

96 (Worksheet C, and worksheet I–4, 

respectively) values in the field home 

program CAPD and home program 

CCPD were stated in terms of patient 

weeks, rather than the number of 

treatments. These cells were multiplied 

by three to make them comparable to 

the number of hemodialysis sessions per 

week. The method used was consistent 

with the research (Dor, Held, Pauley 

1992, Hirth, et.al., 1999, Griffiths, et.al., 

1994, and Ozgen and Ozcan, 2002). 

This method created an average 

Medicare allowable cost per dialysis 

treatment for each facility year of 

observation. Using the facility’s 

Medicare billing number, cost report 

data were linked to claims data. For 

some facilities more than one billing 

number appears on claims and a list of 

correspondence among billing was used 

to link the claims to the cost report 

facility identifiers. This linkage was 

somewhat ambiguous for hospital 

facilities with satellite centers. 

Patient level data was obtained from 

the Medicare claims data, and the 

Medical Evidence Form (CMS 2728). 

ESRD patients were identified using the 

Renal Beneficiary and Utilization 

System (REBUS), Medical Evidence and 

Master Patient File Records. Dialysisrelated services (for example, the 

number of dialysis sessions) were 

identified for ESRD patients by Billing 

source (72x: renal dialysis facility bills), 

revenue center codes and the Healthcare 

Common Procedure Coding System 

(HCPCS).

6. Study Sample 

Regression models for the average cost 

per session were used to estimate the 

typical cost per session. The average 

cost per session can be influenced by 

facilities with exceptional costs or with 

exceptional case-mix measures. To 

insure that the sample would 

characterize the patterns across the 

majority of facilities rather than being 

influenced by a few exceptional, nonrepresentative facilities, the following 

facilities were excluded: 

• Facilities with missing data from 

the cost reports or claims data. Twelve 

percent of the facilities lacked reported 

data. 

• Facilities with high or low average 

costs. 

• Facilities with exceptions. 

• Facilities with extremely high or 

low proportions of patients with 

relevant medical cormorbidities. 

• Small facilities. 

Facilities with high or low average 

costs were determined based upon their 

composite rate. Facilities, having values 

for the log of the ratio of average costs 

to the composite rate of less than minus 

0.5 or greater than 1.0 were excluded. 

This excluded less than 1 percent of 

facilities. Some facilities, that is, those 

with extremely high or low values based 

on selected patient characteristics (for 

example, percent of patients having a 

specific comorbidities such as AIDs, 

HIV, or alcohol and drug dependence) 

and selected facility characteristics (for 

example, facility size or URR). As with 

average costs, facilities with extreme 

variables did not represent the normal 

distribution of patient characteristics 

across facilities. This excluded 1.6 

percent of the facilities. In addition, we 

excluded small facilities with less than 

20 full patient years of dialysis during 

the year because it was difficult to 

assess the relationship between casemix and facility costs based on the 

experience of a small number of 

patients. Facilities treating a small 

number of patients represented 

approximately 6.9 percent of the total 

facilities. 

The sample excluded facilities with 

exceptional reimbursement levels. 

These included facilities with 

exceptions, facilities with higher than 

average payments, for example, with 

$3.00 or greater than the predicted 

composite rate payments. We excluded 

facilities based on our list of exceptions 

granted from November 1993 to July 

2001. Some facilities were not included 

within the sample because their average 

payments were greater than the 

calculated (predicted) composite rate for 

the individual facility. While for the 

majority of the facilities, average 

composite rate payments were exactly 

as predicted, for some facilities, the 

payments were $3.00 greater than the 

predicted rate. These facilities were 

excluded because they were likely to be 

facilities with errors in reporting or 

facilities with exceptions. Of all of the 

facilities in the sample, 7.5 of the 

facilities were excluded from the 

sample. 

7. Developing Case-Mix Measures at 

Each Facility Based on Patient-Specific 

Data 

Facility-level case-mix measures were 

defined using certain demographic and 

comorbidity indicators for the Medicare 

dialysis patients in each facility for CYs 

2000 to 2002. In aggregating patient data 

by facility, case-mix measures for each 

patient were weighted by the number of 

hemodialysis-equivalent dialysis 

sessions received in each facility. This 

process gives approximately 12 times as 

much weight to the characteristics of 

patients receiving a full year of dialysis 

care at a particular facility as compared 

to a patient receiving only one month of 

care at that facility. The resulting 

facility-level case-mix measures reflect 

how case-mix is distributed across 

individual treatments provided in the 

facility for Medicare dialysis patients. 

The number of dialysis sessions for each 

patient in each facility was obtained 

from Medicare outpatient institutional 

dialysis claims. The number of 

peritoneal dialysis patient days reported 

on each claim was multiplied by 3/7 to 

yield the number of hemodialysisequivalent dialysis sessions provided 

during the time period covered by each 

claim. (For additional information see 

Phase I KECC Report, dated August 

2002, p. 43). 

8. Statistical Models 

We explored a number of statistical 

methods to model the relationship 

between composite rate costs and 

patient/facility characteristics. We 

explored both linear and log-linear 

ordinary least squares regression models 

for each year from 2000 to 2002 to 

predict the natural log of the ratio of 

each facility’s composite rate costs 

divided by that facility’s composite 

payment rate (without regard to 

exception payments). 

i. Choice of Estimation Method 

We are proposing to use the log linear 

model in the methodology explained 

below in order to yield an easily 

administered case-mix adjuster which 

can be multiplied by the patient’s 

otherwise applicable composite 

payment rate. This case-mix adjustment 

system also controls for selected 

variables. 

We used the cost to payment ratio 

(that is, the natural log of the ratio of 

reported costs compared to the 

composite rate calculated for each 

facility) as the dependent variable in the 

models. The analysis that supports our 

decision is described in detailed below. 

In order to determine how 

reimbursement levels could be adjusted 

to reflect the costs of treating different 

patients, estimates of how the cost of 

providing dialysis services (that is, the 

composite rate) varies according to the 

patient characteristics (for example, age 

gender and comorbidities) were 

completed. Because the reported cost 

per treatment for each facility, in part, 

reflects the level of reimbursement (for 

example, Medicare payments) that the 

facility received, the measure of facility 

costs used is defined as the ratio relative 

to the current standard reimbursement 

level for each facility. For the purposes 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47533

of these analyses, the standard Medicare 

reimbursement payments for composite 

rate services (excluding those facilities 

with payment exceptions) were used. 

These currently vary across facilities 

based on the application of the area 

wage index used to develop the patient 

characteristics adjustment. This wage 

index (that is, labor costs) was used to 

account for regional differences in labor 

costs, and includes an adjustment for 

hospital based versus independent 

facility status. 

As we have indicated, the costs of 

treatment varies from the composite rate 

payment for a number of reasons, 

including differences in the patient 

case-mix. The ratio of average reported 

costs at each facility were compared 

with the calculated composite rate 

payment in order to measure any 

variation in costs (that is, facility costs) 

from the composite rate. This cost to 

payment ratio measures the extent to 

which costs at a facility are higher or 

lower than the payment that would be 

expected based on their labor costs and 

facility type. Regression analysis was 

used to determine the extent to which 

the ratio varied with the average casemix for each facility. 

The analysis indicated that a log 

transformation of this cost to payment 

ratio was less skewed and a better fit 

(that is, the predicted variables were 

closer to the actual values using the log 

transformation). 

ii. Control Variables

Apart from patient clinical and 

demographic characteristics, the 

proposed model also controls for 

selected other variables. These selected 

control variables include the wage 

index, the natural log of facility size 

(number of annual treatments), hospitalbased/independent status, chain 

affiliation, and percent of patients with 

urea reduction ratios (URRs) greater 

than or equal to 65 percent. These 

control variables were included in the 

proposed model in order to account for 

the separate effect of facility variables 

and one readily available outcome 

variable on composite rate costs. These 

control variables were included in order 

to reduce potential distortion in the 

patient specific case-mix adjustors 

attributable to facility characteristics. 

We included the wage index to account 

for differences among facilities in area 

wage levels. We used facility size as a 

control factor because larger facilities, 

on average, have lower per treatment 

costs than smaller facilities. The 

hospital-based/independent 

classification was used because hospital 

based providers tend to have higher selfreported costs. Chain ownership is 

included in the model to account for 

differences among chains due to 

reporting conventions, as well as reflect 

similarities among facilities within 

chains. The URR was included as a 

control variable to account for a quality 

of care outcome measure at each facility, 

thereby mitigating any potential bias 

between composite rate costs and 

quality of care on the model’s 

coefficients. 

iii. The Log-Linear Model for Facility 

Costs 

We identified a limited number of 

comorbidities that are strong predictors 

of composite rate costs and developed 

an estimated adjustment factor for each 

of these comorbidities. In order to yield 

an adjustor that can be multiplied with 

the composite rate payment, the model 

was used to estimate the facility’s 

reported composite rate costs per 

treatment, divided by the composite 

payment rate calculated for each 

facility. The resulting ratio was modeled 

using case-mix and control variables. 

Analysis indicated that a log 

transformation of this ratio was less 

skewed and was better fit by the model 

(that is, predicted values were closer to 

actual values using the log 

transformation, especially for high cost 

facilities). 

For facility j, the case-mix is 

measured by a vector of values, denoted 

by Xj. These values include both control 

variables and case-mix measures. The 

log of the ratio of cost per session (Cj) 

to composite rate (Rj) is denoted by 

Yj=log(Cj/Rj). The multiple observations 

for three years are not indicated 

explicitly. The model equation is Yj = Xj

b + ej, where b is the vector of 

coefficients for the predictor variables 

and ej is an error term. This model is 

equivalent to the following model for 

cost for patient i, with a vector of 

individual characteristics Xij, at facility 

j: Cij = Rj eXijb. 

9. Identifying Factors for Case-Mix 

Adjustment 

An evaluation of individual case-mix 

factors as potential risk adjusters was 

performed using several criteria to 

explain variation in facility costs. 

Consideration was also given to the 

validity of these potential case adjustors 

to costs based on clinical judgment, the 

stability of this relationship over time, 

the objectivity and accuracy of the data 

used to compute the factors, the 

reliability of information reported by 

different providers, and the feasibility of 

including them as risk adjusters. 

Case-mix factors that explained 

statistically significant variation in 

facility costs were identified based on a 

regression model that used a stepwise 

selection method. Unless otherwise 

specified, case-mix measures represent 

the fraction of dialysis sessions in each 

facility that were provided to patients 

having the relevant characteristic or 

comorbidity. Case-mix measures that 

were considered for selection in the 

model included age/gender groups (ages 

<65, 65–79 and 80+ years, separately for 

females and males), less than one year 

of treatment for ESRD, average weight 

among adult dialysis patients (ages≥20), 

low body mass index among adult 

dialysis patients (BMI<18.5 kg/m2) and 

the presence of individual comorbidities 

that were previously described that 

were developed from a combination of 

data from the Medicare claims history 

file and the CMS Form 2728. 

10. Using the Model To Apply a PatientSpecific Case-Mix Adjustment to the 

Composite Rate 

The regression coefficients that are 

estimated using facility cost model we 

discuss above can be used to apply a 

patient-specific case mix adjustment to 

the composite rate. This is 

accomplished by re-transforming the 

estimated coefficients to obtain relative 

factors for case mix adjustment. Based 

on a facility level cost model, where Xn

is the proportion of patients in a facility 

having a specific characteristic (for 

example, a specific comorbidity), a one 

unit change in Xn can be used to 

characterize the difference between 

having and not having a specific patient 

characteristic. The coefficient for Xn,bn, 

then estimates the change in the 

dependent variable (the natural log of 

the ratio of average composite rate costs 

to the composite rate) corresponding to 

whether or not a patient has that 

characteristic. The estimated 

coefficients can be re-transformed as e 

Xinbtv to obtain relative factors for n=1 

to N case-mix measures included in the 

model. 

The relative factors can then be 

applied multiplicatively to the 

composite rate in order to derive a case 

mix adjusted composite rate. Since 

these relative factors were all estimated 

to have values of 1.00 or greater, an 

adjustment to the composite rate based 

on these factors would necessarily lead 

to higher payments by Medicare. 

However, the MMA provision requires 

that the modification to the composite 

rate payment system be budget neutral. 

For the purpose of this example only, a 

budget neutrality factor that is less than 

1.00 must, therefore, also be applied, 

with the same factor being applied to all 

patients and all facilities. 

For patient i in facility j, a case-mix 

adjusted composite rate, ARij is 

47534 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

calculated as a function of the current 

composite rate, Rij, the estimated budget 

neutrality factor, N (to be determined), 

and an overall relative factor for case 

mix adjustment, Aij, where ARij = Rj * 

N * Aij, Rj = (rBjWj + (1¥r)Bj, and Aij

= eXijb. 

In the above equations, r is the 

fraction of costs attributed to labor and 

therefore subject to an adjustment for 

geographic differences in wages, 1-r is 

the fraction of costs attributed to nonlabor inputs, Bj is the base rate for 

facility j, Wj is the CMS/BLS wage index 

for facility j (with 0.9 and 1.3 

representing the minimum and 

maximum values for Wj, respectively), 

Xij is a vector of case-mix measures for 

patient i at facility j, and B is the vector 

of coefficients estimated by the 

regression model. Parameters Pj and Bj

vary according to whether facilities are 

independent or hospital-based and may 

also vary over time, while Wj is 

determined either by the MSA in which 

each facility is located or by the state 

location for facilities not in an MSA. 

As suggested by the equations above, 

the coefficients estimated by the cost 

model can be used to derive an 

aggregate relative adjustment factor for 

each patient (Aij) based on their 

individual characteristics (Xi). By 

applying this factor in a multiplicative 

fashion to the composite rate, it is also 

being applied multiplicatively to the 

wage index, so that the dollar effect of 

the case-mix adjustment also varies 

across facilities according to regional 

differences in labor costs. That is, the 

case-mix adjustment will be larger in 

magnitude for facilities that face 

relatively high labor costs. This is 

appropriate if we expect the higher level 

of care that may be necessary for certain 

types of patients, such as those with 

PVD, to require additional staff time or 

more highly trained staff in locales with 

differential wage levels. An overall 

relative case-mix adjustment factor for 

patient i, Ai, can be calculated based on 

the model as Ai = eXib = eX1ib1 + X2ib2

+ + Xpibp. 

However, since this is equivalent to Ai

= eXib = eX1ib1*eX2ib2* . . . *eXnibn, 

the overall relative case-mix adjustment 

factor, or patient multiplier, can be 

calculated by multiplying together the 

relative adjustment factors for each casemix measure. For every n=1 to p, Xpi

corresponds to a 1 if that characteristic 

is present and a 0 if that characteristic 

is not present. For any characteristic 

that is not present, Xpi=0 and eXpibp=1, 

such that the equation can be simplified 

by including only those terms that are 

relevant for each patient. For 

characteristics that are present, Xpi=1, 

and the equation can be further 

simplified by dropping Xpi. 

Where the individual factors for casemix adjustment are age/gender, PVD 

and AIDS, the equation used to 

calculate the relative factor for case mix 

adjustment can then be expressed as Ai

=eβ = eβAS*eβPVD*eβAIDS where eβAS is 

the relative factor for the appropriate 

age and sex category (one of six age/sex 

groups), eβPVD is the relative factor for 

the relevant PVD category (whether PVD 

is present or absent) and eβAIDS is the 

relative factor for the appropriate AIDS 

category (whether AIDS is present or 

absent). 

11. Example 

To illustrate, the proposed adjustment 

factors in section 4. above were used to 

derive a case-mix multiplier for a 7-year 

old male who has been diagnosed with 

PVD, but not AIDS. Using the proposed 

adjustment factors that correspond to 

males between the ages of 65 and 79 

years and the presence of PVD, the 

overall case-mix multiplier for this 

patient is calculated as A = eXb = 

eβAS*eβPVD = 1.17 × 1.07 = 1.2519. 

A detailed example of the 

computation of the adjusted composite 

payment rate that includes the patient 

characteristics adjustments, as well as 

the applicable adjustments related to the 

ESRD drug payment revisions and 

budget neutrality, is provided later in 

this section I. below. 

e. Geographic Index 

Section 623(d)(1) of the MMA 

provides that the Secretary shall adjust 

the payment rates under this section by 

a geographic index as the Secretary 

determines to be appropriate. This 

section also specifies that, if the 

Secretary revises the current geographic 

adjustments applied to the composite 

payment rate, the revised adjustments 

must be phased in over a period of time. 

The current geographic adjustment 

(wage index) is a blend of two wage 

indexes, one based on hospital wage 

data collected by us from fiscal year 

1986 and the other developed from 1980 

hospital wage and employment data 

from the Bureau of Labor Statistics 

(BLS). The hospital and BLS 

proportions of the blended wage index 

are 40 percent and 60 percent. The 

actual wage index values and MSA/nonMSA designations currently used in 

connection with the composite rates 

were published in the August 15, 1986 

Federal Register (51 FR 29412–29417). 

For the reasons discussed below, we 

have decided not to propose any 

changes to the current wage index 

adjustments at this time. 

On June 6, 2003, OMB issued Bulletin 

03–04 that announced new MSAs and 

two new sets of statistical areas, 

Micropolitan Statistical Areas and 

Combined Statistical Areas (CSAs). We 

recognize that the new OMB definitions 

will have implications for the various 

payment systems we administer that 

reflect payment distinctions based on 

geographic location. Any changes 

adopted will not only result in payment 

redistributions among ESRD facilities, 

but will also affect hospitals, home 

health agencies, skilled nursing 

facilities, and rehabilitation providers. 

Therefore, it is essential that we 

evaluate any proposals to revise the area 

definitions and assess the impact of 

changes in geographical areas on those 

payment systems that incorporate 

adjusters for area wage levels among 

urban and rural locations. 

Although the MMA gives the 

Secretary discretion to revise the 

outdated wage indexes used in the 

composite rates, we believe that we 

should take no action to replace them 

with revised measures pending 

completion of our assessments. 

Therefore, we are proposing to take no 

action at this time to revise the current 

set of composite rate wage indexes and 

the urban and rural definitions used to 

develop them. Once revisions to the 

urban and rural definitions are adopted, 

we may be in a better position to 

propose revisions to the geographic 

adjustments applied to the case-mix 

adjusted composite payment rates. 

For purposes of applying the required 

geographic adjustments to the case-mix 

adjusted composite rate payment 

system, we are proposing to continue 

using the wage index values and urban 

and rural designations that are currently 

applied to the composite payment rates. 

Section 1881(b)(12)(E)(i) of the Act, as 

added by section 623(d)(1) of the MMA, 

requires that the basic case-mix adjusted 

composite rate system be designed to 

result in the same aggregate amount of 

expenditure for such services, as 

estimated by the Secretary, as would 

have been made for 2005 if that 

paragraph did not apply. Therefore, the 

drug add-on adjustment and the patient 

characteristics case-mix adjustment 

required by section 623(d)(1) of the 

MMA must result in the same aggregate 

expenditures for 2005 as if these 

adjustments were not made. 

With respect to the drug payment 

add-on adjustment the total estimated 

difference between the current drug 

payment based on 95 percent of AWP 

and the payment amount generated from 

payment based on ASP minus 3 percent 

is reflected in the proposed adjustment 

which is designed so that aggregate 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47535

payments are budget neutral. (See 

section H.4.c.2. of this proposed rule for 

more detailed explanation of drug addon adjustment). 

In order to account for the payment 

effect related to the case-mix 

adjustment, we standardized the 

composite rate by dividing the rate by 

the average case-mix modifier of 1.1919. 

(See section 4.ii Proposed Cormorbidity 

Adjustments). The resulting adjustment 

to the composite rate is .8390. However, 

we were not able to simulate the casemix effects from the ESRD billing file 

because comorbidities are generally not 

included on the ESRD bill. (See section 

H.3. of this proposed rule for the 

discussion of the data issues.) We 

propose to refine our adjustments for 

case-mix once we have more complete 

data on the ESRD bill. 

F. Payment Exceptions and the Revised 

Composite Payment Rates 

Before the enactment of BIPA, an 

ESRD facility could apply for and 

receive prospective adjustments or 

exceptions to its otherwise applicable 

composite payment rate under specified 

circumstances. Section 1881(b)(7) of the 

Act and § 413.182 contain the statutory 

and regulatory authorities for the 

provision of exceptions to the composite 

payment rates. Section 422(a)(2) of BIPA 

prohibited the granting of new 

exceptions to the composite payment 

rates on or after December 31, 2000, 

except under very limited 

circumstances, which expired July 1, 

2001. That prohibition remains in effect, 

with one exception. Section 623(b) of 

the MMA amended section 422(a)(2) of 

BIPA to afford pediatric facilities the 

opportunity to seek exceptions provided 

they did not have an exception rate in 

effect as of October 1, 2002. The statute 

defines a pediatric facility as a renal 

facility, 50 percent of whose patients are 

under age 18. On April 1, 2004, we 

opened an exception window for 

pediatric facilities. The exception 

window closes September 27, 2004. 

Section 422(a)(2)(C) of BIPA provided 

that any ESRD composite rate exception 

in effect on December 31, 2000 would 

continue as long as the exception rate 

exceeds the applicable composite 

payment rate. The MMA did not revise 

that provision. Comparisons of a 

provider’s exception rate and the 

standard composite payment rate are 

straightforward, because each payment 

rate was applied on a facility specific 

basis, without any adjustments for casemix. However, in this proposed rule, we 

are proposing revised composite 

payment rates that are case-mix 

adjusted. The wage adjusted composite 

payment rates listed for each urban and 

rural area noted in Tables I and II at the 

end of this section, although applied on 

a per treatment basis, are subject to case 

mix adjustments in accordance with 

section 623(d)(1) of the MMA. The 

proposed methodology for applying 

patient characteristic adjusters 

applicable to each treatment will 

determine the case-mix adjustment 

which will vary for each patient. Thus, 

an ESRD facility’s average composite 

rate per treatment will depend on its 

unique case mix. 

Our policy was not to increase any 

ESRD facility’s exception rate when 

there has been a congressionally 

mandated update to the ESRD 

composite payment rates. When 

computing an exception amount, we 

take into consideration the ESRD 

facility’s patient population and the 

higher costs relating to the patient mix. 

Since ESRD facilities can maintain their 

current exception rates, we would 

expect them to compare the exception 

rate to the basic case-mix adjusted 

composite rate to determine the best 

payment rate for their facility. We are 

proposing to allow each dialysis facility 

the option of continuing to be paid at its 

exception rate or at the basic case-mix 

adjusted composite rate (which includes 

all the MMA 623 payment adjustments). 

If the facility retains its exception rate, 

it would not be subject to any of the 

adjustments specified in section 623 of 

the MMA. Whether a provider’s 

exception rate in effect on December 31, 

2000 will exceed its average case-mix 

adjusted composite payment rate is 

impossible for us to accurately 

determine. We believe that projections 

as to whether an ESRD facility’s 

exception rate per treatment will exceed 

its average case-mix adjusted composite 

rate per treatment are best left to the 

entities affected. Therefore, we are 

proposing that each ESRD facility with 

composite rate exceptions currently in 

effect, and each pediatric ESRD facility 

granted an exception, must notify its 

fiscal intermediary in writing if it 

wishes to withdraw its exception and be 

subject to the basic case-mix adjusted 

composite payment rate methodology 

set forth in this notice. 

We are proposing to allow an ESRD 

facility to notify its fiscal intermediary 

at any time if it wishes to give up its 

exception rate. Once a facility has 

notified its fiscal intermediary of its 

election to give up its exception rate, it 

would lose that exception rate, 

regardless of basis or amount, and be 

subject to the proposed case-mix 

adjusted composite payment rates 

beginning 30 days after the 

intermediary’s receipt of the facility’s 

notification letter. Facilities with 

exception rates will be required to 

notify their fiscal intermediaries only if 

they wish to forego their exceptions. 

ESRD facilities electing to retain their 

exceptions do not need to notify their 

intermediaries. ESRD facilities without 

exceptions, of course, will be subject to 

the composite payment rates 

determined using the basic case-mix 

methodology described in this notice 

beginning January 1, 2005.

G. Summary of Composite Rate 

Revisions and Proposed Implementation 

As set forth in this proposed rule, we 

will increase the ESRD composite 

payment rates by 1.6 percent effective 

January 1, 2005 in accordance with 

section 623(a) of the MMA. Also, the 

composite payment rates will be 

increased to reflect revisions to the drug 

pricing methodology for separately 

billable drugs, as discussed in section 

H.4.b. of this proposed rule. That 

increase represents the spread or 

difference between the payment 

amounts for separately billable drugs 

and biologicals and their acquisition 

costs based on the OIG’s May 2004 

report to the Secretary. The 

development and computation of the 

drug add-on adjustment are described in 

section H.4.c of this proposed rule. We 

have also proposed a basic case-mix 

methodology for adjusting the 

composite payment rates based on a 

limited number of patient 

characteristics, as prescribed in section 

623(d) of the MMA. The development 

and application of the case-mix 

adjusters are explained in section 

H.4.d.4 of this proposed rule. The MMA 

requires that the basic case-mix adjusted 

composite payment rates be effective for 

services furnished beginning January 1, 

2005. Despite the law’s specificity with 

respect to effective date, the systems 

and operational changes necessary to 

apply the case-mix adjusters cannot be 

completed in time for a prospective 

January 1, 2005 effective date. 

The 1.6 percent statutory increase and 

11.3 drug add-on for independent and 

hospital-based facilities for separately 

billable drugs will be applied to the 

composite rates for all ESRD facilities 

beginning January 1, 2005. However, the 

computation of the case mix adjusters 

depends on age, sex, and specific 

comorbidities which must be obtained 

from the bills for each ESRD facility. 

Therefore, the combination of case-mix 

adjusters used to increase a provider’s 

otherwise applicable composite 

payment rate depends on a provider’s 

unique patient profile and is facilityspecific. The correct computation of 

these facility-specific case-mix adjusters 

will require numerous programming, 

47536 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

systems, billing, and instructional 

changes by us, fiscal intermediaries, and 

system maintainers. In addition, 

providers and their fiscal intermediaries 

will require education and training not 

only on the basic features of the new 

ESRD PPS, but also on the proper 

reporting of patient and clinical 

information on the bills, essential for an 

accurate case mix adjustment in 

connection with each patient’s claims. 

Given these requirements, the lead 

time necessary for systems changes, and 

the anticipated time necessary for 

providers and their fiscal intermediaries 

to familiarize themselves with and 

correctly apply the basic case-mix 

adjustments, we are proposing an April 

1, 2005 effective date. 

As an alternative to an April 1, 2005 

effective date for the patient 

characteristic case mix adjustments, we 

considered two options for an April 1, 

2005 prospective implementation date 

that would effectively comply with the 

MMA’s January 1, 2005 effective date. 

Under the first option, we would 

implement the patient characteristic 

adjustments on April 1, 2005 and 

reprocess bills and adjust payments to 

January 1, 2005. Under this option, the 

budget neutrality adjustment related to 

the patient characteristic factors would 

not be applied to the composite rate 

until bills are reprocessed. 

The second option that we considered 

was to make payment to facilities 

starting January 1, 2005, at the budget 

neutralized composite rate, until the 

systems changes for the case-mix 

adjustment can be implemented, April 

1, 2005. Payment at this rate would 

avoid overpayments, and thus, the need 

to recoup moneys that may occur when 

we retroactively process the claims for 

case-mix adjustments on April 1, 2005. 

Under this option, facilities would 

receive approximately 16 percent less 

than they would otherwise be entitled to 

on January 1, 2005. 

We rejected both of these alternatives. 

Both options require the reprocessing 

and adjustment of bills for the first 

quarter of 2005. In addition, because of 

the likelihood of payment error due to 

the complexity of the process and costly 

implementation and potential 

disruption of payment to ESRD 

facilities, we believe that these options 

are problematic. Given that the expected 

impact of the patient characteristic 

adjustments on ESRD facility payments 

will, for the most part, be minimal, we 

believe that applying the adjustments 

prospectively from April 1, 2005 

provides a smoother transition to the 

new payment methodology.

Finally, this notice provides for a 

budget neutrality reduction of .8390 

percent to the case-mix adjusted 

composite payment rates. Our budget 

neutrality methodology is explained in 

section H.4.f. of this proposed rule. 

Because section 623(d) of the MMA 

requires that budget neutrality be 

applied in the context of implementing 

the case-mix adjusted composite rate 

payment system, we are proposing that 

the effective date of the budget 

neutrality adjustment should also be 

April 1, 2005. If we applied the budget 

neutrality adjustment in January, rather 

than when the case-mix adjustment is 

applied in April, the result would be 

that all the composite rates would go 

down. 

We are specifically soliciting 

comments on these options of the 

proposed rule. However, the 1.6 percent 

statutory increase to the composite 

payment rates, and the drug add-on for 

separately billable drugs, will be 

effective January 1, 2005, as these 

adjustments are easily implemented 

prospectively. 

IV. Example of Payment Calculation 

Under the Proposed Case-Mix Adjusted 

Composite Rate System 

The following example presents 2 

patients dialyzing at Neighbor Dialysis, 

an independent facility in Baltimore, 

MD. Patient #1, John Smith, is a 71-year 

old male who has been diagnosed with 

PVD and AIDS. Patient #2, Jane Doe, is 

a 59-year old female who has been 

diagnosed with PVD. 

Calculation of Basic Composite Rate for 

Neighbor Dialysis 

Wage adjusted Composite Rate for 

independent facilities in Baltimore, 

Md. (Table I): $134.93 

Wage adjusted Composite Rate 

increased by proposed drug add-on 

adjustment ($134.93 x 1.113): $150.18 

Adjusted Facility Composite Rate after 

budget neutrality (150.18 x .8490): 

$126.00 

Calculation of Case-mix Adjusted 

Payments 

Patient #1—John Smith: 

Male age 65–79 years: 1.17 

AIDS: 1.15 

PVD: 1.07 

Case-mix adjusted rate for John Smith 

($126.00 x 1.17 x 1.15 x 1.07): $181.40 

Patient #2—Jane Doe: 

Female age < 65 years: 1.11 

PVD: 1.07 

Case-mix adjusted rate for Jane Doe 

($126.00 x 1.11 x 1.07): $149.65

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005 

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

0040 .................. ABILENE ......................................................................................................... TX ................ 127.58 123.18 

0060 .................. AGUADILLA .................................................................................................... PR ............... 127.57 123.18 

0080 .................. AKRON ........................................................................................................... OH ............... 137.39 133.68 

0120 .................. ALBANY .......................................................................................................... GA ............... 127.57 123.18 

0160 .................. ALBANY-SCHENECTADY-TROY .................................................................. NY ............... 129.93 125.70 

0200 .................. ALBUQUERQUE ............................................................................................ NM ............... 135.60 131.77 

0220 .................. ALEXANDRIA ................................................................................................. LA ................ 129.70 125.46 

0240 .................. ALLENTOWN-BETHLEHEM .......................................................................... PA-NJ .......... 134.75 130.87 

0280 .................. ALTOONA ....................................................................................................... PA ............... 133.79 129.84 

0320 .................. AMARILLO ...................................................................................................... TX ................ 130.03 125.80 

0360 .................. ANAHEIM-SANTA ANA .................................................................................. CA ............... 145.72 142.64 

0380 .................. ANCHORAGE ................................................................................................. AK ............... 146.35 146.35 

0400 .................. ANDERSON .................................................................................................... IN ................ 131.74 127.63 

0405 .................. ANDERSON .................................................................................................... SC ............... 127.57 123.18 

0440 .................. ANN ARBOR .................................................................................................. MI ................ 145.80 142.71 

0450 .................. ANNISTON ..................................................................................................... AL ................ 127.57 123.18 

0460 .................. APPLETON-OSHKOSH-NEENAH ................................................................. WI ................ 132.60 128.56 

0470 .................. ARECIBO ........................................................................................................ PR ............... 127.57 123.18 

0480 .................. ASHEVILLE .................................................................................................... NC ............... 130.57 126.39 

0500 .................. ATHENS ......................................................................................................... GA ............... 127.57 123.18 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47537 

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued 

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

0520 .................. ATLANTA ........................................................................................................ GA ............... 130.07 125.84 

0560 .................. ATLANTIC CITY ............................................................................................. NJ ................ 134.72 130.82 

0600 .................. AUGUSTA ....................................................................................................... GA-SC ......... 130.08 125.85 

0620 .................. AURORA-ELGIN ............................................................................................. IL ................. 140.21 136.70 

0640 .................. AUSTIN ........................................................................................................... TX ................ 135.14 131.29 

0680 .................. BAKERSFIELD ............................................................................................... CA ............... 141.64 138.25 

0720 .................. BALTIMORE ................................................................................................... MD ............... 138.55 134.93 

0733 .................. BANGOR ........................................................................................................ ME ............... 129.34 125.09 

0760 .................. BATON ROUGE ............................................................................................. LA ................ 131.80 127.71 

0780 .................. BATTLE CREEK ............................................................................................. MI ................ 134.05 130.11 

0840 .................. BEAUMONT-PORT ARTHUR ........................................................................ TX ................ 130.85 126.67 

0845 .................. BEAVER COUNTY ......................................................................................... PA ............... 138.52 134.89 

0860 .................. BELLINGHAM ................................................................................................. WA .............. 132.87 128.85 

0870 .................. BENTON HARBOR ........................................................................................ MI ................ 127.57 123.18 

0875 .................. BERGEN-PASSAIC ........................................................................................ NJ ................ 142.22 140.71 

0880 .................. BILLINGS ........................................................................................................ MT ............... 132.16 128.08 

0920 .................. BILOXI-GULFPORT ........................................................................................ MS ............... 127.57 123.18 

0960 .................. BINGHAMTON ................................................................................................ NY ............... 130.00 125.77 

1000 .................. BIRMINGHAM ................................................................................................. AL ................ 131.83 127.73 

1010 .................. BISMARCK ..................................................................................................... ND ............... 130.64 126.47 

1020 .................. BLOOMINGTON ............................................................................................. IN ................ 129.78 125.54 

1040 .................. BLOOMINGTON-NORMAL ............................................................................ IL ................. 129.69 125.45 

1080 .................. BOISE CITY .................................................................................................... ID ................ 135.23 131.39 

1123 .................. BOSTON-SALEM-BROCKTON ...................................................................... MA ............... 139.45 135.89 

1125 .................. BOULDER-LONGMONT ................................................................................. CO ............... 140.62 137.15 

1140 .................. BRADENTON ................................................................................................. FL ................ 128.79 124.47 

1145 .................. BRAZORIA ...................................................................................................... TX ................ 134.02 130.08 

1150 .................. BREMERTON ................................................................................................. WA .............. 129.14 124.87 

1163 .................. BRIDGEPORT-NORWALK-DANBURY .......................................................... CT ............... 141.49 138.08 

1240 .................. BROWNSVILLE-HARLINGEN ........................................................................ TX ................ 129.79 125.56 

1260 .................. BRYAN-COLLEGE STATION ......................................................................... TX ................ 128.68 124.37 

1280 .................. BUFFALO ....................................................................................................... NY ............... 133.55 129.59 

1300 .................. BURLINGTON ................................................................................................ NC ............... 127.57 123.18 

1303 .................. BURLINGTON ................................................................................................ VT ................ 131.37 127.24 

1310 .................. CAGUAS ......................................................................................................... PR ............... 127.57 123.18 

1320 .................. CANTON ......................................................................................................... OH ............... 131.51 127.40 

1350 .................. CASPER ......................................................................................................... WY .............. 136.29 132.52 

1360 .................. CEDAR RAPIDS ............................................................................................. IA ................. 131.05 126.92 

1400 .................. CHAMPAIGN-URBANA-RANTOUL ................................................................ IL ................. 133.39 129.39 

1440 .................. CHARLESTON ............................................................................................... SC ............... 131.44 127.33 

1480 .................. CHARLESTON ............................................................................................... WVA ............ 135.86 132.06 

1520 .................. CHARLOTTE-ROCK HILL .............................................................................. NC-SC ......... 129.79 125.57 

1540 .................. CHARLOTTESVILLE ...................................................................................... VA ............... 133.15 129.15 

1560 .................. CHATTANOOGA ............................................................................................ TN-GA ......... 132.45 128.39 

1580 .................. CHEYENNE .................................................................................................... WY .............. 131.21 127.06 

1600 .................. CHICAGO ....................................................................................................... IL ................. 142.79 139.48 

1620 .................. CHICO ............................................................................................................ CA ............... 139.53 135.98 

1640 .................. CINCINNATI ................................................................................................... OH-KY-IN .... 137.22 133.50 

1660 .................. CLARKSVILLE-HOPKINSVILLE ..................................................................... TN-KY ......... 127.57 123.18 

1680 .................. CLEVELAND ................................................................................................... OH ............... 141.66 138.27 

11720 ................ COLORADO SPRINGS .................................................................................. CO ............... 135.83 132.03 

1740 .................. COLUMBIA ..................................................................................................... MO .............. 140.08 136.56 

1760 .................. COLUMBIA ..................................................................................................... SC ............... 130.43 126.24 

1800 .................. COLUMBUS .................................................................................................... GA-AL ......... 128.15 123.79 

1840 .................. COLUMBUS .................................................................................................... OH ............... 134.12 130.19 

1880 .................. CORPUS CHRISTI ......................................................................................... TX ................ 131.52 127.41 

1900 .................. CUMBERLAND ............................................................................................... MD-WVA ..... 128.22 123.87 

1920 .................. DALLAS .......................................................................................................... TX ................ 134.47 130.56 

1950 .................. DANVILLE ....................................................................................................... VA ............... 127.57 123.18 

1960 .................. DAVENPORT-MOLINE ................................................................................... IA-IL ............ 133.12 129.11 

2000 .................. DAYTON-SPRINGFIELD ................................................................................ OH ............... 137.82 134.14 

2020 .................. DAYTONA BEACH ......................................................................................... FL ................ 127.85 123.47 

2030 .................. DECATUR ....................................................................................................... AL ................ 127.57 123.18 

2040 .................. DECATUR ....................................................................................................... IL ................. 131.69 127.57 

2080 .................. DENVER ......................................................................................................... CO ............... 143.60 140.35 

2120 .................. DES MOINES ................................................................................................. IA ................. 135.21 131.36 

2160 .................. DETROIT ........................................................................................................ MI ................ 143.03 139.73 

2180 .................. DOTHAN ......................................................................................................... AL ................ 127.57 123.18 

2200 .................. DUBUQUE ...................................................................................................... IA ................. 132.63 128.61 

2240 .................. DULUTH ......................................................................................................... MN-WI ......... 130.10 125.88 

2290 .................. EAU CLAIRE .................................................................................................. WI ................ 128.84 124.53 

47538 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued 

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

2320 .................. EL PASO ........................................................................................................ TX ................ 128.41 124.08 

2330 .................. ELKHART-GOSHEN ....................................................................................... IN ................ 129.30 125.01 

2335 .................. ELMIRA ........................................................................................................... NY ............... 132.63 128.60 

2340 .................. ENID ............................................................................................................... OK ............... 129.51 125.24 

2360 .................. ERIE ................................................................................................................ PA ............... 131.82 127.74 

2400 .................. EUGENE-SPRINGFIELD ................................................................................ OR ............... 133.37 129.37 

2440 .................. EVANSVILLE .................................................................................................. IN-KY ........... 134.10 130.16 

2520 .................. FARGO-MOORHEAD ..................................................................................... ND-MN ........ 133.83 129.88 

2560 .................. FAYETTEVILLE .............................................................................................. NC ............... 127.57 123.18 

2580 .................. FAYETTEVILLE-SPRINGDALE ...................................................................... AR ............... 127.57 123.18 

2640 .................. FLINT .............................................................................................................. MI ................ 141.83 138.45 

2650 .................. FLORENCE .................................................................................................... AL ................ 127.57 123.18 

2655 .................. FLORENCE .................................................................................................... SC ............... 127.57 123.18 

2670 .................. FORT COLLINS-LOVELAND ......................................................................... CO ............... 131.49 127.38 

2680 .................. FT LAUDERDALE-POMPANO BEACH ......................................................... FL ................ 137.23 133.51 

2700 .................. FORT MYERS-CAPE CORAL ........................................................................ FL ................ 129.73 125.49 

2710 .................. FORT PIERCE ................................................................................................ FL ................ 130.09 125.87 

2720 .................. FORT SMITH .................................................................................................. AR-OK ......... 128.97 124.67 

2750 .................. FORT WALTON BEACH ................................................................................ FL ................ 127.57 123.18 

2760 .................. FORT WAYNE ................................................................................................ IN ................ 129.32 125.05 

2800 .................. FORT WORTH-ARLINGTON ......................................................................... TX ................ 133.06 129.04 

2840 .................. FRESNO ......................................................................................................... CA ............... 142.09 138.72 

2880 .................. GADSDEN ...................................................................................................... AL ................ 128.48 124.17 

2900 .................. GAINESVILLE ................................................................................................. FL ................ 130.25 126.06 

2920 .................. GALVESTON-TEXAS CITY ............................................................................ TX ................ 137.86 134.20 

2960 .................. GARY-HAMMOND .......................................................................................... IN ................ 138.47 134.85 

2975 .................. GLENS FALLS ................................................................................................ NY ............... 128.98 124.68 

2985 .................. GRAND FORKS ............................................................................................. ND ............... 129.26 124.98 

3000 .................. GRAND RAPIDS ............................................................................................ MI ................ 133.41 129.44 

3040 .................. GREAT FALLS ............................................................................................... MT ............... 132.09 128.01 

3060 .................. GREELEY ....................................................................................................... CO ............... 134.34 130.43 

3080 .................. GREEN BAY ................................................................................................... WI ................ 133.34 129.33 

3120 .................. GREENSBORO-WINSTON SALEM-HIGH PT ............................................... NC ............... 129.67 125.42 

3160 .................. GREENVILLE-SPARTANBURG ..................................................................... SC ............... 130.15 125.95 

3180 .................. HAGERSTOWN .............................................................................................. MD ............... 132.79 128.78 

3200 .................. HAMILTON-MIDDLETOWN ............................................................................ OH ............... 134.87 130.98 

3240 .................. HARRISBURG-LEBANON-CARLISLE ........................................................... PA ............... 133.92 129.97 

3283 .................. HARTFORD-NEW BRITAIN-BRISTOL .......................................................... CT ............... 140.38 136.90 

3290 .................. HICKORY ........................................................................................................ NC ............... 127.57 123.18 

3320 .................. HONOLULU .................................................................................................... HI ................ 141.73 138.34 

3350 .................. HOUMA-THIBODAUX .................................................................................... LA ................ 128.02 123.66 

3360 .................. HOUSTON ...................................................................................................... TX ................ 137.24 133.53 

3400 .................. HUNTINGTON-ASHLAND .............................................................................. WVA-KY-OH 130.11 125.88 

3440 .................. HUNTSVILLE .................................................................................................. AL ................ 127.57 123.18 

3480 .................. INDIANAPOLIS ............................................................................................... IN ................ 135.16 131.30 

3500 .................. IOWA CITY ..................................................................................................... IA ................. 143.23 140.37 

3520 .................. JACKSON ....................................................................................................... MI ................ 134.43 130.53 

3560 .................. JACKSON ....................................................................................................... MS ............... 128.82 124.51 

3580 .................. JACKSON ....................................................................................................... TN ............... 127.57 123.18 

3600 .................. JACKSONVILLE ............................................................................................. FL ................ 130.77 126.58 

3605 .................. JACKSONVILLE ............................................................................................. NC ............... 127.75 123.37 

3620 .................. JANESVILLE-BELOIT ..................................................................................... WI ................ 128.39 124.05 

3640 .................. JERSEY CITY ................................................................................................. NJ ................ 138.46 134.84 

3660 .................. JOHNSON CITY-BRISTOL ............................................................................ TN-VA ......... 127.57 123.18 

3680 .................. JOHNSTOWN ................................................................................................. PA ............... 133.36 129.36 

3690 .................. JOLIET ............................................................................................................ IL ................. 140.66 137.19 

3710 .................. JOPLIN ........................................................................................................... MO .............. 127.97 123.61 

3720 .................. KALAMAZOO .................................................................................................. MI ................ 143.25 139.98 

3740 .................. KANKAKEE ..................................................................................................... IL ................. 130.84 126.66 

3760 .................. KANSAS CITY ................................................................................................ MO-KS ........ 133.22 129.21 

3800 .................. KENOSHA ...................................................................................................... WI ................ 137.39 133.69 

3810 .................. KILLEEN-TEMPLE .......................................................................................... TX ................ 128.12 123.75 

3840 .................. KNOXVILLE .................................................................................................... TN ............... 127.83 123.45 

3850 .................. KOKOMO ........................................................................................................ IN ................ 132.39 128.34 

3870 .................. LA CROSSE ................................................................................................... WI ................ 131.00 126.87 

3880 .................. LAFAYETTE ................................................................................................... LA ................ 132.84 128.83 

3920 .................. LAFAYETTE ................................................................................................... IN ................ 128.65 124.33 

3960 .................. LAKE CHARLES ............................................................................................. LA ................ 130.17 125.97 

3965 .................. LAKE COUNTY .............................................................................................. IL ................. 141.41 137.98 

3980 .................. LAKELAND-WINTER HAVEN ........................................................................ FL ................ 127.57 123.18 

4000 .................. LANCASTER .................................................................................................. PA ............... 135.38 131.54 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47539

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

4040 .................. LANSING-EAST LANSING ............................................................................. MI ................ 135.98 132.18 

4080 .................. LAREDO ......................................................................................................... TX ................ 127.57 123.18 

4100 .................. LAS CRUCES ................................................................................................. NM ............... 127.57 123.18 

4120 .................. LAS VEGAS .................................................................................................... NV ............... 141.01 137.58 

4150 .................. LAWRENCE .................................................................................................... KS ............... 131.82 127.73 

4200 .................. LAWTON ......................................................................................................... OK ............... 130.27 126.08 

4243 .................. LEWISTON-AUBURN ..................................................................................... ME ............... 128.39 124.06 

4280 .................. LEXINGTON-FAYETTE .................................................................................. KY ............... 130.21 126.01 

4320 .................. LIMA ................................................................................................................ OH ............... 133.29 129.29 

4360 .................. LINCOLN ........................................................................................................ NE ............... 129.96 125.72 

4400 .................. LITTLE ROCK-N LITTLE ROCK .................................................................... AR ............... 135.96 132.17 

4420 .................. LONGVIEW-MARSHALL ................................................................................ TX ............... 127.57 123.18 

4440 .................. LORAIN-ELYRIA ............................................................................................. OH ............... 134.22 130.30 

4480 .................. LOS ANGELES-LONG BEACH ...................................................................... CA ............... 146.35 145.02 

4520 .................. LOUISVILLE ................................................................................................... KY-IN ........... 134.40 130.50 

4600 .................. LUBBOCK ....................................................................................................... TX ................ 129.87 125.63 

4640 .................. LYNCHBURG ................................................................................................. VA ............... 128.00 123.63 

4680 .................. MACON-WARNER ROBINS .......................................................................... GA ............... 129.46 125.19 

4720 .................. MADISON ....................................................................................................... WI ................ 135.45 131.63 

4763 .................. MANCHESTER-NASHUA ............................................................................... NH ............... 131.20 127.04 

4800 .................. MANSFIELD ................................................................................................... OH ............... 130.40 126.20 

4840 .................. MAYAGUEZ .................................................................................................... PR ............... 127.57 123.18 

4880 .................. MCALLEN-EDINBURG-MISSION .................................................................. TX ................ 127.57 123.18 

4890 .................. MEDFORD ...................................................................................................... OR ............... 133.00 128.99 

4900 .................. MELBOURNE-TITUSVILLE ............................................................................ FL ................ 130.19 125.99 

4920 .................. MEMPHIS ....................................................................................................... TN-AR-MS ... 135.10 131.23 

4940 .................. MERCED ........................................................................................................ CA ............... 138.45 134.83 

5000 .................. MIAMI-HIALEAH ............................................................................................. FL ................ 138.47 134.85 

5015 .................. MIDDLESEX-HUNTERDON ........................................................................... NJ ................ 134.87 130.99 

5040 .................. MIDLAND ........................................................................................................ TX ................ 135.10 131.24 

5080 .................. MILWAUKEE .................................................................................................. WI ................ 136.75 133.02 

5120 .................. MINNEAPOLIS-ST PAUL ............................................................................... MN-WI ......... 136.11 132.33 

5160 .................. MOBILE .......................................................................................................... AL ................ 129.00 124.70 

5170 .................. MODESTO ...................................................................................................... CA ............... 138.05 134.41 

5190 .................. MONMOUTH-OCEAN .................................................................................... NJ ................ 133.08 129.06 

5200 .................. MONROE ........................................................................................................ LA ................ 129.18 124.90 

5240 .................. MONTGOMERY ............................................................................................. AL ................ 130.14 125.92 

5280 .................. MUNCIE .......................................................................................................... IN ................ 131.36 127.22 

5320 .................. MUSKEGON ................................................................................................... MI ................ 131.68 127.57 

5345 .................. NAPLES .......................................................................................................... FL ................ 130.55 126.35 

5360 .................. NASHVILLE .................................................................................................... TN ............... 132.71 128.70 

5380 .................. NASSAU-SUFFOLK ....................................................................................... NY ............... 146.35 144.35 

5403 .................. NEW BEDFORD-FALL RIVER-ATTELBORO ................................................ MA ............... 131.79 127.70 

5483 .................. NEW HAVEN-WATERBURY-MERIDEN ........................................................ CT ............... 137.50 133.80 

5523 .................. NEW LONDON-NORWICH ............................................................................ CT ............... 137.24 133.52 

5560 .................. NEW ORLEANS ............................................................................................. LA ................ 130.68 126.50 

5600 .................. NEW YORK .................................................................................................... NY ............... 146.35 146.35 

5640 .................. NEWARK ........................................................................................................ NJ ................ 141.09 137.67 

5700 .................. NIAGARA FALLS ............................................................................................ NY ............... 130.31 126.11 

5720 .................. NORFOLK-NEWPORT NEWS ....................................................................... VA ............... 129.67 125.42 

5775 .................. OAKLAND ....................................................................................................... CA ............... 146.35 145.92 

5790 .................. OCALA ............................................................................................................ FL ................ 128.79 124.48 

5800 .................. ODESSA ......................................................................................................... TX ............... 129.63 125.38 

5880 .................. OKLAHOMA CITY .......................................................................................... OK ............... 134.67 130.78 

5910 .................. OLYMPIA ........................................................................................................ WA .............. 135.49 131.66 

5920 .................. OMAHA ........................................................................................................... NE-IA ........... 132.99 128.98 

5950 .................. ORANGE COUNTY ........................................................................................ NY ............... 132.46 128.39 

5960 .................. ORLANDO ...................................................................................................... FL ................ 132.46 128.39 

5990 .................. OWENSBORO ................................................................................................ KY ............... 127.57 123.18 

6000 .................. OXNARD-VENTURA ...................................................................................... CA ............... 146.28 145.05 

6015 .................. PANAMA CITY ............................................................................................... FL ................ 127.57 123.18 

6020 .................. PARKERSBURG-MARIETTA ......................................................................... WVA-OH ..... 130.89 126.73 

6025 .................. PASCAGOULA ............................................................................................... MS ............... 135.50 131.67 

6080 .................. PENSACOLA .................................................................................................. FL ................ 128.26 123.91 

6120 .................. PEORIA .......................................................................................................... IL ................. 136.83 133.10 

6160 .................. PHILADELPHIA .............................................................................................. PA-NJ .......... 141.48 138.07 

6200 .................. PHOENIX ........................................................................................................ AZ ................ 137.96 134.32 

6240 .................. PINE BLUFF ................................................................................................... AR ............... 127.57 123.18 

6280 .................. PITTSBURGH ................................................................................................. PA ............... 138.69 135.09 

6323 .................. PITTSFIELD .................................................................................................... MA ............... 133.87 129.91 

6360 .................. PONCE ........................................................................................................... PR ............... 127.57 123.18 

47540 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

6403 .................. PORTLAND .................................................................................................... ME ............... 132.96 128.94 

6440 .................. PORTLAND .................................................................................................... OR ............... 139.91 136.40 

6453 .................. PORTSMOUTH-DOVER-ROCHESTER ......................................................... NH-ME ........ 128.29 123.95 

6460 .................. POUGHKEEPSIE ........................................................................................... NY ............... 135.84 132.03 

6483 .................. PROVIDENCE-PAWTUCKET-WOONSOCKET ............................................. RI ................ 134.58 130.69 

6520 .................. PROVO-OREM ............................................................................................... UT ............... 130.42 126.22 

6560 .................. PUEBLO ......................................................................................................... CO ............... 137.23 133.52 

6600 .................. RACINE .......................................................................................................... WI ................ 129.52 125.26 

6640 .................. RALEIGH-DURHAM ....................................................................................... NC ............... 132.93 128.90 

6660 .................. RAPID CITY .................................................................................................... SD ............... 128.78 124.47 

6680 .................. READING ........................................................................................................ PA ............... 133.16 129.15 

6690 .................. REDDING ....................................................................................................... CA ............... 138.98 135.39 

6720 .................. RENO .............................................................................................................. NV ............... 144.32 142.52 

6740 .................. RICHLAND-KENNEWICK ............................................................................... WA .............. 131.96 127.89 

6760 .................. RICHMOND-PETERSBURG .......................................................................... VA ............... 129.76 125.53 

6780 .................. RIVERSIDE-SAN BERNARDINO ................................................................... CA ............... 143.65 140.40 

6800 .................. ROANOKE ...................................................................................................... VA ............... 130.33 126.13 

6820 .................. ROCHESTER ................................................................................................. MN ............... 134.23 130.31 

6840 .................. ROCHESTER ................................................................................................. NY ............... 134.50 130.60 

6880 .................. ROCKFORD ................................................................................................... IL ................. 136.62 132.85 

6920 .................. SACRAMENTO ............................................................................................... CA ............... 144.16 141.12 

6960 .................. SAGINAW-BAY CITY-MIDLAND .................................................................... MI ................ 138.22 134.57 

6980 .................. ST CLOUD ...................................................................................................... MN ............... 129.55 125.29 

7000 .................. ST JOSEPH .................................................................................................... MO .............. 132.19 128.12 

7040 .................. ST LOUIS ....................................................................................................... MO-IL .......... 135.07 131.21 

7080 .................. SALEM ............................................................................................................ OR ............... 136.70 132.96 

7120 .................. SALINAS-SEASIDE-MONTEREY .................................................................. CA ............... 144.09 140.88 

7160 .................. SALT LAKE CITY-OGDEN ............................................................................. UT ............... 131.27 127.13 

7200 .................. SAN ANGELO ................................................................................................ TX ................ 127.57 123.18 

7240 .................. SAN ANTONIO ............................................................................................... TX ................ 129.30 125.03 

7320 .................. SAN DIEGO .................................................................................................... CA ............... 144.75 142.04 

7360 .................. SAN FRANCISCO .......................................................................................... CA ............... 146.35 145.92 

7400 .................. SAN JOSE ...................................................................................................... CA ............... 146.35 145.68 

7440 .................. SAN JUAN ...................................................................................................... PR ............... 127.57 123.18 

7480 .................. SANTA BARBARA-LOMPOC ......................................................................... CA ............... 139.14 135.58 

7485 .................. SANTA CRUZ ................................................................................................. CA ............... 140.64 137.18 

7490 .................. SANTA FE ...................................................................................................... NM ............... 129.81 125.59 

7500 .................. SANTA ROSA-PETALUMA ............................................................................ CA ............... 146.35 145.59 

7510 .................. SARASOTA .................................................................................................... FL ................ 131.98 127.90 

7520 .................. SAVANNAH .................................................................................................... GA ............... 129.72 125.48 

7560 .................. SCRANTON-WILKES BARRE ....................................................................... PA ............... 133.66 129.70 

7600 .................. SEATTLE ........................................................................................................ WA .............. 136.87 133.14 

7610 .................. SHARON ......................................................................................................... PA ............... 132.08 128.00 

7620 .................. SHEBOYGAN ................................................................................................. WI ................ 129.28 125.01 

7640 .................. SHERMAN-DENISON .................................................................................... TX ................ 127.57 123.18 

7680 .................. SHREVEPORT ............................................................................................... LA ................ 133.23 129.23 

7720 .................. SIOUX CITY ................................................................................................... IA-NE ........... 132.47 128.40 

7760 .................. SIOUX FALLS ................................................................................................. SD ............... 130.62 126.44 

7800 .................. SOUTH BEND-MISHAWAKA ......................................................................... IN ................ 130.13 125.92 

7840 .................. SPOKANE ....................................................................................................... WA .............. 138.38 134.75 

7880 .................. SPRINGFIELD ................................................................................................ IL ................. 137.27 133.56 

7920 .................. SPRINGFIELD ................................................................................................ MO .............. 129.48 125.21 

8003 .................. SPRINGFIELD ................................................................................................ MA ............... 133.39 129.39 

8050 .................. STATE COLLEGE .......................................................................................... PA ............... 137.91 134.25 

8080 .................. STEUBENVILLE-WEIRTON ........................................................................... OH-WVA ..... 131.46 127.35 

8120 .................. STOCKTON .................................................................................................... CA ............... 146.35 145.06 

8160 .................. SYRACUSE .................................................................................................... NY ............... 141.36 139.77 

8200 .................. TACOMA ......................................................................................................... WA .............. 136.53 132.76 

8240 .................. TALLAHASSE ................................................................................................. FL ................ 129.91 125.67 

8280 .................. TAMPA-ST PETERSBURG-CLEARWATER .................................................. FL ................ 132.27 128.21 

8320 .................. TERRE HAUTE .............................................................................................. IN ................ 127.57 123.18 

8360 .................. TEXARKANA .................................................................................................. TX-AR ......... 135.59 131.75 

8400 .................. TOLEDO ......................................................................................................... OH ............... 140.91 137.45 

8440 .................. TOPEKA ......................................................................................................... KS ............... 135.89 132.10 

8480 .................. TRENTON ....................................................................................................... NJ ................ 135.66 131.82 

8520 .................. TUCSON ......................................................................................................... AZ ................ 134.02 130.07 

8560 .................. TULSA ............................................................................................................ OK ............... 133.31 129.30 

8600 .................. TUSCALOOSA ............................................................................................... AL ................ 133.86 129.91 

8640 .................. TYLER ............................................................................................................ TX ............... 132.17 128.09 

8680 .................. UTICA-ROME ................................................................................................. NY ............... 130.41 126.22 

8720 .................. VALLEJO-FAIRFIELD-NAPA .......................................................................... CA ............... 146.35 146.18 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47541

TABLE 18.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued

[For urban renal facilities] 

MSA code Name of MSA State Hospital Independent 

8725 .................. VANCOUVER ................................................................................................. WA .............. 139.12 135.53 

8750 .................. VICTORIA ....................................................................................................... TX ............... 127.57 123.18 

8760 .................. VINELAND-MILLVILLE-BRIDGETON ............................................................ NJ ................ 132.48 128.41 

8780 .................. VISALIA-PORTERVILLE ................................................................................ CA ............... 142.02 140.48 

8800 .................. WACO ............................................................................................................. TX ................ 127.81 123.43 

8840 .................. WASHINGTON ............................................................................................... DC-MD-VA .. 141.74 138.35 

8920 .................. WATERLOO-CEDAR FALLS ......................................................................... IA ................. 129.50 125.24 

8940 .................. WAUSAU ........................................................................................................ WI ................ 130.90 126.74 

8960 .................. WEST PALM & DELRAY BEACH .................................................................. FL ................ 131.84 127.75 

9000 .................. WHEELING ..................................................................................................... WVA-OH ..... 131.83 127.74 

9040 .................. WICHITA ......................................................................................................... KS ............... 136.67 132.93 

9080 .................. WICHITA FALLS ............................................................................................. TX ................ 127.57 123.18 

9140 .................. WILLIAMSPORT ............................................................................................. PA ............... 130.24 126.04 

9160 .................. WILMINGTON ................................................................................................. DE-NJ-MD ... 136.71 132.97 

9200 .................. WILMINGTON ................................................................................................. NC ............... 128.74 124.42 

9243 .................. WORCESTER-LEOMINSTER ........................................................................ MA ............... 132.43 128.37 

9260 .................. YAKIMA .......................................................................................................... WA .............. 132.24 128.18 

9280 .................. YORK .............................................................................................................. PA ............... 132.45 128.39 

9320 .................. YOUNGSTOWN-WARREN ............................................................................ OH ............... 137.25 133.54 

9340 .................. YUBA CITY ..................................................................................................... CA ............... 137.02 133.29 

TABLE 19.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005 

[For rural renal facilities] 

MSA Code Name of MSA State Hospital Independent 

AL ...................... ALABAMA ....................................................................................................... AL ................ 127.57 123.18 

AK ..................... ALASKA .......................................................................................................... AK ............... 146.35 146.35 

AZ ..................... ARIZONA ........................................................................................................ AZ ................ 128.68 124.35 

AR ..................... ARKANSAS .................................................................................................... AR ............... 127.57 123.18 

CA ..................... CALIFORNIA .................................................................................................. CA ............... 137.00 133.27 

CO ..................... COLORADO ................................................................................................... CO ............... 128.21 123.86 

CT ..................... CONNECTICUT .............................................................................................. CT ............... 136.02 132.22 

DE ..................... DELAWARE .................................................................................................... DE ............... 128.76 124.44 

FL ...................... FLORIDA ........................................................................................................ FL ................ 127.75 123.37 

GA ..................... GEORGIA ....................................................................................................... GA ............... 127.57 123.18 

HI ...................... HAWAII ........................................................................................................... HI ................ 140.40 136.92 

ID ...................... IDAHO ............................................................................................................. ID ................ 127.83 123.45 

IL ....................... ILLINOIS ......................................................................................................... IL ................. 127.57 123.18 

IN ...................... INDIANA ......................................................................................................... IN ................ 127.57 123.18 

IA ....................... IOWA .............................................................................................................. IA ................. 127.57 123.18 

KS ..................... KANSAS ......................................................................................................... KS ............... 127.57 123.18 

KY ..................... KENTUCKY .................................................................................................... KY ............... 127.57 123.18 

LA ...................... LOUISIANA ..................................................................................................... LA ................ 127.57 123.18 

ME ..................... MAINE ............................................................................................................. ME ............... 127.57 123.18 

MD .................... MARYLAND .................................................................................................... MD ............... 130.27 126.08 

MA ..................... MASSACHUSETTS ........................................................................................ MA ............... 135.99 132.19 

MI ...................... MICHIGAN ...................................................................................................... MI ................ 132.98 128.97 

MN .................... MINNESOTA ................................................................................................... MN ............... 127.57 123.18 

MS ..................... MISSISSIPPI ................................................................................................... MS ............... 127.57 123.18 

MO .................... MISSOURI ...................................................................................................... MO .............. 127.57 123.18 

MT ..................... MONTANA ...................................................................................................... MT ............... 127.87 123.50 

NE ..................... NEBRASKA .................................................................................................... NE ............... 127.57 123.18 

NV ..................... NEVADA ......................................................................................................... NV ............... 133.20 129.20 

NH ..................... NEW HAMPSHIRE ......................................................................................... NH ............... 132.24 128.18 

NM .................... NEW MEXICO ................................................................................................ NM ............... 128.68 124.36 

NY ..................... NEW YORK .................................................................................................... NY ............... 127.78 123.40 

NC ..................... NORTH CAROLINA ........................................................................................ NC ............... 127.57 123.18 

ND ..................... NORTH DAKOTA ........................................................................................... ND ............... 127.70 123.31 

OH ..................... OHIO ............................................................................................................... OH ............... 128.66 124.34 

OK ..................... OKLAHOMA .................................................................................................... OK ............... 127.57 123.18 

OR ..................... OREGON ........................................................................................................ OR ............... 132.66 128.64 

PA ..................... PENNSYLVANIA ............................................................................................ PA ............... 132.54 128.48 

PR ..................... PUERTO RICO ............................................................................................... PR ............... 127.57 123.18 

RI ...................... RHODE ISLAND ............................................................................................. RI ................ 130.86 126.69 

SC ..................... SOUTH CAROLINA ........................................................................................ SC ............... 127.57 123.18 

SD ..................... SOUTH DAKOTA ........................................................................................... SD ............... 127.57 123.18 

TN ..................... TENNESSEE .................................................................................................. TN ............... 127.57 123.18 

TX ..................... TEXAS ............................................................................................................ TX ............... 127.57 123.18 

47542 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 19.—COMPOSITE PAYMENT RATES EFFECTIVE JANUARY 1, 2005—Continued

[For rural renal facilities] 

MSA Code Name of MSA State Hospital Independent 

UT ..................... UTAH .............................................................................................................. UT ............... 128.56 124.24 

VT ..................... VERMONT ...................................................................................................... VT ................ 127.57 123.18 

VA ..................... VIRGINIA ........................................................................................................ VA ............... 127.57 123.18 

WA .................... WASHINGTON ............................................................................................... WA .............. 131.35 127.21 

WV .................... WEST VIRGINIA ............................................................................................. WV .............. 128.43 124.09 

WI ...................... WISCONSIN ................................................................................................... WI ................ 127.57 123.18 

WY .................... WYOMING ...................................................................................................... WY .............. 131.29 127.15 

TABLE 20.—COMORBIDITIES

AIDS

042 ............................................................... Human immunodeficiency disease 

Peripheral vascular disease

0400 ............................................................. Gas gangrene 

4151 ............................................................. Pulmonary embolism and infarction 

41511 ........................................................... Pulmonary embolism and infarction, iatrogenic pulmonary embolism and infarction 

440 ............................................................... Atherosclerosis 

4400 ............................................................. Atherosclerosis of aorta 

4401 ............................................................. Atherosclerosis of renal artery 

4402 ............................................................. Atherosclerosis of native arteries of the extremities 

44020 ........................................................... Atherosclerosis of native arteries of the extremities, unspecified 

44021 ........................................................... Atherosclerosis of native arteries of the extremities, with intermittent claudication 

44022 ........................................................... Atherosclerosis of native arteries of the extremities, with rest pain 

44023 ........................................................... Atherosclerosis of the extremities with ulceration 

44024 ........................................................... Atherosclerosis of the extremities with gangrene 

44029 ........................................................... Atherosclerosis of native arteries of the extremities, with ulceration 

4403 ............................................................. Atherosclerosis of bypass graft of the extremities 

44030 ........................................................... Atherosclerosis of bypass graft of the extremities of unspecified graft 

44031 ........................................................... Atherosclerosis of bypass graft of the extremities of autologous vein bypass graft 

44032 ........................................................... Atherosclerosis of bypass graft of the extremities of nonautologous biological bypass graft 

441 ............................................................... Aortic aneurysm and dissection 

4410 ............................................................. Aortic aneurysm and dissection, dissection of aorta 

44100 ........................................................... Aortic aneurysm and dissection, dissection of aorta, unspecified site 

44101 ........................................................... Aortic aneurysm and dissection, dissection of aorta, thoracic 

44102 ........................................................... Aortic aneurysm and dissection, dissection of aorta, abdominal 

44103 ........................................................... Aortic aneurysm and dissection, dissection of aorta, thoracoabdominal 

4411 ............................................................. Thoracic aneurysm, ruptured 

4412 ............................................................. Thoracic aneurysm without mention of rupture 

4413 ............................................................. Abdominal aneurysm, ruptured 

4414 ............................................................. Abdominal aneurysm without mention of rupture 

4415 ............................................................. Aortic aneurysm of unspecified site, ruptured 

4416 ............................................................. Thoracoabdominal aneurysm, ruptured 

4417 ............................................................. Thoracoabdominal aneurysm without mention of rupture 

4419 ............................................................. Aortic aneurysm and dissection of unspecified site without mention of rupture 

442 ............................................................... Other aneurysm 

4420 ............................................................. Other aneurysm of artery of upper extremity 

4421 ............................................................. Other aneurysm of renal artery 

4422 ............................................................. Other aneurysm of iliac artery 

4423 ............................................................. Other aneurysm of artery of lower extremity 

4428 ............................................................. Other aneurysm of other specified artery 

44281 ........................................................... Other aneurysm of other specified artery, artery of neck 

44282 ........................................................... Other aneurysm of other specified artery, subclavian artery 

44283 ........................................................... Other aneurysm of other specified artery, splenic artery 

44284 ........................................................... Other aneurysm of other specified artery, other visceral artery

44289 ........................................................... Other aneurysm of other specified artery, other 

4429 ............................................................. Other aneurysm of unspecified site 

443 ............................................................... Other peripheral vascular disease 

4430 ............................................................. Other peripheral vascular disease, Raynaud’s syndrome 

4431 ............................................................. Other peripheral vascular disease, thromboangiitis obliterans [Buerger’s disease] 

4432 ............................................................. Other peripherovascular diseases, other arterial dissection 

44321 ........................................................... Other peripherovascular diseases, other arterial dissection, dissection of carotid artery 

44322 ........................................................... Other peripherovascular diseases, other arterial dissection, dissection of iliac artery 

44323 ........................................................... Other peripherovascular diseases, other arterial dissection, dissection of renal artery 

44324 ........................................................... Other peripherovascular diseases, other arterial dissection, dissection of vertebral artery 

44329 ........................................................... Other peripherovascular diseases, other arterial dissection, dissection of other artery 

4438 ............................................................. Other peripheral vascular disease, other specified peripheral vascular disease 

44381 ........................................................... Other peripheral vascular disease, other specified peripheral vascular disease, peripheral angiopathy in diseases classified elsewhere 

44389 ........................................................... Other peripheral vascular disease, other specified peripheral vascular disease, other 

4439 ............................................................. Peripheral vascular disease, unspecified 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47543

TABLE 20.—COMORBIDITIES

444 ............................................................... Arterial embolism and thrombosis 

4440 ............................................................. Arterial embolism and thrombosis, of abdominal aorta 

4441 ............................................................. Arterial embolism and thrombosis, of thoracic aorta 

4442 ............................................................. Arterial embolism and thrombosis, of arteries of the extremities 

44421 ........................................................... Arterial embolism and thrombosis, of arteries of the extremities, upper extremity 

44422 ........................................................... Arterial embolism and thrombosis, of arteries of the extremities, lower extremity 

4448 ............................................................. Arterial embolism and thrombosis, of other specified artery 

44481 ........................................................... Arterial embolism and thrombosis, of other specified artery, upper extremity 

44489 ........................................................... Arterial embolism and thrombosis, of other specified artery, lower extremity 

449 ............................................................... Arterial embolism and thrombosis, of unspecified artery 

4450 ............................................................. Atheroembolism, of extremities 

44501 ........................................................... Atheroembolism, of extremities, upper extremity 

44502 ........................................................... Atheroembolism, of extremities, lower extremity 

446 ............................................................... Polyarteritis nodosa and allied conditions 

4460 ............................................................. Polyarteritis nodosa and allied conditions, polyarteritis nodosa 

451 ............................................................... Phlebitis and thrombophlebitis 

4510 ............................................................. Phlebitis and thrombophlebitis of superficial vessels of lower extremities 

4511 ............................................................. Phlebitis and thrombophlebitis, of deep vessels of lower extremities 

45111 ........................................................... Phlebitis and thrombophlebitis, of deep vessels of lower extremities, femoral vein 

45119 ........................................................... Phlebitis and thrombophlebitis, of deep vessels of lower extremities, other 

4512 ............................................................. Phlebitis and thrombophlebitis, of lower extremities, unspecified 

45181 ........................................................... Phlebitis and thrombophlebitis, of other sites, iliac vein 

45182 ........................................................... Phlebitis and thrombophlebitis, of other sites, of superficial veins of upper extremities 

45183 ........................................................... Phlebitis and thrombophlebitis, of other sites, of deep veins of upper extremities 

45184 ........................................................... Phlebitis and thrombophlebitis, of upper extremities, unspecified 

45189 ........................................................... Phlebitis and thrombophlebitis, other 

4519 ............................................................. Phlebitis and thrombophlebitis, unspecified 

453 ............................................................... Other venous embolism and thrombosis 

4530 ............................................................. Other venous embolism and thrombosis, Budd-Chiari syndrome 

4531 ............................................................. Other venous embolism and thrombosis, Thrombophlebitis migrans

4532 ............................................................. Other venous embolism and thrombosis of vena cava 

4533 ............................................................. Other venous embolism and thrombosis of renal vein 

4538 ............................................................. Other venous embolism and thrombosis of other specified sites 

4539 ............................................................. Other venous embolism and thrombosis of unspecified site 

I. Section 731(b)—Coverage for Routine 

Costs of Category A Clinical Trials 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 731(b)’’ at the beginning of 

your comments.]

Section 1862(m) of the Act, as added 

by Section 731(b) of the MMA, prohibits 

the Secretary from excluding payment 

for the routine costs of care furnished to 

a Medicare beneficiary participating in 

a clinical trial of a Category A device 

based on a determination that such care 

is not ‘‘reasonable and necessary’’ under 

section 1862(a)(1). In effect, this section 

authorizes Medicare to cover the routine 

costs of clinical trials involving 

Category A devices. Category A 

(experimental/investigational) devices 

are defined in § 405.201 as innovative 

medical devices about which the Food 

and Drug Administration (FDA) has 

major questions about safety and 

effectiveness. 

For a trial to qualify for payment of 

routine costs, it must meet certain 

criteria established by the Secretary to 

ensure that the trial conforms to 

appropriate scientific and ethical 

standards. Current criteria are 

established in the National Coverage 

Determination Manual (CMS Pub. 100–

3, Manual section 310.1). 

In addition, the MMA established 

additional criteria for trials initiated 

before January 1, 2010 to ensure that the 

devices involved in these trials be 

intended for use in the diagnosis, 

monitoring, or treatment of an 

immediately life-threatening disease or 

condition. Guidelines for determining if 

a device meets this requirement will be 

defined through the NCD process. 

Section 411.15(o) currently precludes 

Medicare payment for Category A 

devices. We would not revise this 

section because the MMA does not 

require Medicare to pay for the cost of 

the Category A device (as opposed to the 

cost of routine care associated with the 

trial of a Category A device). 

We are proposing changes to 

§ 405.207. As currently written, this 

section precludes coverage of services 

related to a noncovered device. Since 

the Category A device is noncovered, we 

would amend this section to allow 

coverage of routine care services related 

to a noncovered Category A device. In 

addition, we propose language to crossreference § 405.201 concerning coverage 

of Category B (nonexperimental/

investigational) devices. We would not 

be changing coverage of Category B 

devices, but providing consistency by 

placing information on Category A and 

Category B devices in the same section. 

J. Section 629—Part B Deductible 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 629’’ at the beginning of your 

comments.]

Section 629 of the MMA provides for 

regular updates to the Medicare Part B 

deductible in consideration of 

inflationary changes in the nation’s 

economy. Since 1991, the Medicare Part 

B deductible has been $100 per year. 

The MMA stipulates that the Medicare 

Part B deductible will be $110 for 

calendar year 2005, and, for a 

subsequent year, the deductible will be 

the previous year’s deductible increased 

by the annual percentage increase in the 

monthly actuarial rate under section 

1839(a)(1) of the Act, ending with that 

subsequent year (rounded to the nearest 

dollar). Section 1839(a)(1) of the Act 

requires the Secretary of Health and 

Human Services to calculate the 

monthly actuarial rate for Medicare 

enrollees age 65 and over. 

We propose to update § 410.160(f), 

‘‘Amount of the Part B annual 

deductible,’’ to conform to the MMA 

and to reflect that the Medicare Part B 

deductible is $100 for calendar years 

47544 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

1991 through 2004. Finally, we plan to 

publish an annual notification in the 

Federal Register, announcing each 

upcoming year’s Part B deductible. This 

notification for the Part B deductible 

will be included as part of the annual 

notice we currently publish announcing 

Medicare’s Part B premiums and 

actuarial rates. 

K. Section 512—Hospice Consultation 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 512’’ at the beginning of your 

comments.] 

1. Coverage of Hospice Consultation 

Services 

Effective January 1, 2005, section 512 

of the MMA provides for payment to be 

made to a hospice for specified services 

furnished by a physician who is either 

the medical director of or employee of 

a hospice agency. Payment will be made 

on behalf of a beneficiary who is 

terminally ill (which is defined as 

having a prognosis of 6 months or less 

if the disease or illness runs its normal 

course), has not made a hospice 

election, and has not previously 

received the pre-election hospice 

services specified in section 

1812(a)(1)(5) of the Act as added by 

section 512 of the MMA. These services 

comprise an evaluation of an 

individual’s need for pain and symptom 

management, counseling the individual 

regarding hospice and other care 

options, and may include advising the 

individual regarding advanced care 

planning. 

The decision to elect hospice services 

is a personal choice and is generally a 

decision made between the individual 

and his or her physician (probably the 

physician making the terminal 

diagnosis). Therefore, we believe that 

most individuals will seek this type of 

service from their own physician. Thus, 

we do not expect that the services of a 

hospice physician would be necessary 

for all individuals who elect hospice. 

However, a beneficiary, or his/her 

physician may seek the expertise of a 

hospice medical director or physician 

employee of a hospice to assure that a 

beneficiary’s end-of-life options for care 

and pain management are discussed and 

evaluated. 

Currently, beneficiaries are able to 

receive this evaluation, pain 

management, counseling, and advice 

through other Medicare benefits. For 

example, physicians, typically those 

who determine the beneficiary’s 

terminal diagnoses, can provide for 

these evaluation and management 

services as well as for pain and 

symptom management under the 

physician fee schedule. Beneficiaries 

may also obtain assistance with 

decisions pertaining to end-of life issues 

through discharge planning in hospitals 

and through services of social workers, 

case managers, and other health care 

professionals. To the extent that 

beneficiaries have already received 

Medicare-covered evaluation and 

counseling with respect to end-of-life 

care, the hospice evaluation and 

counseling would seem duplicative. We 

intend to monitor data regarding these 

services to assess whether Medicare is 

paying for duplicative services. 

We are proposing to cover the services 

described above for a terminally ill 

beneficiary, at the request of the 

beneficiary or the beneficiary’s 

physician. The service would, in 

accordance with the statute, be available 

on a one-time basis to a beneficiary who 

has not elected or previously used the 

hospice benefit, but who might benefit 

from evaluation and counseling with a 

hospice physician regarding the 

beneficiary’s decision-making process or 

to provide recommendations for pain 

and symptom management. Since the 

beneficiary or his/her physician decides 

to obtain this service from the hospice 

medical director or physician employee, 

the evaluation and counseling service 

may not be initiated by the hospice, that 

is, the entity receiving payment for the 

service. 

The statute specifies that payment 

will be made to the hospice when the 

physician providing the service is an 

employee physician or medical director 

of a hospice. Therefore, other hospice 

personnel, such as nurse practitioners, 

nurses, or social workers, cannot furnish 

the services. The statute requires the 

physicians to be employed by a hospice; 

therefore, the service cannot be 

furnished by a physician under 

contractual arrangements with the 

hospice or by the beneficiary’s 

physician, if that physician is not an 

employee of the hospice. Moreover, if 

the beneficiary’s physician is also the 

medical director or physician employee 

of a hospice, that physician already 

possesses the expertise necessary to 

furnish end-of-life evaluation, 

management, and counseling services 

and is providing these services to the 

beneficiary and is receiving payment for 

these services through the use of 

evaluation and management (E&M) 

codes. 

In the event that the individual’s 

physician initiates the request for 

services of the hospice medical director 

or physician, we would expect that 

appropriate documentation guidelines 

would be followed. The request or 

referral would be in writing, and the 

hospice medical director or employee 

physician would be expected to provide 

a written note on the patient’s medical 

chart. The hospice employee physician 

providing these services would be 

required to maintain a written record of 

this service. If the beneficiary initiates 

the services, we would expect that the 

hospice agency would maintain a 

written record of the service and that 

communication between the hospice 

medical director or physician and the 

beneficiary’s physician would occur, 

with the beneficiary’s permission, to the 

extent necessary to ensure continuity of 

care. 

We propose to add new § 418.205 and 

§ 418.304(d) to implement section 512 

of the MMA.

2. Payment for Hospice Consultation 

Services 

Section 512(b) of the MMA amends 

section 1414(i) of the Act and 

establishes payment for this service at 

an amount ‘‘equal to an amount 

established for an office or other 

outpatient visit for evaluation and 

management associated with presenting 

problems of moderate severity and 

requiring medical decision-making of 

low complexity under the physician fee 

schedule, other than the portion of such 

amount attributable to the practice 

expense component.’’ No existing CPT 

or HCPCS code specifically represents 

these services. We are proposing to 

establish a new HCPCS code, G0xx4 

Hospice—evaluation and counseling 

services, pre-election. The hospice 

would use this HCPCS code to submit 

claims to the Regional Home Health 

Intermediary (RHHI) for payment for 

these services. Utilization of this code 

would allow us to provide payment for 

this service as well as enable us to 

monitor the frequency with which the 

code is used and to assess whether the 

code is used appropriately. Payments by 

hospices to physicians or others in a 

position to refer patients for services 

furnished under this provision may 

implicate the Federal anti-kickback 

statute. 

In accordance with the statute, we are 

proposing that the payment amount for 

this service would be based on the work 

and malpractice expense RVUs for CPT 

code 99203 multiplied by the CF (1.34 

Work RVU + 0.10 Malpractice RVU)* 

(CF). This CPT code for an office or 

outpatient visit for the evaluation and 

management of a new patient represents 

a detailed history, detailed examination 

and medical decision making of low 

complexity, which, we believe, is quite 

similar to the components of this new 

service provided by a medical director 

or physician employed by the hospice 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47545

agency. Assuming that there are no 

changes in RVUs for CPT code 99203 

and that the CY 2005 update to the 

physician fee schedule is the 1.5 percent 

specified in the MMA, the national 

payment amount for this service would 

be $54.57 for this service (1.44 * 

37.8975). 

L. Section 302—Clinical Conditions for 

Coverage of Durable Medical Equipment 

(DME) 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 302’’ at the beginning of your 

comments.] 

1. Legislative Requirement 

Section 1832(a)(1)(E) of the Act, as 

added by section 302(a)(2) of the MMA, 

requires the Secretary to establish 

clinical conditions for payment of 

covered items of durable medical 

equipment (DME). The law requires the 

Secretary to establish types or classes of 

covered items that require a face-to-face 

examination of the individual by a 

physician or practitioner and also 

require a prescription for these items. 

Covered items of durable medical 

equipment, prosthetics, orthotics, and 

supplies (DMEPOS) have already been 

divided into classes of covered items, as 

established by the local medical review 

policies (LMRP) and local coverage 

determinations (LCD) issued by the 

durable medical equipment regional 

carriers (DMERCs). For example, the 

contractors have developed policies on 

long term home oxygen therapy, canes, 

crutches, wheelchairs, hospital beds, 

urological supplies, spinal orthoses, 

surgical dressing, and enteral and 

parenteral nutrition therapy. These and 

other policies for each of the four 

DMERCs are entered into the Medicare 

Coverage Database at http://

www.cms.hhs.gov/coverage. 

These policies are developed based on 

clinical evidence and after discussion 

with clinical experts in the area. There 

are already a number of local coverage 

determinations and national coverage 

determinations that outline the clinical 

conditions for which these items are 

covered. These determinations outline 

the conditions for coverage, payment, 

and the documentation or testing 

necessary to establish medical necessity. 

We propose to continue developing 

these clinical conditions of coverage 

through the local and national coverage 

determination process. 

We are also proposing to expand the 

requirement for clinical conditions of 

coverage to medical supplies, 

appliances and devices defined in 42 

CFR 410.36. These are commonly 

referred to as prosthetics, orthotics and 

supplies (POS). We believe items of POS 

require the same level of medical 

intervention and skill as DME. As with 

DME, there are already a number of 

local and national coverage 

determinations outlining appropriate 

clinical conditions for coverage and 

propose to continue this process. 

From a clinical perspective, we 

believe that it is appropriate for 

beneficiaries requiring DMEPOS to be 

under the care of a physician and for 

DMEPOS orders to occur in the context 

of routine clinical care. We believe it is 

good clinical practice for the beneficiary 

to be seen by the physician for their 

medical condition and the physician to 

decide whether or not an item of 

DMEPOS is appropriate during the faceto-face examination of the beneficiary. 

Since we expect a beneficiary to be seen 

by their physician for a specific medical 

condition, we do not believe that a 

requirement for a face-to-face 

examination for initial orders and at the 

time of the prescription renewals for 

items of continued need (those 

DMEPOS items where an order is good 

for only a certain period of time and 

requires a follow-up examination by the 

physician) would place a burden on the 

physician or beneficiary, as it would be 

part of a necessary examination. We 

believe this to be the current practice in 

most cases. 

Our goal is to encourage quality care, 

to mitigate any proliferation of use of 

these products and ensure that only 

patients that need items of DMEPOS 

receive them. To comply with the 

requirements of section 302(a)(2) of the 

MMA and to enhance quality and 

reduce fraud, we would establish basic 

requirements that apply to all items of 

durable medical equipment, prosthetics, 

orthotics, and supplies. We have 

identified a proliferation of use for some 

items of DMEPOS and we believe that 

engaging the physician or practitioner 

early in the process of ordering 

DMEPOS will assist us in mitigating any 

unnecessary proliferation of use. 

This regulation proposes to make a 

face-to-face exam by the physician to 

determine the medical necessity and 

ordering an item of DMEPOS an explicit 

requirement for all initial orders of 

DMEPOS and at the time of prescription 

renewal for all DMEPOS continued need 

items. However, we seek specific 

comments about whether specific items 

of DMEPOS should be exempt from the 

face-to-face examination requirement. 

In order for us to verify the medical 

necessity for an item, the prescribing 

physician’s or practitioner’s records 

must document the need at the time the 

physician or practitioner examines the 

beneficiary. For example, a letter to the 

supplier or to us dated months after the 

date the examination was conducted 

and the order was written would not be 

sufficient verification. 

2. Provisions Related to DMEPOS 

To implement the provisions of the 

MMA, we would—

• Establish a requirement for a faceto-face examination by a physician, 

physician assistant (PA), clinical nurse 

specialist (CNS), or nurse practitioner 

(NP), as they are defined in the Act (the 

prescribing physician or practitioner) to 

determine the medical necessity of 

durable medical equipment, orthotics 

and prosthetics. 

• Require that the prescribing 

physician or practitioner be 

independent from the DMEPOS supplier 

and may not be a contractor or an 

employee of the supplier. 

• Establish a requirement that the 

face-to-face examination should be for 

the purpose of evaluating and treating 

the patient’s medical condition and not 

for the sole purpose of obtaining the 

prescribing physician’s or practitioner’s 

order for the DMEPOS. We expect the 

prescribing physician or practitioner to 

conduct a sufficient examination of the 

patient’s medical condition to ascertain 

the appropriate overall treatment plan 

and to order the DMEPOS as only one 

aspect of that treatment plan. 

• Require an order prior to delivery 

for all items of durable medical 

equipment, prosthetics, or orthotics. 

• Require that the order be dated and 

signed within 30 days after the face-toface examination and include 

verification of the examination. We are 

soliciting comments on the appropriate 

verification process. 

• Require the prescribing physician 

or practitioner to maintain appropriate 

and timely documentation in the 

medical records that support the need 

for all DMEPOS ordered. 

• Provide that we would promulgate 

through contractor instructions other 

criteria required for payment, such as 

for prescription renewal requirements, 

repair, minor revisions and 

replacement. We are interested in 

comments on whether the Agency 

should establish national renewal 

requirements or permit contractor 

discretion.

• Provide that we would promulgate 

through the national coverage 

determination process or through the 

local coverage determination process 

additional clinical conditions for items 

of DMEPOS. 

We propose to revise language in 

§ 410.36 and § 410.38 to implement 

section 302(a)(2) of the MMA. 

47546 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

M. Section 614—Payment for Certain 

Mammography Services 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 614’’ at the beginning of your 

comments.]

Medicare covers an annual screening 

mammogram for all beneficiaries who 

are women age 40 and older, and one 

baseline mammogram for beneficiaries 

who are women age 35 through 39. 

Medicare also covers medically 

necessary diagnostic mammograms. 

Payment for screening mammography, 

regardless of setting, is paid under the 

physician fee schedule, but diagnostic 

mammography performed in the 

hospital outpatient department is 

currently paid under the hospital 

outpatient prospective payment system 

(OPPS). 

Section 614 of the MMA amended 

section 1833(t)(1)(B)(iv) of the Act to 

exclude payment for screening and 

diagnostic mammograms from the 

OPPS. In the OPPS proposed rule, we 

will discuss our proposal for payment 

for diagnostic mammograms using the 

payments established under the 

physician fee schedule. This proposal 

will parallel the current practice used 

for the payment of screening 

mammography services provided in the 

OPPS setting and will be effective 

January 1, 2005. 

N. Section 305—Payment for Inhalation 

Drugs 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Section 305’’ at the beginning of your 

comments.] 

1. Background 

Lung diseases such as chronic 

obstructive pulmonary disease (COPD) 

affect large numbers of Medicare 

beneficiaries. COPD is the fourth largest 

cause of death in America behind heart 

disease, certain cancers, and stroke. We 

hope to reduce the number of new 

COPD cases by educating Americans 

about the disease, its causes, and ways 

to prevent it. We hope to improve the 

lives of Medicare beneficiaries and 

improve beneficiary access to treatment 

for those who already suffer from these 

conditions. 

Depending on an individual’s age and 

health, a number of steps can be taken 

to treat or prevent this. Because 

approximately 85 percent of those with 

COPD are smokers, the first step to 

avoid the disease is to stop smoking. 

Smoking has been linked to a large 

number of health problems and is a 

leading cause of cancer and pulmonary 

disease. The Department of Health and 

Human Services (HHS) has been 

actively encouraging Americans to quit 

smoking through its smoking cessation 

initiatives. Americans who quit smoking 

will enjoy longer, healthier lives and 

avoid diseases such as COPD. 

We have also recently approved 

services to address the needs of 

Americans suffering from COPD, 

including lung-volume reduction 

surgery, which, performed in more 

serious cases, removes the diseased lung 

tissue, allowing the rest of the lung to 

function better. Specifically, effective 

January 1, 2004, Medicare expanded 

coverage of lung volume reduction 

surgery to include patients, who are not 

high-risk surgical patients, who either 

have severe, upper-lobe emphysema, or 

have severe, non-upper-lobe 

emphysema with low exercise capacity. 

A number of drugs are available to 

treat the persons with asthma or who 

develop COPD. These include agents, 

often inhaled, that expand the bronchial 

tubes, allowing the patient to breathe 

more freely. Access to these drugs for 

Medicare beneficiaries has been 

expanded by the MMA. 

Nebulizers and metered dose inhalers 

(MDIs) are two different delivery 

methods to administer inhalation drugs 

to a beneficiary. A nebulizer works by 

aerosolizing liquefied inhalation drugs 

so that the medication can be more 

easily inhaled into the lungs. For about 

10 to 30 minutes, a beneficiary breathes 

the mist via compressor tubing hooked 

up to the nebulizer. An MDI consists of 

a canister of pressurized medication that 

is propelled directly into the airways of 

the lungs when a beneficiary presses on 

the inhaler and breathes in through the 

mouth, thereby allowing the medicine 

to take effect quickly. 

Medicare Part B currently pays for 

nebulizers and inhalation drugs. 

However, Medicare Part B does not 

cover MDIs and, therefore, does not pay 

for inhalation drugs delivered by an 

MDI. An MDI is considered to be an 

item of disposable medical equipment 

(for which there is no current Part B 

benefit category) while a nebulizer is 

considered to be an item of DME. 

The Part D drug benefit improves 

beneficiary access to inhalation therapy 

by covering MDIs (including the 

inhalation drugs they furnish) beginning 

January 1, 2006. In addition, the 

prescription drug discount card began 

offering discounts on MDIs effective 

June 1, 2004. 

Since Medicare currently covers 

inhalation drugs provided through 

nebulizers, but not alternative forms of 

inhalation therapy, there are strong 

financial incentives toward use of the 

former compared to alternatives. Our 

review of the literature over the past 

decade did not find that bronchodilators 

delivered via nebulizers were more 

effective than bronchodilators delivered 

via metered dose inhalers. 

Since one delivery method is not 

clinically superior to the other, when 

Medicare covers both methods of 

delivery of inhalation therapy, the 

decision to prescribe one over the other 

will be made by the physician and 

beneficiary based on beneficiary needs 

and preferences consistent with 

applicable standards of medical 

practice. It would not be unlikely for 

many beneficiaries to choose the 

convenience of MDIs over nebulizers 

once the Medicare coverage imbalance 

is removed in 2006. Since MDIs are less 

expensive, very portable, and easier to 

use, it is likely there will be a 

substantial shift of Medicare 

beneficiaries from nebulizers to MDIs 

beginning in 2006, even absent the 

Medicare payment changes for 

nebulizers and inhalation drugs in 2005.

2. What Medicare Part B Currently 

Covers 

Medicare Part B currently covers and 

pays for five separate items related to 

nebulizers. All of the items are subject 

to the standard Part B deductible and 

coinsurance. 

a. Nebulizers 

Medicare Part B currently covers the 

rental of nebulizers. Nebulizers are in 

the ‘‘capped rental’’ category of DME for 

payment purposes. Payment is made on 

a monthly basis during the period of 

medical need. Medicare pays 10 percent 

of the payment amount during the first 

three months and 7.5 percent during the 

next 12 months. Section 1834(a) of the 

Act specifies that the payment amount 

is equal to the amount paid for purchase 

of the nebulizer in 1986, indexed to 

current levels by the cumulative DME 

update factor specified in this 

subsection. Thus, Medicare will pay up 

to a cumulative total of 120 percent of 

the payment amount for 15 months of 

renting a nebulizer. 

If the beneficiary needs a nebulizer for 

more than 15 months, and continues to 

rent it, Medicare makes no further 

payment for the equipment because the 

equipment has already been paid for. 

Medicare does continue to pay for 

maintenance and servicing of the 

nebulizer, as well as the inhalation 

drugs, but the supplier retains title to 

the equipment. 

During the 10th month of continuous 

rental of a nebulizer, the supplier is 

required to offer the beneficiary a 

purchase option, and if the beneficiary 

accepts the offer and exercises the 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47547

purchase option, the supplier transfers 

title to the nebulizer in the 13th month. 

In this case, Medicare would make its 

final monthly rental payment in the 

13th month, and the title then would 

transfer to the beneficiary. About 3 

percent of beneficiaries exercise the 

purchase option. 

In 2003, the average Medicare 

monthly rental payment for nebulizers 

was $19.07 for the first three months 

and $14.30 for the fourth through 

fifteenth month. Thus, Medicare would 

pay $228.81 for a nebulizer if the 

beneficiary’s period of medical need 

were 15 months. There are various types 

of nebulizers (compressor, ultrasonic, 

portable, disposable) and nebulizer 

accessories (breathing circuits, air 

filters, tubing extensions, mouthpieces, 

spare battery packs, DC adapters) 

available. Internet prices for compressor 

nebulizers range from $50 to $100, and 

prices for portable nebulizers range from 

$100 to $200, depending on the specific 

features of the nebulizer. The Medicare 

payment amount includes payment for 

delivery of the equipment. (Shipping 

costs for nebulizers available for 

purchase on the Internet range from free 

shipping up to $25). 

b. Maintenance and Servicing of 

Nebulizers 

Medicare Part B makes an additional 

separate payment to the supplier for 

maintenance and servicing of the 

equipment (for parts and labor not 

covered by the supplier’s or 

manufacturer’s warranty). For 

nebulizers that are not purchased, but 

are used for more than 21 months, the 

servicing fee covers six-month periods 

beginning after the 21st month of use. 

As required by section 1834(a)(7) of the 

Act, Medicare’s payment for 

maintenance and servicing is equal to 

the lesser of a reasonable and necessary 

maintenance and servicing fee, or 10 

percent of the total purchase price of the 

equipment. For nebulizers that are 

purchased, Medicare may make a 

payment to the supplier for any 

necessary maintenance and servicing 

that is performed. 

In 2003, the average service fee for 

nebulizers was $19.07 per six-month 

period. Other than routine cleaning of 

the unit (that is, cleaning and changing 

filters, cleaning and disinfecting 

nebulizers, tubing, and mouthpieces), 

very little maintenance is required to 

maintain a nebulizer’s peak 

performance. There is usually no 

scheduled maintenance for the 

nebulizer. Medicare pays for the usual 

frequency for replacement of 

accessories. Maintenance kits and 

replacement parts are available through 

online suppliers for approximately $5 to 

$15. 

c. Inhalation Drugs 

Medicare Part B pays for drugs that 

the nebulizer furnishes to a beneficiary. 

Unlike nebulizers, inhalation drugs are 

not an explicit benefit covered by 

statute. However, there was an 

administrative decision made early in 

the program’s history to cover 

inhalation drugs as a supply so that the 

nebulizer could work. Without the 

inhalation drugs, the nebulizer would 

not be effective for a beneficiary. 

The two most common inhalation 

drugs used by beneficiaries are albuterol 

sulfate (a beta-adrenergic 

bronchodilator) and ipratropium 

bromide (an anticholinergic 

bronchodilator). A beneficiary may use 

one or the other of these inhalation 

drugs, and they are frequently 

prescribed together. Both albuterol 

sulfate and ipratropium bromide are 

manufactured in powder form, but are 

generally liquefied and furnished to 

beneficiaries in liquid form for use in a 

nebulizer. The beneficiary may use a 

solution of one drug, or a combination 

of both drugs, in addition to saline if 

necessary, with the nebulizer. The 

beneficiary may mix the solution, or the 

supplier may furnish the drug in a premixed form (either commercially premixed or pharmacy compounded). The 

shelf life of these drugs is at least 18 to 

24 months, and they do not require any 

special storage arrangements such as 

refrigeration. 

Medicare also pays for other 

inhalation drugs, such as budesonide 

(an inhaled corticosteroid), which are 

used in conjunction with albuterol 

sulfate and ipratropium bromide. These 

drugs can also be administered using a 

nebulizer or an MDI. 

d. Dispensing Fee 

Medicare has paid a monthly $5 

dispensing fee for each covered 

inhalation drug or combination of drugs 

used in a nebulizer. The dispensing fee 

is paid for each drug dispensed, not the 

number of unit dose vials provided to 

the beneficiaries. Additionally, if two or 

more drugs are combined in single unit 

dose vials, only one dispensing fee will 

be paid per drug combination per 

month. A dispensing fee for saline is not 

separately billable or payable. 

Inhalation drugs are the only drugs for 

which Medicare Part B currently pays a 

separate dispensing fee. 

e. Beneficiary Training. 

In 2003, CPT code 94664 was revised 

to include beneficiary training by a 

physician or physician’s staff regarding 

use of a nebulizer, MDI, aerosol 

generator, or intermittent positive 

pressure breathing (IPPB) machine. The 

narrative terminology for the code 

currently is—Demonstration and/or 

evaluation of patient utilization of an 

aerosol generator, nebulizer, metered 

dose inhaler or IPPB machine.’’ The 

2004 Medicare physician fee schedule 

payment for this service is $13.44. This 

service has no physician work relative 

value units reflecting that the training is 

typically performed by physician office 

staff. In 2004, this service has 0.32 

practice expense relative value units 

(RVUs) and 0.04 malpractice RVUs. 

Additionally, the supplier of the 

nebulizer, under § 424.57(c)(12), must 

‘‘document that it or another qualified 

party has at an appropriate time, 

provided beneficiaries with necessary 

information and instructions on how to 

use Medicare covered-items safely and 

effectively.’’ Beneficiary training by a 

physician or physician’s staff regarding 

use of a nebulizer would meet the 

definition of ‘‘another qualified party’’

for purposes of this supplier 

requirement. 

3. Medicare Spending for Nebulizers 

and Inhalation Drugs 

In 2003, Medicare spent about $1.6 

billion for nebulizers and inhalation 

drugs. This amount includes—

(a) About $130 million for nebulizers 

(both rental and purchase) and 

nebulizer related accessories and 

supplies; 

(b) About $13 million for servicing/

maintenance fees; 

(c) About $1.3 billion for albuterol 

sulfate and ipratropium bromide and 

another $120 million for other 

inhalation drugs for a total of 

approximately $1.4 billion. (This 

represents about 88 percent of Medicare 

spending for inhalation therapy.);

(d) About $35.5 million for 7.1 

million dispensing fees; and 

(e) About $4.5 million for beneficiary 

training under CPT code 94664 (though 

this figure also includes training for 

other items as well as nebulizers). 

Medicare spending for inhalation 

drugs has grown rapidly. Preliminary 

data indicate that between 2001 and 

2003, Medicare spending increased by 

77 percent for albuterol sulfate and 

ipratropium bromide. 

4. Inspector General and General 

Accounting Office Studies 

The HHS IG issued 10 reports 

between February 1996 and January 

2004 about Medicare payments for 

albuterol sulfate and ipratropium 

bromide in excess of acquisition costs. 

In a report issued in September 2001, 

47548 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

the General Accounting Office (GAO) 

also concluded that Medicare payment 

for these drugs was in excess of 

acquisition costs. 

Table 1 of the Interim Final Rule 

regarding Changes to Medicare Payment 

for Drugs and Physician Fee Schedule 

Payments for Calendar Year 2004, 

published in the January 7, 2004 

Federal Register (69 FR 1084), showed 

that the acquisition cost (averaging IG 

and GAO results) was 34 percent of the 

Average Wholesale Price (AWP) for 

ipratropium bromide and 17 percent for 

albuterol sulfate. Prior to 2004, 

Medicare paid 95 percent of the AWP 

for each of these drugs and beneficiary 

coinsurance was 20 percent of the 

Medicare payment amount. In the case 

of albuterol sulfate, the beneficiary 

coinsurance was more than the actual 

acquisition cost for the drug. During 

2004, Medicare payment is 80 percent of 

the AWP for each of these drugs. 

Beginning with 2005, Medicare payment 

will be 106 percent of the Average Sales 

Price (ASP). 

The IG report issued in January 2004 

again concluded that Medicare 

payments were far in excess of 

acquisition costs for both albuterol 

sulfate and ipratropium bromide. The IG 

found that the Medicare 2004 payment 

(and payment in prior years) was a 

multiple of the actual acquisition costs 

for both drugs based on a comparison to 

the median price that the drug was 

available through wholesalers/

distributors and group purchasing 

organizations (GPOs) and comparison to 

the manufacturer-reported Wholesale 

Acquisition Cost (WAC). 

5. Inhalation Drug Spread 

In 2003, ipratropium bromide and 

albuterol sulfate were the third and 

seventh largest drugs in terms of 

Medicare spending for carrier paid 

drugs. The differences between 

Medicare’s payment amount and 

acquisition costs (that is, spread) for 

albuterol sulfate and ipratropium 

bromide are among the largest spreads 

for drugs studied by the IG and GAO. 

Based on the actual acquisition costs 

determined by IG and GAO studies, in 

2003, Medicare paid an estimated nearly 

$900 million in excess of acquisition 

costs for albuterol sulfate and 

ipratropium bromide. 

The IG and GAO findings of large 

differences between Medicare payment 

amounts and acquisition costs for 

inhalation drugs provided the 

foundation for Congressional enactment 

of section 305 of the MMA. This section 

of the MMA sets Medicare payment for 

inhalation drugs at 106 percent of the 

ASP. (The Congressional Budget Office’s 

November 20, 2003 pricing of the MMA 

estimated section 305 as having savings 

of $4.2 billion over 10 years.) 

Suppliers argue that inhalation drug 

spread has allowed them to fund 

activities related to care for beneficiaries 

with asthma or COPD that otherwise do 

not have a Medicare Part B benefit 

category. These other activities may 

include the following: 

• Respiratory therapists on staff or in 

networks available on-call for home 

visits or telephone consultations. 

• On-call pharmacists. 

• Monthly calls to schedule 

medication refills. 

• Continuous education on disease 

states, including monthly follow-ups.

• 24-hour support lines. 

• On-call and/or monthly home 

delivery of medication and supplies. 

• Quality improvement programs. 

6. Nebulizers vs. MDIs 

Medicare Part B currently covers only 

one type of inhalation therapy, 

nebulizers and inhalation drugs. 

Although Medicare Part B does not 

cover MDIs and the inhalation drugs 

they furnish, the new Part D benefit 

beginning in 2006 will cover these 

alternative hand-held inhalation therapy 

devices (MDIs). In addition, the 

discount card and $600 transitional 

assistance payment for low-income 

beneficiaries will help seniors buy 

inhalers in 2004 and 2005, helping to 

bridge the gap until 2006 when coverage 

begins. 

MDIs are the quickest and easiest way 

to take inhalation medication for most 

asthmatics and patients with COPD. The 

medication is propelled directly into the 

lungs, allowing it to take effect more 

quickly, and with fewer medication side 

effects. An MDI contains a specific 

number of ‘‘metered inhalations,’’ and is 

made to deliver the prescribed amount 

of medication for the labeled number of 

doses (typically 200 doses, which is 8 

doses per day for 25 days). Inhalation 

accessory devices, such as holding 

chambers and spacers, are used to 

improve the direction and deposition of 

medication delivered by MDIs, making 

it easier for beneficiaries to use an MDI 

and making the MDI more effective in 

delivering the medicine to the lungs. 

Since Medicare currently covers 

nebulizers and inhalation drugs, but not 

alternative forms of inhalation therapy, 

there are strong financial incentives 

toward use of the former compared to 

alternatives. Our review of the literature 

over the past decade, including two 

meta-analyses and over two dozen 

individual studies applicable to adults, 

did not find that bronchodilators 

delivered via nebulizer were more 

effective than when delivered via 

metered dose inhaler. 

Since one delivery method is not 

clinically superior to the other, when 

Medicare covers both methods of 

delivery of inhalation therapy, the 

decision to prescribe one over the other 

will be made by the physician and 

beneficiary based on beneficiary needs 

and preferences consistent with 

applicable standards of medical 

practice. It would not be unlikely for 

many beneficiaries to choose the 

convenience of MDIs over nebulizers 

once the Medicare coverage imbalance 

is removed in 2006. Since MDIs are less 

expensive, very portable, and easier to 

use, it is likely there will be a 

substantial shift of Medicare 

beneficiaries from nebulizers to MDIs 

beginning in 2006, even absent the 

Medicare payment changes for 

nebulizers and inhalation drugs in 2005. 

Some claim that beneficiaries cannot 

use MDIs because they do not have the 

dexterity to use them. Use of an MDI 

requires proper inhalation techniques in 

order to receive the full benefit possible 

from the amount of medication included 

in each dose. Spacers and holding 

chambers extend the mouthpiece of the 

inhaler and increase the air volume into 

which the medication is atomized, 

allowing more time for the patient to 

breathe the medication and avoid 

misdirecting the medication onto the 

soft tissues inside the mouth where it 

will have little effect on lung function. 

A nebulizer may also require a certain 

level of dexterity (that is, operating, 

maintaining, and cleaning the nebulizer 

correctly). There may also be 

beneficiaries who do not have the 

dexterity to use either an MDI or 

nebulizer, which would require the 

availability of alternative therapies, 

such as an IPPB machine to aid in the 

delivery of aerosol medication by 

increasing the depth of breathing more 

than the patient alone can achieve. 

7. Payments Beginning in 2005 

Including Provisions of the Proposed 

Rule 

Our goal is to assure that each 

beneficiary who needs inhalation 

therapy has access to the most 

appropriate medication and delivery 

method. We expect that the combined 

changes to cover MDIs, adjust payments 

for inhalation drugs, and provide for an 

appropriate dispensing fee will improve 

beneficiary access and choice. We seek 

comments about an appropriate amount 

for a dispensing fee that would assure 

beneficiary access to inhalation 

medications provided through 

nebulizers. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47549

We believe that a dispensing fee is 

intended to cover a pharmacy’s 

activities to get inhalation drugs to 

beneficiaries. We seek data and 

information on the additional services 

these pharmacies provide to Medicare 

beneficiaries, the extent to which 

inhalation drugs can be furnished 

without these additional services and 

the extent to which such services are 

covered under Medicare. We are 

concerned about significant shifts in 

beneficiary access to inhalation therapy 

prior to implementation of the Part D 

drug benefit in light of the reduction in 

Medicare payment for inhalation drugs 

beginning in 2005, and also seek 

comments about whether the dispensing 

fee should include a somewhat higher, 

transitional payment. 

Below we discuss, changes in 

payment for inhalation drugs and 

nebulizers beginning in 2005.

a. Nebulizers 

Section 1834(a)(21) of the Act, as 

amended by section 302(c)(2) of the 

MMA, requires a reduction in Medicare 

payment, beginning with 2005, for 

specified items of DME, including 

nebulizers paid under code E0570. The 

reduction is the difference in payment 

amounts under Medicare and the 

median Federal Employees Health 

Benefits (FEHB) plan, as identified in IG 

testimony before the Senate Committee 

of Appropriations on June 12, 2002. 

Other codes for nebulizers and related 

equipment are not affected by the 

payment reduction. 

b. Maintenance and Servicing of 

Nebulizers 

Since the maintenance and servicing 

fee is equal to the first month’s rental 

payment, the maintenance and servicing 

fee for nebulizers will also be reduced 

in 2005. 

c. Inhalation Drugs 

As discussed in the ASP payment 

section of this proposed rule, for the 

first quarter of 2005, the Medicare 

payment at ASP plus 6 percent is 

estimated to be $0.04 per milligram for 

albuterol sulfate and $0.30 per 

milligram for ipratropium bromide. 

While these figures represent estimated 

reductions from 2004 payment levels of 

about 90 percent, they are not 

necessarily the actual payment amounts 

for the first quarter of 2005. The actual 

payment amounts will be based on 

ASP’s calculated from the manufacturer 

ASP to be submitted for the third 

quarter of 2004. 

Both albuterol sulfate and 

ipratropium bromide are generic drugs 

that have multiple manufacturers. Since 

these ASPs are average figures across all 

manufacturers, a pharmacy should be 

able to acquire albuterol sulfate and 

ipratropium bromide at these prices. 

Moreover, to the extent there is price 

variation among manufacturers, there 

will be some manufacturers with lower 

prices than others. In this case, a 

pharmacy might be able to obtain 

albuterol sulfate and ipratropium 

bromide at a price below the average. 

The Medicare payment amount 

includes a 6 percent add-on. Assuming 

that ASP remains constant between the 

first and third quarters of 2004, the 6 

percent add-on would be about $1.00 for 

a typical month’s supply of 450 

milligrams of albuterol sulfate and about 

$3.00 for a 90-day supply. Similarly, the 

6 percent add-on would be about $1.60 

for a typical month’s supply of 93 

milligrams of ipratropium bromide and 

about $4.80 for a 90-day supply. 

Because albuterol sulfate and 

ipratropium bromide are often 

prescribed together, Medicare payment 

at 106 percent of ASP would include, as 

additional payments above the 

acquisition cost of the drugs, a total 

payment to the supplier of about $2.60 

for a 30-day supply and about $7.80 for 

a 90-day supply of both drugs. 

d. Dispensing Fee 

Given the overall reduction in 

payment for inhalation drugs, we are 

concerned about beneficiary access to 

these drugs. Because shipping, 

handling, compounding, and other 

pharmacy activities would usually 

exceed the 6 percent payment above the 

drug acquisition cost, we believe that it 

is appropriate for Medicare to continue 

to pay a separate dispensing fee to 

pharmacies that furnish inhalation 

drugs to beneficiaries. 

We propose to establish a separate 

dispensing fee for inhalation drugs. This 

separate dispensing fee will be in 

addition to the difference between the 

supplier’s acquisition cost and the 

Medicare payment for the drug. For 

example, if a supplier is acquiring 

albuterol and ipratropium bromide for 

the average sales price, the supplier 

would receive a separate dispensing fee 

amount plus their acquisition cost plus 

$7.80 for a 90-day supply. The $7.80 is 

the amount included in the payment for 

the drug itself since Medicare pays 6 

percent above the average sales price. 

As noted above, Medicare has paid a 

$5 monthly dispensing fee for each 

covered inhalation drug or combination 

of drugs used in a nebulizer. Dispensing 

fees are paid by Medicaid and private 

insurers; we seek information about 

these dispensing fees for inhalation 

drugs and their applicability to 

Medicare. In addition, we seek 

comments about an appropriate 

dispensing fee amount to cover the 

shipping, handling, compounding, and 

other pharmacy activities required to get 

these inhalation medications to 

Medicare beneficiaries. We seek data 

and information that explains the direct 

labor and non-labor costs as well as 

indirect costs of overhead for these 

pharmacy activities as they relate to 

dispensing of inhalation drugs. 

Consideration of dispensing fees 

needs to be viewed in the context of 

several important changes and 

clarifications in Medicare policy and 

billing requirements. 

First, we are proposing to allow a 

prescription for inhalation drugs 

covering a 90-day period to be written 

by a physician and filled by a pharmacy. 

Current guidelines are that a pharmacy 

generally should not fill a prescription 

for inhalation drugs for more than a 

month’s supply for a beneficiary. We 

believe that this requirement needs 

revision in the case of inhalation drugs 

for two key reasons. Most beneficiaries 

who use inhalation drugs use them for 

extended periods of time and often use 

them for the rest of their lives. In 

addition, we understand that many 

inhalation drugs are delivered to a 

beneficiary through the mail. We 

understand that a mail-order 

prescription drug model works well for 

a 90-day prescription. We believe that 

there will be significant savings in 

shipping for a 90-day prescription rather 

than a monthly prescription. 

We would expect that reasonableness 

would govern filling a monthly vs. a 90-

day prescription with a physician 

writing and a pharmacy filling a 

monthly or a 90-day prescription 

depending on the circumstances of the 

beneficiary. For example, it would be 

reasonable to expect that the first time 

a beneficiary receives a prescription for 

a nebulizer and inhalation drugs that 

the prescription would be for a month. 

Similarly, it would be reasonable to 

expect that refill prescriptions for 

beneficiaries would be for a 90-day 

period. Carriers would continue to 

assess claims for dispensed quantities 

greater than what would be reasonable 

based on usual dosing guidelines. We 

would expect that the bulk of 

prescriptions would be for 90-day 

periods.

Second, we recently revised the 

guidelines regarding the time frame for 

delivery of refills of DMEPOS products 

to occur no sooner than ‘‘approximately 

5 days prior to the end of the usage for 

the current product’’. As previously 

noted, inhalation drugs are often 

furnished to a beneficiary by mail. It has 

47550 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

been suggested that Medicare guidelines 

for refill prescriptions allowed too short 

of a window between shipping the next 

month’s prescription and the end of the 

current month. It was argued that as a 

result, a pharmacy ‘‘effectively’’ had to 

ship the product to a beneficiary using 

an overnight delivery service. 

On January 2, 2004, we revised the 

guidelines (effective February 2, 2004) 

regarding the time frame for subsequent 

deliveries of refills of DMEPOS products 

to occur no sooner than ‘‘approximately 

5 days prior to the end of the usage for 

the current product’’ (see section 4.26.1 

of Chapter 4—Benefit Integrity of the 

Medicare Program Integrity Manual). 

This change allows shipping of 

inhalation drugs on ‘‘approximately’’

the 25th day of the month in the case 

of a month’s supply, and on 

‘‘approximately’’ the 85th day in the 

case of a 90-day supply. We emphasize 

the word ‘‘approximately’’; while we 

believe that normal ground service 

shipping would allow delivery in 5 

days, if there were circumstances where 

ground service could not occur in 5 

days, the guideline would still be met if 

the shipment occurs in 6 or 7 days. 

(‘‘Days’’ refers to business days or 

shipping days applicable to the shipper, 

that is, a 6 day week in the case of the 

U.S. Postal Service.). We believe that 

this change eliminates the need for 

suppliers to use overnight shipping 

methods and allows shipping of 

inhalation drugs by less expensive 

ground service. 

Third, we understand that some 

pharmacies believe that Medicare has a 

requirement that a pharmacy must 

obtain an original signed prescription 

before each prescription is dispensed. 

The Program Integrity Manual (section 

5.1 of Chapter 5) addresses the ordering 

requirement for DMEPOS items. The 

Manual indicates that most DMEPOS 

items, including drugs, can be 

dispensed based on a verbal order from 

a physician. The Manual further 

indicates that a written order must be 

obtained before submitting a claim, but 

that such written order may be faxed, 

photocopied, electronic or pen and ink. 

The order for inhalation drugs must 

specify the name of the drug, the 

concentration (if applicable), dosage, 

and frequency of administration. We 

hope that clarification of this 

requirement would reduce a pharmacy’s 

costs of supplying covered inhalation 

drugs to Medicare beneficiaries to the 

extent that pharmacies are currently 

applying an original signed prescription 

requirement. 

Fourth, Medicare regulations 

(§ 424.57) specify the requirements a 

DMEPOS supplier must meet in order to 

receive payment for a Medicare covered 

item. Section 424.57(c)(12) contains the 

proof of delivery requirement and 

indicates that a ‘‘supplier must be 

responsible for the delivery of Medicare 

covered items to beneficiaries and 

maintain proof of delivery.’’ We recently 

revised the Program Integrity Manual 

(section 4.26 of Chapter 4) to address 

proof of delivery requirements for 

suppliers. As discussed in the Manual, 

the burden of proving delivery is left to 

the supplier. The Manual provides 

examples of the types of proof that are 

reasonable and acceptable, but it does 

not provide an all-inclusive list. Other 

acceptable proof-of-delivery methods 

may exist and may be employed by 

suppliers. This documentation is 

normally only requested by the 

contractor when a complaint is received 

that the item was not provided or 

received. The documentation is 

necessary to investigate the allegation. 

We believe that the current provisions 

on proof of delivery are adequate and 

appropriate for inhalation drugs. 

Fifth, in section IV.H (Assignment of 

Medicare Claims—Payment to the 

Supplier) of this proposed rule, we 

propose to change current regulations at 

§ 424.55 to eliminate the requirement 

that beneficiaries assign claims to 

suppliers in situations where suppliers 

are required by section 1842(o)(3) of the 

Act to accept assignment. This change 

would eliminate the need for suppliers 

to have a signed Assignment of Benefits 

(AOB) form from a beneficiary in order 

for Medicare to make payment. Because 

such section of the Act requires 

Medicare to make payment for drugs 

only on an assigned basis, this change 

would eliminate a billing requirement 

for drugs, including inhalation drugs. 

We believe that this change would 

reduce a pharmacy’s costs of supplying 

covered inhalation drugs to Medicare 

beneficiaries to the extent that 

pharmacies are requiring a signed AOB 

form before submitting a claim. 

We believe that the amount of 

dispensing fee needs to be considered in 

conjunction with—

(1) Our proposal to allow 90-day 

prescriptions; 

(2) Our recent revision to allow the 

next month’s refill prescription to be 

shipped approximately 5 business days 

prior to the end of usage for the product, 

that is, to allow shipping on the 25th of 

the month for a month’s supply, and 

shipping or 85th day in the case of a 90-

day period;

(3) Our policy clarification regarding 

signed original orders before a 

prescription is filled; 

(4) Our proof of delivery requirement 

revisions; and 

(5) Our proposed change regarding the 

Assignment of Benefits form. 

e. Beneficiary Training 

Medicare Part B will continue to pay 

for beneficiary training by a physician’s 

staff regarding use of a nebulizer, MDI, 

aerosol generator, or IPPB machine. 

Section 424.57(c)(12) specifies that ‘‘The 

supplier must document that it or 

another qualified party has at an 

appropriate time, provided beneficiaries 

with necessary information and 

instructions on how to use Medicare 

covered-items safely and effectively.’’

Beneficiary training by a physician or 

physician’s staff regarding use of a 

nebulizer would meet the definition of 

‘‘another qualified party’’ for purposes 

of this supplier requirement. 

IV. Other Issues 

A. Proposals Related to Therapy 

Services 

1. Outpatient Therapy Services 

Performed ‘‘Incident To’’ Physicians’

Services 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Therapy—Incident To’’ at the 

beginning of your comments.]

In last year’s proposed rule, we 

requested comments on clarifying that 

the personnel qualifications of 

therapists in home health settings at 

§ 484.4 apply consistently to all therapy 

settings, including the offices of 

physical and occupational therapists, 

physicians, and nonphysician 

practitioners. We received comments 

from therapists, physicians, 

nontherapist health care providers and 

their representative organizations. After 

consideration of all comments, we now 

propose to revise 42 CFR 410.26, 410.59, 

410.60 and 410.62 to reflect that 

physical therapy, occupational therapy, 

and speech-language pathology services 

provided incident to a physician’s 

professional services are subject to 

certain limitations as described at 

section 1862(a)(20) of the Act. 

Regulations in 42 CFR 485.705 specify 

that, in almost all settings, outpatient 

rehabilitative therapy services, (physical 

therapy (PT), occupational therapy (OT), 

or speech-language pathology (SLP)) can 

be furnished only by the following 

individuals meeting the qualifications 

in § 484.4: physical therapists, 

occupational therapists, appropriately 

supervised physical therapist assistants, 

appropriately supervised occupational 

therapy assistants, and speech-language 

pathologists. Some States permit 

licensed physicians, physician 

assistants, clinical nurse specialists, and 

nurse practitioners to furnish PT, OT, 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47551

and SLP services also. Therapy services, 

and those who provide therapy services, 

must also meet the standards and 

conditions as specified in Medicare 

manuals. 

Section 1862(a)(20) of the Act permits 

payment for therapy services furnished 

incident to a physician’s professional 

services only if the practitioner meets 

the standards and conditions that would 

apply to such therapy services if they 

were furnished by a therapist, with the 

exception of the licensing requirement. 

We are proposing to amend the 

regulations to include the statutory 

requirement that only individuals 

meeting the existing qualification and 

training standards for therapists (with 

the exception of licensure) consistent 

with § 484.4 qualify to provide therapy 

services incident to physicians’ services. 

Section 1862(a)(20) of the Act refers 

only to PT, OT, and SLP services and 

not to any other type of therapy or 

service. This section applies to services 

of the type described in section 1861(p), 

1861(g) and 1861(ll) of the Act; it does 

not, for example, apply to therapy 

provided by qualified clinical 

psychologists. This section also does not 

apply to services that are not covered 

either as therapy or as evaluation and 

management services provided incident 

to a physician or nonphysician 

practitioner such as recreational 

therapy, relaxation therapy, athletic 

training, exercise physiology, 

kinesiology, or massage therapy 

services. 

2. Qualification Standards and 

Supervision Requirements in Therapy 

Private Practice Settings 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Therapy Standards and Requirements’’

at the beginning of your comments.]

Section 1861(p) includes services 

furnished to individuals by physical 

and occupational therapists meeting 

licensing and other standards prescribed 

by the Secretary if the services meet the 

necessary conditions for standards for 

health and safety. These services 

include those furnished in the 

therapist’s office or the individual’s 

home. By regulation, we have defined 

therapists under this provision as 

physical or occupational therapists in 

private practice (PTPPs and OTPPs). 

Under Medicare Part B, outpatient 

therapy services, including physical and 

occupational therapy services, are 

generally covered when reasonable and 

necessary and when provided by 

physical and occupational therapists 

meeting the qualifications set forth at 

§ 484.4. Services provided by qualified 

therapy assistants, including physical 

therapist assistants (PTAs) and 

occupational therapy assistants (OTAs), 

may also be covered by Medicare when 

furnished under the specified level of 

therapist supervision that is required for 

the setting in which the services are 

provided (institutions and private 

practice therapist offices). For PTPPs 

and OTPPs, the regulations specify that 

the PT or OT meets only State licensure 

or certification standards and do not 

currently refer to the professional 

qualification requirements at § 484.4.

Since 1999, when therapy services are 

provided by PTAs and OTAs in the PT 

or OT private practice setting, the 

services must be personally supervised 

by the PTPP or OTPP. In response to a 

requirement to report to Congress on 

State standards for supervision of PTAs, 

CMS contracted with the Urban 

Institute. The Urban Institute found that 

no State has the strict, full-time 

‘‘personal’’ supervision requirement, for 

any setting, that Medicare places on 

PTAs in PTPPs (the report only 

examined PTAs, which are more heavily 

regulated than OTAs). The Urban 

Institute study found that only 7 States 

require any ‘‘personal’’ PTA supervision 

by the PT, and all 7 required this level 

of supervision only periodically, every 

14, 30 or 60 days. The remaining States 

and Washington, DC all have less 

stringent PTA supervision requirements, 

including: 7 States and Washington, DC 

require full-time on-site supervision, 

which corresponds to Medicare’s direct 

supervision level; 16 States require the 

equivalent of Medicare’s general 

supervision level, which does not 

require the PT to be on site, but requires 

the PT to be in contact via 

telecommunication; and another 16 

States have rules for periodic on-site PT 

visits. Most States permit a supervision 

level similar to the Medicare ‘‘general’’

supervision requirement for physical 

therapy services delivered in 

institutional settings. To provide a 

consistent therapy assistant supervision 

policy, we are proposing to revise the 

regulations at 410.59 and 410.60 to 

require direct supervision of PTAs and 

OTAs when therapy services are 

provided by PTs or OTs in private 

practice. This proposed change would 

no longer require the personal presence 

of the PTPP or OTPP when their PTAs 

or OTAs provide services in the private 

practice setting. We are particularly 

interested in receiving comments 

regarding the proposed PTA supervision 

change, from personal to direct, for the 

private practice setting as whether or 

not it will have implications for the 

quality of services provided, or for 

Medicare spending, either through 

increased capacity to provide these 

services, or, alternatively, in the event 

that the Congress again extends the 

moratorium on the implementation of 

the limits on Medicare reimbursement 

for therapy services imposed by the 

Balanced Budget Act of 1997. 

Currently, the OTPP or PTPP 

regulations at § 410.59(c) and § 410.60(c) 

do not reference qualification 

requirements for therapy assistants, or 

other staff, working for PTs and OTs in 

private practices. These qualification 

requirements were removed during 1998 

rulemaking—when the coverage 

conditions requiring survey and 

certification, at § 486 Subpart D, for 

independently practicing PTs and OTs 

were replaced with a simplified carrier 

enrollment process for PTPPs and 

OTPPs. In our 1998 rule, at 63 FR 

58868, we deleted the references at 

§ 410.59 and § 410.60 to the 

requirements at § 484.4 for PTs and OTs 

in private practice. At that time, the 

qualifications for the staff of the PTPP 

and OTPP, including PTAs and OTAs, 

were inadvertently removed because the 

coverage conditions at § 486 Subpart D 

were no longer applicable. In order to 

provide a consistent policy regarding 

requirements for therapists and therapy 

assistants, we are proposing to restore 

the qualifications by adding at § 410.59 

and § 410.60 the cross-reference to the 

qualifications at § 484.4 for privately 

practicing therapists and their therapy 

assistants. 

3. Other Technical Revisions 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Therapy Technical Revisions’’ at the 

beginning of your comments.]

We are making technical corrections 

to § 410.62 to refer consistently to 

speech-language pathology in this 

section (currently the terms ‘‘speech 

pathology’’ and ‘‘speech-language 

pathology’’ are used interchangeably) 

and are revising § 410.62(a)(2)(iii) to 

appropriately reference § 410.61 (the 

current reference is to § 410.63). 

We are also removing subpart D, 

Conditions for Coverage: Outpatient 

Physical Therapy Services Furnished by 

Physical Therapists, from part 486. Our 

November 1998 rule (63 FR 58868) 

discussed replacing this subpart with a 

simplified carrier enrollment process for 

physical or occupational therapists in 

private practice; however, the 

conforming regulatory change to remove 

Subpart D was never made. 

In addition, we are making a technical 

change at § 484.4 to correct the title 

‘‘physical therapy assistant’’ to 

‘‘physical therapist assistant.’’

47552 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

We are also amending § 410.59(e) and 

§ 410.60(e) to include a reference to the 

2-year moratorium on the therapy caps 

established by section 624 of the MMA.

B. Low Osmolar Contrast Media 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘LOW OSMOLAR CONTRAST MEDIA’’

at the beginning of your comments.]

Contrast media are used to enhance 

the images produced by various types of 

diagnostic radiological procedures. High 

osmolar contrast media (HOCM), 

initially developed for use with these 

procedures, was relatively inexpensive 

and payment for HOCM is subsumed in 

the payment for the technical 

component of these procedures. When 

the more expensive low osmolar 

contrast media (LOCM) were developed, 

estimates showed that if all radiologic 

studies requiring contrast media were to 

use LOCM, the costs to the Medicare 

program would have been substantial. 

At that time, there were no definitive 

studies showing that the benefits of 

using LOCM justified the very high 

additional costs. 

When the Medicare physician fee 

schedule was established, findings of 

studies of patients receiving both types 

of contrast media had been published, 

and the American College of Radiology 

(ACR) had adopted criteria for the use 

of LOCM. We determined that the older, 

less expensive contrast media (HOCM) 

could be used safely in a large 

percentage of the Medicare population. 

However, we also decided that separate 

payment for LOCM should be made for 

patients with certain medical 

characteristics. We adopted the ACR 

criteria, with some modification, as the 

basis for a policy that separate payments 

be made for the use of LOCM in 

radiological procedures for patients 

meeting certain criteria. These criteria 

were established at § 414.38. 

Specifically, separate payment is made 

for all intrathecal, intravenous, and 

intra-arterial injections of LOCM, when 

it is used for nonhospital patients who 

have one or more of the following five 

medical conditions—

• A history of previous adverse 

reactions to contrast media, with the 

exception of a sensation of heat, 

flushing, or a single episode of nausea 

or vomiting; 

• A history of asthma or allergy; 

• Significant cardiac dysfunction, 

including recent or imminent cardiac 

decompensation, severe arrhythmias, 

unstable angina pectoris, recent 

myocardial infarction, and pulmonary 

hypertension; 

• Generalized debilitation; 

• Sickle cell disease.

Under these conditions, we pay for 

LOCM, utilizing HCPCS codes A4644 

through A4646. The payment amount 

for LOCM is calculated according to the 

rules applicable to drugs provided 

incident to a physician’s service. The 

amount is reduced by 8 percent to 

account for the allowance for contrast 

media already included in the technical 

component of the service.

ACR has requested that we allow 

further separate payment for LOCM by 

either expanding or eliminating the 

conditions. According to ACR, use of 

LOCM has become the standard in most 

radiology practices and benefits both 

physicians and patients. The benefits of 

uniform use of LOCM would include—

• The reduction of patient discomfort 

arising when HOCM is used instead of 

LOCM; and 

• A reduction in physician resources 

now required to screen for high-risk 

patients.

The price differential between HOCM 

and LOCM is also decreasing. Universal 

use of LOCM, along with declining 

prices, will result in an efficient, and 

safer alternative to HOCM.

We are proposing to revise the 

regulations at § 414.38 to eliminate the 

restrictive criteria for the payment of 

LOCM. This proposal would make 

Medicare payment for LOCM consistent 

across settings. Before January 1, 2003, 

the criteria in § 414.38 were also used to 

determine payment in the hospital 

setting. However, as instructed in our 

Program Memorandum A–02–120, 

issued November 22, 2002, hospitals 

that are subject to the outpatient 

prospective payment system (OPPS) no 

longer use these criteria. Instead, 

payment for both ionic and non-ionic 

contrast media (including LOCM) is 

packaged into the APC payment for the 

procedure. Under OPPS there is no 

longer a payment difference between 

LOCM and other contrast materials.

Effective January 1, 2005, payment for 

LOCM would be made on the basis of 

the average sales price plus six percent 

in accordance with the standard 

methodology for drug pricing 

established by the MMA. However, 

because the technical portions of 

radiology services are currently valued 

in the nonphysician workpool and the 

CPEP inputs for these services are not 

used in calculating payment, we will 

continue to reduce payment for LOCM 

by eight percent to avoid any duplicate 

payment for contrast media. 

C. Payments for Physicians and 

Practitioners Managing Patients on 

Dialysis 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘MANAGING PATIENTS ON 

DIALYSIS’’ at the beginning of your 

comments.] 

1. ESRD-Related Services Provided to 

Patients in Observation Settings 

In response to comments received on 

billing procedures when the patient is 

hospitalized during the month, we 

stated in the November 7, 2003 Federal 

Register (68 FR 63220) that the 

physician may bill the code that reflects 

the number of visits during the month 

on days when the patient was not in the 

hospital (either admitted as an inpatient 

or in observation status). (We refer to 

Medicare’s payment amount below as 

the monthly capitation payment or MCP 

and the patient’s normal attending 

physician for ESRD-related services as 

the MCP physician). 

In comments on the August 15, 2003 

proposed rule, the Renal Physicians 

Association (RPA) indicated that the 

observation area is not an uncommon 

setting for outpatient face-to-face 

encounters to occur and the observation 

area should be an approved site-ofservice for physician-dialysis patient 

encounters that count toward the MCP 

visit total. We indicated in the final 

rule, however, that observation services 

would not be counted as a visit under 

the MCP, but would be paid separately. 

Prior to this, long-standing Medicare 

policy had subsumed ESRD-related 

observation visits within the MCP. 

Upon further review of this issue, we 

now agree with RPA’s comment and 

propose that ESRD-related visits 

provided to patients by the MCP 

physician in an observation setting 

would be counted as visits for purposes 

of billing the MCP codes. 

2. Payment for Outpatient ESRD-Related 

Services for Partial Month Scenarios 

Since changing our payments for 

managing patients on dialysis, we have 

received a number of comments from 

the nephrology community requesting 

guidance on billing for outpatient ESRDrelated services provided to transient 

patients and in partial month scenarios 

where the comprehensive visit may not 

have been furnished: for example, when 

the patient is hospitalized during the 

month, or receives a kidney transplant 

before the monthly comprehensive visit 

is furnished. To address this issue, we 

propose to change the description of the 

G codes for ESRD-related home dialysis 

services, less than full month, as 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47553

identified by G0324 through G0327. The 

new descriptor would include other 

partial month scenarios, in addition to 

patients dialyzing at home. The 

proposed descriptors for G0324 through 

G0327 are as follows: 

‘‘G0324: End stage renal disease 

(ESRD) related services for dialysis less 

than a full month of service, per day; for 

patients under two years of age.’’

‘‘G0325: End stage renal disease 

(ESRD) related services for dialysis less 

than a full month of service, per day; for 

patients between two and eleven years 

of age.’’

‘‘G0326: End stage renal disease 

(ESRD) related services for dialysis less 

than a full month of service, per day; for 

patients between twelve and nineteen 

years of age.’’

‘‘G0327: End stage renal disease 

(ESRD) related services for dialysis less 

than a full month of service, per day; for 

patients twenty years of age and over.’’

The G codes G0324 through G0327 

would be used to bill for outpatient 

ESRD-related services provided in the 

following scenarios: 

• Transient patients—Patients 

traveling away from home (less than full 

month); 

• Home Dialysis Patients (less than 

full month); 

• Partial month where there was one 

or more face-to-face visits without the 

comprehensive visit and either the 

patient was hospitalized before a 

complete assessment was furnished, 

dialysis stopped due to death, or the 

patient had a transplant. 

We believe that modifying the 

definition of the per diem G codes (as 

identified by G0324 through G0327) 

would provide a consistent way to bill 

for these partial month scenarios. 

However, this proposed change to the 

descriptions of G0324 through G0327 is 

intended to accommodate unusual 

circumstances when the outpatient 

ESRD-related services would not be 

paid for under the MCP. Use of these 

per diem codes would be limited to the 

scenarios listed above. Physicians who 

have an on-going formal agreement with 

the MCP physician to provide cursory 

visits during the month (for example 

‘‘rounding physicians’’) may not use the 

per diem codes. 

Clarification on Billing for Transient 

Patients 

For transient patients who are away 

from their home dialysis site, and at 

another site for fewer than 30 

consecutive days, the revised per diem 

G codes (G0324 through G0327) would 

be billed by the physician or 

practitioner responsible for the transient 

patient’s ESRD-related care. Only the 

physician or practitioner responsible for 

the traveling ESRD patient’s care would 

be permitted to bill for ESRD-related 

services using the per diem G codes 

(G0324 through G0327). 

If the transient patient is under the 

care of a physician or practitioner other 

than his or her regular MCP physician 

for a complete month, the physician or 

practitioner responsible for the transient 

patient’s ESRD-related care cannot bill 

using the per diem codes. In this case 

the transient physician or practitioner 

treating the patient must furnish a 

complete assessment and bill for ESRDrelated services under the MCP.

We are currently evaluating the 

criteria for defining a transient patient 

and welcome comments on when a 

patient should be considered transient. 

D. Technical Revision 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘TECHNICAL REVISION’’ at the 

beginning of your comments.] 

In § 411.404, Medicare noncoverage of 

all obesity-related services is used as an 

example. Since we are currently 

revising this coverage policy, we are 

proposing to omit this example. 

E. Diagnostic Psychological Tests 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘DIAGNOSTIC PSYCHOLOGICAL 

TESTS’’ at the beginning of your 

comments.] 

All 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. Additionally, the physician 

or nonphysician practitioner who is 

treating the patient must order all 

diagnostic tests in order for these tests 

to be considered reasonable and 

necessary. These tests must be furnished 

under at least a general level of 

physician supervision, that is, the test is 

furnished under the physician’s overall 

direction and control, but the 

physician’s presence is not required 

during the performance of the 

procedure. 

However, certain diagnostic tests 

require either direct or personal 

supervision. 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. Personal supervision 

means the physician must be in 

attendance in the room during the 

performance of the procedure. Physician 

supervision at the specified level is 

required throughout the performance of 

the test. Services furnished without the 

required level of supervision are not 

reasonable and necessary, and Medicare 

payment is precluded. 

Section 410.32(b)(2)(iii) does permit 

an exception to these physician 

supervision level requirements for 

clinical psychologists and 

independently practicing psychologists 

(who are not clinical psychologists) to 

personally perform diagnostic 

psychological testing services without 

physician supervision. However, 

diagnostic psychological tests 

performed by anyone other than a 

clinical psychologist or independently 

practicing psychologist must be 

provided under the general supervision 

of a physician as defined above. 

Accordingly, clinical psychologists and 

independently practicing psychologists 

have not been permitted to supervise 

others in the administration of 

diagnostic psychological tests. 

In § 410.71(d), we require a clinical 

psychologist who furnishes diagnostic, 

assessment, preventive, and therapeutic 

services directly to individuals to hold 

a doctoral degree in psychology and to 

be licensed or certified, on the basis of 

the doctoral degree in psychology, by 

the State in which he or she practices. 

Program instructions define an 

independently practicing psychologist 

as an individual who is not a clinical 

psychologist and practices 

independently of an institution, agency, 

or physician’s office. Examples include, 

but are not limited to, educational 

psychologists and counseling 

psychologists. Any psychologist who is 

licensed or certified to practice 

psychology in the State or jurisdiction 

where he or she is furnishing services 

may qualify as an independent 

psychologist. It is our understanding 

that all States, the District of Columbia, 

and Puerto Rico license psychologists, 

but that some trust territories do not. In 

the jurisdictions that do not issue 

licenses, an independently practicing 

psychologist may be any practicing 

psychologist. 

The American Psychological 

Association (APA) requested that we reevaluate our regulations regarding 

clinical psychologists’ supervision of 

diagnostic psychological tests. The APA 

also provided additional information 

concerning provision of these services. 

According to the APA, clinical 

psychologists generally have seven 

years of graduate education in the study 

of human behavior and are highly 

trained in the selection, administration, 

47554 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

and interpretation of psychological 

tests. In addition, according to our 

payment data, the majority of health 

care practitioners, other than 

physicians, performing psychological 

and neuropsychological testing services 

under the central nervous system codes 

(CPT codes 96100 through 96117) are 

psychologists. We agree that clinical 

psychologists possess core knowledge in 

test measurement and development, 

psychometric theory, specialized 

psychological assessment techniques, 

statistics, and the psychology of 

behavior that uniquely qualifies them to 

direct test selection and interpret test 

data.

Therefore, we are proposing to change 

the supervision requirements regarding 

who can supervise diagnostic 

psychological testing services. 

Having ancillary staff supervised by 

clinical psychologists would enable 

these practitioners with a higher level of 

expertise to oversee psychological 

testing. It could also potentially relieve 

burdens on physicians and healthcare 

facilities. 

Additionally, in rural areas, we 

anticipate that permitting psychologists 

to supervise diagnostic psychological 

testing services would reduce delays in 

testing, diagnosis, and treatment that 

could result from the unavailability of 

physicians to supervise the tests. 

We propose that the appropriate level 

of supervision of diagnostic 

psychological tests by clinical 

psychologists be general supervision, 

the level required of physicians 

supervising the same services. 

We are proposing to revise the 

regulations at § 410.32(b)(2)(iii) to 

permit clinical psychologists to 

supervise the performance of diagnostic 

psychological and neuropsychological 

testing services. This proposal extends 

solely to clinical psychologists, and it 

does not include independently 

practicing psychologists. 

F. Care Plan Oversight 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘CARE PLAN OVERSIGHT’’ at the 

beginning of your comments.] 

Care Plan Oversight (CPO) refers to 

the supervision of patients under 

Medicare-covered home health or 

hospice care requiring complex multidisciplinary care modalities, including 

regular development and review of 

plans of care. In the December 8, 1994 

physician fee schedule final rule (59 FR 

63423), we established separate 

payment for CPO when performed by 

physicians. The Balanced Budget Act 

(BBA) of 1997 extended to nonphysician 

practitioners (NPPs) the right to receive 

payment for Medicare physicians’

services that fall within their scope of 

practice under State law. In the 

November 1, 2000 final rule (65 FR 

65407), we created HCPCS codes G0181 

and G0182 for reporting home health 

and hospice CPO, respectively. We also 

clarified in that rule that services of 

NPPs, practicing within the scope of 

State law applicable to their services, 

could be billed as CPO services. 

To certify a patient for home health 

services, a physician must review the 

patient records and sign the plan of 

care. Our policy has been that the 

physician who bills for CPO must be the 

same physician who signs the plan of 

care and that, according to the statute, 

(sections 1814(a)(2)(C) and 1835(a)(2)(A) 

of the Act), only a physician can sign 

the plan of care for home health 

services. The effect of these two 

provisions, both of which were in place 

prior to the BBA of 1997, created a 

problem with respect to an NPP billing 

for CPO in the home health setting. 

We propose to revise § 414.39 to 

clarify that NPPs can perform home 

health CPO even though they cannot 

certify a patient for home health 

services and sign the plan of care. 

However, we are also proposing the 

conditions under which NPP services 

may be billed for CPO; we established 

these conditions in consultation with 

our contractor medical directors and 

CMS medical staff. In general, the 

proposed conditions are meant to 

ensure that the NPP has seen and 

examined the patient and that the 

appropriate and established relationship 

exists between the physician who 

certifies the patient for home health 

services and the NPP who will provide 

the home health CPO. 

G. Assignment of Medicare Claims—

Payment to the Supplier 

[If you choose to comment on issues in 

this section, please include the caption 

‘‘Assignment’’ at the beginning of your 

comments.] 

Current regulations require the 

beneficiary (or the person authorized to 

request payment on the beneficiary’s 

behalf) to assign a claim to the supplier 

for an assignment to be effective. Over 

time, however, the Act has been 

amended in various sections to require 

suppliers, in some instances, to accept 

assignment for a Medicare covered 

service regardless of whether or not the 

beneficiary actually assigns the claim to 

the supplier. (This would include 

situations in which services are 

furnished by a participating physician 

or supplier.) In these instances, the 

requirement in our current regulations 

at § 424.55(a) that the beneficiary assign 

the claim to the supplier is now 

unnecessary. Therefore, we are 

proposing to create an exception to the 

general rule in § 424.55(a). New 

§ 424.55(c) would eliminate the 

requirement that beneficiaries assign 

claims to suppliers in situations where 

suppliers are required by statute to 

accept assignment. 

We believe the creation of this 

exception to the requirement for 

beneficiaries to assign benefits in 

situations where benefits can by statute 

only be paid on an assigned basis will 

reduce the paperwork burden on 

beneficiaries and suppliers. 

V. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

of 1995 (PRA), we are required to 

provide 60-day notice in the Federal 

Register and solicit public comment 

before a collection of information 

requirement is submitted to the Office of 

Management and Budget (OMB) for 

review and approval. In order to fairly 

evaluate whether OMB should approve 

an information collection, section 

3506(c)(2)(A) of the PRA requires that 

we solicit comment on the following 

issues: 

• The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

Section 410.16 requires the furnishing 

of education, counseling, and referral 

services as part of an initial preventive 

physical examination, a written plan for 

obtaining the appropriate screening and 

other preventive services which are also 

covered as separate Medicare B Part 

services. 

The burden associated with this 

requirement is the time required of the 

physician or practitioner to provide 

beneficiaries with education, 

counseling, and referral services and to 

develop and provide a written plan for 

obtaining screening and other 

preventive services. 

While these requirements are subject 

to the PRA, we believe the burden 

associated with these requirements to be 

reasonable and customary business 

practice; therefore, the burden for this 

collection requirement is exempt under 

5 CFR 1320.3(b)(2)&(3). 

Section 411.404 requires that written 

notice must be given to a beneficiary, or 

someone acting on his or her behalf, that 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47555

the services were not covered because 

they did not meet Medicare coverage 

guidelines. 

Although this section is subject to the 

PRA, the burden associated with this 

requirement is currently captured and 

accounted for in two currently approved 

information collections under OMB 

numbers 0938–0566 and 0938–0781. 

Sections 410.36 and 410.38 require 

that the physician must document in the 

medical records the need for the 

prosthetic, orthotic, durable medical 

equipment, and/or supplies being 

ordered. 

While these information collection 

requirements are subject to the PRA, the 

burden associated with them is exempt 

as defined in 5 CFR 1320.3(b)(2).

If you comment on these information 

collection and recordkeeping 

requirements, please mail copies 

directly to the following: 

Centers for Medicare & Medicaid 

Services, Office of Strategic Operations 

and Regulatory Affairs, Attn: Melissa 

Musotto (CMS–1429–P), Room C5–13–

28, 7500 Security Boulevard, Baltimore, 

MD 21244–1850; and Office of 

Information and Regulatory Affairs, 

Office of Management and Budget, 

Room 10235, New Executive Office 

Building, Washington, DC 20503, Attn: 

Christopher Martin, CMS Desk Officer 

(CMS–1429–P), 

ChristopherlMartin@omb.eop.gov.

FAX (202) 395–6974. 

VI. Response to Comments 

Because of the large number of public 

comments we normally receive on 

Federal Register documents, we are not 

able to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, when we proceed 

with a subsequent document, we will 

respond to the comments in the 

preamble to that document. 

VII. Regulatory Impact Analysis 

[If you choose to comment on issues 

in this section, please include the 

caption ‘‘IMPACT’’ at the beginning of 

your comments.] 

We have examined the impact of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 16, 

1980 Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub.L. 

104–4), and Executive Order 13132. 

Executive Order 12866 (as amended 

by Executive Order 13258, which 

merely reassigns responsibilities of 

duties) 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 

must be prepared for proposed rules 

with economically significant effects 

(that is, a proposed rule that would have 

an annual effect on the economy of $100 

million or more in any 1 year, or would 

adversely affect in a material way the 

economy, a sector of the economy, 

productivity, competition, jobs, the 

environment, public health or safety, or 

State, local, or tribal governments or 

communities). As indicated in more 

detail below, we estimate that the 

physician fee schedule provisions 

included in this proposed rule will 

redistribute more than $100 million in 

1 year. We are also estimating that the 

combined effect of several provisions of 

the MMA implemented in this proposed 

rule will increase spending by more 

than $100 million. Other MMA 

provisions implemented in this 

proposed rule are estimated to reduce 

spending by more than $100 million. 

We are considering this proposed rule to 

be economically significant because its 

provisions are estimated to result in an 

increase, decrease or aggregate 

redistribution of Medicare spending that 

will exceed $100 million. Therefore, 

this proposed rule is a major rule and 

we have prepared a regulatory impact 

analysis. 

The RFA requires that we analyze 

regulatory options for small businesses 

and other entities. We prepare a 

regulatory flexibility analysis unless we 

certify that a rule would not have a 

significant economic impact on a 

substantial number of small entities. 

The analysis must include a justification 

concerning the reason action is being 

taken, the kinds and number of small 

entities the rule affects, and an 

explanation of any meaningful options 

that achieve the objectives with less 

significant adverse economic impact on 

the small entities. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any proposed rule that may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside a 

Metropolitan Statistical Area and has 

fewer than 100 beds. We have 

determined that this proposed rule 

would have minimal impact on small 

hospitals located in rural areas. Of 431 

hospital-based ESRD facilities located in 

rural areas, only 40 are affiliated with 

hospitals with fewer than 100 beds. 

For purposes of the RFA, physicians, 

nonphysician practitioners, and 

suppliers are considered small 

businesses if they generate revenues of 

$6 million or less. Approximately 95 

percent of physicians are considered to 

be small entities. There are about 

875,000 physicians, other practitioners 

and medical suppliers that receive 

Medicare payment under the physician 

fee schedule. There are in excess of 

20,000 physicians and other 

practitioners that receive Medicare 

payment for drugs. (As noted previously 

in this proposed rule and described 

further below, we are proposing 

significant changes to the payments for 

drugs.) These physicians are 

concentrated in the specialties of 

oncology, urology, and rheumatology. 

Of the physicians in these specialties, 

approximately 40 percent are in 

oncology and 45 percent in urology. 

For purposes of the RFA, 

approximately 98 percent of suppliers of 

durable medical equipment (DME) and 

prosthetic devices are considered small 

businesses according to the Small 

Business Administration’s (SBA) size 

standards. We estimate that 106,000 

entities bill Medicare for durable 

medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS) each 

year. Total annual estimated Medicare 

revenues for DME suppliers exceed 

approximately $4.0 billion. Of this 

amount, approximately $1.6 billion are 

for DME drugs. 

In addition, most ESRD facilities are 

considered small entities, either based 

on nonprofit status, or by having 

revenues of $29 million or less in any 

year. We consider a substantial number 

of entities to be affected if the proposed 

rule is estimated to impact more than 5 

percent of the total number of small 

entities. Based on our analysis of the 

697 nonprofit ESRD facilities 

considered small entities in accordance 

with the above definitions, we estimate 

that the combined impact of the 

proposed changes to payment for renal 

dialysis services included in this rule 

would have a 1.6 percent increase in 

payments relative to current composite 

rate payments.

The analysis and discussion provided 

in this section, as well as elsewhere in 

this proposed rule, complies with the 

RFA requirements. Section 202 of the 

Unfunded Mandates Reform Act of 1995 

also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule that may result in 

expenditures in any year by State, local, 

47556 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

or tribal governments, in the aggregate, 

or by the private sector, of $110 million. 

Medicare beneficiaries are considered to 

be part of the private sector for this 

purpose. The net impact of the 

provisions of this rule, including those 

related to the MMA, are estimated to 

result in a savings to beneficiaries of 

nearly $270 million for FY 2005. The 

specific effects of the provisions being 

implemented in this proposed rule are 

explained in greater detail below. 

We have examined this proposed rule 

in accordance with Executive Order 

13132 and have determined that this 

regulation would not have any 

significant impact on the rights, roles, or 

responsibilities of State, local, or tribal 

governments. 

We have prepared the following 

analysis, which, together with the 

information provided in the rest of this 

preamble, meets all 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 

we propose to use to minimize the 

burden on small entities. As indicated 

elsewhere in this proposed rule, we 

propose to refine resource-based 

practice expense RVUs and make a 

variety of other changes to our 

regulations, payments, or payment 

policy to ensure that our payment 

systems are updated to reflect changes 

in medical practice and the relative 

value of services. We are also proposing 

several changes resulting from the 

MMA, including changes to Medicare 

payment rates for outpatient drugs, 

changes to the payment for renal 

dialysis services, creating new 

preventive health care benefits and 

creating incentive payment program 

improvements for physician scarcity. 

We are providing information for each 

of the policy changes in the relevant 

sections of this proposed rule. We are 

unaware of any relevant Federal rules 

that duplicate, overlap or conflict with 

this proposed rule. The relevant 

sections of this proposed rule contain a 

description of significant alternatives if 

applicable. 

A. Resource-Based Practice Expense 

and Malpractice Relative Value Units 

Under section 1848(c)(2) of the Act, 

adjustments to RVUs may not cause the 

amount of expenditures to differ by 

more than $20 million from the amount 

of expenditures that would have 

resulted without such adjustments. We 

are proposing several changes that 

would result in a change in 

expenditures that would exceed $20 

million if we made no offsetting 

adjustments to either the conversion 

factor or RVUs. 

With respect to practice expense, our 

policy has been to meet the budgetneutrality requirements in the statute by 

incorporating a rescaling adjustment in 

the practice expense methodologies. 

That is, we estimate the aggregate 

number of practice expense RVUs that 

will be paid under current and proposed 

policy in CY 2005. We apply a uniform 

adjustment factor to make the aggregate 

number of proposed practice expense 

RVUs equal the number estimated that 

would be paid under current policy. 

Table 21 shows the specialty level 

impact on payment of changes being 

proposed for CY 2005. Our estimates of 

changes in Medicare revenues for 

physician fee schedule services compare 

payment rates for 2005 with payment 

rates for 2004 using 2003 Medicare 

utilization for both years. We are using 

2003 Medicare claims processed and 

paid through June 30, 2004 that we 

estimate are 96.7 complete and have 

adjusted the figures to reflect a full year 

of data. Thus, because we are using a 

single year of utilization, the estimated 

changes in revenues reflect payment 

changes only between 2004 and 2005. 

To the extent that there are year-to-year 

changes in the volume and mix of 

services provided by physicians, the 

actual impact on total Medicare 

revenues will be different than those 

shown here. The payment impacts 

reflect averages for each specialty based 

on Medicare utilization. The payment 

impact for an individual physician 

would be different from the average, 

based on the mix of services the 

physician provides. The average change 

in total revenues would be less than the 

impact displayed here because 

physicians furnish services to both 

Medicare and non-Medicare patients 

and specialties may receive substantial 

Medicare revenues for services that are 

not paid under the physician fee 

schedule. For instance, independent 

laboratories receive approximately 80 

percent of their Medicare revenues from 

clinical laboratory services that are not 

paid under the physician fee schedule. 

The table shows only the payment 

impact on physician fee schedule 

services. 

We modeled the impact of changes to 

the practice expense methodology and 

illustrated the effect in table 21 below. 

The column labeled ‘‘Practice Expense 

RVU Refinements’’ shows the effect of 

the refinements we are making to the 

practice expense methodology for 2005. 

For instance, we are incorporating 

refined practice expense inputs 

recommended by the PEAC into the 

methodology as well as updating the 

prices of medical equipment. We are 

also adding 2003 utilization data for 

codes that did not exist in the 1997 

through 2002 period. 

In general, updating the methodology 

with 2003 utilization data has little or 

no impact on total payments to a 

specialty but the practice expense 

values for specific services may change. 

In general, the largest changes to a 

practice expense RVU will occur when 

a code was established after 2002 and 

we did not have any Medicare 

utilization data to determine the 

specialty that performs the service. In 

these cases, we either assigned the code 

to a specialty cost pool based on the 

specialty most likely to do the service or 

we used the ‘‘all physician’’ scaling 

factors to determine the code’s practice 

expense RVUs. While we are trying to 

minimize instability in the practice 

expense RVUs for new services by 

assigning the specialty that is most 

likely to perform the service when we 

have no utilization data, the addition of 

utilization to the methodology may still 

result in some change to the practice 

expense RVUs during the first few years 

a code is in existence. 

The practice expense refinements will 

reduce payments to audiologists by 

approximately 4 percent. Virtually all of 

the reduction in payment is due to the 

refinement of procedure code 92547. We 

accepted the PEAC recommendation to 

reduce the clinical staff time of the 

audiologist involved in this add-on 

service from 71 minutes to 1 minute. 

The refinement of clinical staff and 

equipment resulted in a reduction from 

1.15 to 0.08 practice expense RVUs 

producing the nearly 4 percent 

reduction in payments shown in table 

21.

Payments to vascular surgeons will 

increase approximately 3 percent as a 

result of the refinements. The increase 

in payment is attributed to the repricing 

of medical equipment used in 

performing noninvasive vascular 

diagnostic tests that will increase the 

practice expense RVUs for procedure 

codes 93880, 93923, 93925, 93970 and 

other codes in that family. The 

estimated 2 percent increase in payment 

from the practice expense refinements 

for interventional radiology is primarily 

due to the establishment of nonfacility 

pricing for procedure codes 35470 to 

35476. The 3 percent increase in 

payment to oral and maxillofacial 

surgeons is largely attributed to the 

refinement of medical supplies for 

procedure codes 21210 and 21215. The 

1 percent decrease in payment to nurse 

practitioners and geriatricians is 

attributed to the refinement of the 

nonfacility practice expense RVUs for 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47557

nursing facility visits (procedure codes 

99301 through 99316). As stated in the 

November 7, 2003 Federal Register (68 

FR 63204), the changes to the 

nonfacility practice expense RVUs for 

these codes were delayed by 1 year to 

allow the PEAC to reconsider its earlier 

recommendation to us to reflect input 

from representatives of specialties that 

provide these services in nursing 

homes. The PEAC reconsidered its 

recommendations with input from these 

specialties. Our acceptance of the PEAC 

recommendations is resulting in a 

decrease in the nonfacility practice 

expense RVUs for the nursing facility 

visit codes. 

The column labeled ‘‘Survey Data’’

shows the impact on payment from 

using the supplemental practice 

expense survey from the College of 

American Pathologists (CAP). Using this 

survey together with making the 

technical component practice expense 

RVUs equal to the difference between 

the global and professional component 

practice expense RVUs and the other 

practice expense refinements will 

increase payments to pathologists by 

approximately 2 percent and 

independent laboratories by more than 

6 percent. As we indicated above, 

independent laboratories receive 

approximately 20 percent of their total 

Medicare revenues from physician fee 

schedule services. The remaining 80 

percent of their Medicare revenues are 

from clinical diagnostic laboratory 

services that will be unchanged by use 

of the CAP survey data. Thus, total 

Medicare revenues to independent 

laboratories as a result of using the CAP 

survey will increase by slightly more 

than 1 percent (or 20 percent of the 6 

percent increase in physician fee 

schedule revenues). There will be little 

or no impact on all other specialties 

from use of the CAP survey. 

The column labeled ‘‘Total’’ in Table 

21 below shows the payment impact by 

specialty of all the changes described 

above. If we change any of these 

proposals following our consideration of 

comments, these figures may change.

TABLE 21.—IMPACT OF PRACTICE EXPENSE RVU CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, 

PRACTITIONER AND SUPPLIER SUBCATEGORY

Specialty 

Medicare allowed charges 

($ in millions) 

Practice expense RVU refinements

(percent) 

Survey data

(percent) 

Total

(percent) 

Physicians: 

ALLERGY/IMMUNOLOGY ....................................................................... 161 ¥1 0 ¥1 

ANESTHESIOLOGY ................................................................................. 1,416 0 0 0 

CARDIAC SURGERY ............................................................................... 359 0 0 0 

CARDIOLOGY .......................................................................................... 6,583 0 0 0 

COLON AND RECTAL SURGERY .......................................................... 111 0 0 0

CRITICAL CARE ...................................................................................... 130 0 0 0 

DERMATOLOGY ...................................................................................... 1,870 0 0 0 

EMERGENCY MEDICINE ........................................................................ 1,672 0 0 0 

ENDOCRINOLOGY .................................................................................. 280 0 0 0 

FAMILY PRACTICE ................................................................................. 4,448 0 0 0 

GASTROENTEROLOGY .......................................................................... 1,636 0 0 0 

GENERAL PRACTICE ............................................................................. 998 0 0 0 

GENERAL SURGERY .............................................................................. 2,258 0 0 0 

GERIATRICS ............................................................................................ 117 ¥1 0 ¥1 

HAND SURGERY ..................................................................................... 57 1 0 1 

HEMATOLOGY/ONCOLOGY ................................................................... 1,753 0 0 0 

INFECTIOUS DISEASE ........................................................................... 401 0 0 0 

INTERNAL MEDICINE ............................................................................. 8,846 0 0 0 

INTERVENTIONAL RADIOLOGY ............................................................ 190 2 0 2 

NEPHROLOGY ........................................................................................ 1,248 1 0 1 

NEUROLOGY ........................................................................................... 1,200 0 0 0 

NEUROSURGERY ................................................................................... 490 0 0 0 

NUCLEAR MEDICINE .............................................................................. 85 0 0 0 

OBSTETRICS/GYNECOLOGY ................................................................ 582 0 0 0 

OPHTHALMOLOGY ................................................................................. 4,583 ¥1 0 ¥1 

ORTHOPEDIC SURGERY ....................................................................... 2,902 0 0 0 

OTOLARNGOLOGY ................................................................................. 815 0 0 0 

PATHOLOGY ........................................................................................... 869 ¥1 3 2 

PEDIATRICS ............................................................................................ 59 ¥1 0 ¥1 

PHYSICAL MEDICINE ............................................................................. 677 0 0 0 

PLASTIC SURGERY ................................................................................ 281 0 0 0 

PSYCHIATRY ........................................................................................... 1,093 0 0 0 

PULMONARY DISEASE .......................................................................... 1,446 0 0 0 

RADIATION ONCOLOGY ........................................................................ 1,164 0 0 0 

RADIOLOGY ............................................................................................ 4,690 0 0 0 

RHEUMATOLOGY ................................................................................... 413 0 0 0 

THORACIC SURGERY ............................................................................ 463 0 0 0 

UROLOGY ................................................................................................ 1,699 0 0 0 

VASCULAR SURGERY ............................................................................ 487 3 0 3 

Practitioners: 

AUDIOLOGIST ......................................................................................... 28 ¥4 0 ¥4 

CHIROPRACTOR ..................................................................................... 656 0 0 0 

CLINICAL PSYCHOLOGIST .................................................................... 490 0 0 0 

CLINICAL SOCIAL WORKER .................................................................. 313 0 0 0 

NURSE ANESTHETIST ........................................................................... 481 0 0 0 

47558 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 21.—IMPACT OF PRACTICE EXPENSE RVU CHANGES ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, 

PRACTITIONER AND SUPPLIER SUBCATEGORY—Continued

Specialty 

Medicare allowed charges 

($ in millions) 

Practice expense RVU refinements

(percent) 

Survey data

(percent) 

Total

(percent) 

NURSE PRACTITIONER ......................................................................... 552 ¥1 0 ¥1 

OPTOMETRY ........................................................................................... 664 0 0 0 

ORAL/MAXILLOFACIAL SURGERY ........................................................ 36 3 0 3 

PHYSICAL/OCCUPATIONAL THERAPY ................................................. 990 ¥1 0 ¥1 

PHYSICIAN ASSISTANT ......................................................................... 410 0 0 0 

PODIATRY ............................................................................................... 1,383 0 0 0 

Suppliers: 

DIAGNOSTIC TESTING FACILITY .......................................................... 876 1 0 1 

INDEPENDENT LABORATORY .............................................................. 530 0 6 6 

PORTABLE X-RAY SUPPLIER ................................................................ 91 0 0 0 

Other: 

ALL OTHER .............................................................................................. 93 0 2 2 

ALL PHYSICIAN FEE SCHEDULE .......................................................... 66,395 0 0 0 

As discussed in Section II.C of this 

rule, we are proposing changes to the 

malpractice RVUs based on more 

current malpractice premium data. As 

anticipated from past revisions to the 

malpractice RVUs, use of more current 

malpractice premium data results in 

minimal proposed impacts on the 

specialty level payments. See Table 22, 

‘‘Specialty Impact of Malpractice RVUs 

Revisions’’, for a breakdown of the 

impacts of these revisions on individual 

specialties. Of the 54 specialties shown, 

15 specialties (representing a total of 40 

percent of Medicare allowed charges) 

experience no estimated change. Total 

Medicare payments for an additional 32 

specialties are estimated to increase or 

decrease between 0.1 percent and 0.5 

percent. We estimate that 7 specialties 

will experience a total payment increase 

or decrease of more than 0.5 percent as 

a result of the malpractice RVU changes. 

If we change any of these proposals 

following our consideration of 

comments, these figures may change.

TABLE 22.—SPECIALTY IMPACT OF MALPRACTICE RVU REVISIONS

Specialty Allowed charges 1 Percent of 

total charges 

Percent 

change 2

DERMATOLOGY ................................................................................................................... 1,870,318,730 2.8 0.7 

PLASTIC SURGERY ............................................................................................................. 280,508,065 0.4 0.6 

ORAL/MAXILLOFACIAL SURGERY ..................................................................................... 35,598,814 0.1 0.6 

COLON AND RECTAL SURGERY ....................................................................................... 110,683,908 0.2 0.6 

GASTROENTEROLOGY ....................................................................................................... 1,635,616,057 2.5 0.5 

GENERAL SURGERY ........................................................................................................... 2,257,836,035 3.4 0.5 

CRITICAL CARE ................................................................................................................... 130,256,300 0.2 0.5 

INFECTIOUS DISEASE ........................................................................................................ 395,195,230 0.6 0.4 

GERIATRICS ......................................................................................................................... 116,547,182 0.2 0.3 

PSYCHIATRY ........................................................................................................................ 1,092,801,668 1.7 0.3 

PULMONARY DISEASE ....................................................................................................... 1,445,180,432 2.2 0.3 

NURSE PRACTITIONER ...................................................................................................... 549,723,060 0.8 0.2 

PATHOLOGY ......................................................................................................................... 868,617,850 1.3 0.2 

NEUROLOGY ........................................................................................................................ 1,199,069,489 1.8 0.2 

PHYSICAL MEDICINE .......................................................................................................... 676,516,230 1.0 0.2 

INDEPENDENT LABORATORY ........................................................................................... 529,571,661 0.8 0.2 

OPTOMETRY ........................................................................................................................ 664,163,601 1.0 0.2 

NEPHROLOGY ...................................................................................................................... 1,247,164,211 1.9 0.1 

VASCULAR SURGERY ......................................................................................................... 486,263,563 0.7 0.1 

OBSTETRICS/GYNECOLOGY ............................................................................................. 578,322,768 0.9 0.1 

INTERNAL MEDICINE .......................................................................................................... 8,821,789,552 13.4 0.1 

ENDOCRINOLOGY ............................................................................................................... 279,359,088 0.4 0.1 

ANESTHESIOLOGY .............................................................................................................. 1,415,251,017 2.1 0.0 

HEMATOLOGY/ONCOLOGY ................................................................................................ 1,553,937,401 2.4 0.0 

CARDIOLOGY ....................................................................................................................... 6,580,625,617 10.0 0.0 

OPHTHALMOLOGY .............................................................................................................. 4,583,221,470 7.0 0.0 

NURSE ANESTHETIST ........................................................................................................ 481,060,016 0.7 0.0 

THORACIC SURGERY ......................................................................................................... 463,428,857 0.7 0.0 

RADIATION ONCOLOGY ..................................................................................................... 1,162,754,357 1.8 0.0 

ALL OTHER ........................................................................................................................... 92,826,859 0.1 0.0 

CLINICAL SOCIAL WORKER ............................................................................................... 313,327,455 0.5 0.0 

GENERAL PRACTICE .......................................................................................................... 995,188,403 1.5 0.0 

UROLOGY ............................................................................................................................. 1,689,047,785 2.6 0.0 

INTERVENTIONAL RADIOLOGY ......................................................................................... 189,980,663 0.3 0.0 

EMERGENCY MEDICINE ..................................................................................................... 1,671,773,516 2.5 0.0 

FAMILY PRACTICE ............................................................................................................... 4,442,795,644 6.7 0.0 

DIAGNOSTIC TESTING FACILITY ....................................................................................... 876,242,174 1.3 0.0 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47559

TABLE 22.—SPECIALTY IMPACT OF MALPRACTICE RVU REVISIONS—Continued

Specialty Allowed charges 1 Percent of 

total charges 

Percent 

change 2

PHYSICIANS ASSISTANT .................................................................................................... 409,700,298 0.6 -0.1 

PEDIATRICS ......................................................................................................................... 58,880,964 0.1 -0.1 

AUDIOLOGIST ...................................................................................................................... 27,930,180 0.0 -0.1 

CLINICAL PSYCHOLOGIST ................................................................................................. 490,006,176 0.7 -0.1 

CARDIAC SURGERY ............................................................................................................ 359,324,850 0.5 -0.1 

PORTABLE X-RAY SUPPLIER ............................................................................................. 91,026,934 0.1 -0.1 

HAND SURGERY .................................................................................................................. 56,595,222 0.1 -0.1 

OTOLARNGOLOGY .............................................................................................................. 814,914,443 1.2 -0.1 

RHEUMATOLOGY ................................................................................................................ 405,622,764 0.6 -0.1 

NUCLEAR MEDICINE ........................................................................................................... 85,239,821 0.1 -0.1 

CHIROPRACTOR .................................................................................................................. 656,312,519 1.0 -0.2 

RADIOLOGY .......................................................................................................................... 4,689,652,801 7.1 -0.3 

PODIATRY ............................................................................................................................. 1,382,552,109 2.1 -0.4 

ORTHOPEDIC SURGERY .................................................................................................... 2,902,084,841 4.4 -0.4 

NEUROSURGERY ................................................................................................................ 489,366,546 0.7 -0.6 

ALLERGY/IMMUNOLOGY .................................................................................................... 160,728,139 0.2 -0.9 

PHYSICAL/OCCUPATIONAL THERAPY .............................................................................. 990,284,755 1.5 -1.3

1 2003 Allowed Charges 

2Percent change based upon percent change in total payment. 

Section 1848(d) and (f) of the Act 

requires the Secretary to set the 

physician fee schedule update under the 

sustainable growth rate (SGR) system. 

For 2004 and 2005, the statute requires 

the update to be no less than 1.5 

percent. We believe it is highly likely 

that the statutory formula in section 

1848(d)(4) will produce an update of 

less than 1.5 percent for 2005. 

Therefore, we estimate that the 

physician fee schedule update for 2005 

will be 1.5 percent. We are currently 

forecasting payment reductions under 

the SGR system for 2006 and later years. 

As in the past, we will include a 

complete discussion of our methodology 

for calculating the SGR in the final rule. 

Table 23 below shows the estimated 

change in average payments by specialty 

resulting from changes to the practice 

expense and malpractice RVUs and the 

2005 physician fee schedule update. 

(Please note that the table does not 

include the specialties of Hematology/

Oncology, Urology, Rheumatology and 

Obstetrics/Gynecology. There are 

unique issues related to drug 

administration that will further affect 

these specialties that are presented in 

detail below).

TABLE 23.—IMPACT OF PRACTICE EXPENSE AND MALPRACTICE RVU CHANGES AND PHYSICIAN FEE SCHEDULE UPDATE

ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER AND SUPPLIER SUBCATEGORY

Speciality 

Medicare allowed charges 

($ in Millions) 

Practice expenses & malpractice RVU 

changes

(percent) 

Physician fee 

schedule update

(percent) 

Total

(percent) 

Physicians: 

ALLERGY/IMMUNOLOGY ....................................................................... 161 ¥2 1.5 0 

ANESTHESIOLOGY ................................................................................. 1,416 0 1.5 2 

CARDIAC SURGERY ............................................................................... 359 0 1.5 1 

CARDIOLOGY .......................................................................................... 6,583 0 1.5 2 

COLON AND RECTAL SURGERY .......................................................... 111 1 1.5 2 

CRITICAL CARE ...................................................................................... 130 0 1.5 2 

DERMATOLOGY ...................................................................................... 1,870 1 1.5 3 

EMERGENCY MEDICINE ........................................................................ 1,672 0 1.5 2 

ENDOCRINOLOGY .................................................................................. 280 0 1.5 2 

FAMILY PRACTICE ................................................................................. 4,448 0 1.5 1 

GASTROENTEROLOGY .......................................................................... 1,636 0 1.5 2 

GENERAL PRACTICE ............................................................................. 998 0 1.5 1 

GENERAL SURGERY .............................................................................. 2,258 1 1.5 2 

GERIATRICS ............................................................................................ 117 ¥1 1.5 1 

HAND SURGERY ..................................................................................... 57 0 1.5 2 

INFECTIOUS DISEASE ........................................................................... 401 0 1.5 2 

INTERNAL MEDICINE ............................................................................. 8,846 0 1.5 1 

INTERVENTIONAL RADIOLOGY ............................................................ 190 2 1.5 4 

NEPHROLOGY ........................................................................................ 1,248 1 1.5 2 

NEUROLOGY ........................................................................................... 1,200 0 1.5 2 

NEUROSURGERY ................................................................................... 490 ¥1 1.5 1 

NUCLEAR MEDICINE .............................................................................. 85 0 1.5 1 

OPHTHALMOLOGY ................................................................................. 4,583 ¥1 1.5 0 

ORTHOPEDIC SURGERY ....................................................................... 2,902 0 1.5 1 

OTOLARNGOLOGY ................................................................................. 815 0 1.5 2 

PATHOLOGY ........................................................................................... 869 2 1.5 4 

47560 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 23.—IMPACT OF PRACTICE EXPENSE AND MALPRACTICE RVU CHANGES AND PHYSICIAN FEE SCHEDULE UPDATE

ON TOTAL MEDICARE ALLOWED CHARGES BY PHYSICIAN, PRACTITIONER AND SUPPLIER SUBCATEGORY—Continued 

Speciality 

Medicare allowed charges 

($ in Millions) 

Practice expenses & malpractice RVU 

changes 

(percent) 

Physician fee 

schedule update 

(percent) 

Total 

(percent) 

PEDIATRICS ............................................................................................ 59 ¥1 1.5 1 

PHYSICAL MEDICINE ............................................................................. 677 0 1.5 2 

PLASTIC SURGERY ................................................................................ 281 1 1.5 2 

PSYCHIATRY ........................................................................................... 1,093 0 1.5 2 

PULMONARY DISEASE .......................................................................... 1,446 0 1.5 2 

RADIATION ONCOLOGY ........................................................................ 1,164 0 1.5 1 

RADIOLOGY ............................................................................................ 4,690 0 1.5 1 

THORACIC SURGERY ............................................................................ 463 0 1.5 2 

VASCULAR SURGERY ............................................................................ 487 3 1.5 4 

Practitioners: 

AUDIOLOGIST ......................................................................................... 28 ¥4 1.5 ¥2 

CHIROPRACTOR ..................................................................................... 656 ¥1 1.5 1 

CLINICAL PSYCHOLOGIST .................................................................... 490 0 1.5 1 

CLINICAL SOCIAL WORKER .................................................................. 313 0 1.5 1 

NURSE ANESTHETIST ........................................................................... 481 0 1.5 2 

NURSE PRACTITIONER ......................................................................... 552 ¥1 1.5 0 

OPTOMETRY ........................................................................................... 664 0 1.5 1 

ORAL/MAXILLOFACIAL SURGERY ........................................................ 36 4 1.5 5 

PHYSICAL/OCCUPATIONAL THERAPY ................................................. 990 ¥2 1.5 ¥1 

PHYSICIAN ASSISTANT ......................................................................... 410 0 1.5 1 

PODIATRY ............................................................................................... 1,383 ¥1 1.5 1 

Suppliers: 

DIAGNOSTIC TESTING FACILITY .......................................................... 876 1 1.5 3 

INDEPENDENT LABORATORY .............................................................. 530 6 1.5 8 

PORTABLE X-RAY SUPPLIER ................................................................ 91 0 1.5 1 

Other: 

ALL OTHER .............................................................................................. 93 2 1.5 3 

ALL PHYSICIAN FEE SCHEDULE .......................................................... 66,395 0 1.5 2 

Table 24 shows the impact on 

payments for selected high-volume 

procedures of all of the changes 

previously discussed. We selected these 

procedures because they are the most 

commonly provided procedures by a 

broad spectrum of physician specialties, 

or they are of particular interest to the 

physician community (for example, the 

preventive office visit, G0XX2). This 

table shows the combined impact of the 

change in the practice expense and 

malpractice RVUs and the estimated 

physician fee schedule update on total 

payment for the procedure. There are 

separate columns that show the change 

in the facility rates and the nonfacility 

rates. For an explanation of facility and 

nonfacility practice expense refer to 

§ 414.22(b)(5)(i). The table shows the 

estimated change in payment rates 

based on provisions of this proposed 

rule and the estimated physician fee 

schedule update. If we change any of 

the provisions following the 

consideration of public comments, these 

figures may change. 

TABLE 24.—IMPACT OF PROPOSED RULE AND PHYSICIAN FEE SCHEDULE UPDATE ON MEDICARE PAYMENT FOR SELECTED

PROCEDURES

CODE MOD Description 

Non-facility Facility 

Old New Percent 

change Old New Percent change 

11721 .......... .............. Debride nail, 6 or more .................... $ 38.08 $ 38.28 1 $ 29.87 $ 29.94 0 

17000 .......... .............. Destroy benign/premlg lesion .......... 60.49 61.39 1 35.84 45.48 27 

27130 .......... .............. Total hip arthroplasty ....................... N/A N/A N/A 1,370.28 1,382.50 1 

27236 .......... .............. Treat thigh fracture ........................... N/A N/A N/A 1,088.01 1,103.20 1 

27244 .......... .............. Treat thigh fracture ........................... N/A N/A N/A 1,115.27 1,133.51 2 

27447 .......... .............. Total knee arthroplasty .................... N/A N/A N/A 1,475.95 1,492.02 1 

33533 .......... .............. CABG, arterial, single ...................... N/A N/A N/A 1,882.18 1,905.49 1 

35301 .......... .............. Rechanneling of artery ..................... N/A N/A N/A 1,114.89 1,122.90 1 

43239 .......... .............. Upper GI endoscopy, biopsy ........... 321.85 336.15 4 159.43 162.58 2 

45385 .......... .............. Lesion removal colonoscopy ............ 497.71 514.65 3 288.24 293.71 2 

66821 .......... .............. After cataract laser surgery .............. 240.83 237.62 ¥1 237.09 230.80 ¥3 

66984 .......... .............. Cataract surg w/iol, 1 stage ............. N/A N/A N/A 684.39 683.67 0 

67210 .......... .............. Treatment of retinal lesion ............... 577.98 599.92 4 560.81 573.01 2 

71010 .......... 26 Chest x-ray ....................................... 9.33 9.47 2 9.33 9.47 2 

71020 .......... 26 Chest x-ray ....................................... 11.20 11.37 2 11.20 11.37 2 

76091 .......... 26 Mammogram, both breasts .............. 96.33 97.40 1 N/A N/A N/A 

76091 .......... .............. Mammogram, both breasts .............. 44.80 45.10 1 44.80 45.10 1 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47561

TABLE 24.—IMPACT OF PROPOSED RULE AND PHYSICIAN FEE SCHEDULE UPDATE ON MEDICARE PAYMENT FOR SELECTED

PROCEDURES—Continued

CODE MOD Description 

Non-facility Facility 

Old New Percent

change Old New Percentchange 

76092 .......... 26 Mammogram, screening .................. 84.76 85.27 1 N/A N/A N/A 

76092 .......... .............. Mammogram, screening .................. 36.22 36.38 0 36.22 36.38 0 

77427 .......... .............. Radiation tx management, x5 .......... 169.14 172.05 2 169.14 172.05 2 

78465 .......... 26 Heart image (3d), multiple ............... 76.17 77.31 1 76.17 77.31 1 

88305 .......... 26 Tissue exam by pathologist ............. 41.44 42.07 2 41.44 42.07 2 

90801 .......... .............. Psy dx interview ............................... 150.84 153.48 2 142.26 144.39 1 

90806 .......... .............. Psytx, off, 45–50 min ....................... 97.45 98.91 1 93.72 95.12 1 

90807 .......... .............. Psytx, off, 45–50 min w/e&m ........... 103.80 104.98 1 101.18 102.32 1 

90862 .......... .............. Medication management .................. 51.15 52.30 2 48.17 49.27 2 

90935 .......... .............. Hemodialysis, one evaluation .......... N/A N/A N/A 72.06 73.14 1 

92004 .......... .............. Eye exam, new patient .................... 126.57 129.61 2 89.24 90.58 2 

92012 .......... .............. Eye exam established pat ................ 63.47 65.18 3 36.22 37.14 3 

92014 .......... .............. Eye exam & treatment ..................... 93.34 96.26 3 58.99 60.64 3 

92980 .......... .............. Insert intracoronary stent ................. N/A N/A N/A 812.09 829.58 2 

92982 .......... .............. Coronary artery dilation .................... N/A N/A N/A 602.63 615.83 2 

93000 .......... .............. Electrocardiogram, complete ........... 26.51 26.91 2 N/A N/A N/A 

93010 .......... .............. Electrocardiogram report .................. 8.96 9.10 2 8.96 9.10 2 

93015 .......... .............. Cardiovascular stress test ................ 106.78 108.01 1 N/A N/A N/A 

93307 .......... 26 Echo exam of heart .......................... 49.29 49.27 0 49.29 49.27 0 

93510 .......... 26 Left heart catheterization ................. 252.77 257.32 2 252.77 257.32 2 

98941 .......... .............. Chiropractic manipulation ................. 36.22 36.76 1 31.74 31.83 0 

99203 .......... .............. Office/outpatient visit, new ............... 95.96 97.40 2 71.69 72.38 1 

99204 .......... .............. Office/outpatient visit, new ............... 135.53 137.57 2 105.66 107.25 2 

99205 .......... .............. Office/outpatient visit, new ............... 172.13 174.71 1 140.39 142.49 1 

99211 .......... .............. Office/outpatient visit, est ................. 21.28 21.98 3 8.96 9.10 2 

99212 .......... .............. Office/outpatient visit, est ................. 37.71 38.66 3 23.52 24.25 3 

99213 .......... .............. Office/outpatient visit, est ................. 52.65 53.06 1 35.47 35.24 ¥1 

99214 .......... .............. Office/outpatient visit, est ................. 82.14 83.00 1 57.87 58.74 2 

99215 .......... .............. Office/outpatient visit, est ................. 119.11 121.27 2 93.34 95.12 2 

99221 .......... .............. Initial hospital care ........................... N/A N/A N/A 66.83 68.22 2 

99222 .......... .............. Initial hospital care ........................... N/A N/A N/A 111.27 112.93 1 

99223 .......... .............. Initial hospital care ........................... N/A N/A N/A 154.95 157.27 1 

99231 .......... .............. Subsequent hospital care ................ N/A N/A N/A 33.23 34.11 3 

99232 .......... .............. Subsequent hospital care ................ N/A N/A N/A 54.89 56.09 2 

99233 .......... .............. Subsequent hospital care ................ N/A N/A N/A 78.04 79.58 2 

99236 .......... .............. Observ/hosp same date ................... N/A N/A N/A 226.26 223.60 ¥1 

99238 .......... .............. Hospital discharge day ..................... N/A N/A N/A 69.82 70.87 2 

99239 .......... .............. Hospital discharge day ..................... N/A N/A N/A 95.21 91.71 ¥4 

99241 .......... .............. Office consultation ............................ 50.03 50.40 1 33.98 34.49 2 

99242 .......... .............. Office consultation ............................ 91.48 92.47 1 69.45 70.11 1 

99243 .......... .............. Office consultation ............................ 120.60 122.79 2 92.22 93.99 2 

99244 .......... .............. Office consultation ............................ 170.63 172.81 1 136.65 138.70 2 

99245 .......... .............. Office consultation ............................ 220.29 224.35 2 181.09 184.56 2 

99251 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 35.84 36.00 0 

99252 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 71.69 72.76 1 

99253 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 97.45 98.91 1 

99254 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 140.39 142.12 1 

99255 .......... .............. Initial inpatient consult ...................... N/A N/A N/A 193.03 195.55 1 

99261 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 22.40 22.36 0 

99262 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 44.80 45.48 2 

99263 .......... .............. Follow-up inpatient consult .............. N/A N/A N/A 66.09 67.46 2 

99282 .......... .............. Emergency dept visit ........................ N/A N/A N/A 27.63 27.67 0 

99283 .......... .............. Emergency dept visit ........................ N/A N/A N/A 61.61 62.15 1 

99284 .......... .............. Emergency dept visit ........................ N/A N/A N/A 95.58 7.02 2 

99285 .......... .............. Emergency dept visit ........................ N/A N/A N/A 149.72 151.97 2 

99291 .......... .............. Critical care, first hour ...................... 242.69 257.32 6 203.12 207.68 2 

99292 .......... .............. Critical care, add’l 30 min ................ 107.91 114.45 6 101.56 103.84 2 

99301 .......... .............. Nursing facility care .......................... 71.69 66.32 ¥7 61.61 66.32 8 

99302 .......... .............. Nursing facility care .......................... 97.82 87.92 ¥10 82.52 87.92 7 

99303 .......... .............. Nursing facility care .......................... 120.97 108.39 ¥10 102.68 108.39 6 

99311 .......... .............. Nursing fac care, subseq ................. 40.70 34.49 ¥15 30.62 34.49 13 

99312 .......... .............. Nursing fac care, subseq ................. 63.10 56.85 ¥10 51.53 56.85 10 

99313 .......... .............. Nursing fac care, subseq ................. 86.25 79.96 ¥7 72.43 79.96 10 

99348 .......... .............. Home visit, est patient ..................... 75.42 72.01 ¥5 N/A N/A N/A 

99350 .......... .............. Home visit, est patient ..................... 169.89 165.23 ¥3 N/A N/A N/A 

G0317 .......... .............. ESRDrelsvc 4+/mo;20+yr ................. 303.18 307.73 2 303.18 307.73 2 

G0318 .......... .............. ESRDrelsvc 2–3/mo;20+yr ............... 252.40 256.19 2 252.40 256.19 2 

G0319 .......... .............. ESRDrelsvc 1/mo;20+yr ................... 201.62 204.65 2 201.62 204.65 2 

47562 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 24.—IMPACT OF PROPOSED RULE AND PHYSICIAN FEE SCHEDULE UPDATE ON MEDICARE PAYMENT FOR SELECTED

PROCEDURES—Continued 

CODE MOD Description 

Non-facility Facility 

Old New Percent 

change Old New Percent change 

G0XX2 ......... .............. Preventive Office Visit ...................... N/A 124.30 N/A N/A 82.24 N/A 

Section 303(a)(1) of the MMA 

amended section 1848(c)(2) of the Act to 

require increased work and practice 

expense RVUs for drug administration 

services. Section 303(a)(4) of the MMA 

required an additional temporary 

increase in payment to specific drug 

administration services (procedure 

codes 90780 through 90788, 96400, 

96408 through 96425, 96520, and 

96530) of 32 percent for 2004 and 3 

percent for 2005. Table 25 shows the 

payment amounts for selected highvolume drug administration CPT codes 

from 2002 to 2006 including the effect 

of the transition adjustment of 32 

percent required for 2004 and 3 percent 

for 2005 and 0 percent for 2006. The 

amounts shown in the table include the 

effect of the 1.5 percent update for 2004 

and 2005. The 2006 payment amount 

shown in the table reflects the 2005 

conversion factor because the 2006 

physician fee schedule update is 

currently unknown. 

With the exception of procedure code 

96412 declining by 17 percent (which 

occurred because resource-based pricing 

replaced the use of charge-based RVUs 

when the services were removed from 

the nonphysician work pool), the MMA 

permanently increases payment for all 

of these services from a low of 17 

percent for procedure code 90781 to 321 

percent for procedure code 90782. The 

volume-weighted average permanent 

increase in payment among these drug 

administration services is 

approximately 105 percent (109 percent 

for oncologists and 94 percent for other 

physicians). Including the effect of the 

transition makes the volume-weighted 

increase in payment for these codes 

more than 170 percent from 2003 to 

2004 and 110 percent from 2003 to 

2005. The payment amount for 

procedure code 96400 in 2002 was 

$5.07. Payment for this code increased 

substantially to $37.52 in 2003 when, at 

the request of the American Urological 

Association (see 67 FR 79981 published 

on December 31, 2002), we removed this 

code from the nonphysician work pool. 

Including the effect of the additional 

changes required by MMA, we expect 

payment for this code to be $49.65 by 

2006. Thus, the payment increase for 

procedure code 96400 between 2002 

and 2006 is 879 percent. As indicated 

earlier, we are continuing to consider 

coding and RVU changes for drug 

administration services for 2005 based 

on the results of the CPT review and our 

consideration of public comments. If we 

change any of the RVUs for these codes 

as a result of CPT’s review or the 

consideration of public comments, these 

figures may change. 

TABLE 25.—IMPACT OF PROPOSED RULE AND PHYSICIAN FEE SCHEDULE UPDATE ON MEDICARE PAYMENT FOR SELECTED

DRUG ADMINISTRATION SERVICES

Code Description 

Non-facility payment 

2002 

Payment 

2003 

Payment 

2004 

Payment 

2005 

Payment * 

w/Current 

PE RVUs 

2006 

Payment * 

w/Current 

PE RVUs 

Percent 

change 

2003 to 

2006 

Percent 

change 

2002 to 

2006 

90780 IV infusion therapy, 1 hour ........... $40.54 $42.67 $117.79 $92.90 $90.20 111 122 

90781 IV infusion, additional hour ........... 20.27 21.70 33.02 26.15 25.39 17 25 

90782 Injection, sc/im .............................. 3.98 4.41 24.64 19.13 18.57 321 367 

96400 Chemotherapy, sc/im .................... 5.07 37.52 64.07 51.14 49.65 32 879 

96408 Chemotherapy, push technique .... 35.11 37.52 154.76 122.96 119.38 218 240 

96410 Chemotherapy,infusion method .... 55.75 59.22 217.35 171.75 166.75 182 199 

96412 Chemo, infuse method add-on ..... 41.63 44.14 48.30 37.86 36.76 –17 –12 

* Payment amounts reflect the current practice expense RVUs and a 1.5 percent update for 2005. The 2006 update is currently unknown. The 

payment amounts for 2006 were calculated using the 2005 conversion factor. If we were to make further revisions to the practice expense RVUs 

following the consideration of public comments and/or the CPT coding process, the payment amounts will be different. 

Table 26 below shows the impact of 

the drug and physician fee schedule 

changes for selected specialties that 

receive a significant portion of their 

total Medicare revenues from drugs. 

Table 27 shows the combined payment 

impact of the drug and physician fee 

schedule payment changes on combined 

Medicare revenues. The first column 

(‘‘Estimated Medicare Drug Revenues’’) 

shows estimated 2004 Medicare Drug 

Revenues using 2003 utilization 

adjusted for drug payment changes 

required in 2004 by the MMA. The next 

column (‘‘% Change Medicare Drug 

Revenues’’) shows the payment impact 

of the adoption of the average sales 

price plus 6 percent (ASP+6) drug 

payment methodology in 2005 relative 

to 2004 on specialty drug payments. The 

payment impacts are based on ASP 

submissions from the 1st quarter of 

2004. The ASP prices that will be used 

to determine payment in 2005 will 

begin with the 3rd quarter 2004 ASP 

submission and will be updated 

quarterly. To model the impact 

illustrated, we assumed an average 

increase in ASP prices of 3.39 percent 

(the national health expenditure 

prescription drug price growth factor) 

from the 1st quarter 2004 submission to 

the prices that will be used to determine 

2005 payments. Table xxxxxxx follows 

table xxxxxx and shows the drug prices 

we used to determine the payment 

impact. The drug payment impacts are 

based on those high volume drugs 

where we have validated the ASP price 

submission that represent the following 

percentages of 2003 drug payments: 72 

percent for Hematology/Oncology, 94 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47563

percent for Urology, 97 percent for 

Rheumatology and 73 percent for 

Obstetrics/Gynecology. For drugs in 

which we did not complete our 

validation of the ASP submission before 

completing the proposed rule, we used 

the average payment change for other 

drugs provided by the specialty unless 

a special circumstance applied. (that is, 

for Hematology/Oncology and 

Obstetrics/Gynecology, we calculated 

the average reduction in payment for 

drugs excluding J9265, J2430, and 

J9390, three drugs having an unusually 

large reduction in payment as a result of 

coming off patent. We do not believe 

these reductions will be typical of other 

drugs furnished by oncologists and 

obstetrician/gynecologists). 

Our estimates of changes in Medicare 

revenues for drugs and physician fee 

schedule services compare payment 

rates for 2005 with payment rates for 

2004 using 2003 Medicare utilization for 

both years. We are using 2003 Medicare 

claims processed and paid through June 

30, 2004 that we estimate are 96.7 

complete and have adjusted the figures 

to reflect a full year of data. Thus, 

because we are using a single year of 

utilization, the estimated changes in 

revenues reflect payment changes only 

between 2004 and 2005. To the extent 

that there are year-to-year changes in the 

volume and mix of drugs and physician 

fee schedule services provided by 

physicians, the actual impact on total 

Medicare revenues will be different than 

those shown here. 

Assuming no change in utilization, 

we estimate that Medicare drug 

revenues for oncologists would decline 

by less than 8 percent as a result of 

policies adopted in this proposed rule. 

Oncologists administer a number of 

drugs that are changing in payments by 

different amounts. For instance, 

oncologists’ highest Medicare revenue 

drug, Q0136 (EPOGEN; PROCRIT), 

would decline in payment by 7 percent 

while its second highest revenue drug, 

J9310 (RITUXAN), would increase in 

payment by 7 percent. Three drugs 

supplied by oncologists, J9265 (ONXOL 

TAXOL), J2430 (PAMIDRONATE 

DISODIUM), and J9390 (NAVELBINE), 

are coming off patent and their price 

would decline respectively by 81 

percent, 71 percent, and 12 percent. The 

2004 Medicare payment amounts for 

these three drugs respectively were 

equal to 81, 85 and 81 percent of the 

April 1, 2003 average wholesale price 

levels that applied or did not decrease 

proportionally after the drugs came off 

patent. These three drugs are estimated 

to account for only 7 percent of 

oncologists adjusted 2004 Medicare 

drug revenues but contribute more than 

5 percent of the approximate 8 percent 

total reduction in Medicare drug 

revenues that oncologists would 

experience as a result of adopting the 

ASP+6 payment methodology. While 

Medicare revenues to oncologists would 

decline from the reductions in payment 

for these three drugs, the cost to acquire 

these drugs has already declined. Thus, 

Medicare’s payment, as with all other 

drugs experiencing payment changes, 

will be much closer to the cost the 

physician pays to acquire the drug. 

Adoption of ASP+6 prices would 

reduce Medicare drug revenues for 

urologists by approximately 36 percent. 

This large reduction can be attributed to 

a 35 percent reduction in payment for 

two drugs: J9202 (ZOLADEX) and J9217 

(LUPRON DEPOT–PED). While we 

estimate an even larger reduction in the 

ASP+6 price for J9217, our payment 

impact assumes that nearly all Medicare 

carriers are using the ‘‘least costly 

alternative’’ pricing and paying code 

J9217 at the J9202 price. 

We estimate a 6 percent reduction in 

Medicare drug revenues for 

rheumatology. Nearly all of this 

reduction can be attributed to a 6 

percent reduction in Medicare payment 

for J1745 (REMICADE). 

We estimate less than an 18 percent 

decrease in Medicare drug revenues for 

obstetrics/gynecology. However, much 

of this revenue reduction can be 

attributed to an 81 percent reduction in 

payment for J9265 (ONXOL TAXOL) 

coming off patent. Even though this one 

drug is estimated to account for only 16 

percent of obstetrics/gynecology 

adjusted 2004 Medicare drug revenues, 

it contributes 13 percent of the 

approximate 18 percent total reduction 

in Medicare drug revenues that 

obstetrics/gynecologists would 

experience as a result of adopting the 

ASP+6 payment methodology. As 

explained above, while Medicare 

revenues to obstetrics/gynecology 

would decline as a result of the price 

reduction for this code, Medicare’s 

payment will be much closer to the 

price physicians pay to acquire the 

drug. We are estimating an average 

approximate reduction of 6 percent 

across other drugs supplied by 

obstetrics/gynecology.

The remaining columns of Table 26 

show the potential impact on physician 

fee schedule services of changes being 

contemplated for 2005 for the 

specialties shown. The column labeled 

‘‘Practice Expense and Malpractice RVU 

Changes’’ show the combined impact of 

the changes previously illustrated for 

these specialties in Tables 21 and 22. 

The column labeled ‘‘Drug 

Administration Payment Changes’’

shows a range of potential physician fee 

schedule impacts for 2005. The left side 

of this column shows the impact of the 

changes required in payment by section 

303(a)(4) of the MMA (that is, the 

change in the transition payment from 

2004 to 2005) if we were to make no 

further changes to the payments or 

codes for drug administration services. 

However, because we are considering 

further changes to the payments or 

codes for drug administration once the 

AMA’s CPT Panel review of this issue 

is complete, the right hand side of the 

column labeled ‘‘Drug Administration 

Payment Changes’’ reflects the amount 

that physician fee schedule payments 

would have to increase to make the net 

reduction across all Medicare revenues 

for these specialties equal to 2 percent. 

The next column shows the physician 

fee schedule update of 1.5 percent and 

the final column labeled ‘‘Total 

Physician Fee Schedule’’ Changes’’

shows the combined effect of all of the 

changes previously described. The left 

hand side of the column shows the 

combined effect of (1) the practice 

expense and malpractice RVU changes, 

(2) the maximum reduction in payment 

that could occur if we made no further 

changes to payments for drug 

administration and (3) the physician fee 

schedule update. The right hand side of 

the column shows the combined effect 

of (1) the practice expense and 

malpractice RVU changes, (2) the 

amount physician fee schedule revenues 

would have to increase to make the 

reduction in total revenues equal to 2 

percent and (3) the physician fee 

schedule update. 

If we made no further changes to drug 

administration, physician fee schedule 

revenues would decline by 9 percent for 

oncology, be unchanged for urology and 

rheumatology, and increase by 1 percent 

for obstetrics/gynecology. Physician fee 

schedule revenues would have to 

increase by 12 percent for oncology, 19 

percent for urology, 2 percent for 

rheumatology and 1 percent for 

obstetrics/gynecology for total revenues 

to these specialties to decline by 2 

percent from adoption of the ASP+6 

percent drug payment methodology. 

Table 27 shows the combined impact 

of changes we are making to Medicare 

drug and physician fee schedule 

payments for the same specialties 

shown in table 26. The column labeled 

‘‘% of Total Medicare Revenues from 

Drugs’’ shows the proportion of total 

Medicare revenues received from drugs, 

while the next column shows the 

payment impact from adoption of the 

ASP+6 drug payment methodology. The 

following columns show the proportion 

of total Medicare revenues received 

47564 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

from physician fee schedule services 

and the payment impact from physician 

fee schedule changes. All of the 

payment impacts are the same as those 

shown in Table 26. We note that these 

impacts and percentages represent 

averages for each specialty or supplier. 

The percentages and impacts for any 

individual physician are dependent on 

the mix of drugs and physician fee 

schedule services they provide to 

Medicare beneficiaries. These tables are 

intended to illustrate, assuming 

constant utilization, the combined 

impact of payment changes from 2004 to 

2005 across all of the services that these 

specialties perform using the most 

recent data available to us. Thus, the 

last 3 columns show combined 

Medicare revenues from all sources and 

the combined Medicare payment impact 

from the earlier described changes being 

proposed or considered for 2005. 

For example, as indicated in the Table 

27, we estimate that approximately 70 

percent of total 2004 Medicare revenues 

for oncologists are attributed to drugs. 

We estimate that Medicare revenues 

from drugs will decline by 

approximately 8 percent for oncology as 

a result of policies adopted in this 

proposed rule. Physician fee schedule 

services account for approximately 28 

percent of oncology’s 2004 Medicare 

revenues. If we made no other changes 

to the RVUs or codes for drug 

administration services and if there is 

no change in the utilization of services, 

we estimate that physician fee schedule 

payments to oncology would decline by 

approximately 9 percent from 2004 to 

2005. In this scenario, combined 

Medicare payments to oncology would 

decline approximately 8 percent. 

However, if we were to make further 

changes to physician fee schedule 

payments so they increased by 12 

percent, we estimate the combined 

revenue reduction to oncology would be 

2 percent. 

We estimate that urology receives 

approximately 37 percent of their 2004 

total revenues from drugs and 60 

percent from physician fee schedule 

services. Because urology and other 

physician specialties receive a smaller 

share of their total Medicare revenues 

from drug administration services than 

oncology, they are less affected than 

oncology by the reduction in the drug 

administration transition payment 

percentage from 32 to 3 percent from 

2004 to 2005. If we made no other 

changes to the RVUs or codes for drug 

administration services, we estimate 

that physician fee schedule revenues for 

urologists would increase by 

approximately 1 percent from 2004 to 

2005. (While the reduction in payment 

for drug administration alone would 

slightly reduce urologists’ physician fee 

schedule revenues, we estimate that any 

reduction would be offset by the 

physician fee schedule update). In this 

scenario, combined Medicare payments 

to urologists would decline 

approximately 13 percent. However, if 

we were to make further changes to 

physician fee schedule payments so that 

they increased by 19 percent, we 

estimate the combined revenue 

reduction to urology would be 2 

percent. 

Rheumatology revenues from drugs 

are estimated to account for 

approximately 46 percent of their total 

revenues and would decline 

approximately 6 percent from adoption 

of the ASP+6 drug payment 

methodology. If we made no other 

changes to the RVUs or codes for drug 

administration services, we estimate 

that physician fee schedule revenues 

would be either unchanged or decline 

slightly in the aggregate and estimate a 

reduction in total Medicare revenues to 

rheumatology of approximately 3 

percent. However, if we were to make 

further changes to physician fee 

schedule payments so they increased by 

2 percent, we estimate the combined 

revenue reduction to rheumatologists 

would be 2 percent. 

Medicare drug revenues represent 13 

percent of total Medicare revenues for 

obstetrics/gynecology while physician 

fee schedule revenues account for 85 

percent. We estimate that Medicare drug 

revenues for obstetrics/gynecology 

would decline by 18 percent and 

physician fee schedule revenues would 

increase 1 percent if we make no further 

changes to the RVUs or codes for drug 

administration services. In this scenario, 

obstetrics/gynecology’s combined 

Medicare revenues would decline by 2 

percent. Any change to the drug 

administration codes that increases their 

payments would make the net revenue 

reduction equal to or less than 2 percent 

for obstetrics/gynecology.

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47565

TABLE 26.

—IMPACT OF

DRUG AND

PHYSICIAN

FEE

SCHEDULE

PAYMENT

CHANGES ON

TOTAL

MEDICARE

ALLOWED

CHARGES FOR

SELECTED

SPECIALTIES

Specialty 

Drugs Physician fee schedule 

Estimated medicare drug revenues ($ in millions) Percent change medicare drug revenues Medicare allowed charges ($ in mil- lions) Practice expense & malpractice RVU changes (percent) Drug administra- tion payment changes Physician fee schedule update (percent) Total physician fee schedule changes 

HEMATOLOGY/ONCOLOGY .......................... $4,363 

¥8 $1,753 0

¥10 to 10 ........ 1.5

¥9% to 12% 

UROLOGY ....................................................... 1,061 

¥36 1,699 0

¥1% to 17% .... 1.5 0% to 19% 

RHEUMATOLOGY .......................................... 373 

¥6 413 0

¥2% to 0% ...... 1.5 0% to 2% 

OBSTETRICS/GYNECOLOGY ....................... 88 

¥18 582 0

¥1% to 

¥1% ... 1.5 1% to 1% 

The amounts shown on the left-hand side of the column labeled ‘‘Drug Administration Payment Changes’’ offset a part of the increase these specialties received in 2004 as shown in the 

January 7, 2004 Federal Register (69 FR 1100). We estimate the 2003–2005 increase in physician fee schedule payments to these specialties (before application of the physician fee 

schedule update) to be 28 percent for oncology, 2 percent for obstetrics/gynecology, 4 percent for rheumatology and 2 percent for urology. Urology received an additional 2 percent increase in total physician fee schedule payments (again, before application of the update) from 2002 to 2003 (see 67 FR 80035–80036 published on December 31, 2002) as a result of the large increase in payment for CPT code 96400 making the 2002–2005 payment increase exceed 4 percent. 

47566 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 27.—COMBINED PAYMENT IMPACT DRUG AND PHYSICIAN FEE SCHEDULE PAYMENT CHANGES FOR SELECTED

SPECIALTIES

Specialty 

Drugs Physician fee schedule All revenues 

Percent of total 

medicare revenues from drugs 

Percent change 

medicare drug 

revenues 

Percent of total 

medicare revenues from fee 

schedule 

Percent change 

physician fee 

schedule revenues 

Combined medicare revenues all 

sources ($ in millions) 

Combined percent change all 

medicare revenues 

HEMATOLOGY/ONCOLOGY.70 ¥8 28 ¥9% to 12% .... $6,251 ¥8% to ¥2% 

UROLOGY ................. 37 ¥36 60 0% to 19% ........ 2,842 ¥13% to ¥2% 

RHEUMATOLOGY ..... 46 ¥6 51 0% to 2% .......... 818 ¥3% to ¥2% 

OBSTETRICS/GYNECOLOGY.13 ¥18 85 1% to 1% .......... 684 ¥2% to ¥2% 

The above tables show those 

specialties that receive significant 

revenues from drugs and physician fee 

schedule services that could be further 

affected by the review of drug 

administration coding currently 

undertaken by the CPT Editorial Panel 

and any changes we may make after 

further consideration of this effort and 

public comments. 

Although infectious disease 

physicians do receive significant 

revenues from drugs and drug 

administration, we are not showing 

them in this table because we have 

validated only drug payment data 

accounting for 27 percent of their 

allowed charges for drugs. Based on 

these data, we estimate an 11 percent 

reduction in their Medicare drug 

payments that account for 

approximately 6 percent of their total 

Medicare revenues. If total drug 

payment were to decline by 11 percent, 

we estimate that net revenues to 

infectious disease physicians will 

remain unchanged, absent any further 

changes in drug and drug 

administration coding. We are not 

showing DME and Other Medical 

Suppliers in the above table because 

they do not receive significant revenues 

for physician fee schedule services and 

will be unaffected by any further 

changes made to drug administration 

coding or RVUs because they do not bill 

for these services. However, they do 

receive a substantial portion of their 

total Medicare revenues from drugs that 

are affected by the change to ASP+6 

pricing. For DME/Other Medical 

Suppliers, 40 and 60 percent of 

Medicare revenues respectively are 

received from drugs and DME fee 

schedule services. These suppliers 

would receive an approximate reduction 

of 70 percent in their Medicare drug 

revenues from the adoption of ASP+6 

drug prices due to the large reduction in 

payment for two high volume inhalation 

drugs (J7619 and J7644). These impacts 

will be reduced somewhat by the 

dispensing fee we are proposing for 

inhalation drugs. We estimate the total 

reduction in payment across all of the 

services provided by DME suppliers as 

a result of provisions of this proposed 

rule would be approximately 28 

percent. 

TABLE 28.—DRUG PRICING TABLE USED FOR PAYMENT IMPACTS

Code Short description Trade name 

CY 2004 

Pay allowance limit 

Estimated 

CY 2005 

allowance 

limit 6%) 

Percent 

change 

J0152 ......... Adenosine injection .................................. ADENOSCAN ........................................... $66.56 $69.78 5% 

J0585 ......... Botulinum toxin a per unit ........................ BOTOX ..................................................... 4.43 4.69 6 

J0880 ......... Darbepoetin alfa injection ......................... ARANESP ................................................ 21.20 18.10 ¥15 

J1441 ......... Filgrastim 480 mcg injection .................... NEUPOGEN ............................................. 267.79 267.04 0 

J1745 ......... Infliximab injection .................................... REMICADE ............................................... 58.79 53.32 ¥9 

J2430 ......... Pamidronate disodium/30 MG .................. AREDIA, PAMIDRONATE DISODIUM, ... 237.88 67.27 ¥72 

J2505 ......... Injection, pegfilgrastim 6mg ..................... NEULASTA ............................................... 2,507.50 2,260.77 ¥10 

J2792 ......... Rho(D) immune globulin h, sd ................. WINRHO ................................................... 18.39 13.04 ¥29 

J3395 ......... Verteporfin injection .................................. VISUDYNE ............................................... 1,404.26 1,368.79 ¥3 

J3487 ......... Zoledronic acid ......................................... ZOMETA ................................................... 194.54 202.50 4 

J7192 ......... Factor viii recombinant ............................. KOGENATE, HELIXATE, 

RECOMBINATE, REFACTO, 

BIOCLATE,.

1.29 0.92 ¥29 

J7317 ......... Sodium hyaluronate injection ................... HYALGAN, SUPARTZ, ORTHOVISC ...... 124.11 110.07 ¥11 

J7320 ......... Hylan G-F 20 injection ............................. SYNVISC .................................................. 204.03 188.88 ¥7 

J7507 ......... Tacrolimus oral per 1 MG ........................ PROGRAF ................................................ 3.13 3.19 2 

J7517 ......... Mycophenolate mofetil oral ...................... CELLCEPT ............................................... 2.55 2.54 0 

J7619 ......... Albuterol inh sol u d ................................. PROVENTIL, ALBUTEROL SULFATE, 

VENTOLIN.

0.39 0.04 ¥89 

J7626 ......... Budesonide inhalation sol ........................ PULMICORT ............................................ 4.04 3.91 ¥3 

J7644 ......... Ipratropium brom inh sol u d .................... IPRATROPIUM BROMIDE ....................... 2.82 0.30 ¥89 

J9045 ......... Carboplatin injection ................................. PARAPLATIN ........................................... 137.54 131.77 ¥4 

J9170 ......... Docetaxel .................................................. TAXOTERE .............................................. 301.40 287.59 ¥5 

J9201 ......... Gemcitabine HCl ...................................... GEMZAR .................................................. 111.33 107.46 ¥3 

J9202 ......... Goserelin acetate implant ........................ ZOLADEX ................................................. 375.99 234.28 ¥38 

J9206 ......... Irinotecan injection ................................... CAMPTOSAR ........................................... 130.24 123.86 ¥5 

J9217* ........ Leuprolide acetate suspnsion .................. LUPRON DEPOT, ELIGARD, LUPRON 

DEPOT-PED.

500.58 234.28 ¥53 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47567 

TABLE 28.—DRUG PRICING TABLE USED FOR PAYMENT IMPACTS—Continued 

Code Short description Trade name 

CY 2004 

Pay allowance limit 

Estimated 

CY 2005 

allowance 

limit 6%) 

Percent 

change 

J9219 ......... Leuprolide acetate implant ....................... VIADUR .................................................... 4,831.40 2,190.71 ¥55 

J9265 ......... Paclitaxel injection .................................... TAXOL, ONXOL, NOV-ONXOL ............... 138.28 25.84 ¥81 

J9310 ......... Rituximab cancer treatment ..................... RITUXAN .................................................. 427.28 438.38 3 

J9350 ......... Topotecan ................................................. HYCAMTIN ............................................... 706.17 731.46 4 

J9355 ......... Trastuzumab ............................................. HERCEPTIN ............................................. 52.01 50.84 ¥2 

J9390 ......... Vinorelbine tartrate/10 mg ........................ NAVELBINE ............................................. 76.19 64.67 ¥15 

Q0136 ........ Non esrd epoetin alpha inj ....................... PROCRIT ................................................. 11.62 10.37 ¥11 

**Unlisted ... ................................................................... ALOXI ....................................................... 307.80 202.51 ¥34 

*The figures here for J9217 reflect the ASP prices submitted by the drug manufacturer. However, we assumed that Medicare carriers are applying ‘‘least costly alternative’’ pricing and are using the J9202 price for J9217. 

**Aloxi is the brand name for an antiemetic that is paid in 2004 at 95% of AWP using an unlisted code because the drug was approved by the 

FDA in the fall of 2003. Even though we do not have a code or volume for this drug from 2003 like we do for the other drugs shown in the table, 

we are showing it here because it is the highest growth injectable antiemetic drug currently on the market. 

B. Geographic Practice Cost Indices 

As discussed in section II.B, in this 

rule, we are proposing changes to the 

work and practice expense GPCIs based 

on new census data. The resulting 

geographic redistributions would not 

result in an overall increase in the 

current geographic adjustment indices 

by more than 3.5 percent or a decrease 

by more than 1.6 percent for any given 

locality in 2005. These geographic 

redistributions would not result in an 

overall increase in the current 

geographic adjustment indices by more 

than 7 percent or a decrease by more 

than 3.5 percent for any given locality 

in 2006. Addenda E and F illustrate the 

locality specific overall impact of this 

proposal. The GAF, as displayed in 

addenda E and F is a weighted 

composite index of the individual 

proposed revisions to the work, practice 

expense, and malpractice expense 

GPCIs, respectively. The malpractice 

GPCI was updated as part of the 

November 7, 2003 final rule, and the 

MMA provisions were addressed in the 

final rule published on January 7, 2004. 

C. Coding Issues 

1. Revisions to Global Period 

In section II.D.1, we are proposing a 

change in the global period for 

procedure code 77427, Radiation 

treatment management, five treatments 

from a global indicator of ‘‘xxx’’

(meaning that the global concept does 

not apply) to ‘‘090’’ (meaning that there 

is a 90-day global period). We are not 

changing any of the RVUs for procedure 

code 77427 because this service was 

valued to reflect a global period of 90 

days. The implication of this change is 

that any visit services provided in the 

90-day global period that are related to 

procedure code 77427 will no longer be 

paid separately. We reviewed Medicare 

data and found that physicians rarely 

bill for services during the 90-day 

period following the date-of-service for 

procedure code 77427. Therefore, we 

believe this proposal will have little 

effect on Medicare program 

expenditures and our payments to 

physicians. 

2. Additions to the List of Medicare 

Telehealth Services 

In section II.D.2, we are proposing to 

add end stage renal disease (ESRD) 

services, as represented by HCPCS 

codes G0308, G0309, G0311, G0312, 

G0314, G0315, G0317, G03178 to the list 

of telehealth services. We believe that 

this change will have little effect on 

Medicare expenditures. 

3. National Pricing of G0238/G0239 

(Respiratory Therapy Service Codes) 

As discussed earlier in the preamble, 

we are proposing to use the 

nonphysician workpool to value two 

respiratory therapy service codes 

(G0238 and G0239) that are currently 

carrier priced. We believe that this 

proposed change will eliminate the 

uncertainty surrounding payment of 

these codes when performed in 

comprehensive outpatient rehabilitation 

facilities that are paid under the 

physician fee schedule through fiscal 

intermediaries. We do not anticipate 

that nationally pricing these services 

would have a significant impact on 

Medicare expenditures. 

4. New HCPCS Code for Bone Marrow 

Aspiration 

We are proposing a new HCPCS code 

for instances when a bone marrow 

aspiration and a bone marrow biopsy 

are performed on the same day through 

a single incision. Currently, we do not 

allow payment for both of these 

procedures on the same day. While this 

coding change will allow for a small 

additional payment for the second 

procedure performed through a single 

incision on the same day, we anticipate 

that the costs will be insignificant. 

5. New HCPCS Code for Venous 

Mapping 

As stated earlier in the preamble, we 

are proposing a new HCPCS code for 

venous mapping for hemodialysis 

access placement. The primary reason 

for this new code is to enable us to track 

the use of venous mapping for quality 

improvement purposes. Since pricing 

for this service is not changing, there 

will be no impact on Medicare 

expenditures. 

D. MMA Provisions 

1. Section 611—Preventive Physical 

Examination 

As discussed earlier in this preamble, 

the MMA authorizes coverage of an 

initial preventive physical examination 

effective January 1, 2005, subject to 

certain eligibility and other limitations. 

We estimate that this new benefit will 

result in an increase in Medicare 

expenditures. These new payments will 

be made to physicians and other 

practitioners who provide these 

examinations and for any medically 

necessary follow-up tests, counseling, or 

treatment that may be required as a 

result of the coverage of these 

examinations. The impact of this 

provision is shown in the following 

table. 

47568 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 29.—MEDICARE COST ESTIMATES FOR MMA PROVISION 611 

(in millions) 

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

Sec. 611 ................................................................................................... 65 75 75 75 75 

2. Section 613—Diabetes Screening 

Section 613 of the MMA adds 

subsection (yy) to section 1861 of the 

Social Security Act and mandates 

coverage of diabetes screening tests, 

effective on or after January 1, 2005. We 

estimate that this change in coverage for 

certain beneficiaries will result in an 

increase in Medicare payments. These 

payments will be made to physicians’

office laboratories and other laboratory 

suppliers who perform these tests as a 

result of the increased frequency of 

coverage of these tests. The impact of 

this provision is shown in Table 30 that 

follows. 

3. Section 612—Cardiovascular 

Screening 

Section 612 of the MMA provides for 

Medicare coverage for cholesterol and 

other lipid or triglyceride levels of 

cardiovascular screening blood tests for 

the early detection of abnormalities 

associated with an elevated risk for such 

diseases effective on or after January 1, 

2005. We estimate that this change in 

coverage for certain beneficiaries will 

result in an increase in Medicare 

payments. These payments will be made 

to physician office laboratories and 

other laboratory suppliers who perform 

these tests as a result of the increased 

frequency of coverage of these tests. 

Increased Medicare program 

expenditures for this provision are 

shown in Table 30 below.

TABLE 30.—MEDICARE COST ESTIMATES FOR MMA PROVISIONS 612 AND 613 

(in millions) 

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

Sec. 612 Cholesterol and Blood Lipid ..................................................... 50 80 90 90 100 

Sec. 613 Diabetes Screening. ................................................................. 20 40 50 60 80 

4. Section 413—Incentive Payment for 

Physician Scarcity 

a. Physician Scarcity Areas 

Section 413(a) of the MMA provides 

a new 5-percent incentive payment to 

physicians who furnish services in 

physician scarcity areas. The MMA 

provides for paying primary care 

physicians furnishing services in a 

primary care scarcity area, and specialty 

physicians furnishing services in a 

specialist care scarcity county, an 

additional amount equal to 5 percent of 

the amount paid for their professional 

services under the fee schedule from 

January 1, 2005 to December 31, 2007. 

We estimate that this new incentive 

payment for physician services will 

result in an increase in Medicare 

payments that are shown in Table 31. 

b. Improvement to Medicare HPSA 

Incentive Payment Program 

Section 413(b) of the MMA amended 

section 1833(m) of the Act to mandate 

that we automate payment of the 10 

percent HPSA incentive payment to 

eligible physicians. Since the inception 

of the HPSA incentive payment 

program, physicians have been required 

to determine their eligibility and 

correctly code their Medicare claims 

using modifiers. We estimate that this 

change to the HPSA incentive payment 

program to provide for automation of 

payment will result in an increase in 

Medicare payments because many 

eligible physicians are not applying for 

bonuses due to the burden of verifying 

eligibility. The impact of this provision 

is shown in Table 31.

TABLE 31.—MEDICARE COST ESTIMATES FOR MMA PROVISIONS

(in millions) 

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

Sec. 413(a) Physician Scarcity Areas ................................................... 30 50 50 20 0 

Sec. 413(b) Improvement to HPSA ....................................................... 20 30 30 30 30 

5. Sections 303–304—Payment for 

Covered Outpatient Drugs and 

Biologicals and Section 305—Payment 

for Inhalation Drugs 

Sections 303 and 304 of the MMA 

make changes to Medicare payment for 

covered outpatient drugs and biologicals 

and changes to the administration of 

those drugs. Section 305 makes changes 

to payment for inhalation drugs. We 

implemented provisions of sections 303 

through 305 changing payments in 2004 

for drugs and their administration in the 

January 7, 2004 Federal Register (69 FR 

1084). In this proposed rule, we are 

making further changes to Medicare’s 

payment for drugs and drug 

administration for 2005 required by 

sections 303 through 305 of the MMA. 

We estimate that adoption of the ASP+6 

payment methodology will result in 

Medicare savings for FY 2005 of $180 

million for section 303 of the MMA, 

$140 million for section 304 of the 

MMA, and $210 million for section 305 

of the MMA. If we were to make no 

further changes to the coding or 

payment for drug administration 

services, we estimate Medicare savings 

of $90 million for section 303 of the 

MMA and $40 million for section 304 of 

the MMA. In addition, we are also 

proposing to pay a supplying fee of $10 

per Medicare Part B oral drug 

prescription. We estimate this proposal 

will increase Medicare expenditures by 

$52 million from FY 2005 through FY 

2009, assuming an average of two 

prescriptions per month. We are also 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47569

proposing to pay a furnishing fee of 

$0.05 per unit off clotting factor. This 

proposal is estimated to cost $13 million 

from FY 2005 through FY 2009. 

6. Section 952—Reassignment

The reassignment provisions 

discussed in section III.F is currently 

estimated to have no significant impact 

on Medicare expenditures. 

7. Section 623—Payment for Renal 

Dialysis Services 

a. Effects on the Medicare Program 

(Budgetary Effect) 

Because the proposed basic case mix 

adjusted composite payment rate and 

the revised payment for ESRD drugs 

must be budget neutral in accordance 

with section 623(d)(1) of the MMA, 

except for the statutorily required 1.6 

percent increase set forth in section 

623(a), we estimate that there would be 

no budgetary impact for the Medicare 

program beyond this increase. The 

impact of this provision (net of 

beneficiary liability) is shown in the 

following table.

TABLE 32.—MEDICARE COST ESTIMATES FOR MMA PROVISION 623 

(in millions) 

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

Section 623 .............................................................................................. 40 50 50 60 60 

b. Impact on ESRD Providers 

In order to understand the impact of 

the proposed changes affecting 

payments to ESRD facilities that result 

from enactment of the MMA on 

different categories of ESRD facilities, it 

is necessary to compare estimated 

payments under the current payment 

system (current payments) to estimated 

payments under the proposed revisions 

to the composite rate payment system as 

set forth in this proposed rule (proposed 

payments). To estimate the impact 

among various classes of ESRD 

facilities, it is imperative that the 

estimates of current payments and 

proposed payments contain similar 

inputs. Therefore, we simulated 

proposed payments only for those ESRD 

facilities for which we are able to 

calculate both current payment and 

proposed payment. 

Due to data limitations, we are unable 

estimate current and proposed 

payments for 592 facilities that bill for 

ESRD drugs. Of these 592 facilities, 174 

are hospital based and 418 are 

independent. Therefore, 29 percent of 

hospital-based facilities and 11 percent 

of independent facilities are not shown 

in the impact table. ESRD providers 

were grouped into the categories based 

on characteristics provided in the 

Online Survey and Certification and 

Reporting (OSCAR) file and the most 

recent cost report data from HCRIS. We 

also used the December 2003 update of 

CY 2003 Standard Analytical File (SAF) 

claims as a basis for Medicare dialysis 

treatments and separately billable drugs 

and biologicals. While the December 

2003 update of the 2003 SAF file is not 

complete, we wanted to use the most 

recent data available, and plan to use an 

updated version of the 2003 SAF file for 

the final rule.

TABLE 33.—IMPACT OF MMA SECTION 623 PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES

(INCLUDES DRUG AND COMPOSITE RATE PAYMENTS) 

[Percent change in total payments to ESRD facilities (both program and beneficiaries)] 

Number of

facilities 

Number of

dialysis

treatments

(in millions) 

Effect of

changes

in drug

payments 1/ 

Effect of 1.6%

composite

rate update

on total

payments 2/ 

Effect of

case mix 3/ 

Overall effect 

4/ 

All ............................................................. 3,671 29.2 0.0 1.0 0.0 1.0 

Independent ............................................. 3,240 26.1 ¥0.6 1.0 ¥0.0 0.4 

Hospital Based ......................................... 431 3.1 5.7 1.1 0.1 7.0 

Size: ........................ ........................ ........................ ........................ ........................ ........................

Small <5000 treatment per year ....... 1,313 4.0 ¥0.6 1.0 ¥0.1 0.3 

Medium 5000–10000 treatments per 

yr ................................................... 1,414 10.2 ¥0.7 1.0 ¥0.1 0.2 

Large > 10000 treatments per year .. 944 15.0 0.6 1.0 0.0 1.7 

Type of Ownership: ........................ ........................ ........................ ........................ ........................ ........................

Not-for-profit ...................................... 697 5.2 2.9 1.1 0.0 4.1 

For-profit ........................................... 2,710 21.9 ¥0.6 1.0 ¥0.0 0.4 

Other ................................................. 264 2.1 ¥0.1 1.0 0.0 1.0 

Urban ................................................ 2,701 23.6 0.1 1.0 0.1 1.2 

Rural ................................................. 970 5.6 ¥0.5 1.0 ¥0.5 ¥0.0 

Region: ........................ ........................ ........................ ........................ ........................ ........................

New England .................................... 125 1.2 1.3 1.1 0.1 2.4 

Middle Atlantic .................................. 475 4.0 0.5 1.0 0.9 2.4 

East North Central ............................ 540 4.5 0.4 1.0 ¥0.1 1.3 

West North Central ........................... 255 1.7 1.4 1.1 ¥0.5 2.0 

South Atlantic .................................... 886 6.9 ¥1.0 1.0 0.0 0.0 

East South Central ........................... 309 2.2 ¥1.0 1.0 ¥0.7 ¥0.7 

West South Central .......................... 522 4.1 ¥1.0 1.0 ¥0.2 ¥0.1 

Mountain ........................................... 194 1.3 0.6 1.1 ¥0.5 1.1 

Pacific ............................................... 339 3.0 1.4 1.1 ¥0.2 2.3 

47570 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

TABLE 33.—IMPACT OF MMA SECTION 623 PAYMENTS TO HOSPITAL BASED AND INDEPENDENT ESRD FACILITIES

(INCLUDES DRUG AND COMPOSITE RATE PAYMENTS)—Continued

[Percent change in total payments to ESRD facilities (both program and beneficiaries)] 

Number of

facilities 

Number of

dialysis

treatments

(in millions) 

Effect of

changes

in drug

payments 1/ 

Effect of 1.6%

composite

rate update

on total

payments 2/ 

Effect of

case mix 3/ 

Overall effect 

4/ 

Puerto Rico ....................................... 26 0.4 0.8 1.0 1.4 3.3 

1This column shows the effect of the changes in drug payments to ESRD providers. These include changes in payment for separately billable 

drugs and the 11.3% drug add-on. 2This column shows the effect of the 1.6% update to the composite rate on total payments to ESRD providers. Note that ESRD providers receive an average of 36% of their total revenues from separately billable drugs which results in an average net increase of 1.0%. 3This column shows impact of case-mix adjustments only. 

4This column shows percent change between the proposed and current payments to ESRD facilities. The proposed payments includes the 

1.6% increase, the 11.3% drug add-on, and the case-mix adjustments times treatments plus proposed payment for separately billable drugs. The 

current payment to ESRD facilities includes the current composite rate times treatments plus current drug payments for separately billable drugs. 

Table 33 shows the impact of MMA 

Section 623 on hospital based and 

independent facilities. We have 

included both composite rate payments 

as well as payments for separately 

billable drugs and biologicals because 

both are effected by Section 623. The 

first column of Table 33 identifies the 

type of ESRD provider, the second 

column indicates the number of ESRD 

facilities for each type, and the third 

column indicates the number of dialysis 

treatments. 

The fourth column shows the effect of 

the changes in drug payments to ESRD 

providers. The overall effect of changes 

in drug payments is budget-neutral as 

required by MMA. The drug add-on 

adjustment is designed to result in the 

same aggregate amount of expenditures 

as would have been made without the 

statutory policy change. 

Current payments for drugs represent 

2005 Medicare reimbursement using 95 

percent of AWP prices for the top ten 

drugs. Medicare spending for drugs 

other than EPO is estimated using 2004 

AWP prices updated by a 3 percent 

inflation factor times actual drug 

utilization from 2003 claims. EPO is 

priced $10 per 1000 units (EPO units are 

estimated using payments because the 

units field on bills represents the 

number of EPO administrations rather 

than the number EPO units). Spending 

under the proposed change is 2004 ASP 

minus 3 percent for the top ten drugs 

plus 3.39 percent inflation factor times 

actual drug utilization from 2003 

claims. 

Proposed payment for drugs under 

MMA also includes the 11.3 percent 

drug add-on to the composite rate. This 

amount is computed by multiplying the 

composite rate for each provider (with 

the 1.6 percent increase) times dialysis 

treatments from 2003 claims. Column 4 

is computed by comparing spending 

under the proposed payment for drugs 

including the 11.3 percent drug add-on 

amount to spending under current 

payments for drugs. In order to make 

column 4 comparable with rest of Table 

33, current composite rate payments to 

ESRD facilities were included in both 

current and proposed spending 

calculations. 

Column 5 shows the effect of the 1.6 

percent increase to the composite rate 

on total payments to ESRD providers. 

While all ESRD providers will get a 1.6 

percent increase to their composite rate, 

this table shows the net effect of this 

increase on ESRD providers total 

Medicare revenues (both drug and 

composite rate payments combined), 

and therefore does not show a 1.6 

percent increase. 

On average, ESRD providers receive 

an average of 36 percent of their total 

revenues from separately billable drugs 

and 64 percent of their total revenues 

from composite rate payment. Since the 

1.6 percent increase is applied to the 64 

percent portion of their total Medicare 

revenues, the 1.6 percent composite rate 

increase is also arithmetically equal to 

a 1.0 percent increase in ESRD 

providers’ total Medicare revenues. 

Column 5 is computed by combining 

proposed payment for drugs (including 

the 11.3 percent drug add-on amount) 

with: (1) Current composite rate times 

dialysis treatments from 2003 claims or 

(2) composite rate with 1.6 percent 

increase times dialysis treatments from 

2003 claims. The difference between 

these two combinations is the net effect 

of the 1.6 percent increase on total 

payments to ESRD providers. In order to 

isolate the effect of the 1.6 percent 

increase, the computation in Column 5 

assumes that drug payments to ESRD 

providers remain constant. 

Column 6 shows the impact of the 

case-mix adjustments as described in 

section H.4.d of this proposed rule. 

Because MMA requires this adjustment 

be budget-neutral in the aggregate, there 

is no overall impact to the ESRD 

providers as a whole. While the casemix adjustment will have an impact 

within the various provider types, 

Column 6 shows that the effect between 

provider groupings is minimal. Column 

6 is computed as the difference between 

proposed payments to ESRD providers 

with the case-mix adjustments 

compared to payments to providers 

without the case-mix adjustments. As 

described in section H.4.f, we 

standardized the composite rate to meet 

the MMA requirement that payment be 

budget-neutral with respect to aggregate 

payments. Therefore, there is no change 

for ESRD providers in aggregate. We 

note that when applying the case-mix 

adjustments, we did so at the summary 

level as shown in Table 33. 

Column 7 shows the overall effect of 

all changes in drug and composite rate 

payments to ESRD providers. The 

overall effect measured as the difference 

between proposed payment with all 

MMA changes as proposed in this rule 

and current payment. Proposed 

payment is computed by multiplying 

the composite rate for each provider 

(with both 1.6 percent increase and the 

11.3 percent add-on) times dialysis 

treatments from 2003 claims times the 

appropriate case-mix adjustment by 

provider category. In addition, proposed 

payment includes payments for 

separately billable drugs under the 

revised pricing methodology as 

described in section III–E–Section 303–

Payment Reform for Outpatient Drugs 

and Biologicals, Subsection 1.d. Current 

payment is the current composite rate 

for each provider times dialysis 

treatments from 2003 claims plus 

current drug payments for separately 

billable drugs. 

The overall impact to ESRD providers 

in aggregate is 1.0 percent. Among the 

three separately shown effects, the effect 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47571

of changes in drug payments has the 

most variation among provider type and 

contributes most to the overall effect. 

Separately billable ESRD drugs are paid 

differently to hospital-based and 

independent ESRD providers. As 

discussed in section H.4.c, we are 

proposing a single drug add-on to the 

composite rates for both hospital based 

and independent facilities. The 7.0 

percent increase in payments to 

hospital-based providers is largely due 

to the proposed single drug add-on to 

the composite rate. Many hospital based 

providers are not-for-profit, which may 

explain the larger than average increase 

in payments. 

8. Section 731—Coverage of Routine 

Costs for Category A Clinical Trials 

The coverage of routine costs 

associated with certain Category A 

clinical trials as discussed in MMA 

section 731(b) has no significant impact 

on Medicare expenditures. 

9. Section 629—Part B Deductible 

As explained earlier in the preamble, 

section 629 of the MMA provides for 

annual updates to the Medicare Part B 

deductible. The MMA stipulates that the 

Medicare Part B deductible will be $110 

for calendar year 2005, and, for 

subsequent years, the deductible will be 

the previous year’s deductible increased 

by the annual percentage increase in the 

monthly actuarial rate under section 

1839(a)(1) of the Act, ending with that 

subsequent year (rounded to the nearest 

dollar). We note that while this MMA 

provision results in a savings to the 

Medicare program, it also increases 

beneficiary costs by an equal amount.

TABLE 34.—ESTIMATED MEDICARE SAVINGS FOR MMA PROVISION 629 

[in millions] 

MMA provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

Sec. 629 ................................................................................................... 110 290 440 590 770 

10. Section 512—Hospice Consultation 

Service 

As explained in section III.K, effective 

January 1, 2005, section 512 of the 

MMA provides for payment to be made 

to a hospice for specified services 

furnished by a physician who is either 

the medical director of, or an employee 

of, a hospice agency. We estimate that 

this MMA provision will increase 

Medicare expenditures by $10 million 

per year beginning in 2005. 

11. Section 302—Clinical Conditions for 

Coverage of Durable Medical Equipment 

(DME)

As explained earlier in the preamble, 

to comply with the requirements of 

section 302 of the MMA and to enhance 

quality and reduce fraud, we are 

proposing to establish basic 

requirements that apply to all items of 

durable medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS). The 

impact to the Medicare program will be 

to improve quality of care because we 

are involving the physician early in the 

process when determining the medical 

necessity for items of DMEPOS. The 

physician community has stated that 

they are often asked to order an item of 

DMEPOS for their patient when they do 

not think the item is reasonable and 

necessary. We believe these 

requirements will result in no costs or 

savings to Medicare because if any 

additional spending from more 

physician visits occur it will be offset by 

savings from Medicare paying for less 

DMEPOS. However, we expect to 

continue evaluating this issue. 

E. Other Issues 

1. Outpatient Therapy Services 

Performed ‘‘Incident to’’ Physicians’’

Services 

As discussed in section IV.A, we are 

proposing to amend the regulations to 

include the statutory requirement that 

only individuals meeting the existing 

qualification and training standards for 

therapists (with the exception of 

licensure) consistent with § 484.4 

qualify to provide therapy services 

incident to physicians’ services. We 

believe that while this will have little 

impact on Medicare expenditures, it 

will assist in ensuring the quality of 

services provided to beneficiaries. 

2. Supervision Requirements for 

Therapy Assistants in Private Practice 

As discussed earlier in section IV.A.2, 

we are proposing to revise the 

regulations at § 410.59 and § 410.60 to 

replace a requirement to provide 

personal supervision and instead 

require direct supervision of physical 

therapist assistants and occupational 

therapy assistants when therapy 

services are provided by physical 

therapists or occupational therapists in 

private practice. This proposed policy 

change would provide beneficiaries 

access to medically necessary therapy 

services, under a physician-certified 

plan of care. We believe that this change 

would result in a 5 percent increase in 

therapy billing in therapy private 

practice settings with an estimated cost 

of $9 million for FY 2005. Projected 

costs for FY 2006 are $17 million while 

each subsequent year would only 

increase by $1 million each year, 

assuming the therapy caps are applied. 

3. Low Osmolar Contrast Media 

As discussed earlier in the preamble, 

we are proposing to revise the 

regulations at § 414.38 to eliminate the 

restrictive criteria for the payment of 

LOCM. This proposal will make 

payment for LOCM consistent across 

Medicare payment systems. By 

identifying contrast-enhanced 

procedures that most commonly use 

LOCM, the typical ranges of LOCM 

amounts used by modality, and the cost 

ranges for LOCM in the marketplace, we 

estimate program costs as shown in the 

following table:

TABLE 35 

Regulatory Provision FY 2005 FY 2006 FY 2007 FY 2008 FY 2009 

LOCM ....................................................................................................... 20 30 30 30 30 

47572 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

4. Payments for Physicians and 

Practitioners Managing Patients on 

Dialysis 

We believe that the proposals with 

respect to ESRD-related services 

furnished to patients in observation 

settings and payment for outpatient 

ESRD-related services for partial month 

scenarios discussed earlier in section 

1V. E. provide clarification of current 

policy surrounding these issues. We do 

not believe these proposals would have 

a significant impact on Medicare 

expenditures. 

5. Supervision of Clinical Psychological 

Testing 

We are proposing to change the 

supervision requirements regarding who 

can supervise diagnostic psychological 

testing services. As previously 

discussed, having ancillary staff 

supervised by clinical psychologists 

would enable these practitioners with a 

higher level of expertise to oversee 

psychological testing and potentially 

relieve burdens on physicians and 

healthcare facilities. 

Additionally, in rural areas, we 

anticipate that permitting psychologists 

to supervise diagnostic psychological 

testing services would reduce delays in 

testing, diagnosis, and treatment that 

could result from the unavailability of 

physicians to supervise the tests. We 

believe that this proposal will have little 

impact on Medicare expenditures. 

6. Care Plan Oversight 

As discussed in section IV.G, we are 

proposing to revise § 414.39 to clarify 

that NPPs can perform home health care 

plan oversight even though they cannot 

certify a patient for home health 

services and sign the plan of care. We 

do not expect that this proposal would 

have an impact on Medicare 

expenditures, since it is only clarifying 

that an NPP or a physician can provide 

care plan oversight for home health 

care. 

7. Assignment of Medicare Claims 

The proposed changes with respect to 

assignment of Medicare claims are 

currently estimated to have no 

significant impact on Medicare 

expenditures. However, as stated earlier 

in this preamble at section IV.H, we 

believe the proposed changes will 

reduce the paperwork burden on 

beneficiaries and suppliers. 

F. Alternatives Considered 

This proposed rule contains a range of 

policies, including proposals related to 

specific MMA provisions. The preamble 

provides descriptions of the statutory 

provisions that are addressed, identifies 

those policies when discretion has been 

exercised and presents rationale for our 

decisions and, when possible, 

alternatives that were considered.

The following is a discussion of 

additional points on the proposed 

changes required by section 302 of the 

MMA involving ordering items of 

durable medical equipment, prosthetics, 

orthotics, and supplies (DMEPOS). 

In developing the proposed changes 

to implement section 302 of the MMA, 

we did consider establishing ‘‘the faceto-face requirement,’’ and ‘‘the order 

prior to delivery’’ requirement only for 

specific items of DMEPOS for which 

there has been an identified 

proliferation of use. However, we 

believe it is important that the physician 

or nonphysician practitioner determine 

the medical need for all items of DME. 

It is good clinical practice for 

beneficiaries to be seen by the physician 

for their medical condition and at that 

time the physician will decide whether 

an item of DME is appropriate. It is our 

intent to make Medicare more 

consistent with private payers in that 

beneficiaries be seen by their physician 

for their medical condition, who then 

makes a diagnosis and orders any 

supplies needed to address their needs. 

Since we expect beneficiaries to be seen 

by their doctor for a specific medical 

condition, we do not believe that this 

would place a burden on the physician, 

as it would be part of a necessary 

examination. 

We also note that in establishing these 

proposed requirements we do make 

exceptions for items of continued need, 

such as, glucose test strips or support 

surfaces. Once the physician has 

initially established the need, we do not 

require additional visits or additional 

documentation. 

G. Impact on Beneficiaries 

There are a number of changes made 

in this proposed rule that would have 

an effect on beneficiaries. In general, we 

believe these changes will improve 

beneficiary access to services that are 

currently covered or will expand the 

Medicare benefit package to include 

new services. As explained in more 

detail below, the MMA or regulatory 

provisions may increase beneficiary 

liability in some cases. Any changes in 

aggregate beneficiary liability from a 

particular provision will be a function 

of the coinsurance (20 percent if 

applicable for the particular provision 

after the beneficiary has met the 

deductible) and the effect of the 

aggregate cost (savings) of the provision 

on the calculation of the Medicare Part 

B premium rate (generally 25 percent of 

the provision’s cost or savings). Taking 

into account the MMA and regulatory 

provisions of this proposed rule, we 

estimate beneficiary savings in FY 2005 

of $270 million. This figure could be 

less if we make further changes to 

Medicare’s drug administration 

payments. 

The MMA provisions that expand 

Medicare benefits include: section 611, 

adding a preventive office visit for 

newly eligible Medicare beneficiaries; 

section 612 providing coverage of 

cardiovascular screening blood tests; 

and section 613, providing coverage for 

diabetes screening tests for Medicare 

beneficiaries at risk for diabetes. While 

the preventive office visit for newly 

eligible Medicare beneficiaries is subject 

to deductible and coinsurance, we 

believe Medicare beneficiaries will 

continue to benefit from expanded 

coverage for this service. We believe 

many beneficiaries have supplemental 

insurance coverage or Medicaid that 

pays the Medicare deductible on their 

behalf and there will be no immediate 

additional out-of-pocket cost. Further, 

even if a beneficiary pays nearly all of 

the costs of this new benefit, the 

preventive office visit will substitute for 

another service a beneficiary may need 

to meet the annual deductible and the 

beneficiary will receive more covered 

benefits at little additional cost. There 

are no out-of-pocket costs to the 

beneficiary for the cardiovascular 

screening blood tests and diabetes 

screening tests. 

Other proposals in this rule related to 

the MMA will also impact beneficiary 

liability, with the most significant 

related to indexing of the part B 

deductible (section 629 of the MMA) 

and the drug administration payment 

changes (sections 303 and 305 of the 

MMA). Indexing of the Part B 

deductible will result in an estimated 

cost to beneficiaries of $110 million in 

2005. MMA provisions that improve 

administration of the 10 percent HPSA 

bonus and provide an additional 5 

percent bonus payment to physicians in 

Medicare scarcity areas will have no 

impact on beneficiary liability because 

the bonus payments are applied to the 

amount Medicare pays the physician net 

of beneficiary liability. These provisions 

will also improve access for Medicare 

beneficiaries by increasing payments to 

physicians in areas that traditionally 

have had a low ratio of physicians to 

population.

The implementation of MMA 

provisions related to drugs and drug 

administration will reduce Medicare 

beneficiary liability for Medicare 

covered services. We estimate that 

implementation of sections 303 through 

305 of the MMA will reduce Medicare 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47573

beneficiary liability for drugs by $360 

million in FY 2005. If we were to make 

no further changes to Medicare’s 

payments for drug administration, we 

estimate additional savings to Medicare 

beneficiaries of $120 million in FY 

2005. Provisions of this proposed rule 

that increase the supplying fee for 

immunosuppressive drugs and the 

furnishing fee for the clotting factor are 

estimated to increase beneficiary 

liability by $36 million and $10 million 

respectively, from FY 2005 through FY 

2009. 

We do not believe that the drug and 

drug administration payment changes 

required by the MMA are intended to 

lessen beneficiary access to care. By 

reducing beneficiary liability, we 

believe it is likely that beneficiary 

access to care will be improved. As 

indicated earlier, without any further 

change in payment for drug 

administration, the MMA increased 

payment for drug administration by 

more than 105 percent from 2003 to 

2005 while making payment for drugs at 

6 percent more than their average sales 

price. Nevertheless, we acknowledge 

that there is a concern among 

physicians and others that the large 

changes in Medicare’s payments may 

affect their ability or willingness to 

continue making drugs and related 

services available. 

As indicated above, we are 

considering making further changes to 

Medicare payment for drug 

administration based on the results of 

CPT’s review of this issue or in response 

to public comment. Further, we are 

gathering Medicare utilization for drugs 

and drug administration beginning in 

2002 and plan to analyze shifts or 

changes in utilization patterns as the 

information becomes available to us 

once the payment changes required by 

the MMA go into effect. While we do 

not believe the payment changes for 

drugs and drug administration will 

result in access problems, we plan to 

continue studying this issue. We also 

note that the MMA requires the 

Medicare Payment Advisory 

Commission (MedPAC) to study related 

issues. Specifically, section 303(a)(5) of 

the MMA requires MedPAC to study 

items and services furnished by 

oncologists and drug administration 

services furnished by other specialists. 

Similarly, section 305(b) requires the 

General Accounting Office to study the 

adequacy of Medicare payments for 

inhalation therapy. 

We are also undertaking several 

changes using our administrative 

authority that will affect Medicare 

beneficiaries. Our proposal to remove 

restrictions that limit Medicare payment 

for use of low osmolar contrast material 

to specific indications would update 

Medicare’s payment policy to be 

consistent with the standard practice of 

medicine and will improve the quality 

of care for beneficiaries. 

We believe early involvement of the 

physician in determining the medical 

necessity for items of DMEPOS will 

assist in improving the accuracy of 

Medicare program payments and the 

quality of care. In addition, it will also 

reduce out-of-pocket costs for 

unnecessary DMEPOS that may have 

otherwise been provided to Medicare 

beneficiaries. 

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 405

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medical 

devices, Medicare, Reporting and 

recordkeeping requirements, Rural 

areas, X-rays 

42 CFR Part 410

Health facilities, Health professions, 

Kidney diseases, Laboratories, 

Medicare, Reporting and recordkeeping 

requirements, 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 

42 CFR Part 418

Health facilities, Hospice care, 

Medicare, Reporting and recordkeeping 

requirements 

42 CFR Part 424

Emergency medical services, Health 

facilities, Health professions, Medicare, 

Reporting and recordkeeping 

requirements 

42 CFR Part 484

Health facilities, Health professions, 

Medicare, Reporting and recordkeeping 

requirements 

42 CFR Part 486

Grant programs-health, Health 

facilities, Medicare, Reporting and 

recordkeeping requirements, X-rays

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services proposes to amend 

42 CFR chapter IV as follows:

PART 405—FEDERAL HEALTH 

INSURANCE FOR THE AGED AND 

DISABLED 

1. The authority citation for part 405 

continues to read as follows:

Authority: Secs. 1102, 1861, 1862(a), 1871, 

1874, 1881, and 1886(k) of the Social 

Security Act (42 U.S.C. 1302, 1395x, 

1395y(a), 1395hh, 1395kk, 1395rr, and 

1395ww(k)), and sec. 353 of the Public 

Health Service Act (42 U.S.C. 263a).

2. Section 405.207 is amended by 

revising paragraph (b) to read as follows:

§ 405.207 Services related to a noncovered 

device.

* * * * *

(b) When payment is made. Medicare 

payment may be made for—

(1) Covered services to treat a 

condition or complication that arises 

due to the use of a noncovered device 

or a noncovered device-related service; 

or 

(2) Routine care services related to 

experimental/investigational (Category 

A) devices as defined in § 405.201(b); 

and furnished in conjunction with an 

FDA-approved clinical trial. The trial 

must meet criteria established through 

the national coverage determination 

process; and if the trial is initiated 

before January 1, 2010, the device must 

be determined as intended for use in the 

diagnosis, monitoring or treatment of an 

immediate life-threatening disease or 

condition. 

(3) Routine care services related to a 

non-experimental/investigational 

(Category B) device defined in 

§ 405.201(b) that is furnished in 

conjunction with an FDA-approved 

clinical trial. 

3. Section 405.517 is amended by 

adding a new paragraph (a)(3) to read as 

follows:

§ 405.517 Payment for drugs and 

biologicals that are not paid on a cost or 

prospective payment basis. 

(a) Applicability. ***

(3) Payment for drugs and biologicals 

on or after January 1, 2005. Effective 

January 1, 2005, payment for drugs and 

biologicals that are not paid on a cost or 

prospective payment basis are paid in 

accordance with part 414, subpart K of 

this chapter.

PART 410—SUPPLEMENTARY 

MEDICAL INSURANCE (SMI) 

BENEFITS 

4. The authority citation for part 410 

continues to read as follows:

47574 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

5. Section 410.10 is amended by 

adding new paragraph (y) to read as 

follows:

§ 410.10 Medical and other health 

services: Included services.

* * * * *

(y) Intravenous immune globulin 

administered in the home for the 

treatment of primary immune deficiency 

diseases. 

6. Section 410.16 is added to read as 

follows:

§ 410.16 Initial preventive physical 

examination: Conditions for and limitations 

on coverage. 

(a) Definitions. As used in this 

section, the following definitions 

apply—

Eligible beneficiary means individuals 

who receive their initial preventive 

physical examinations within 6 months 

after the effective date of their first 

Medicare Part B coverage period, but 

only if their first Part B coverage period 

begins on or after January 1, 2005. 

Initial preventive physical 

examination means all of the following 

services furnished to an individual by a 

physician or other qualified 

nonphysician practitioner with the goal 

of health promotion and disease 

detection: 

(1) Review of the individual’s 

comprehensive medical and social 

history. 

(2) Review of the individual’s 

potential (risk factors) for depression, 

including past experiences with 

depression or other mood disorders, 

based on the use of an appropriate 

screening instrument, which the 

physician or other qualified 

nonphysician practitioner may select 

unless the appropriate screening 

instrument is further defined through a 

national coverage determination. 

(3) Review of the individual’s 

functional ability, and level of safety, 

based on the use of an appropriate 

screening instrument, which the 

physician or other qualified 

nonphysician practitioner may select 

unless the appropriate screening 

instrument is defined through a national 

coverage determination. 

(4) An examination to include 

measurement of the individual’s height, 

weight, blood pressure, a visual acuity 

screen, and other factors as deemed 

appropriate, based on the individual’s 

medical and social history, and current 

clinical standards. 

(5) Performance and interpretation of 

an electrocardiogram. 

(6) Education, counseling, and 

referral, as deemed appropriate by the 

physician or qualified nonphysician 

practitioner, based on the results of the 

review and evaluation services 

described in this section.

(7) Education, counseling, and 

referral, including a written plan 

provided to the individual for obtaining 

the appropriate screening and other 

preventive services for the individual 

that are covered as separate Medicare 

Part B benefits as described in section 

1861(s)(10), section 1861(jj), section 

1861(nn), section 1861(oo), section 

1861(pp), section 1861(qq)(1), section 

1861(rr), section 1861(uu), section 

1861(vv), section 1861(xx)(1), and 

section 1861(yy) of the Social Security 

Act (the Act). 

Medical history is defined to include, 

at a minimum, the following: 

(1) Past medical and surgical history, 

including experiences with illnesses, 

hospital stays, operations, allergies, 

injuries and treatments. 

(2) Current medications and 

supplements, including calcium and 

vitamins. 

(3) Family history, including a review 

of medical events in the patient’s 

family, including diseases that may be 

hereditary or place the individual at 

risk. 

Physician for purposes of this 

provision means a doctor of medicine or 

osteopathy (as defined in section 

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

Qualified nonphysician practitioner

for purposes of this provision means a 

physician assistant, nurse practitioner, 

or clinical nurse specialist (as 

authorized under section 

1861(s)(2)(K)(i) and section 

1861(s)(2)(K)(ii) of the Act and defined 

in section 1861(aa)(5) of the Act, or in 

regulations at § 410.74, § 410.75, and 

§ 410.76). 

Review of the individual’s functional 

ability and level of safety. Review of the 

individual’s functional ability and level 

of safety must include, at a minimum, 

a review of the following areas: 

(1) Hearing impairment. 

(2) Activities of daily living. 

(3) Falls risk. 

(4) Home safety. 

Social history is defined to include, at 

a minimum, the following: 

(1) History of alcohol, tobacco, and 

illicit drug use. 

(2) Work and travel history. 

(3) Diet. 

(4) Social activities. 

(5) Physical activities. 

(b) Condition for coverage of an initial 

preventive physical examination.

Medicare Part B pays for an initial 

preventive physical examination 

provided to an eligible beneficiary, as 

described in paragraph (a) of this 

section, if it is furnished by a physician 

or other qualified nonphysician 

practitioner, as defined in paragraphs (a) 

of this section. 

(c) Limitations on coverage of initial 

preventive physical examinations.

Payment may not be made for an initial 

preventive physical preventive 

examination that is performed for an 

individual who is not an eligible 

beneficiary as described in paragraph (a) 

of this section. 

7. A new § 410.17 is added to read as 

follows:

§ 410.17 Cardiovascular disease screening 

tests. 

(a) Definition. For purposes of this 

subpart, the following definition 

applies: 

Cardiovascular screening blood test

means: 

(1) A lipid panel consisting of a total 

cholesterol, HDL cholesterol, and 

triglyceride. The test is performed after 

a 12-hour fasting period. 

(2) Other blood tests, previously 

recommended by the U.S. Preventive 

Services Task Force (USPSTF), as 

determined by the Secretary through a 

national coverage determination 

process. 

(3) Other non-invasive tests, for 

indications that have a blood test 

recommended by the USPSTF, as 

determined by the Secretary through a 

national coverage determination 

process. 

(b) General conditions of coverage.

Medicare Part B covers cardiovascular 

disease screening tests when ordered by 

the physician who is treating the 

beneficiary (see § 410.32(a)) for the 

purpose of early detection of 

cardiovascular disease in individuals 

without apparent signs or symptoms of 

cardiovascular disease. 

(c) Limitation on coverage of 

cardiovascular screening tests. Payment 

may be made for cardiovascular 

screening tests performed for an 

asymptomatic individual only if the 

individual has not had the screening 

tests paid for by Medicare during the 

preceding 59 months following the 

month in which the last cardiovascular 

screening tests were performed. 

8. A new § 410.18 is added to read as 

follows:

§ 410.18 Diabetes screening tests. 

(a) Definitions. For purposes of this 

section, the following definitions apply: 

Diabetes means diabetes mellitus, a 

condition of abnormal glucose 

metabolism diagnosed using the 

following criteria: a fasting blood sugar 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47575

greater than or equal to 126 mg/dL on 

two different occasions; a 2-hour postglucose challenge greater than or equal 

to 200 mg/dL on two different 

occasions; or a random glucose test over 

200 mg/dL for a person with symptoms 

of uncontrolled diabetes. 

Pre-diabetes means a condition of 

abnormal glucose metabolism diagnosed 

using the following criteria: a fasting 

glucose level of 100–125 mg/dL, or a 2-

hour post-glucose challenge of 140–199 

mg/dL. The term pre-diabetes includes 

the following conditions: 

(1) Impaired fasting glucose. 

(2) Impaired glucose tolerance. 

(b) General conditions of coverage.

Medicare Part B covers diabetes 

screening tests after a referral from a 

physician or qualified nonphysician 

practitioner to an individual at risk for 

diabetes for the purpose of early 

detection of diabetes. 

(c) Types of tests covered. The 

following tests are covered if all other 

conditions of this subpart are met: 

(1) Fasting plasma glucose test. 

(2) Post-glucose challenges including, 

but not limited to, an oral glucose 

tolerance test with a glucose challenge 

of 75 grams of glucose for non-pregnant 

adults, a 2-hour post glucose challenge 

test alone. 

(3) Other tests as determined by the 

Secretary through a national coverage 

determination.

(d) Amount of testing covered.

Medicare covers the following for 

individuals: 

(1) Diagnosed with pre-diabetes 

Medicare, two screening tests per 

calendar year. 

(2) Previously tested who were not 

diagnosed with pre-diabetes, or who 

have never been tested before, one 

screening test per year. 

(e) Eligible risk factors. Individuals 

with the following risk factors are 

eligible to receive the benefit: 

(1) Hypertension. 

(2) Dyslipidemia. 

(3) Obesity, defined as a body mass 

index greater than or equal to 30 kg/m2. 

(4) Prior identification of impaired 

fasting glucose or glucose intolerance. 

(5) Any two of the following 

characteristics: 

(i) Overweight, defined as body mass 

index greater than 25, but less than 30, 

kg/m2. 

(ii) A family history of diabetes. 

(iii) 65 years of age or older. 

(iv) A history of birthing a baby 

weighing more than 9 pounds. 

(f) Individuals not covered. For 

individuals previously diagnosed as 

diabetic, no coverage. 

9. Section 410.26 is amended by 

revising paragraph (c) to read as follows:

§ 410.26 Services and supplies incident to 

a physician’s professional services: 

Conditions.

* * * * *

(c) Limitations. (1) Drugs and 

biologicals are also subject to the 

limitations specified in § 410.29. 

(2) Physical therapy, occupational 

therapy and speech-language pathology 

services provided incident to a 

physician’s professional services are 

subject to the provisions established in 

§ 410.59(a)(3)(iii), § 410.60(a)(3)(iii), and 

§ 410.62(a)(3)(ii). 

10. Section 410.32 is amended by 

revising paragraph (b)(2)(iii) to read as 

follows:

§ 410.32 Diagnostic x-ray tests, diagnostic 

laboratory tests, and other diagnostic tests: 

Conditions.

* * * * *

(b) * * *

(2) * * *

(iii) Diagnostic psychological testing 

services when—

(A) Personally furnished by a clinical 

psychologist or an independently 

practicing psychologist as defined in 

program instructions; or 

(B) Furnished under the general 

supervision of a physician or a clinical 

psychologist.

* * * * *

11. Section 410.36 is amended by—

A. Revising the section heading. 

B. Adding to paragraph (a), the 

paragraph heading ‘‘Condition for 

coverage medical supplies, appliances, 

and devices.’’

C. Revising paragraph (b). 

D. Adding new paragraphs (c) and (d). 

The additions and revisions read as 

follows:

§ 410.36 Medical supplies, appliances, and 

devices: Conditions for and limitations on 

coverage. 

(a) Conditions for coverage of medical 

supplies, appliances, and medical 

devices. ***

(b) Conditions for coverage. Medicare 

Part B pays for the medical supplies, 

appliances, and devices listed in 

paragraph (a) of this section when: 

(1) The medical supplies, appliances, 

and devices are ordered by a physician, 

physician assistant, clinical nurse 

specialist, or nurse practitioner as 

defined in the Act. 

(2) The physician or prescribing 

practitioner—

(i) Conducts a face-to-face 

examination to determine the medical 

necessity for medical supplies, 

appliances, and devices. 

(ii) Conducts the face-to-face 

examination only for the initial order 

and at the time of the prescription 

renewal for items of continued need, 

such as glucose testing supplies. 

(iii) Is independent from the DME 

supplier and may not be an employee or 

contractor of the supplier. 

(3) A written order is completed and 

signed before delivery of these medical 

supplies, appliances, and devices to the 

beneficiary. 

(4) The physician’s or prescribing 

practitioner’s order is dated and signed 

within 30 days after the face-to-face 

examination and the beneficiary’s 

medical record includes verification of 

the face-to-face examination. 

(5) The physician or prescribing 

practitioner documents in the 

beneficiary’s medical record the need 

for the medical supplies, appliances, 

and devices being ordered. 

(6) CMS may determine other criteria, 

such as prescription renewal 

requirements, repairs, minor revisions 

and replacement, through contractor 

instructions. 

(c) Limitation. Medicare does not pay 

for a face-to-face examination for the 

sole purpose of the beneficiary’s 

obtaining the physician or prescribing 

practitioner’s order for the medical 

supplies, appliances, and devices. 

(d) Clinical conditions for coverage.

Clinical conditions for coverage, other 

than those set forth in paragraph (b) of 

this section, of medical supplies, 

appliances, and devices are determined 

through the national or local coverage 

determination process. 

12. Section 410.38 is amended by—

A. Revising paragraph (g). 

B. Adding paragraphs (h) and (i). 

The revision and additions read as 

follows:

§ 410.38 Durable medical equipment: 

Scope and conditions.

* * * * *

(g) Conditions for coverage. (1) 

Medicare Part B pays for durable 

medical equipment ordered by a 

physician, physician assistant, clinical 

nurse specialist, or nurse practitioner, as 

defined in the Act. 

(2) The physician or prescribing 

practitioner must—

(i) Conduct a face-to-face examination 

to determine the medical necessity of 

each item of durable medical 

equipment. 

(ii) Conduct the face-to-face 

examination for the initial order and at 

the time of the prescription renewal for 

items of continued need, such as 

infusion pumps or hospital beds. 

(iii) Be independent from the DME 

supplier and cannot be an employee or 

contractor of the supplier. 

(3) A written order must be completed 

and signed before delivery of any 

47576 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

durable medical equipment to the 

beneficiary. 

(4) The physician’s or prescribing 

practitioner’s order must be dated and 

signed within 30 days after the face-toface examination and the beneficiary’s 

medical record must include 

verification of the face-to-face 

examination. 

(5) The physician or prescribing 

practitioner must document in the 

beneficiary’s medical record the need 

for the durable medical equipment 

being ordered. 

(6) CMS may determine other 

additional payment criteria, such as 

prescription renewal requirements, 

repairs, minor revisions and 

replacement, through contractor 

instructions. 

(h) Limitation. Medicare does not pay 

for a face-to-face examination for the 

sole purpose of the beneficiary’s 

obtaining the physician’s or prescribing 

practitioner’s order for the durable 

medical equipment. 

(i) Clinical conditions for coverage.

Clinical conditions for coverage, not 

defined in paragraph (g) of this section, 

of durable medical equipment are 

determined through the national or local 

coverage determination process. 

13. Section 410.59 is amended by—

A. Revising paragraph (a) introductory 

text and paragraph (a)(3)(ii). 

B. Adding new paragraph (a)(3)(iii). 

C. Revising paragraph (b) heading. 

C. Revising paragraph (c)(2). 

D. Adding new paragraph (e)(1)(iii). 

The additions and revisions read as 

follows:

§ 410.59 Outpatient occupational therapy 

services: Conditions. 

(a) Basic rule. Except as specified in 

paragraph (a)(3)(iii) of this section, 

Medicare Part B pays for outpatient 

occupational therapy services only if 

they are furnished by an individual 

meeting the qualifications in § 484.4 for 

an occupational therapist or by an 

appropriately supervised occupational 

therapy assistant who meets the 

following conditions: * * *

(3) * * *

(ii) By, or under the direct supervision 

of, an occupational therapist in private 

practice as described in paragraph (c) of 

this section; or 

(iii) By, or incident to the service of, 

a physician, physician assistant, clinical 

nurse specialist, or nurse practitioner 

when those professionals may perform 

occupational therapy services within 

the scope of their State practice. When 

an occupational therapy service is 

provided incident to the service of a 

physician, physician assistant, clinical 

nurse specialist, or nurse practitioner, 

the service and the person who 

furnishes the service must meet the 

standards and conditions that apply to 

occupational therapy and occupational 

therapists, except that a license to 

practice occupational therapy in the 

State is not required. 

(b) Conditions for coverage of 

outpatient therapy services furnished to 

certain inpatients of a hospital or a CAH 

or SNF. ***

* * * * *

(c) Special provisions for services 

furnished by occupational therapists in 

private practice. ***

(2) Supervision of occupational 

therapy services. Occupational therapy 

services are performed by, or under the 

direct supervision of, an occupational 

therapist in private practice. All services 

not performed personally by the 

therapist must be performed by 

employees of the practice, directly 

supervised by the therapist, and 

included in the fee for the therapist’s 

services.

* * * * *

(e) Annual limitation on incurred 

expenses.

(1) * * *

(iii) The limitation is not applied for 

services furnished from December 8, 

2003 through December 31, 2005.

* * * * *

14. Section 410.60 is amended by—

A. Revising paragraph (a) introductory 

text. 

B. Revising paragraph (a)(3)(ii). 

C. Adding new paragraph (a)(3)(iii). 

D. Revising paragraph (b) heading. 

E. Revising paragraph (c)(2). 

F. Adding new paragraph (e)(1)(iii). 

The additions and revisions read as 

follows:

§ 410.60 Outpatient physical therapy 

services: Conditions. 

(a) Basic rule. Except as specified in 

paragraph (a)(3)(iii) of this section, 

Medicare Part B pays for outpatient 

physical therapy services only if they 

are furnished by an individual meeting 

the qualifications in § 484.4 for a 

physical therapist or by an 

appropriately supervised physical 

therapist assistant who meets the 

following conditions:

* * * * *

(3) * * *

(ii) By or under the direct supervision 

of a physical therapist in private 

practice as described in paragraph (c) of 

this section; or 

(iii) By, or incident to, the service of 

a physician, physician assistant, clinical 

nurse specialist, or nurse practitioner 

when those professionals may perform 

physical therapy services within the 

scope of their State practice. When a 

physical therapy service is provided 

incident to the service of a physician, 

physician’s assistant, clinical nurse 

specialist, or nurse practitioner, the 

service and person who furnishes the 

service must meet the standards and 

conditions that apply to physical 

therapy and physical therapists, except 

that a license to practice physical 

therapy in the State is not required. 

(b) Condition for coverage of 

outpatient physical therapy services 

furnished to certain inpatients of a 

hospital or a CAH or SNF. ***

(c) Special provisions for services 

furnished by physical therapists in 

private practice. * * *

(2) Supervision of physical therapy 

services. Physical therapy services are 

performed by, or under the direct 

supervision of, a physical therapist in 

private practice. All services not 

performed personally by the therapist 

must be performed by employees of the 

practice, directly supervised by the 

therapist, and included in the fee for the 

therapist’s services.

* * * * *

(e) Annual limitation on incurred 

expenses.

(1) * * *

(iii) The limitation is not applied for 

services furnished from December 8, 

2003 through December 31, 2005.

* * * * *

15. Section 410.62 is amended by—

A. Revising paragraph (a) introductory 

text and (a)(2)(i), (a)(2)(iii) and (a)(3). 

B. Revising paragraphs (b) and (c). 

The revisions read as follows:

§ 410.62 Outpatient speech-language 

pathology services: Conditions and 

exclusions. 

(a) Basic rule. Except as specified in 

paragraph (a)(3)(ii) of this section, 

Medicare Part B pays for outpatient 

speech-language pathology services only 

if they are furnished by an individual 

who meets the qualifications for a 

speech-language pathologist in § 484.4 

of this chapter if they meet the 

following conditions: * * *

(2) * * *

(i) Is established by a physician or, 

effective January 1, 1982, by either a 

physician or the speech-language 

pathologist who provides the services to 

the particular individual; 

(ii) * * *

(iii) Meets the requirements of 

§ 410.61. 

(3) They are furnished—

(i) By a provider as defined in § 489.2 

of this chapter, or by others under 

arrangements with, and under the 

supervision of, a provider; or 

(ii) By, or incident to, the service of 

a physician, physician assistant, clinical 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47577

nurse specialist, or nurse practitioner 

when those professionals may perform 

speech-language pathology services 

within the scope of their State practice. 

When a speech-language pathology 

service is provided incident to the 

services of a physician, physician’s 

assistant, clinical nurse specialist, or 

nurse practitioner, the service and the 

person who furnishes the service must 

meet the standards and conditions that 

apply to speech-language pathology and 

speech-language pathologists, except 

that a license to practice speechlanguage pathology services in the State 

is not required. 

(b) Condition for coverage of 

outpatient speech-language pathology 

services to certain inpatients of a 

hospital, CAH, or SNF. Medicare Part B 

pays for outpatient speech-language 

pathology services furnished to an 

inpatient of a hospital, CAH, or SNF 

who requires the services but has 

exhausted or is otherwise ineligible for 

benefit days under Medicare Part A. 

(c) Excluded services. No service is 

included as an outpatient speechlanguage pathology service if it is not 

included as an inpatient hospital service 

if furnished to a hospital or CAH 

inpatient.

* * * * *

16. Section 410.63 is amended by—

A. Revising paragraph (b) section 

heading. 

B. Adding a new paragraph (c). 

The revision and addition reads as 

follows:

§ 410.63 Hepatitis vaccine and blood 

clotting factors: Conditions. 

(b) Blood clotting factors: Conditions.

***

(c) Blood clotting factors: Separate 

payment. Effective January 1, 2005, 

Medicare pays hemophilia treatment 

centers and homecare companies that 

furnish blood clotting factor a separate 

payment of $0.05 per unit for the items 

and services associated with the 

furnishing of the blood clotting factor. 

These items and services include the 

mixing and delivery of factors, 

including special inventory 

management and storage requirements, 

as well as ancillary supplies and patient 

training necessary for the selfadministration of these factors. 

17. Section 410.78 is amended by—

A. Revising paragraph (a)(4). 

B. Revising paragraph (b) introductory 

text. 

The revisions read as follows:

§ 410.78 Telehealth services. 

(a) * * *

(4) Originating site means the location 

of an eligible Medicare beneficiary at 

the time the service being furnished via 

a telecommunications system occurs. 

For asynchronous store and forward 

telecommunications technologies, the 

only originating sites are Federal 

telemedicine demonstration programs 

conducted in Alaska or Hawaii. 

(b) General rule. Medicare Part B pays 

for office and other outpatient visits, 

professional consultation, psychiatric 

diagnostic interview examination, 

individual psychotherapy, monthly end 

stage renal disease (ESRD) related 

evaluation and management services 

and pharmacologic management 

furnished by an interactive 

telecommunications system if the 

following conditions are met:

* * * * *

18. Section 410.160 is amended by 

revising paragraph (f) to read as follows:

§ 410.160 Part B annual deductible.

* * * * *

(f) Amount of the Part B annual 

deductible. (1) Beginning with expenses 

for services furnished during calendar 

year 2006, and for all succeeding years, 

the annual deductible is the previous 

year’s deductible plus the annual 

percentage increase in the monthly 

actuarial rate for Medicare enrollees age 

65 and over, rounded to the nearest 

dollar. 

(2) For 2005, the deductible is $110. 

(3) From 1991 through 2004, the 

deductible was $100. 

(4) From 1982 through 1990, the 

deductible was $75. 

(5) From 1973 through 1981, the 

deductible was $60. 

(6) From 1966 through 1972, the 

deductible was $50.

* * * * *

PART 411—EXCLUSIONS FROM 

MEDICARE AND LIMITATIONS ON 

MEDICARE PAYMENT

19. 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).

20. Section 411.15 is amended by—

A. Revising paragraph (a)(1). 

B. Adding paragraph (k)(11). 

The revision and addition read as 

follows:

§ 411.15 Particular services excluded from 

coverage.

* * * * *

(a) * * *

(1) Examinations performed for a 

purpose other than treatment or 

diagnosis of a specific illness, 

symptoms, complaint, or injury, except 

for screening mammography, colorectal 

cancer screening tests, screening pelvic 

exams, prostate cancer screening tests, 

glaucoma screening exams, or initial 

preventive physical examinations that 

meet the criteria specified in paragraphs 

(k)(6) through (k)(11) of this section.

* * * * *

(k) * * *

(11) In the case of initial preventive 

physical examinations, with the goal of 

health promotion and disease 

prevention, subject to the conditions 

and limitations specified in § 410.16 of 

this chapter.

* * * * *

21. Section 411.404 is amended by 

revising paragraph (b) to read as follows:

§ 411.404 Criteria for determining that a 

beneficiary knew that services were 

excluded from coverage as custodial care 

or as not reasonable and necessary.

* * * * *

(b) Written notice. Written notice is 

given to the beneficiary, or to someone 

acting on his or her behalf, that the 

services were not covered because they 

did not meet Medicare coverage 

guidelines. A notice concerning similar 

or reasonably comparable services 

furnished on a previous occasion also 

meets this criterion. After a beneficiary 

is notified that there is no Medicare 

payment for a service that is not covered 

by Medicare, he or she is presumed to 

know that there is no Medicare payment 

for any form of subsequent treatment for 

the non-covered condition.

* * * * *

PART 414—PAYMENT FOR PART B 

MEDICAL AND OTHER HEALTH 

SERVICES. 

22. 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)).

§ 414.38 [Removed] 

23. Section 414.38 is removed. 

24. Section 414.39 is amended by—

A. Revising paragraph (a). 

B. Adding paragraph (c). 

The revision and addition read as 

follows:

§ 414.39 Special rules for payment of care 

plan oversight. 

(a) General. Except as specified in 

paragraphs (b) and (c) of this section, 

payment for care plan oversight is 

included in the payment for visits and 

other services under the physician fee 

schedule. For purposes of this section a 

nonphysician practitioner (NPP) is a 

nurse practitioner, clinical nurse 

specialist or physician assistant.

* * * * *

47578 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

(c) Special rules for payment of care 

plan oversight provided by 

nonphysician practitioners for 

beneficiaries who receive HHA services 

covered by Medicare. (1) An NPP can 

perform physician care plan oversight 

without certifying a patient for home 

health services (only a physician can 

certify a patient for home health care) if 

the relationship with the physician who 

signs the plan of care meets one of the 

following conditions: 

(i) The physician and NPP are part of 

the same group practice; 

(ii) If the NPP is a nurse practitioner 

or clinical nurse specialist, the 

physician signing the plan of care also 

has a collaborative agreement with the 

NPP; 

(iii) If the NPP is a physician 

assistant, the physician signing the plan 

of care is also the physician who 

provides general supervision of 

physician assistant services for the 

practice; or 

(iv) The physician signing the plan of 

care provides regular ongoing care 

under the same plan of care as does the 

NPP billing for care plan oversight. 

(2) Payment may be made for care 

plan oversight services furnished by an 

NPP when: 

(i) The NPP providing the care plan 

oversight has seen and examined the 

patient; 

(ii) The NPP providing care plan 

oversight is not functioning as a 

consultant whose participation is 

limited to a single medical condition 

rather than multi-disciplinary 

coordination of care; or

(iii) The NPP providing care plan 

oversight integrates his or her care with 

that of the physician who signed the 

plan of care. 

25. Section 414.65 is amended by 

revising paragraph (a)(1) to read as 

follows:

§ 414.65 Payment for telehealth services. 

(a) * * *

(1) The Medicare payment amount for 

office or other outpatient visits, 

consultation, individual psychotherapy, 

psychiatric diagnostic interview 

examination, monthly end stage renal 

disease (ESRD) related evaluation and 

management services and 

pharmacologic management furnished 

via an interactive telecommunications 

system is equal to the current fee 

schedule amount applicable for the 

service of the physician or practitioner.

* * * * *

26. Section 414.66 is added to read as 

follows:

§ 414.66 Incentive payments for 

physicians scarcity areas. 

(a) Definition. As used in this section, 

the following definition applies—

Primary care physician is defined as 

a general practitioner, family practice 

practitioner, general internist, 

obstetrician or gynecologist. 

(b) Physicians’ services furnished to a 

beneficiary in a Physician Scarcity Area 

(PSA) for primary or specialist care are 

eligible for a 5 percent incentive 

payment. 

(c) Primary care physicians furnishing 

services in primary care PSAs are 

entitled to an additional 5 percent 

incentive payment above the amount 

paid under the physician fee schedule 

for their professional services furnished 

on or after January 1, 2005 and before 

January 1, 2008. 

(d) Physicians (other than dentists, 

podiatrists, optometrists, chiropractors, 

and those identified in paragraph (a) of 

this section) furnishing services in 

specialist care PSAs are entitled to an 

additional 5 percent payment above the 

amount paid under the physician fee 

schedule for their professional services 

furnished on or after January 1, 2005 

and before January 1, 2008. 

27. Section 414.67 is added to read as 

follows:

§ 414.67 Incentive payments for Health 

Professional Shortage Areas. 

(a) Physicians’ services furnished to a 

beneficiary in a geographic-based Health 

Professional Shortage Area (HPSA) are 

eligible for a 10 percent incentive 

payment. 

(b) Physicians furnishing services in a 

geographic-based primary medical care 

HPSA are entitled to a 10 percent 

incentive payment above the amount 

paid for their professional services 

under the physician fee schedule. 

(c) Psychiatrists furnishing services in 

a mental health HPSA are entitled to a 

10 percent incentive payment above the 

amount paid for their professional 

services under the physician fee 

schedule. (The only physicians eligible 

to receive the 10 percent incentive 

payment in mental health HPSAs that 

do not overlap with primary care HPSAs 

are psychiatrists.) 

28. Part 414 is amended by adding a 

new subpart K to read as follows:

Subpart K—Payment for Drugs and 

Biologicals in 2005

Sec. 

414.900 Basis. 

414.902 Definitions. 

414.904 Basis of Payment.

Subpart K—Payment for Drugs and 

Biologicals in 2005

§ 414.900 Basis. 

(a) This subpart implements section 

1842(o) of the Social Security Act by 

specifying the methodology for 

determining the payment allowance 

limit for drugs and biologicals covered 

under Medicare Part B that are not paid 

on a cost or prospective payment system 

basis.

(b) Examples of drugs that are subject 

to the requirements specified in this 

subpart are: 

(1) Drugs furnished incident to a 

physician’s service; durable medical 

equipment (DME) drugs. 

(2) Separately billable drugs at 

independent dialysis facilities not under 

the ESRD composite rate. 

(3) Statutorily covered drugs, for 

example—

(i) Influenza 

(ii) Pneumococcal and hepatitis 

vaccines. 

(iii) Antigens. 

(iv) Hemophilia blood clotting factor. 

(v) Immunosuppressive drugs. 

(vi) Certain oral anti-cancer drugs.

§ 414.902 Definitions. 

As used in this subpart, unless the 

context indicates otherwise—

Drug means both drugs and 

biologicals. 

Manufacturer’s average sales price

means the price calculated and reported 

by a manufacturer under part 414, 

subpart J of this chapter. 

Multiple source drug means a drug 

described by section 1847A(c)(6)(C) of 

the Act. 

Single source drug means a drug 

described by section 1847A(c)(6)(D) of 

the Act. 

Unit is defined as in part 414, subpart 

J of this chapter. 

Wholesale acquisition cost (WAC)

means the price described by section 

1847A(c)(6)(B) of the Act.

§ 414.904 Basis of payment. 

(a) Method of payment. Payment for a 

drug for calendar year 2005 is based on 

the lesser of—

(1) The actual charge on the claim for 

program benefits; or 

(2) 106 percent of the average sales 

price, subject to the applicable 

limitations specified in paragraph (d) of 

this section or subject to the exceptions 

described in paragraph (e) of this 

section. 

(b) Multiple source drugs. (1) Average 

sales prices. The average sales price for 

all drug products included within the 

same multiple source drug billing and 

payment code is the volume-weighted 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47579

average of the manufacturers’ average 

sales prices for those drug products. 

(2) Calculation of the average sales 

price. The average sales price is 

determined by—

(i) Computing the sum of the products 

(for each National Drug Code assigned 

to the drug products) of the 

manufacturer’s average sales price and 

the total number of units sold; and 

(ii) Dividing that sum by the sum of 

the total number of units sold for all 

NDCs assigned to the drug products. 

(c) Single source drugs. (1) Average 

sales price. The average sales price is 

the volume-weighted average of the 

manufacturers’ average sales prices for 

all National Drug Codes assigned to the 

drug or biological product. 

(2) Calculation of the average sales 

price. The average sales price is 

determined by computing—

(i) The sum of the products (for each 

National Drug Code assigned to the drug 

product) of the manufacturer’s average 

sales price and the total number of units 

sold; and 

(ii) Dividing that sum by the sum of 

the total number of units sold for all 

NDCs assigned to the drug product. 

(d) Limitations on the average sales 

price. (1) Wholesale acquisition cost for 

a single source drug. The payment limit 

for a single source drug product is the 

lesser of 106 percent of the average sales 

price for the product or 106 percent of 

the wholesale acquisition cost for the 

product. 

(2) Payment limit for a drug furnished 

to an end-stage renal disease patient.

The payment for a drug furnished to an 

end-stage renal disease patient that is 

separately billed by an end stage renal 

disease facility, including 

erythropoietin, cannot exceed 97 

percent of the average sales price. 

(3) Widely available market price and 

average manufacturer price. If the 

Inspector General finds that the average 

sales price exceeds the widely available 

market price or the average 

manufacturer price by 5 percent or more 

in calendar year 2005, the payment limit 

in the quarter following the transmittal 

of this information to the Secretary is 

the lesser of the widely available market 

price or 103 percent of the average 

manufacturer price. 

(e) Exceptions to the average sales 

price. (1) Vaccines. The payment limits 

for hepatitis B vaccine furnished to 

individuals at high or intermediate risk 

of contracting hepatitis B (as determined 

by the Secretary), pneumococcal 

vaccine, and influenza vaccine and are 

calculated using 95 percent of the 

average wholesale price. 

(2) Infusion drugs furnished through a 

covered item of durable medical 

equipment. The payment limit for an 

infusion drug furnished through a 

covered item of durable medical 

equipment is calculated using 95 

percent of the average wholesale price 

in effect on October 1, 2003 and is not 

updated in 2005.

(3) Blood and blood products. In the 

case of blood and blood products (other 

than blood clotting factors), the payment 

limits are determined in the same 

manner as the payment limits were 

determined on October 1, 2003. 

(4) Payment limit in a case where the 

average sales price during the first 

quarter of sales is unavailable. In the 

case of a drug during an initial period 

(not to exceed a full calendar quarter) in 

which data on the prices for sales of the 

drug are not sufficiently available from 

the manufacturer to compute an average 

sales price for the drug, the payment 

limit is based on the wholesale 

acquisition cost or the applicable 

Medicare Part B drug payment 

methodology in effect on November 1, 

2003. 

(f) Except as otherwise specified (see 

paragraph (e)(2)of this section) for 

infusion drugs, the payment limits are 

updated quarterly. 

(g) The payment limit is computed 

without regard to any special packaging, 

labeling, or identifiers on the dosage 

form or product or package. 

(h) The payment amount is subject to 

applicable deductible and coinsurance.

PART 418—HOSPICE CARE 

29. The authority citation for part 418 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

30. Section 418.205 is added to read 

as follows:

§ 418.205 Special requirements for 

hospice pre-election evaluation and 

counseling services. 

(a) Definition. For purposes of this 

section, the following definition applies: 

Terminal illness is defined as having 

a prognosis of 6 months or less if the 

disease or illness runs its normal course. 

(b) Effective date for payment and 

requirements. Effective January 1, 2005, 

payment for hospice pre-election 

evaluation and counseling services as 

specified in § 418.304(d) may be made 

to a hospice agency on behalf of a 

Medicare beneficiary who is terminally 

ill if the requirements of this section are 

met. 

(1) The beneficiary: (i) Is certified as 

having a terminal illness. 

(ii) Has not made a hospice election. 

(iii) Has not previously received 

hospice pre-election evaluation and 

consultation services specified under 

this section. 

(2) Services provided. The hospice 

pre-election services include—(i) An 

evaluation of an individual’s need for 

pain and symptom management; 

(ii) Counseling regarding hospice and 

other care options; and 

(iii) May include advising the 

individual regarding advanced care 

planning. 

(3) Provider of pre-election hospice 

services. (i) The physician furnishing 

these services must be an employee or 

medical director of the hospice billing 

for this service. 

(ii) The services cannot be furnished 

by other hospice personnel, such as but 

not limited to nurse practitioners, 

nurses, or social workers, physicians 

under contractual arrangements with 

the hospice or by the beneficiary’s 

physician, if that physician is not an 

employee of the hospice. 

(iii) If the beneficiary’s physician is 

also the medical director or a physician 

employee of the hospice, the attending 

physician is not required to request or 

provide this service because that 

physician already possesses the 

expertise necessary to furnish end-oflife evaluation and management, and 

counseling services.

(4) Documentation. (i) If the 

individual’s physician initiates the 

request for services of the hospice 

medical director or physician, 

appropriate documentation is required. 

(ii) The request or referral must be in 

writing, and the hospice medical 

director or physician employee is 

expected to provide a written note on 

the patient’s medical record. 

(iii) The hospice agency employing 

the physician providing these services is 

required to maintain a written record of 

the services rendered. 

(iv) If the services are initiated by the 

beneficiary, the hospice agency is 

required to maintain a record of the 

services and that communication 

between the hospice medical director or 

physician and the beneficiary’s 

physician occurs, with the beneficiary’s 

permission, to the extent necessary to 

ensure continuity of care. 

31. Section 418.304 is amended by 

adding paragraph (d) to read as follows.

§ 418.304 Payment for physician services.

* * * * *

(d) Payment for hospice evaluation 

and counseling services—pre-election.

The intermediary makes payment for 

these services established in § 418.205 

to the hospice. As directed by the 

statute, payment for this service is set at 

an amount established for an office or 

other outpatient visit for evaluation and 

47580 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

management associated with presenting 

problems of moderate severity and 

requiring medical decision-making of 

low complexity under the physician fee 

schedule, other than the portion of such 

amount attributable to the practice 

expense component. Payment for this 

pre-election service is not calculated 

towards the hospice cap amount.

PART 424—CONDITIONS FOR 

MEDICARE PAYMENT 

32. The authority citation for part 424 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

33. Section 424.55 is amended by 

adding new paragraph (c) to read as 

follows:

§ 424.55 Payment to the supplier.

* * * * *

(c) Exception. In situations when 

payment under the Act can only be 

made on an assignment-related basis or 

when payment is for services furnished 

by a participating physician or supplier, 

the beneficiary (or the person 

authorized to request payment on the 

beneficiary’s behalf) is not required to 

assign the claim to the supplier in order 

for an assignment to be effective. 

34. Section 424.71 is amended as 

follows: 

A. The definition of ‘‘Health care 

delivery system or system’’ is removed. 

B. The definition of the term ‘‘Entity’’

is added in alphabetical order. 

The addition reads as follows:

§ 424.71 Definitions.

* * * * *

Entity means a person, group, or 

facility that is enrolled in the Medicare 

program.

* * * * *

35. Section 424.80 is amended by—

A. Revising paragraph (b)(2). 

B. Removing paragraph (b)(3). 

C. Redesignating paragraphs (b)(4) 

through (6) as paragraphs (b) (3) through 

(5), respectively. 

D. Revising paragraph (c). 

E. Adding a new paragraph (d). 

The revisions and addition read as 

follows:

§ 424.80 Prohibition of reassignment of 

claims by suppliers.

* * * * *

(b) * * *

(1) * * *

(2) Payment to an entity under a 

contractual arrangement. Medicare may 

pay an entity enrolled in the Medicare 

program if there is a contractual 

arrangement between the entity and the 

supplier under which the entity bills for 

the supplier’s services, subject to the 

provisions of paragraph (d) of this 

section.

* * * * *

(c) Rules applicable to an employer or 

entity. An employer or entity that may 

receive payment under paragraph (b)(1) 

or (b)(2) of this section is considered the 

supplier of those services for purposes 

of subparts C, D, and E of this part, 

subject to the provisions of paragraph 

(d) of this section. 

(d) Reassignment to an entity under a 

contractual arrangement: Conditions 

and limitations. (1) Liability of the 

parties. An entity enrolled in the 

Medicare program that receives 

payment under a contractual 

arrangement under paragraph (b)(2) of 

this section and the supplier that 

otherwise receives payment are jointly 

and severally responsible for any 

Medicare overpayment to that entity. 

(2) Access to records. The supplier 

furnishing the service has unrestricted 

access to claims submitted by an entity 

for services provided by that supplier.

PART 484–HOME HEALTH SERVICES 

36. The authority citation for part 484 

continues to read as follows:

Authority: Secs. 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395(hh).

§ 484.4 [Amended] 

37. In § 484.4 in the definition of 

physical therapy assistant the term 

‘‘physical therapy assistant’’ is removed 

and the term ‘‘physical therapist 

assistant’’ is added in its place wherever 

it appears.

PART 486—CONDITIONS FOR 

COVERAGE OF SPECIALIZED 

SERVICES FURNISHED BY 

SUPPLIERS 

38. The authority citation for part 486 

continues to read as follows:

Authority: Sections 1102 and 1871 of the 

Social Security Act (42 U.S.C. 1302 and 

1395hh).

Subpart D [Removed and Reserved] 

39. Part 486 subpart D, consisting of 

§ 486.150 through § 486.163, is removed 

and reserved.

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program)

Dated: July 13, 2004. 

Mark B. McClellan, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: July 23, 2004. 

Tommy G. Thompson, 

Secretary.

Note: These addenda will not appear in the 

Code of Federal Regulations.

Addendum A—Explanation and Use of 

Addenda B 

The addenda on the following pages 

provide various data pertaining to the 

Medicare fee schedule for physicians’

services furnished in 2005. Addendum B 

contains the RVUs for work, non-facility 

practice expense, facility practice expense, 

and malpractice expense, and other 

information for all services included in the 

physician fee schedule. 

In previous years, we have listed many 

services in Addendum B that are not paid 

under the physician fee schedule. To avoid 

publishing as many pages of codes for these 

services, we are not including clinical 

laboratory codes and most alpha-numeric 

codes (Healthcare Common Procedure 

Coding System (HCPCS) codes not included 

in CPT) in Addendum B. 

Addendum B—2005 Relative Value Units 

and Related Information Used in 

Determining Medicare Payments for 2005

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 

nonphysicians’ 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. 

47581

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 case-by-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.

F = Deleted/discontinued codes. Code not 

subject to a 90-day grace period. 

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. 

H = Deleted modifier. Either the TC or PC 

component shown for the code has been 

deleted, and the deleted component is shown 

in the data base with the H status indicator. 

(Code subject to a 90-day grace period.) 

I = Not valid for Medicare purposes. 

Medicare uses another code for the reporting 

of, and the payment for these services. (Code 

NOT subject to a 90-day grace period.) 

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’s service and is furnished on 

the same day as a physician’s service, 

payment for it is bundled into the payment 

for the physician’s service to which it is 

incident (an example is an elastic bandage 

furnished by a physician incident to a 

physician’s service). 

—If the item or service is covered as other 

than incident to a physician’s 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 ‘‘physicians’ 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 2005. Codes that are not used for Medicare 

payment are identified with a ‘‘+.’’

6. Facility practice expense RVUs. These 

are the fully implemented resource-based 

practice expense RVUs for facility settings. 

7. Non-facility practice expense RVUs.

These are the fully implemented resourcebased practice expense RVUs for non-facility 

settings. 

8. Malpractice expense RVUs. These are 

the RVUs for the malpractice expense for the 

service for 2005. 

9. Facility total. This is the sum of the 

work, fully implemented facility practice 

expense, and malpractice expense RVUs. 

10. Non-facility total. This is the sum of the 

work, fully implemented non-facility practice 

expense, and malpractice expense RVUs. 

11. 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 1999 

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 = Code related to another service that 

is always included in the global period of the 

other service. (Note: Physician work and 

practice expense are associated with intra 

service time and in some instances the post 

service time.)

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

10021 ......... ............ A Fna w/o image ............................................. 1.27 2.16 0.54 0.11 3.54 1.92 XXX 

10022 ......... ............ A Fna w/image ................................................ 1.27 2.55 0.42 0.08 3.90 1.77 XXX 

10040 ......... ............ A Acne surgery ................................................ 1.18 1.01 0.79 0.10 2.29 2.07 010 

10060 ......... ............ A Drainage of skin abscess ............................ 1.17 1.21 0.94 0.10 2.48 2.21 010 

10061 ......... ............ A Drainage of skin abscess ............................ 2.40 1.82 1.50 0.21 4.43 4.11 010 

10080 ......... ............ A Drainage of pilonidal cyst ............................ 1.17 3.12 1.12 0.11 4.40 2.40 010 

10081 ......... ............ A Drainage of pilonidal cyst ............................ 2.45 4.10 1.51 0.26 6.81 4.22 010 

10120 ......... ............ A Remove foreign body .................................. 1.22 2.19 0.99 0.11 3.52 2.32 010 

10121 ......... ............ A Remove foreign body .................................. 2.69 3.53 1.79 0.30 6.52 4.78 010 

10140 ......... ............ A Drainage of hematoma/fluid ........................ 1.53 1.77 1.29 0.15 3.45 2.97 010 

10160 ......... ............ A Puncture drainage of lesion ......................... 1.20 1.61 1.09 0.12 2.93 2.41 010 

10180 ......... ............ A Complex drainage, wound ........................... 2.25 3.00 1.98 0.32 5.57 4.55 010 

11000 ......... ............ A Debride infected skin ................................... 0.60 0.58 0.21 0.05 1.23 0.86 000 

11001 ......... ............ A Debride infected skin add-on ....................... 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ 

11010 ......... ............ A Debride skin, fx ............................................ 4.19 6.89 2.62 0.59 11.67 7.40 010 

11011 ......... ............ A Debride skin/muscle, fx ............................... 4.94 8.19 2.33 0.69 13.82 7.96 000 

11012 ......... ............ A Debride skin/muscle/bone, fx ...................... 6.87 12.09 3.83 1.11 20.07 11.81 000 

11040 ......... ............ A Debride skin, partial ..................................... 0.50 0.52 0.21 0.04 1.06 0.75 000 

11041 ......... ............ A Debride skin, full .......................................... 0.82 0.66 0.33 0.07 1.55 1.22 000 

11042 ......... ............ A Debride skin/tissue ...................................... 1.12 0.97 0.44 0.11 2.20 1.67 000 

11043 ......... ............ A Debride tissue/muscle ................................. 2.38 3.40 2.59 0.27 6.05 5.24 010 

11044 ......... ............ A Debride tissue/muscle/bone ........................ 3.06 4.47 3.75 0.38 7.91 7.19 010 

11055 ......... ............ R Trim skin lesion ............................................ 0.43 0.56 0.17 0.03 1.02 0.63 000 

11056 ......... ............ R Trim skin lesions, 2 to 4 .............................. 0.61 0.63 0.23 0.05 1.29 0.89 000 

47582

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

11057 ......... ............ R Trim skin lesions, over 4 ............................. 0.79 0.74 0.30 0.06 1.59 1.15 000 

11100 ......... ............ A Biopsy, skin lesion ....................................... 0.81 1.25 0.36 0.07 2.13 1.24 000 

11101 ......... ............ A Biopsy, skin add-on ..................................... 0.41 0.33 0.19 0.03 0.77 0.63 ZZZ 

11200 ......... ............ A Removal of skin tags ................................... 0.77 1.05 0.76 0.07 1.89 1.60 010 

11201 ......... ............ A Remove skin tags add-on ............................ 0.29 0.16 0.12 0.03 0.48 0.44 ZZZ 

11300 ......... ............ A Shave skin lesion ......................................... 0.51 0.99 0.21 0.04 1.54 0.76 000 

11301 ......... ............ A Shave skin lesion ......................................... 0.85 1.11 0.38 0.07 2.03 1.30 000 

11302 ......... ............ A Shave skin lesion ......................................... 1.05 1.30 0.46 0.09 2.44 1.60 000 

11303 ......... ............ A Shave skin lesion ......................................... 1.24 1.58 0.52 0.11 2.93 1.87 000 

11305 ......... ............ A Shave skin lesion ......................................... 0.67 0.84 0.27 0.06 1.57 1.00 000 

11306 ......... ............ A Shave skin lesion ......................................... 0.99 1.10 0.42 0.08 2.17 1.49 000 

11307 ......... ............ A Shave skin lesion ......................................... 1.14 1.29 0.49 0.10 2.53 1.73 000 

11308 ......... ............ A Shave skin lesion ......................................... 1.41 1.45 0.59 0.12 2.98 2.12 000 

11310 ......... ............ A Shave skin lesion ......................................... 0.73 1.12 0.32 0.07 1.92 1.12 000 

11311 ......... ............ A Shave skin lesion ......................................... 1.05 1.23 0.49 0.09 2.37 1.63 000 

11312 ......... ............ A Shave skin lesion ......................................... 1.20 1.42 0.55 0.11 2.73 1.86 000 

11313 ......... ............ A Shave skin lesion ......................................... 1.62 1.79 0.72 0.15 3.56 2.49 000 

11400 ......... ............ A Exc tr-ext b9+marg 0.5 < cm ....................... 0.85 2.00 0.88 0.09 2.94 1.82 010 

11401 ......... ............ A Exc tr-ext b9+marg 0.6-1 cm ....................... 1.23 2.06 1.02 0.13 3.42 2.38 010 

11402 ......... ............ A Exc tr-ext b9+marg 1.1-2 cm ....................... 1.51 2.23 1.08 0.17 3.91 2.76 010 

11403 ......... ............ A Exc tr-ext b9+marg 2.1-3 cm ....................... 1.79 2.40 1.32 0.21 4.40 3.32 010 

11404 ......... ............ A Exc tr-ext b9+marg 3.1-4 cm ....................... 2.06 2.71 1.40 0.25 5.02 3.71 010 

11406 ......... ............ A Exc tr-ext b9+marg > 4.0 cm ....................... 2.76 3.07 1.66 0.33 6.16 4.75 010 

11420 ......... ............ A Exc h-f-nk-sp b9+marg 0.5 < ....................... 0.98 1.76 0.93 0.10 2.84 2.01 010 

11421 ......... ............ A Exc h-f-nk-sp b9+marg 0.6-1 ....................... 1.42 2.06 1.11 0.15 3.63 2.68 010 

11422 ......... ............ A Exc h-f-nk-sp b9+marg 1.1-2 ....................... 1.63 2.25 1.34 0.18 4.06 3.15 010 

11423 ......... ............ A Exc h-f-nk-sp b9+marg 2.1-3 ....................... 2.01 2.58 1.45 0.23 4.82 3.69 010 

11424 ......... ............ A Exc h-f-nk-sp b9+marg 3.1-4 ....................... 2.43 2.80 1.60 0.28 5.51 4.31 010 

11426 ......... ............ A Exc h-f-nk-sp b9+marg > 4 cm .................... 3.77 3.49 2.10 0.44 7.70 6.31 010 

11440 ......... ............ A Exc face-mm b9+marg 0.5 < cm ................. 1.06 2.21 1.31 0.10 3.37 2.47 010 

11441 ......... ............ A Exc face-mm b9+marg 0.6-1 cm ................. 1.48 2.34 1.49 0.16 3.98 3.13 010 

11442 ......... ............ A Exc face-mm b9+marg 1.1-2 cm ................. 1.72 2.54 1.57 0.20 4.46 3.49 010 

11443 ......... ............ A Exc face-mm b9+marg 2.1-3 cm ................. 2.29 2.92 1.81 0.26 5.47 4.36 010 

11444 ......... ............ A Exc face-mm b9+marg 3.1-4 cm ................. 3.14 3.47 2.17 0.35 6.96 5.66 010 

11446 ......... ............ A Exc face-mm b9+marg > 4 cm .................... 4.48 4.04 2.76 0.47 8.99 7.71 010 

11450 ......... ............ A Removal, sweat gland lesion ....................... 2.73 5.06 2.02 0.35 8.14 5.10 090 

11451 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.64 2.54 0.52 11.10 7.00 090 

11462 ......... ............ A Removal, sweat gland lesion ....................... 2.51 5.14 2.01 0.31 7.96 4.83 090 

11463 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.85 2.68 0.51 11.30 7.13 090 

11470 ......... ............ A Removal, sweat gland lesion ....................... 3.25 5.09 2.26 0.38 8.72 5.89 090 

11471 ......... ............ A Removal, sweat gland lesion ....................... 4.40 6.74 2.76 0.54 11.68 7.70 090 

11600 ......... ............ A Exc tr-ext mlg+marg 0.5 < cm ..................... 1.31 2.64 0.97 0.13 4.08 2.41 010 

11601 ......... ............ A Exc tr-ext mlg+marg 0.6-1 cm ..................... 1.80 2.70 1.22 0.18 4.68 3.20 010 

11602 ......... ............ A Exc tr-ext mlg+marg 1.1-2 cm ..................... 1.95 2.83 1.26 0.20 4.98 3.41 010 

11603 ......... ............ A Exc tr-ext mlg+marg 2.1-3 cm ..................... 2.19 3.07 1.33 0.24 5.50 3.76 010 

11604 ......... ............ A Exc tr-ext mlg+marg 3.1-4 cm ..................... 2.40 3.38 1.39 0.28 6.06 4.07 010 

11606 ......... ............ A Exc tr-ext mlg+marg > 4 cm ........................ 3.42 4.06 1.73 0.40 7.88 5.55 010 

11620 ......... ............ A Exc h-f-nk-sp mlg+marg 0.5 < ..................... 1.19 2.60 0.95 0.13 3.92 2.27 010 

11621 ......... ............ A Exc h-f-nk-sp mlg+marg 0.6-1 ..................... 1.76 2.70 1.24 0.19 4.65 3.19 010 

11622 ......... ............ A Exc h-f-nk-sp mlg+marg 1.1-2 ..................... 2.09 2.97 1.38 0.23 5.29 3.70 010 

11623 ......... ............ A Exc h-f-nk-sp mlg+marg 2.1-3 ..................... 2.61 3.33 1.58 0.31 6.25 4.50 010 

11624 ......... ............ A Exc h-f-nk-sp mlg+marg 3.1-4 ..................... 3.06 3.74 1.77 0.38 7.18 5.21 010 

11626 ......... ............ A Exc h-f-nk-sp mlg+mar > 4 cm .................... 4.29 4.64 2.38 0.50 9.43 7.17 010 

11640 ......... ............ A Exc face-mm malig+marg 0.5 < .................. 1.35 2.66 1.11 0.15 4.16 2.61 010 

11641 ......... ............ A Exc face-mm malig+marg 0.6-1 .................. 2.16 3.02 1.52 0.24 5.42 3.92 010 

11642 ......... ............ A Exc face-mm malig+marg 1.1-2 .................. 2.59 3.40 1.71 0.30 6.29 4.60 010 

11643 ......... ............ A Exc face-mm malig+marg 2.1-3 .................. 3.10 3.80 1.95 0.37 7.27 5.42 010 

11644 ......... ............ A Exc face-mm malig+marg 3.1-4 .................. 4.02 4.67 2.44 0.49 9.18 6.95 010 

11646 ......... ............ A Exc face-mm mlg+marg > 4 cm .................. 5.94 5.74 3.46 0.67 12.35 10.07 010 

11719 ......... ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 

11720 ......... ............ A Debride nail, 1-5 .......................................... 0.32 0.34 0.12 0.03 0.69 0.47 000 

11721 ......... ............ A Debride nail, 6 or more ................................ 0.54 0.43 0.21 0.04 1.01 0.79 000 

11730 ......... ............ A Removal of nail plate ................................... 1.13 1.03 0.43 0.09 2.25 1.65 000 

11732 ......... ............ A Remove nail plate, add-on .......................... 0.57 0.44 0.22 0.05 1.06 0.84 ZZZ 

11740 ......... ............ A Drain blood from under nail ......................... 0.37 0.56 0.36 0.03 0.96 0.76 000 

11750 ......... ............ A Removal of nail bed ..................................... 1.86 2.16 1.75 0.15 4.17 3.76 010 

11752 ......... ............ A Remove nail bed/finger tip ........................... 2.67 2.99 2.99 0.28 5.94 5.94 010 

11755 ......... ............ A Biopsy, nail unit ........................................... 1.31 1.57 0.77 0.11 2.99 2.19 000 

11760 ......... ............ A Repair of nail bed ........................................ 1.58 2.63 1.79 0.18 4.39 3.55 010 

11762 ......... ............ A Reconstruction of nail bed ........................... 2.89 2.88 2.34 0.27 6.04 5.50 010 

11765 ......... ............ A Excision of nail fold, toe .............................. 0.69 1.78 0.76 0.06 2.53 1.51 010 

11770 ......... ............ A Removal of pilonidal lesion .......................... 2.61 3.50 1.50 0.32 6.43 4.43 010 

11771 ......... ............ A Removal of pilonidal lesion .......................... 5.73 5.66 3.31 0.72 12.11 9.76 090 

11772 ......... ............ A Removal of pilonidal lesion .......................... 6.97 7.54 5.08 0.88 15.39 12.93 090 

11900 ......... ............ A Injection into skin lesions ............................. 0.52 0.65 0.21 0.04 1.21 0.77 000 

47583

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

11901 ......... ............ A Added skin lesions injection ........................ 0.80 0.66 0.35 0.07 1.53 1.22 000 

11920 ......... ............ R Correct skin color defects ............................ 1.61 3.69 1.09 0.22 5.52 2.92 000 

11921 ......... ............ R Correct skin color defects ............................ 1.93 3.95 1.27 0.28 6.16 3.48 000 

11922 ......... ............ R Correct skin color defects ............................ 0.49 1.13 0.25 0.07 1.69 0.81 ZZZ 

11950 ......... ............ R Therapy for contour defects ........................ 0.84 1.14 0.39 0.09 2.07 1.32 000 

11951 ......... ............ R Therapy for contour defects ........................ 1.19 1.49 0.51 0.15 2.83 1.85 000 

11952 ......... ............ R Therapy for contour defects ........................ 1.69 1.85 0.68 0.24 3.78 2.61 000 

11954 ......... ............ R Therapy for contour defects ........................ 1.85 2.43 0.90 0.17 4.45 2.92 000 

11960 ......... ............ A Insert tissue expander(s) ............................. 9.07 NA 10.37 1.23 NA 20.67 090 

11970 ......... ............ A Replace tissue expander ............................. 7.05 NA 6.12 1.04 NA 14.21 090 

11971 ......... ............ A Remove tissue expander(s) ......................... 2.13 9.13 3.78 0.30 11.56 6.21 090 

11976 ......... ............ R Removal of contraceptive cap ..................... 1.78 1.73 0.68 0.20 3.71 2.66 000 

11980 ......... ............ A Implant hormone pellet(s) ............................ 1.48 1.08 0.54 0.13 2.69 2.15 000 

11981 ......... ............ A Insert drug implant device ........................... 1.48 1.70 0.68 0.11 3.29 2.27 XXX 

11982 ......... ............ A Remove drug implant device ....................... 1.78 1.94 0.83 0.18 3.90 2.79 XXX 

11983 ......... ............ A Remove/insert drug implant ......................... 3.30 2.28 1.46 0.24 5.82 5.00 XXX 

12001 ......... ............ A Repair superficial wound(s) ......................... 1.70 2.00 0.78 0.15 3.85 2.63 010 

12002 ......... ............ A Repair superficial wound(s) ......................... 1.86 2.06 0.91 0.17 4.09 2.94 010 

12004 ......... ............ A Repair superficial wound(s) ......................... 2.24 2.35 1.02 0.21 4.80 3.47 010 

12005 ......... ............ A Repair superficial wound(s) ......................... 2.86 2.85 1.21 0.27 5.98 4.34 010 

12006 ......... ............ A Repair superficial wound(s) ......................... 3.66 3.42 1.52 0.37 7.45 5.55 010 

12007 ......... ............ A Repair superficial wound(s) ......................... 4.11 3.86 1.82 0.44 8.41 6.37 010 

12011 ......... ............ A Repair superficial wound(s) ......................... 1.76 2.15 0.79 0.16 4.07 2.71 010 

12013 ......... ............ A Repair superficial wound(s) ......................... 1.99 2.30 0.95 0.18 4.47 3.12 010 

12014 ......... ............ A Repair superficial wound(s) ......................... 2.46 2.59 1.07 0.22 5.27 3.75 010 

12015 ......... ............ A Repair superficial wound(s) ......................... 3.19 3.16 1.26 0.29 6.64 4.74 010 

12016 ......... ............ A Repair superficial wound(s) ......................... 3.92 3.59 1.53 0.37 7.88 5.82 010 

12017 ......... ............ A Repair superficial wound(s) ......................... 4.70 NA 1.89 0.48 NA 7.07 010 

12018 ......... ............ A Repair superficial wound(s) ......................... 5.52 NA 2.25 0.58 NA 8.35 010 

12020 ......... ............ A Closure of split wound ................................. 2.62 3.84 1.92 0.30 6.76 4.84 010 

12021 ......... ............ A Closure of split wound ................................. 1.84 1.83 1.42 0.23 3.90 3.49 010 

12031 ......... ............ A Layer closure of wound(s) ........................... 2.15 2.28 0.96 0.22 4.65 3.33 010 

12032 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.85 1.81 0.24 6.56 4.52 010 

12034 ......... ............ A Layer closure of wound(s) ........................... 2.92 3.20 1.46 0.31 6.43 4.69 010 

12035 ......... ............ A Layer closure of wound(s) ........................... 3.42 5.22 2.16 0.39 9.03 5.97 010 

12036 ......... ............ A Layer closure of wound(s) ........................... 4.04 5.59 2.55 0.52 10.15 7.11 010 

12037 ......... ............ A Layer closure of wound(s) ........................... 4.66 6.13 2.96 0.61 11.40 8.23 010 

12041 ......... ............ A Layer closure of wound(s) ........................... 2.37 2.54 1.13 0.24 5.15 3.74 010 

12042 ......... ............ A Layer closure of wound(s) ........................... 2.74 3.27 1.47 0.26 6.27 4.47 010 

12044 ......... ............ A Layer closure of wound(s) ........................... 3.14 3.23 1.61 0.32 6.69 5.07 010 

12045 ......... ............ A Layer closure of wound(s) ........................... 3.63 5.30 2.28 0.41 9.34 6.32 010 

12046 ......... ............ A Layer closure of wound(s) ........................... 4.24 6.55 2.75 0.49 11.28 7.48 010 

12047 ......... ............ A Layer closure of wound(s) ........................... 4.64 6.39 3.08 0.57 11.60 8.29 010 

12051 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.27 1.45 0.25 5.99 4.17 010 

12052 ......... ............ A Layer closure of wound(s) ........................... 2.77 3.22 1.44 0.26 6.25 4.47 010 

12053 ......... ............ A Layer closure of wound(s) ........................... 3.12 3.24 1.54 0.30 6.66 4.96 010 

12054 ......... ............ A Layer closure of wound(s) ........................... 3.45 3.56 1.64 0.34 7.35 5.43 010 

12055 ......... ............ A Layer closure of wound(s) ........................... 4.42 4.49 2.12 0.46 9.37 7.00 010 

12056 ......... ............ A Layer closure of wound(s) ........................... 5.23 6.76 3.05 0.53 12.52 8.81 010 

12057 ......... ............ A Layer closure of wound(s) ........................... 5.95 6.16 3.75 0.64 12.75 10.34 010 

13100 ......... ............ A Repair of wound or lesion ........................... 3.12 4.05 2.30 0.33 7.50 5.75 010 

13101 ......... ............ A Repair of wound or lesion ........................... 3.91 4.66 2.68 0.40 8.97 6.99 010 

13102 ......... ............ A Repair wound/lesion add-on ........................ 1.24 1.17 0.57 0.15 2.56 1.96 ZZZ 

13120 ......... ............ A Repair of wound or lesion ........................... 3.30 4.14 2.35 0.35 7.79 6.00 010 

13121 ......... ............ A Repair of wound or lesion ........................... 4.32 4.85 2.79 0.43 9.60 7.54 010 

13122 ......... ............ A Repair wound/lesion add-on ........................ 1.44 1.51 0.63 0.18 3.13 2.25 ZZZ 

13131 ......... ............ A Repair of wound or lesion ........................... 3.78 4.36 2.68 0.39 8.53 6.85 010 

13132 ......... ............ A Repair of wound or lesion ........................... 5.94 5.58 3.80 0.56 12.08 10.30 010 

13133 ......... ............ A Repair wound/lesion add-on ........................ 2.19 1.66 1.03 0.24 4.09 3.46 ZZZ 

13150 ......... ............ A Repair of wound or lesion ........................... 3.80 4.87 2.76 0.41 9.08 6.97 010 

13151 ......... ............ A Repair of wound or lesion ........................... 4.44 4.80 3.14 0.45 9.69 8.03 010 

13152 ......... ............ A Repair of wound or lesion ........................... 6.32 6.03 4.03 0.62 12.97 10.97 010 

13153 ......... ............ A Repair wound/lesion add-on ........................ 2.38 1.93 1.14 0.28 4.59 3.80 ZZZ 

13160 ......... ............ A Late closure of wound ................................. 10.46 NA 7.15 1.48 NA 19.09 090 

14000 ......... ............ A Skin tissue rearrangement ........................... 5.88 7.82 5.43 0.70 14.40 12.01 090 

14001 ......... ............ A Skin tissue rearrangement ........................... 8.46 9.39 7.03 1.00 18.85 16.49 090 

14020 ......... ............ A Skin tissue rearrangement ........................... 6.58 8.58 6.48 0.77 15.93 13.83 090 

14021 ......... ............ A Skin tissue rearrangement ........................... 10.04 9.96 8.23 1.10 21.10 19.37 090 

14040 ......... ............ A Skin tissue rearrangement ........................... 7.86 8.78 7.16 0.83 17.47 15.85 090 

14041 ......... ............ A Skin tissue rearrangement ........................... 11.47 10.58 8.64 1.13 23.18 21.24 090 

14060 ......... ............ A Skin tissue rearrangement ........................... 8.49 8.78 7.41 0.88 18.15 16.78 090 

14061 ......... ............ A Skin tissue rearrangement ........................... 12.27 11.59 9.46 1.20 25.06 22.93 090 

14300 ......... ............ A Skin tissue rearrangement ........................... 11.74 11.11 9.13 1.40 24.25 22.27 090 

14350 ......... ............ A Skin tissue rearrangement ........................... 9.60 NA 7.14 1.22 NA 17.96 090 

15000 ......... ............ A Skin graft ...................................................... 3.99 3.79 2.18 0.47 8.25 6.64 000 

47584

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

15001 ......... ............ A Skin graft add-on ......................................... 1.00 1.35 0.41 0.13 2.48 1.54 ZZZ 

15050 ......... ............ A Skin pinch graft ............................................ 4.29 6.92 5.11 0.55 11.76 9.95 090 

15100 ......... ............ A Skin split graft .............................................. 9.04 12.55 7.82 1.24 22.83 18.10 090 

15101 ......... ............ A Skin split graft add-on .................................. 1.72 3.72 1.17 0.24 5.68 3.13 ZZZ 

15120 ......... ............ A Skin split graft .............................................. 9.82 10.72 7.79 1.19 21.73 18.80 090 

15121 ......... ............ A Skin split graft add-on .................................. 2.67 4.49 1.84 0.36 7.52 4.87 ZZZ 

15200 ......... ............ A Skin full graft ................................................ 8.02 9.41 6.19 1.02 18.45 15.23 090 

15201 ......... ............ A Skin full graft add-on ................................... 1.32 2.56 0.62 0.18 4.06 2.12 ZZZ 

15220 ......... ............ A Skin full graft ................................................ 7.86 9.18 6.67 0.97 18.01 15.50 090 

15221 ......... ............ A Skin full graft add-on ................................... 1.19 2.31 0.56 0.17 3.67 1.92 ZZZ 

15240 ......... ............ A Skin full graft ................................................ 9.03 10.20 7.94 1.08 20.31 18.05 090 

15241 ......... ............ A Skin full graft add-on ................................... 1.86 2.44 0.91 0.24 4.54 3.01 ZZZ 

15260 ......... ............ A Skin full graft ................................................ 10.04 10.21 8.57 0.97 21.22 19.58 090 

15261 ......... ............ A Skin full graft add-on ................................... 2.23 2.68 1.40 0.26 5.17 3.89 ZZZ 

15342 ......... ............ A Cultured skin graft, 25 cm ........................... 1.00 1.86 0.55 0.10 2.96 1.65 010 

15343 ......... ............ A Culture skn graft addl 25 cm ....................... 0.25 0.09 0.09 0.03 0.37 0.37 ZZZ 

15350 ......... ............ A Skin homograft ............................................. 3.99 6.44 3.84 0.48 10.91 8.31 090 

15351 ......... ............ A Skin homograft add-on ................................ 1.00 0.36 0.36 0.14 1.50 1.50 ZZZ 

15400 ......... ............ A Skin heterograft ........................................... 3.99 4.01 4.01 0.39 8.39 8.39 090 

15401 ......... ............ A Skin heterograft add-on ............................... 1.00 1.89 0.44 0.12 3.01 1.56 ZZZ 

15570 ......... ............ A Form skin pedicle flap ................................. 9.20 11.30 6.75 1.30 21.80 17.25 090 

15572 ......... ............ A Form skin pedicle flap ................................. 9.26 9.49 6.44 1.29 20.04 16.99 090 

15574 ......... ............ A Form skin pedicle flap ................................. 9.87 10.67 7.77 1.22 21.76 18.86 090 

15576 ......... ............ A Form skin pedicle flap ................................. 8.68 9.75 6.87 0.95 19.38 16.50 090 

15600 ......... ............ A Skin graft ...................................................... 1.91 7.61 3.06 0.27 9.79 5.24 090 

15610 ......... ............ A Skin graft ...................................................... 2.42 4.74 3.42 0.33 7.49 6.17 090 

15620 ......... ............ A Skin graft ...................................................... 2.94 7.76 3.87 0.36 11.06 7.17 090 

15630 ......... ............ A Skin graft ...................................................... 3.27 7.03 4.14 0.38 10.68 7.79 090 

15650 ......... ............ A Transfer skin pedicle flap ............................ 3.96 7.14 4.20 0.49 11.59 8.65 090 

15732 ......... ............ A Muscle-skin graft, head/neck ....................... 17.81 18.03 12.20 1.98 37.82 31.99 090 

15734 ......... ............ A Muscle-skin graft, trunk ............................... 17.76 18.12 12.36 2.52 38.40 32.64 090 

15736 ......... ............ A Muscle-skin graft, arm ................................. 16.25 18.14 11.20 2.38 36.77 29.83 090 

15738 ......... ............ A Muscle-skin graft, leg ................................... 17.89 17.91 11.70 2.58 38.38 32.17 090 

15740 ......... ............ A Island pedicle flap graft ............................... 10.23 10.14 8.25 1.01 21.38 19.49 090 

15750 ......... ............ A Neurovascular pedicle graft ......................... 11.39 NA 9.02 1.51 NA 21.92 090 

15756 ......... ............ A Free myo/skin flap microvasc ...................... 35.18 NA 20.52 4.51 NA 60.21 090 

15757 ......... ............ A Free skin flap, microvasc ............................. 35.18 NA 21.55 4.05 NA 60.78 090 

15758 ......... ............ A Free fascial flap, microvasc ......................... 35.05 NA 21.53 3.91 NA 60.49 090 

15760 ......... ............ A Composite skin graft .................................... 8.73 10.02 7.25 0.94 19.69 16.92 090 

15770 ......... ............ A Derma-fat-fascia graft .................................. 7.51 NA 6.67 1.01 NA 15.19 090 

15775 ......... ............ R Hair transplant punch grafts ........................ 3.95 2.97 1.30 0.52 7.44 5.77 000 

15776 ......... ............ R Hair transplant punch grafts ........................ 5.53 5.33 2.80 0.72 11.58 9.05 000 

15780 ......... ............ A Abrasion treatment of skin ........................... 7.28 11.57 8.24 0.75 19.60 16.27 090 

15781 ......... ............ A Abrasion treatment of skin ........................... 4.84 6.91 5.36 0.47 12.22 10.67 090 

15782 ......... ............ A Abrasion treatment of skin ........................... 4.31 9.92 6.56 0.35 14.58 11.22 090 

15783 ......... ............ A Abrasion treatment of skin ........................... 4.28 6.87 4.18 0.42 11.57 8.88 090 

15786 ......... ............ A Abrasion, lesion, single ................................ 2.03 3.35 1.32 0.18 5.56 3.53 010 

15787 ......... ............ A Abrasion, lesions, add-on ............................ 0.33 1.10 0.16 0.03 1.46 0.52 ZZZ 

15788 ......... ............ R Chemical peel, face, epiderm ...................... 2.09 6.72 3.08 0.19 9.00 5.36 090 

15789 ......... ............ R Chemical peel, face, dermal ........................ 4.91 8.09 4.82 0.43 13.43 10.16 090 

15792 ......... ............ R Chemical peel, nonfacial ............................. 1.86 7.11 4.45 0.17 9.14 6.48 090 

15793 ......... ............ A Chemical peel, nonfacial ............................. 3.73 6.29 4.39 0.32 10.34 8.44 090 

15810 ......... ............ A Salabrasion .................................................. 4.73 NA 3.90 0.34 NA 8.97 090 

15811 ......... ............ A Salabrasion .................................................. 5.38 5.47 4.76 0.80 11.65 10.94 090 

15819 ......... ............ A Plastic surgery, neck ................................... 9.37 NA 7.17 0.91 NA 17.45 090 

15820 ......... ............ A Revision of lower eyelid ............................... 5.14 6.93 5.52 0.48 12.55 11.14 090 

15821 ......... ............ A Revision of lower eyelid ............................... 5.71 7.32 5.68 0.46 13.49 11.85 090 

15822 ......... ............ A Revision of upper eyelid .............................. 4.44 5.82 4.47 0.39 10.65 9.30 090 

15823 ......... ............ A Revision of upper eyelid .............................. 7.04 7.84 6.40 0.50 15.38 13.94 090 

15831 ......... ............ A Excise excessive skin tissue ....................... 12.38 NA 8.15 1.69 NA 22.22 090 

15832 ......... ............ A Excise excessive skin tissue ....................... 11.57 NA 8.33 1.63 NA 21.53 090 

15833 ......... ............ A Excise excessive skin tissue ....................... 10.62 NA 8.20 1.48 NA 20.30 090 

15834 ......... ............ A Excise excessive skin tissue ....................... 10.83 NA 7.68 1.60 NA 20.11 090 

15835 ......... ............ A Excise excessive skin tissue ....................... 11.65 NA 7.53 1.63 NA 20.81 090 

15836 ......... ............ A Excise excessive skin tissue ....................... 9.33 NA 6.77 1.31 NA 17.41 090 

15837 ......... ............ A Excise excessive skin tissue ....................... 8.42 8.63 7.36 1.19 18.24 16.97 090 

15838 ......... ............ A Excise excessive skin tissue ....................... 7.12 NA 6.05 0.63 NA 13.80 090 

15839 ......... ............ A Excise excessive skin tissue ....................... 9.37 8.87 6.39 1.15 19.39 16.91 090 

15840 ......... ............ A Graft for face nerve palsy ............................ 13.24 NA 9.96 1.39 NA 24.59 090 

15841 ......... ............ A Graft for face nerve palsy ............................ 23.23 NA 14.98 2.79 NA 41.00 090 

15842 ......... ............ A Flap for face nerve palsy ............................. 37.90 NA 22.88 2.91 NA 63.69 090 

15845 ......... ............ A Skin and muscle repair, face ....................... 12.55 NA 9.29 0.86 NA 22.70 090 

15850 ......... ............ B Removal of sutures ...................................... 0.78 1.57 0.29 0.05 2.40 1.12 XXX 

15851 ......... ............ A Removal of sutures ...................................... 0.86 1.70 0.31 0.06 2.62 1.23 000 

15852 ......... ............ A Dressing change not for burn ...................... 0.86 1.87 0.33 0.09 2.82 1.28 000 

47585

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

15860 ......... ............ A Test for blood flow in graft ........................... 1.95 0.83 0.78 0.25 3.03 2.98 000 

15920 ......... ............ A Removal of tail bone ulcer ........................... 7.94 NA 5.55 0.97 NA 14.46 090 

15922 ......... ............ A Removal of tail bone ulcer ........................... 9.89 NA 7.20 1.41 NA 18.50 090 

15931 ......... ............ A Remove sacrum pressure sore ................... 9.23 NA 5.68 1.23 NA 16.14 090 

15933 ......... ............ A Remove sacrum pressure sore ................... 10.83 NA 7.84 1.48 NA 20.15 090 

15934 ......... ............ A Remove sacrum pressure sore ................... 12.67 NA 8.03 1.76 NA 22.46 090 

15935 ......... ............ A Remove sacrum pressure sore ................... 14.55 NA 10.31 2.06 NA 26.92 090 

15936 ......... ............ A Remove sacrum pressure sore ................... 12.36 NA 8.21 1.74 NA 22.31 090 

15937 ......... ............ A Remove sacrum pressure sore ................... 14.19 NA 9.80 2.01 NA 26.00 090 

15940 ......... ............ A Remove hip pressure sore .......................... 9.33 NA 6.17 1.30 NA 16.80 090 

15941 ......... ............ A Remove hip pressure sore .......................... 11.41 NA 9.43 1.63 NA 22.47 090 

15944 ......... ............ A Remove hip pressure sore .......................... 11.44 NA 8.59 1.63 NA 21.66 090 

15945 ......... ............ A Remove hip pressure sore .......................... 12.67 NA 9.63 1.80 NA 24.10 090 

15946 ......... ............ A Remove hip pressure sore .......................... 21.54 NA 14.34 3.09 NA 38.97 090 

15950 ......... ............ A Remove thigh pressure sore ....................... 7.53 NA 5.41 1.02 NA 13.96 090 

15951 ......... ............ A Remove thigh pressure sore ....................... 10.70 NA 7.85 1.48 NA 20.03 090 

15952 ......... ............ A Remove thigh pressure sore ....................... 11.37 NA 7.74 1.58 NA 20.69 090 

15953 ......... ............ A Remove thigh pressure sore ....................... 12.61 NA 8.97 1.83 NA 23.41 090 

15956 ......... ............ A Remove thigh pressure sore ....................... 15.50 NA 10.75 2.18 NA 28.43 090 

15958 ......... ............ A Remove thigh pressure sore ....................... 15.46 NA 11.02 2.17 NA 28.65 090 

16000 ......... ............ A Initial treatment of burn(s) ........................... 0.89 0.87 0.26 0.08 1.84 1.23 000 

16010 ......... ............ A Treatment of burn(s) .................................... 0.87 0.66 0.63 0.08 1.61 1.58 000 

16015 ......... ............ A Treatment of burn(s) .................................... 2.35 NA 1.15 0.30 NA 3.80 000 

16020 ......... ............ A Treatment of burn(s) .................................... 0.80 1.31 0.59 0.08 2.19 1.47 000 

16025 ......... ............ A Treatment of burn(s) .................................... 1.85 1.77 0.96 0.19 3.81 3.00 000 

16030 ......... ............ A Treatment of burn(s) .................................... 2.08 2.18 1.12 0.22 4.48 3.42 000 

16035 ......... ............ A Incision of burn scab, initi ............................ 3.74 NA 1.58 0.42 NA 5.74 090 

16036 ......... ............ A Escharotomy; add-l incision ......................... 1.50 NA 0.60 0.20 NA 2.30 ZZZ 

17000 ......... ............ A Destroy benign/premlg lesion ...................... 0.60 0.97 0.55 0.05 1.62 1.20 010 

17003 ......... ............ A Destroy lesions, 2-14 ................................... 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ 

17004 ......... ............ A Destroy lesions, 15 or more ........................ 2.79 2.30 1.59 0.23 5.32 4.61 010 

17106 ......... ............ A Destruction of skin lesions ........................... 4.58 4.58 3.33 0.44 9.60 8.35 090 

17107 ......... ............ A Destruction of skin lesions ........................... 9.15 7.17 5.43 0.87 17.19 15.45 090 

17108 ......... ............ A Destruction of skin lesions ........................... 13.18 9.25 7.64 1.33 23.76 22.15 090 

17110 ......... ............ A Destruct lesion, 1-14 .................................... 0.65 1.63 0.71 0.05 2.33 1.41 010 

17111 ......... ............ A Destruct lesion, 15 or more ......................... 0.92 1.68 0.81 0.08 2.68 1.81 010 

17250 ......... ............ A Chemical cautery, tissue ............................. 0.50 1.22 0.34 0.05 1.77 0.89 000 

17260 ......... ............ A Destruction of skin lesions ........................... 0.91 1.28 0.68 0.08 2.27 1.67 010 

17261 ......... ............ A Destruction of skin lesions ........................... 1.17 1.61 0.83 0.10 2.88 2.10 010 

17262 ......... ............ A Destruction of skin lesions ........................... 1.58 1.88 1.02 0.13 3.59 2.73 010 

17263 ......... ............ A Destruction of skin lesions ........................... 1.79 2.05 1.09 0.15 3.99 3.03 010 

17264 ......... ............ A Destruction of skin lesions ........................... 1.94 2.22 1.12 0.16 4.32 3.22 010 

17266 ......... ............ A Destruction of skin lesions ........................... 2.34 2.50 1.22 0.20 5.04 3.76 010 

17270 ......... ............ A Destruction of skin lesions ........................... 1.32 1.70 0.87 0.11 3.13 2.30 010 

17271 ......... ............ A Destruction of skin lesions ........................... 1.49 1.77 0.98 0.13 3.39 2.60 010 

17272 ......... ............ A Destruction of skin lesions ........................... 1.77 1.99 1.11 0.15 3.91 3.03 010 

17273 ......... ............ A Destruction of skin lesions ........................... 2.05 2.20 1.21 0.17 4.42 3.43 010 

17274 ......... ............ A Destruction of skin lesions ........................... 2.59 2.56 1.44 0.22 5.37 4.25 010 

17276 ......... ............ A Destruction of skin lesions ........................... 3.20 2.94 1.68 0.29 6.43 5.17 010 

17280 ......... ............ A Destruction of skin lesions ........................... 1.17 1.61 0.81 0.10 2.88 2.08 010 

17281 ......... ............ A Destruction of skin lesions ........................... 1.72 1.90 1.09 0.15 3.77 2.96 010 

17282 ......... ............ A Destruction of skin lesions ........................... 2.04 2.15 1.24 0.17 4.36 3.45 010 

17283 ......... ............ A Destruction of skin lesions ........................... 2.64 2.54 1.49 0.22 5.40 4.35 010 

17284 ......... ............ A Destruction of skin lesions ........................... 3.21 2.92 1.74 0.28 6.41 5.23 010 

17286 ......... ............ A Destruction of skin lesions ........................... 4.43 3.67 2.43 0.41 8.51 7.27 010 

17304 ......... ............ A 1 stage mohs, up to 5 spec ......................... 7.59 8.22 3.55 0.64 16.45 11.78 000 

17305 ......... ............ A 2 stage mohs, up to 5 spec ......................... 2.85 3.88 1.34 0.24 6.97 4.43 000 

17306 ......... ............ A 3 stage mohs, up to 5 spec ......................... 2.85 3.90 1.35 0.24 6.99 4.44 000 

17307 ......... ............ A Mohs addl stage up to 5 spec ..................... 2.85 2.63 1.36 0.24 5.72 4.45 000 

17310 ......... ............ A Mohs any stage > 5 spec each ................... 0.95 1.62 0.46 0.09 2.66 1.50 ZZZ 

17340 ......... ............ A Cryotherapy of skin ...................................... 0.76 0.37 0.36 0.06 1.19 1.18 010 

17360 ......... ............ A Skin peel therapy ......................................... 1.43 1.44 0.87 0.12 2.99 2.42 010 

19000 ......... ............ A Drainage of breast lesion ............................ 0.84 1.98 0.31 0.08 2.90 1.23 000 

19001 ......... ............ A Drain breast lesion add-on .......................... 0.42 0.25 0.14 0.04 0.71 0.60 ZZZ 

19020 ......... ............ A Incision of breast lesion ............................... 3.56 6.36 2.68 0.45 10.37 6.69 090 

19030 ......... ............ A Injection for breast x-ray .............................. 1.53 2.88 0.50 0.09 4.50 2.12 000 

19100 ......... ............ A Bx breast percut w/o image ......................... 1.27 2.08 0.42 0.15 3.50 1.84 000 

19101 ......... ............ A Biopsy of breast, open ................................. 3.18 4.51 1.91 0.36 8.05 5.45 010 

19102 ......... ............ A Bx breast percut w/image ............................ 2.00 3.83 0.66 0.15 5.98 2.81 000 

19103 ......... ............ A Bx breast percut w/device ........................... 3.69 11.53 1.23 0.30 15.52 5.22 000 

19110 ......... ............ A Nipple exploration ........................................ 4.29 5.82 2.87 0.56 10.67 7.72 090 

19112 ......... ............ A Excise breast duct fistula ............................. 3.66 6.11 2.69 0.48 10.25 6.83 090 

19120 ......... ............ A Removal of breast lesion ............................. 5.55 4.55 3.06 0.72 10.82 9.33 090 

19125 ......... ............ A Excision, breast lesion ................................. 6.05 4.79 3.28 0.79 11.63 10.12 090 

19126 ......... ............ A Excision, addl breast lesion ......................... 2.93 NA 1.00 0.38 NA 4.31 ZZZ 

47586

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

19140 ......... ............ A Removal of breast tissue ............................. 5.13 7.18 3.41 0.69 13.00 9.23 090 

19160 ......... ............ A Removal of breast tissue ............................. 5.98 NA 3.43 0.78 NA 10.19 090 

19162 ......... ............ A Remove breast tissue, nodes ...................... 13.51 NA 6.34 1.74 NA 21.59 090 

19180 ......... ............ A Removal of breast ....................................... 8.79 NA 5.03 1.14 NA 14.96 090 

19182 ......... ............ A Removal of breast ....................................... 7.72 NA 4.77 1.03 NA 13.52 090 

19200 ......... ............ A Removal of breast ....................................... 15.47 NA 7.98 1.82 NA 25.27 090 

19220 ......... ............ A Removal of breast ....................................... 15.70 NA 8.25 1.97 NA 25.92 090 

19240 ......... ............ A Removal of breast ....................................... 15.98 NA 8.23 2.06 NA 26.27 090 

19260 ......... ............ A Removal of chest wall lesion ....................... 15.42 NA 11.17 2.01 NA 28.60 090 

19271 ......... ............ A Revision of chest wall .................................. 18.87 NA 17.99 2.51 NA 39.37 090 

19272 ......... ............ A Extensive chest wall surgery ....................... 21.52 NA 18.97 3.01 NA 43.50 090 

19290 ......... ............ A Place needle wire, breast ............................ 1.27 2.89 0.42 0.08 4.24 1.77 000 

19291 ......... ............ A Place needle wire, breast ............................ 0.63 1.22 0.21 0.04 1.89 0.88 ZZZ 

19295 ......... ............ A Place breast clip, percut .............................. 0.00 2.70 NA 0.01 2.71 NA ZZZ 

19316 ......... ............ A Suspension of breast ................................... 10.67 NA 7.52 1.60 NA 19.79 090 

19318 ......... ............ A Reduction of large breast ............................ 15.60 NA 11.12 2.79 NA 29.51 090 

19324 ......... ............ A Enlarge breast ............................................. 5.84 NA 4.87 0.84 NA 11.55 090 

19325 ......... ............ A Enlarge breast with implant ......................... 8.44 NA 6.53 1.28 NA 16.25 090 

19328 ......... ............ A Removal of breast implant ........................... 5.67 NA 5.02 0.89 NA 11.58 090 

19330 ......... ............ A Removal of implant material ........................ 7.58 NA 6.02 1.24 NA 14.84 090 

19340 ......... ............ A Immediate breast prosthesis ....................... 6.32 NA 3.10 1.03 NA 10.45 ZZZ 

19342 ......... ............ A Delayed breast prosthesis ........................... 11.18 NA 8.89 1.77 NA 21.84 090 

19350 ......... ............ A Breast reconstruction ................................... 8.91 13.79 7.15 1.38 24.08 17.44 090 

19355 ......... ............ A Correct inverted nipple(s) ............................ 7.56 10.25 4.70 1.07 18.88 13.33 090 

19357 ......... ............ A Breast reconstruction ................................... 18.13 NA 13.76 2.79 NA 34.68 090 

19361 ......... ............ A Breast reconstruction ................................... 19.23 NA 11.71 2.84 NA 33.78 090 

19364 ......... ............ A Breast reconstruction ................................... 40.94 NA 23.49 5.85 NA 70.28 090 

19366 ......... ............ A Breast reconstruction ................................... 21.25 NA 11.16 3.07 NA 35.48 090 

19367 ......... ............ A Breast reconstruction ................................... 25.69 NA 16.45 3.84 NA 45.98 090 

19368 ......... ............ A Breast reconstruction ................................... 32.37 NA 20.12 4.63 NA 57.12 090 

19369 ......... ............ A Breast reconstruction ................................... 29.78 NA 19.66 4.29 NA 53.73 090 

19370 ......... ............ A Surgery of breast capsule ........................... 8.04 NA 6.87 1.27 NA 16.18 090 

19371 ......... ............ A Removal of breast capsule .......................... 9.34 NA 7.79 1.65 NA 18.78 090 

19380 ......... ............ A Revise breast reconstruction ....................... 9.13 NA 7.67 1.42 NA 18.22 090 

19396 ......... ............ A Design custom breast implant ..................... 2.17 1.08 0.99 0.26 3.51 3.42 000 

20000 ......... ............ A Incision of abscess ...................................... 2.12 2.70 1.73 0.19 5.01 4.04 010 

20005 ......... ............ A Incision of deep abscess ............................. 3.41 3.50 2.25 0.41 7.32 6.07 010 

20100 ......... ............ A Explore wound, neck ................................... 10.06 NA 4.46 1.19 NA 15.71 010 

20101 ......... ............ A Explore wound, chest .................................. 3.22 5.94 1.62 0.41 9.57 5.25 010 

20102 ......... ............ A Explore wound, abdomen ............................ 3.93 7.50 1.91 0.50 11.93 6.34 010 

20103 ......... ............ A Explore wound, extremity ............................ 5.29 8.60 3.39 0.70 14.59 9.38 010 

20150 ......... ............ A Excise epiphyseal bar .................................. 13.67 NA 7.04 1.43 NA 22.14 090 

20200 ......... ............ A Muscle biopsy .............................................. 1.46 3.05 0.75 0.22 4.73 2.43 000 

20205 ......... ............ A Deep muscle biopsy .................................... 2.35 4.07 1.19 0.31 6.73 3.85 000 

20206 ......... ............ A Needle biopsy, muscle ................................ 0.99 6.63 0.63 0.07 7.69 1.69 000 

20220 ......... ............ A Bone biopsy, trocar/needle .......................... 1.27 4.89 0.80 0.09 6.25 2.16 000 

20225 ......... ............ A Bone biopsy, trocar/needle .......................... 1.87 26.72 1.13 0.18 28.77 3.18 000 

20240 ......... ............ A Bone biopsy, excisional ............................... 3.23 NA 2.56 0.41 NA 6.20 010 

20245 ......... ............ A Bone biopsy, excisional ............................... 7.77 NA 6.59 1.19 NA 15.55 010 

20250 ......... ............ A Open bone biopsy ....................................... 5.02 NA 3.50 0.91 NA 9.43 010 

20251 ......... ............ A Open bone biopsy ....................................... 5.55 NA 4.15 1.05 NA 10.75 010 

20500 ......... ............ A Injection of sinus tract .................................. 1.23 2.27 1.53 0.10 3.60 2.86 010 

20501 ......... ............ A Inject sinus tract for x-ray ............................ 0.76 2.98 0.25 0.05 3.79 1.06 000 

20520 ......... ............ A Removal of foreign body ............................. 1.85 2.93 1.77 0.20 4.98 3.82 010 

20525 ......... ............ A Removal of foreign body ............................. 3.49 9.14 2.62 0.47 13.10 6.58 010 

20526 ......... ............ A Ther injection, carp tunnel ........................... 0.94 0.97 0.51 0.10 2.01 1.55 000 

20550 ......... ............ A Inj tendon sheath/ligament .......................... 0.75 0.71 0.23 0.08 1.54 1.06 000 

20551 ......... ............ A Inj tendon origin/insertion ............................ 0.75 0.69 0.33 0.08 1.52 1.16 000 

20552 ......... ............ A Inj trigger point, 1/2 muscl ........................... 0.66 0.72 0.20 0.07 1.45 0.93 000 

20553 ......... ............ A Inject trigger points, =/> 3 ............................ 0.75 0.82 0.22 0.05 1.62 1.02 000 

20600 ......... ............ A Drain/inject, joint/bursa ................................ 0.66 0.65 0.35 0.06 1.37 1.07 000 

20605 ......... ............ A Drain/inject, joint/bursa ................................ 0.68 0.76 0.36 0.07 1.51 1.11 000 

20610 ......... ............ A Drain/inject, joint/bursa ................................ 0.79 0.95 0.42 0.10 1.84 1.31 000 

20612 ......... ............ A Aspirate/inj ganglion cyst ............................. 0.70 0.71 0.36 0.07 1.48 1.13 000 

20615 ......... ............ A Treatment of bone cyst ................................ 2.28 3.53 1.84 0.19 6.00 4.31 010 

20650 ......... ............ A Insert and remove bone pin ........................ 2.23 2.36 1.55 0.25 4.84 4.03 010 

20660 ......... ............ A Apply, rem fixation device ........................... 2.51 3.05 1.61 0.54 6.10 4.66 000 

20661 ......... ............ A Application of head brace ............................ 4.88 NA 5.06 1.11 NA 11.05 090 

20662 ......... ............ A Application of pelvis brace ........................... 6.06 NA 5.58 0.53 NA 12.17 090 

20663 ......... ............ A Application of thigh brace ............................ 5.42 NA 4.89 0.33 NA 10.64 090 

20664 ......... ............ A Halo brace application ................................. 8.05 NA 7.15 1.68 NA 16.88 090 

20665 ......... ............ A Removal of fixation device .......................... 1.31 2.21 1.35 0.19 3.71 2.85 010 

20670 ......... ............ A Removal of support implant ......................... 1.74 11.52 2.09 0.26 13.52 4.09 010 

20680 ......... ............ A Removal of support implant ......................... 3.34 8.77 3.71 0.52 12.63 7.57 090 

20690 ......... ............ A Apply bone fixation device ........................... 3.51 NA 2.54 0.58 NA 6.63 090 

47587

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

20692 ......... ............ A Apply bone fixation device ........................... 6.40 NA 3.77 0.99 NA 11.16 090 

20693 ......... ............ A Adjust bone fixation device .......................... 5.85 NA 5.73 0.98 NA 12.56 090 

20694 ......... ............ A Remove bone fixation device ...................... 4.15 7.13 4.04 0.69 11.97 8.88 090 

20802 ......... ............ A Replantation, arm, complete ........................ 41.09 NA 21.49 4.51 NA 67.09 090 

20805 ......... ............ A Replant forearm, complete .......................... 49.93 NA 35.25 4.64 NA 89.82 090 

20808 ......... ............ A Replantation hand, complete ....................... 61.56 NA 43.10 5.37 NA 110.03 090 

20816 ......... ............ A Replantation digit, complete ........................ 30.89 NA 38.46 4.37 NA 73.72 090 

20822 ......... ............ A Replantation digit, complete ........................ 25.55 NA 35.14 3.46 NA 64.15 090 

20824 ......... ............ A Replantation thumb, complete ..................... 30.89 NA 37.30 4.15 NA 72.34 090 

20827 ......... ............ A Replantation thumb, complete ..................... 26.37 NA 37.15 3.73 NA 67.25 090 

20838 ......... ............ A Replantation foot, complete ......................... 41.35 NA 22.78 10.71 NA 74.84 090 

20900 ......... ............ A Removal of bone for graft ............................ 5.57 8.44 5.66 0.85 14.86 12.08 090 

20902 ......... ............ A Removal of bone for graft ............................ 7.54 NA 7.06 1.21 NA 15.81 090 

20910 ......... ............ A Remove cartilage for graft ........................... 5.33 NA 5.26 0.66 NA 11.25 090 

20912 ......... ............ A Remove cartilage for graft ........................... 6.34 NA 6.15 0.70 NA 13.19 090 

20920 ......... ............ A Removal of fascia for graft .......................... 5.30 NA 4.40 0.58 NA 10.28 090 

20922 ......... ............ A Removal of fascia for graft .......................... 6.60 7.54 4.87 0.68 14.82 12.15 090 

20924 ......... ............ A Removal of tendon for graft ......................... 6.47 NA 6.06 0.97 NA 13.50 090 

20926 ......... ............ A Removal of tissue for graft .......................... 5.52 NA 4.99 0.81 NA 11.32 090 

20931 ......... ............ A Spinal bone allograft .................................... 1.81 NA 0.93 0.42 NA 3.16 ZZZ 

20937 ......... ............ A Spinal bone autograft .................................. 2.79 NA 1.45 0.49 NA 4.73 ZZZ 

20938 ......... ............ A Spinal bone autograft .................................. 3.02 NA 1.55 0.57 NA 5.14 ZZZ 

20950 ......... ............ A Fluid pressure, muscle ................................ 1.26 6.83 0.99 0.19 8.28 2.44 000 

20955 ......... ............ A Fibula bone graft, microvasc ....................... 39.15 NA 25.19 4.72 NA 69.06 090 

20956 ......... ............ A Iliac bone graft, microvasc ........................... 39.21 NA 25.05 7.16 NA 71.42 090 

20957 ......... ............ A Mt bone graft, microvasc ............................. 40.59 NA 19.21 4.32 NA 64.12 090 

20962 ......... ............ A Other bone graft, microvasc ........................ 39.21 NA 26.71 6.19 NA 72.11 090 

20969 ......... ............ A Bone/skin graft, microvasc .......................... 43.85 NA 27.63 4.68 NA 76.16 090 

20970 ......... ............ A Bone/skin graft, iliac crest ........................... 43.00 NA 25.97 6.77 NA 75.74 090 

20972 ......... ............ A Bone/skin graft, metatarsal .......................... 42.93 NA 20.56 3.44 NA 66.93 090 

20973 ......... ............ A Bone/skin graft, great toe ............................ 45.69 NA 25.46 5.61 NA 76.76 090 

20974 ......... ............ A Electrical bone stimulation ........................... 0.62 0.69 0.54 0.10 1.41 1.26 000 

20975 ......... ............ A Electrical bone stimulation ........................... 2.60 NA 1.71 0.46 NA 4.77 000 

20979 ......... ............ A Us bone stimulation ..................................... 0.62 0.80 0.33 0.09 1.51 1.04 000 

20982 ......... ............ A Ablate, bone tumor(s) perq .......................... 7.27 109.89 2.97 0.69 117.85 10.93 000 

21010 ......... ............ A Incision of jaw joint ...................................... 10.12 NA 7.14 1.02 NA 18.28 090 

21015 ......... ............ A Resection of facial tumor ............................. 5.28 NA 5.43 0.70 NA 11.41 090 

21025 ......... ............ A Excision of bone, lower jaw ......................... 10.04 12.22 9.35 1.30 23.56 20.69 090 

21026 ......... ............ A Excision of facial bone(s) ............................ 4.84 7.85 6.31 0.63 13.32 11.78 090 

21029 ......... ............ A Contour of face bone lesion ........................ 7.70 9.34 6.99 0.90 17.94 15.59 090 

21030 ......... ............ A Excise max/zygoma b9 tumor ..................... 4.49 6.32 5.03 0.86 11.67 10.38 090 

21031 ......... ............ A Remove exostosis, mandible ....................... 3.24 5.16 3.62 0.47 8.87 7.33 090 

21032 ......... ............ A Remove exostosis, maxilla .......................... 3.24 5.34 3.51 0.46 9.04 7.21 090 

21034 ......... ............ A Excise max/zygoma mlg tumor ................... 16.15 15.88 12.63 1.74 33.77 30.52 090 

21040 ......... ............ A Excise mandible lesion ................................ 4.49 6.38 4.72 0.57 11.44 9.78 090 

21044 ......... ............ A Removal of jaw bone lesion ........................ 11.84 NA 9.37 1.10 NA 22.31 090 

21045 ......... ............ A Extensive jaw surgery .................................. 16.15 NA 12.34 1.57 NA 30.06 090 

21046 ......... ............ A Remove mandible cyst complex .................. 12.98 NA 11.86 0.88 NA 25.72 090 

21047 ......... ............ A Excise lwr jaw cyst w/repair ........................ 18.72 NA 13.42 0.88 NA 33.02 090 

21048 ......... ............ A Remove maxilla cyst complex ..................... 13.48 NA 12.08 0.88 NA 26.44 090 

21049 ......... ............ A Excis uppr jaw cyst w/repair ........................ 17.97 NA 13.00 0.88 NA 31.85 090 

21050 ......... ............ A Removal of jaw joint .................................... 10.75 NA 9.43 1.36 NA 21.54 090 

21060 ......... ............ A Remove jaw joint cartilage .......................... 10.21 NA 8.60 1.51 NA 20.32 090 

21070 ......... ............ A Remove coronoid process ........................... 8.19 NA 7.10 1.16 NA 16.45 090 

21076 ......... ............ A Prepare face/oral prosthesis ........................ 13.40 12.34 9.99 1.91 27.65 25.30 010 

21077 ......... ............ A Prepare face/oral prosthesis ........................ 33.70 31.27 25.96 5.03 70.00 64.69 090 

21079 ......... ............ A Prepare face/oral prosthesis ........................ 22.31 21.46 17.12 3.09 46.86 42.52 090 

21080 ......... ............ A Prepare face/oral prosthesis ........................ 25.06 24.45 19.33 3.68 53.19 48.07 090 

21081 ......... ............ A Prepare face/oral prosthesis ........................ 22.85 22.26 17.45 3.10 48.21 43.40 090 

21082 ......... ............ A Prepare face/oral prosthesis ........................ 20.84 19.30 15.69 2.95 43.09 39.48 090 

21083 ......... ............ A Prepare face/oral prosthesis ........................ 19.27 18.76 14.41 2.55 40.58 36.23 090 

21084 ......... ............ A Prepare face/oral prosthesis ........................ 22.48 22.40 17.67 2.28 47.16 42.43 090 

21085 ......... ............ A Prepare face/oral prosthesis ........................ 8.99 8.27 6.77 1.17 18.43 16.93 010 

21086 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 23.73 19.39 3.19 51.80 47.46 090 

21087 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 23.23 19.14 3.58 51.69 47.60 090 

21100 ......... ............ A Maxillofacial fixation ..................................... 4.21 11.59 4.76 0.35 16.15 9.32 090 

21110 ......... ............ A Interdental fixation ....................................... 5.20 9.57 8.35 0.62 15.39 14.17 090 

21116 ......... ............ A Injection, jaw joint x-ray ............................... 0.81 4.36 0.33 0.06 5.23 1.20 000 

21120 ......... ............ A Reconstruction of chin ................................. 4.92 10.62 7.48 0.49 16.03 12.89 090 

21121 ......... ............ A Reconstruction of chin ................................. 7.63 9.73 7.81 0.93 18.29 16.37 090 

21122 ......... ............ A Reconstruction of chin ................................. 8.51 NA 8.62 0.98 NA 18.11 090 

21123 ......... ............ A Reconstruction of chin ................................. 11.14 NA 10.78 0.91 NA 22.83 090 

21125 ......... ............ A Augmentation, lower jaw bone .................... 10.60 55.70 8.31 0.76 67.06 19.67 090 

21127 ......... ............ A Augmentation, lower jaw bone .................... 11.10 42.76 9.44 1.66 55.52 22.20 090 

21137 ......... ............ A Reduction of forehead ................................. 9.81 NA 7.71 1.13 NA 18.65 090 

47588

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

21138 ......... ............ A Reduction of forehead ................................. 12.17 NA 9.50 0.61 NA 22.28 090 

21139 ......... ............ A Reduction of forehead ................................. 14.59 NA 11.04 1.68 NA 27.31 090 

21141 ......... ............ A Reconstruct midface, lefort .......................... 18.07 NA 13.75 2.41 NA 34.23 090 

21142 ......... ............ A Reconstruct midface, lefort .......................... 18.78 NA 12.94 2.26 NA 33.98 090 

21143 ......... ............ A Reconstruct midface, lefort .......................... 19.55 NA 14.30 1.09 NA 34.94 090 

21145 ......... ............ A Reconstruct midface, lefort .......................... 19.91 NA 14.02 2.58 NA 36.51 090 

21146 ......... ............ A Reconstruct midface, lefort .......................... 20.68 NA 15.44 3.09 NA 39.21 090 

21147 ......... ............ A Reconstruct midface, lefort .......................... 21.74 NA 15.13 1.83 NA 38.70 090 

21150 ......... ............ A Reconstruct midface, lefort .......................... 25.20 NA 16.75 3.04 NA 44.99 090 

21151 ......... ............ A Reconstruct midface, lefort .......................... 28.26 NA 22.88 4.22 NA 55.36 090 

21154 ......... ............ A Reconstruct midface, lefort .......................... 30.47 NA 23.07 4.55 NA 58.09 090 

21155 ......... ............ A Reconstruct midface, lefort .......................... 34.40 NA 23.85 6.61 NA 64.86 090 

21159 ......... ............ A Reconstruct midface, lefort .......................... 42.32 NA 29.02 6.31 NA 77.65 090 

21160 ......... ............ A Reconstruct midface, lefort .......................... 46.37 NA 27.46 4.91 NA 78.74 090 

21172 ......... ............ A Reconstruct orbit/forehead .......................... 27.76 NA 14.01 2.83 NA 44.60 090 

21175 ......... ............ A Reconstruct orbit/forehead .......................... 33.12 NA 18.18 3.43 NA 54.73 090 

21179 ......... ............ A Reconstruct entire forehead ........................ 22.22 NA 14.72 3.24 NA 40.18 090 

21180 ......... ............ A Reconstruct entire forehead ........................ 25.15 NA 15.92 3.08 NA 44.15 090 

21181 ......... ............ A Contour cranial bone lesion ......................... 9.89 NA 7.78 1.37 NA 19.04 090 

21182 ......... ............ A Reconstruct cranial bone ............................. 32.14 NA 19.47 3.42 NA 55.03 090 

21183 ......... ............ A Reconstruct cranial bone ............................. 35.26 NA 21.18 3.51 NA 59.95 090 

21184 ......... ............ A Reconstruct cranial bone ............................. 38.18 NA 22.37 6.84 NA 67.39 090 

21188 ......... ............ A Reconstruction of midface ........................... 22.43 NA 18.83 2.97 NA 44.23 090 

21193 ......... ............ A Reconst lwr jaw w/o graft ............................ 17.12 NA 12.84 2.10 NA 32.06 090 

21194 ......... ............ A Reconst lwr jaw w/graft ............................... 19.81 NA 13.91 2.11 NA 35.83 090 

21195 ......... ............ A Reconst lwr jaw w/o fixation ........................ 17.21 NA 14.79 1.22 NA 33.22 090 

21196 ......... ............ A Reconst lwr jaw w/fixation ........................... 18.88 NA 15.66 2.03 NA 36.57 090 

21198 ......... ............ A Reconstr lwr jaw segment ........................... 14.14 NA 12.69 1.41 NA 28.24 090 

21199 ......... ............ A Reconstr lwr jaw w/advance ........................ 15.98 NA 9.15 1.39 NA 26.52 090 

21206 ......... ............ A Reconstruct upper jaw bone ........................ 14.08 NA 12.62 1.78 NA 28.48 090 

21208 ......... ............ A Augmentation of facial bones ...................... 10.21 22.32 9.56 1.11 33.64 20.88 090 

21209 ......... ............ A Reduction of facial bones ............................ 6.71 10.78 8.06 0.90 18.39 15.67 090 

21210 ......... ............ A Face bone graft ........................................... 10.21 24.84 9.33 1.37 36.42 20.91 090 

21215 ......... ............ A Lower jaw bone graft ................................... 10.75 41.85 9.35 1.51 54.11 21.61 090 

21230 ......... ............ A Rib cartilage graft ........................................ 10.75 NA 8.46 1.20 NA 20.41 090 

21235 ......... ............ A Ear cartilage graft ........................................ 6.71 9.83 6.40 0.68 17.22 13.79 090 

21240 ......... ............ A Reconstruction of jaw joint .......................... 14.03 NA 12.17 2.28 NA 28.48 090 

21242 ......... ............ A Reconstruction of jaw joint .......................... 12.93 NA 11.66 2.29 NA 26.88 090 

21243 ......... ............ A Reconstruction of jaw joint .......................... 20.76 NA 17.37 3.05 NA 41.18 090 

21244 ......... ............ A Reconstruction of lower jaw ........................ 11.84 NA 12.07 1.24 NA 25.15 090 

21245 ......... ............ A Reconstruction of jaw .................................. 11.84 14.35 9.83 1.12 27.31 22.79 090 

21246 ......... ............ A Reconstruction of jaw .................................. 12.45 NA 9.03 1.24 NA 22.72 090 

21247 ......... ............ A Reconstruct lower jaw bone ........................ 22.60 NA 17.43 3.23 NA 43.26 090 

21248 ......... ............ A Reconstruction of jaw .................................. 11.46 12.11 9.38 1.67 25.24 22.51 090 

21249 ......... ............ A Reconstruction of jaw .................................. 17.49 16.70 12.67 2.02 36.21 32.18 090 

21255 ......... ............ A Reconstruct lower jaw bone ........................ 16.69 NA 16.15 2.57 NA 35.41 090 

21256 ......... ............ A Reconstruction of orbit ................................. 16.17 NA 12.03 1.36 NA 29.56 090 

21260 ......... ............ A Revise eye sockets ...................................... 16.50 NA 12.75 0.98 NA 30.23 090 

21261 ......... ............ A Revise eye sockets ...................................... 31.44 NA 24.21 3.09 NA 58.74 090 

21263 ......... ............ A Revise eye sockets ...................................... 28.38 NA 19.17 2.61 NA 50.16 090 

21267 ......... ............ A Revise eye sockets ...................................... 18.87 NA 19.72 1.64 NA 40.23 090 

21268 ......... ............ A Revise eye sockets ...................................... 24.44 NA 20.22 2.43 NA 47.09 090 

21270 ......... ............ A Augmentation, cheek bone .......................... 10.21 11.66 7.24 1.04 22.91 18.49 090 

21275 ......... ............ A Revision, orbitofacial bones ......................... 11.22 NA 8.63 1.29 NA 21.14 090 

21280 ......... ............ A Revision of eyelid ........................................ 6.02 NA 5.95 0.46 NA 12.43 090 

21282 ......... ............ A Revision of eyelid ........................................ 3.48 NA 4.58 0.27 NA 8.33 090 

21295 ......... ............ A Revision of jaw muscle/bone ....................... 1.53 NA 2.54 0.15 NA 4.22 090 

21296 ......... ............ A Revision of jaw muscle/bone ....................... 4.24 NA 4.90 0.35 NA 9.49 090 

21300 ......... ............ A Treatment of skull fracture ........................... 0.72 2.39 0.26 0.11 3.22 1.09 000 

21310 ......... ............ A Treatment of nose fracture .......................... 0.58 2.30 0.15 0.05 2.93 0.78 000 

21315 ......... ............ A Treatment of nose fracture .......................... 1.51 4.23 1.88 0.14 5.88 3.53 010 

21320 ......... ............ A Treatment of nose fracture .......................... 1.85 3.91 1.62 0.18 5.94 3.65 010 

21325 ......... ............ A Treatment of nose fracture .......................... 3.76 NA 8.61 0.34 NA 12.71 090 

21330 ......... ............ A Treatment of nose fracture .......................... 5.37 NA 9.64 0.61 NA 15.62 090 

21335 ......... ............ A Treatment of nose fracture .......................... 8.60 NA 9.60 0.75 NA 18.95 090 

21336 ......... ............ A Treat nasal septal fracture ........................... 5.71 NA 9.57 0.56 NA 15.84 090 

21337 ......... ............ A Treat nasal septal fracture ........................... 2.70 6.49 3.56 0.27 9.46 6.53 090 

21338 ......... ............ A Treat nasoethmoid fracture ......................... 6.45 NA 13.90 0.75 NA 21.10 090 

21339 ......... ............ A Treat nasoethmoid fracture ......................... 8.08 NA 13.77 0.92 NA 22.77 090 

21340 ......... ............ A Treatment of nose fracture .......................... 10.75 NA 8.59 0.97 NA 20.31 090 

21343 ......... ............ A Treatment of sinus fracture ......................... 12.93 NA 15.39 1.67 NA 29.99 090 

21344 ......... ............ A Treatment of sinus fracture ......................... 19.69 NA 16.42 2.45 NA 38.56 090 

21345 ......... ............ A Treat nose/jaw fracture ................................ 8.15 9.84 7.16 1.11 19.10 16.42 090 

21346 ......... ............ A Treat nose/jaw fracture ................................ 10.59 NA 12.18 1.22 NA 23.99 090 

21347 ......... ............ A Treat nose/jaw fracture ................................ 12.67 NA 16.03 1.57 NA 30.27 090 

47589

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

21348 ......... ............ A Treat nose/jaw fracture ................................ 16.66 NA 11.21 1.62 NA 29.49 090 

21355 ......... ............ A Treat cheek bone fracture ........................... 3.76 6.24 3.49 0.28 10.28 7.53 010 

21356 ......... ............ A Treat cheek bone fracture ........................... 4.14 7.10 4.53 0.47 11.71 9.14 010 

21360 ......... ............ A Treat cheek bone fracture ........................... 6.45 NA 5.92 0.71 NA 13.08 090 

21365 ......... ............ A Treat cheek bone fracture ........................... 14.93 NA 10.79 1.72 NA 27.44 090 

21366 ......... ............ A Treat cheek bone fracture ........................... 17.74 NA 11.52 1.90 NA 31.16 090 

21385 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 8.27 0.83 NA 18.25 090 

21386 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 7.06 1.04 NA 17.25 090 

21387 ......... ............ A Treat eye socket fracture ............................. 9.69 NA 8.93 0.96 NA 19.58 090 

21390 ......... ............ A Treat eye socket fracture ............................. 10.11 NA 7.91 0.92 NA 18.94 090 

21395 ......... ............ A Treat eye socket fracture ............................. 12.66 NA 9.21 1.60 NA 23.47 090 

21400 ......... ............ A Treat eye socket fracture ............................. 1.40 2.64 1.90 0.14 4.18 3.44 090 

21401 ......... ............ A Treat eye socket fracture ............................. 3.26 8.05 3.49 0.27 11.58 7.02 090 

21406 ......... ............ A Treat eye socket fracture ............................. 7.00 NA 6.26 0.82 NA 14.08 090 

21407 ......... ............ A Treat eye socket fracture ............................. 8.60 NA 7.05 0.94 NA 16.59 090 

21408 ......... ............ A Treat eye socket fracture ............................. 12.36 NA 9.10 1.39 NA 22.85 090 

21421 ......... ............ A Treat mouth roof fracture ............................. 5.13 9.33 8.31 0.61 15.07 14.05 090 

21422 ......... ............ A Treat mouth roof fracture ............................. 8.31 NA 8.06 0.97 NA 17.34 090 

21423 ......... ............ A Treat mouth roof fracture ............................. 10.38 NA 9.30 1.20 NA 20.88 090 

21431 ......... ............ A Treat craniofacial fracture ............................ 7.04 NA 9.51 1.05 NA 17.60 090 

21432 ......... ............ A Treat craniofacial fracture ............................ 8.60 NA 8.05 0.87 NA 17.52 090 

21433 ......... ............ A Treat craniofacial fracture ............................ 25.31 NA 16.66 3.07 NA 45.04 090 

21435 ......... ............ A Treat craniofacial fracture ............................ 17.22 NA 12.82 2.81 NA 32.85 090 

21436 ......... ............ A Treat craniofacial fracture ............................ 28.00 NA 18.25 3.23 NA 49.48 090 

21440 ......... ............ A Treat dental ridge fracture ........................... 2.70 7.10 6.16 0.35 10.15 9.21 090 

21445 ......... ............ A Treat dental ridge fracture ........................... 5.37 9.73 8.36 0.68 15.78 14.41 090 

21450 ......... ............ A Treat lower jaw fracture ............................... 2.97 7.38 6.92 0.37 10.72 10.26 090 

21451 ......... ............ A Treat lower jaw fracture ............................... 4.86 9.34 8.40 0.65 14.85 13.91 090 

21452 ......... ............ A Treat lower jaw fracture ............................... 1.98 13.11 4.61 0.20 15.29 6.79 090 

21453 ......... ............ A Treat lower jaw fracture ............................... 5.53 10.73 10.71 0.71 16.97 16.95 090 

21454 ......... ............ A Treat lower jaw fracture ............................... 6.45 NA 6.50 0.76 NA 13.71 090 

21461 ......... ............ A Treat lower jaw fracture ............................... 8.08 24.43 12.64 0.95 33.46 21.67 090 

21462 ......... ............ A Treat lower jaw fracture ............................... 9.78 27.59 12.69 0.94 38.31 23.41 090 

21465 ......... ............ A Treat lower jaw fracture ............................... 11.89 NA 9.99 1.63 NA 23.51 090 

21470 ......... ............ A Treat lower jaw fracture ............................... 15.32 NA 12.18 1.97 NA 29.47 090 

21480 ......... ............ A Reset dislocated jaw .................................... 0.61 1.77 0.19 0.06 2.44 0.86 000 

21485 ......... ............ A Reset dislocated jaw .................................... 3.98 8.22 7.67 0.49 12.69 12.14 090 

21490 ......... ............ A Repair dislocated jaw .................................. 11.84 NA 9.84 1.79 NA 23.47 090 

21493 ......... ............ A Treat hyoid bone fracture ............................ 1.27 NA 0.55 0.07 NA 1.89 090 

21494 ......... ............ A Treat hyoid bone fracture ............................ 6.27 NA 3.53 0.53 NA 10.33 090 

21495 ......... ............ A Treat hyoid bone fracture ............................ 5.68 NA 8.41 0.46 NA 14.55 090 

21497 ......... ............ A Interdental wiring ......................................... 3.85 8.44 7.63 0.44 12.73 11.92 090 

21501 ......... ............ A Drain neck/chest lesion ............................... 3.80 6.47 3.83 0.45 10.72 8.08 090 

21502 ......... ............ A Drain chest lesion ........................................ 7.11 NA 5.67 0.93 NA 13.71 090 

21510 ......... ............ A Drainage of bone lesion .............................. 5.73 NA 5.70 0.79 NA 12.22 090 

21550 ......... ............ A Biopsy of neck/chest .................................... 2.06 3.59 1.72 0.19 5.84 3.97 010 

21555 ......... ............ A Remove lesion, neck/chest .......................... 4.34 5.53 3.20 0.54 10.41 8.08 090 

21556 ......... ............ A Remove lesion, neck/chest .......................... 5.56 NA 4.08 0.66 NA 10.30 090 

21557 ......... ............ A Remove tumor, neck/chest .......................... 8.87 NA 5.41 1.09 NA 15.37 090 

21600 ......... ............ A Partial removal of rib ................................... 6.88 NA 5.77 0.95 NA 13.60 090 

21610 ......... ............ A Partial removal of rib ................................... 14.59 NA 9.11 2.49 NA 26.19 090 

21615 ......... ............ A Removal of rib ............................................. 9.86 NA 6.70 1.39 NA 17.95 090 

21616 ......... ............ A Removal of rib and nerves .......................... 12.02 NA 8.04 1.72 NA 21.78 090 

21620 ......... ............ A Partial removal of sternum .......................... 6.78 NA 6.03 0.93 NA 13.74 090 

21627 ......... ............ A Sternal debridement .................................... 6.80 NA 6.43 0.95 NA 14.18 090 

21630 ......... ............ A Extensive sternum surgery .......................... 17.35 NA 11.89 2.45 NA 31.69 090 

21632 ......... ............ A Extensive sternum surgery .......................... 18.11 NA 11.13 2.45 NA 31.69 090 

21685 ......... ............ A Hyoid myotomy & suspension ..................... 12.98 NA 9.96 1.05 NA 23.99 090 

21700 ......... ............ A Revision of neck muscle .............................. 6.18 NA 4.44 0.72 NA 11.34 090 

21705 ......... ............ A Revision of neck muscle/rib ......................... 9.59 NA 5.60 1.21 NA 16.40 090 

21720 ......... ............ A Revision of neck muscle .............................. 5.67 2.45 2.45 0.86 8.98 8.98 090 

21725 ......... ............ A Revision of neck muscle .............................. 6.98 NA 5.63 0.78 NA 13.39 090 

21740 ......... ............ A Reconstruction of sternum ........................... 16.48 NA 8.56 2.06 NA 27.10 090 

21750 ......... ............ A Repair of sternum separation ...................... 10.75 NA 6.11 1.44 NA 18.30 090 

21800 ......... ............ A Treatment of rib fracture .............................. 0.96 NA 1.37 0.09 NA 2.42 090 

21805 ......... ............ A Treatment of rib fracture .............................. 2.75 NA 3.38 0.35 NA 6.48 090 

21810 ......... ............ A Treatment of rib fracture(s) .......................... 6.85 NA 5.01 0.93 NA 12.79 090 

21820 ......... ............ A Treat sternum fracture ................................. 1.28 1.84 1.79 0.15 3.27 3.22 090 

21825 ......... ............ A Treat sternum fracture ................................. 7.40 NA 6.68 0.99 NA 15.07 090 

21920 ......... ............ A Biopsy soft tissue of back ............................ 2.06 3.29 1.48 0.20 5.55 3.74 010 

21925 ......... ............ A Biopsy soft tissue of back ............................ 4.48 5.20 3.24 0.59 10.27 8.31 090 

21930 ......... ............ A Remove lesion, back or flank ...................... 4.99 5.73 3.40 0.63 11.35 9.02 090 

21935 ......... ............ A Remove tumor, back ................................... 17.93 NA 10.24 2.46 NA 30.63 090 

22100 ......... ............ A Remove part of neck vertebra ..................... 9.72 NA 7.73 1.68 NA 19.13 090 

22101 ......... ............ A Remove part, thorax vertebra ...................... 9.80 NA 7.99 1.80 NA 19.59 090 

47590

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

22102 ......... ............ A Remove part, lumbar vertebra ..................... 9.80 NA 8.25 1.57 NA 19.62 090 

22103 ......... ............ A Remove extra spine segment ...................... 2.34 NA 1.21 0.39 NA 3.94 ZZZ 

22110 ......... ............ A Remove part of neck vertebra ..................... 12.72 NA 9.38 2.24 NA 24.34 090 

22112 ......... ............ A Remove part, thorax vertebra ...................... 12.79 NA 9.46 1.92 NA 24.17 090 

22114 ......... ............ A Remove part, lumbar vertebra ..................... 12.79 NA 9.45 2.13 NA 24.37 090 

22116 ......... ............ A Remove extra spine segment ...................... 2.32 NA 1.16 0.41 NA 3.89 ZZZ 

22210 ......... ............ A Revision of neck spine ................................ 23.78 NA 15.63 4.60 NA 44.01 090 

22212 ......... ............ A Revision of thorax spine .............................. 19.39 NA 13.45 3.12 NA 35.96 090 

22214 ......... ............ A Revision of lumbar spine ............................. 19.42 NA 13.98 3.10 NA 36.50 090 

22216 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.12 1.05 NA 10.20 ZZZ 

22220 ......... ............ A Revision of neck spine ................................ 21.34 NA 13.87 3.43 NA 38.64 090 

22222 ......... ............ A Revision of thorax spine .............................. 21.49 NA 11.74 3.46 NA 36.69 090 

22224 ......... ............ A Revision of lumbar spine ............................. 21.49 NA 14.40 3.63 NA 39.52 090 

22226 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.08 1.05 NA 10.16 ZZZ 

22305 ......... ............ A Treat spine process fracture ........................ 2.05 2.31 1.92 0.33 4.69 4.30 090 

22310 ......... ............ A Treat spine fracture ..................................... 2.61 2.79 2.34 0.42 5.82 5.37 090 

22315 ......... ............ A Treat spine fracture ..................................... 8.83 9.68 7.32 1.60 20.11 17.75 090 

22318 ......... ............ A Treat odontoid fx w/o graft .......................... 21.47 NA 13.56 4.70 NA 39.73 090 

22319 ......... ............ A Treat odontoid fx w/graft .............................. 23.96 NA 14.97 5.38 NA 44.31 090 

22325 ......... ............ A Treat spine fracture ..................................... 18.27 NA 12.26 3.18 NA 33.71 090 

22326 ......... ............ A Treat neck spine fracture ............................. 19.56 NA 12.93 3.85 NA 36.34 090 

22327 ......... ............ A Treat thorax spine fracture .......................... 19.17 NA 12.55 3.21 NA 34.93 090 

22328 ......... ............ A Treat each add spine fx ............................... 4.60 NA 2.26 0.78 NA 7.64 ZZZ 

22505 ......... ............ A Manipulation of spine ................................... 1.87 NA 0.94 0.30 NA 3.11 010 

22520 ......... ............ A Percut vertebroplasty thor ........................... 8.90 99.93 5.09 1.43 110.26 15.42 010 

22521 ......... ............ A Percut vertebroplasty lumb .......................... 8.33 90.95 4.94 1.34 100.62 14.61 010 

22522 ......... ............ A Percut vertebroplasty add-l .......................... 4.30 NA 1.67 0.69 NA 6.66 ZZZ 

22532 ......... ............ A Lat thorax spine fusion ................................ 23.96 NA 14.84 3.78 NA 42.58 090 

22533 ......... ............ A Lat lumbar spine fusion ............................... 23.09 NA 13.60 2.80 NA 39.49 090 

22534 ......... ............ A Lat thor/lumb, add-l seg ............................... 5.99 NA 3.03 1.04 NA 10.06 ZZZ 

22548 ......... ............ A Neck spine fusion ........................................ 25.78 NA 15.79 5.15 NA 46.72 090 

22554 ......... ............ A Neck spine fusion ........................................ 18.59 NA 12.33 3.73 NA 34.65 090 

22556 ......... ............ A Thorax spine fusion ..................................... 23.42 NA 14.72 3.78 NA 41.92 090 

22558 ......... ............ A Lumbar spine fusion .................................... 22.25 NA 13.28 2.80 NA 38.33 090 

22585 ......... ............ A Additional spinal fusion ................................ 5.52 NA 2.79 1.04 NA 9.35 ZZZ 

22590 ......... ............ A Spine & skull spinal fusion .......................... 20.48 NA 13.31 4.31 NA 38.10 090 

22595 ......... ............ A Neck spinal fusion ....................................... 19.36 NA 12.82 3.88 NA 36.06 090 

22600 ......... ............ A Neck spine fusion ........................................ 16.12 NA 11.18 3.24 NA 30.54 090 

22610 ......... ............ A Thorax spine fusion ..................................... 16.00 NA 11.40 2.95 NA 30.35 090 

22612 ......... ............ A Lumbar spine fusion .................................... 20.97 NA 14.18 3.55 NA 38.70 090 

22614 ......... ............ A Spine fusion, extra segment ........................ 6.43 NA 3.35 1.14 NA 10.92 ZZZ 

22630 ......... ............ A Lumbar spine fusion .................................... 20.81 NA 13.59 3.86 NA 38.26 090 

22632 ......... ............ A Spine fusion, extra segment ........................ 5.22 NA 2.66 0.98 NA 8.86 ZZZ 

22800 ......... ............ A Fusion of spine ............................................ 18.22 NA 12.74 3.04 NA 34.00 090 

22802 ......... ............ A Fusion of spine ............................................ 30.83 NA 19.55 5.01 NA 55.39 090 

22804 ......... ............ A Fusion of spine ............................................ 36.22 NA 22.65 5.68 NA 64.55 090 

22808 ......... ............ A Fusion of spine ............................................ 26.23 NA 16.28 4.55 NA 47.06 090 

22810 ......... ............ A Fusion of spine ............................................ 30.22 NA 18.33 4.43 NA 52.98 090 

22812 ......... ............ A Fusion of spine ............................................ 32.65 NA 20.03 4.55 NA 57.23 090 

22818 ......... ............ A Kyphectomy, 1-2 segments ......................... 31.78 NA 18.85 6.00 NA 56.63 090 

22819 ......... ............ A Kyphectomy, 3 or more ............................... 36.39 NA 20.03 5.64 NA 62.06 090 

22830 ......... ............ A Exploration of spinal fusion ......................... 10.83 NA 7.95 1.89 NA 20.67 090 

22840 ......... ............ A Insert spine fixation device .......................... 12.52 NA 6.48 2.19 NA 21.19 ZZZ 

22842 ......... ............ A Insert spine fixation device .......................... 12.56 NA 6.49 2.21 NA 21.26 ZZZ 

22843 ......... ............ A Insert spine fixation device .......................... 13.44 NA 6.59 2.37 NA 22.40 ZZZ 

22844 ......... ............ A Insert spine fixation device .......................... 16.42 NA 8.73 2.63 NA 27.78 ZZZ 

22845 ......... ............ A Insert spine fixation device .......................... 11.94 NA 6.06 2.39 NA 20.39 ZZZ 

22846 ......... ............ A Insert spine fixation device .......................... 12.40 NA 6.32 2.47 NA 21.19 ZZZ 

22847 ......... ............ A Insert spine fixation device .......................... 13.78 NA 7.01 2.37 NA 23.16 ZZZ 

22848 ......... ............ A Insert pelv fixation device ............................ 5.99 NA 3.18 0.96 NA 10.13 ZZZ 

22849 ......... ............ A Reinsert spinal fixation ................................ 18.48 NA 11.86 3.14 NA 33.48 090 

22850 ......... ............ A Remove spine fixation device ...................... 9.51 NA 7.11 1.61 NA 18.23 090 

22851 ......... ............ A Apply spine prosth device ........................... 6.70 NA 3.35 1.23 NA 11.28 ZZZ 

22852 ......... ............ A Remove spine fixation device ...................... 9.00 NA 6.90 1.52 NA 17.42 090 

22855 ......... ............ A Remove spine fixation device ...................... 15.11 NA 9.79 2.90 NA 27.80 090 

22900 ......... ............ A Remove abdominal wall lesion .................... 5.79 NA 3.25 0.74 NA 9.78 090 

23000 ......... ............ A Removal of calcium deposits ....................... 4.35 8.62 4.42 0.59 13.56 9.36 090 

23020 ......... ............ A Release shoulder joint ................................. 8.92 NA 7.79 1.43 NA 18.14 090 

23030 ......... ............ A Drain shoulder lesion ................................... 3.42 7.42 2.90 0.53 11.37 6.85 010 

23031 ......... ............ A Drain shoulder bursa ................................... 2.74 7.91 2.72 0.44 11.09 5.90 010 

23035 ......... ............ A Drain shoulder bone lesion .......................... 8.60 NA 8.72 1.38 NA 18.70 090 

23040 ......... ............ A Exploratory shoulder surgery ....................... 9.19 NA 8.09 1.50 NA 18.78 090 

23044 ......... ............ A Exploratory shoulder surgery ....................... 7.11 NA 6.71 1.19 NA 15.01 090 

23065 ......... ............ A Biopsy shoulder tissues ............................... 2.27 2.48 1.62 0.24 4.99 4.13 010 

23066 ......... ............ A Biopsy shoulder tissues ............................... 4.15 7.70 3.98 0.62 12.47 8.75 090 

47591

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

23075 ......... ............ A Removal of shoulder lesion ......................... 2.39 3.68 1.78 0.33 6.40 4.50 010 

23076 ......... ............ A Removal of shoulder lesion ......................... 7.62 NA 5.86 1.11 NA 14.59 090 

23077 ......... ............ A Remove tumor of shoulder .......................... 16.07 NA 10.90 2.27 NA 29.24 090 

23100 ......... ............ A Biopsy of shoulder joint ............................... 6.02 NA 5.89 0.96 NA 12.87 090 

23101 ......... ............ A Shoulder joint surgery .................................. 5.57 NA 5.58 0.91 NA 12.06 090 

23105 ......... ............ A Remove shoulder joint lining ....................... 8.22 NA 7.39 1.32 NA 16.93 090 

23106 ......... ............ A Incision of collarbone joint ........................... 5.95 NA 5.94 0.83 NA 12.72 090 

23107 ......... ............ A Explore treat shoulder joint .......................... 8.61 NA 7.60 1.40 NA 17.61 090 

23120 ......... ............ A Partial removal, collar bone ......................... 7.10 NA 6.69 1.13 NA 14.92 090 

23125 ......... ............ A Removal of collar bone ................................ 9.38 NA 7.81 1.45 NA 18.64 090 

23130 ......... ............ A Remove shoulder bone, part ....................... 7.54 NA 7.33 1.27 NA 16.14 090 

23140 ......... ............ A Removal of bone lesion ............................... 6.88 NA 5.50 0.99 NA 13.37 090 

23145 ......... ............ A Removal of bone lesion ............................... 9.08 NA 7.79 1.42 NA 18.29 090 

23146 ......... ............ A Removal of bone lesion ............................... 7.82 NA 7.38 1.13 NA 16.33 090 

23150 ......... ............ A Removal of humerus lesion ......................... 8.47 NA 7.15 1.24 NA 16.86 090 

23155 ......... ............ A Removal of humerus lesion ......................... 10.33 NA 8.68 1.48 NA 20.49 090 

23156 ......... ............ A Removal of humerus lesion ......................... 8.67 NA 7.60 1.36 NA 17.63 090 

23170 ......... ............ A Remove collar bone lesion .......................... 6.85 NA 6.54 1.10 NA 14.49 090 

23172 ......... ............ A Remove shoulder blade lesion .................... 6.89 NA 6.63 0.95 NA 14.47 090 

23174 ......... ............ A Remove humerus lesion .............................. 9.50 NA 8.63 1.56 NA 19.69 090 

23180 ......... ............ A Remove collar bone lesion .......................... 8.52 NA 9.43 1.47 NA 19.42 090 

23182 ......... ............ A Remove shoulder blade lesion .................... 8.14 NA 9.09 1.26 NA 18.49 090 

23184 ......... ............ A Remove humerus lesion .............................. 9.37 NA 9.78 1.50 NA 20.65 090 

23190 ......... ............ A Partial removal of scapula ........................... 7.23 NA 6.38 1.18 NA 14.79 090 

23195 ......... ............ A Removal of head of humerus ...................... 9.80 NA 7.95 1.18 NA 18.93 090 

23200 ......... ............ A Removal of collar bone ................................ 12.06 NA 9.14 1.69 NA 22.89 090 

23210 ......... ............ A Removal of shoulder blade .......................... 12.47 NA 9.49 2.01 NA 23.97 090 

23220 ......... ............ A Partial removal of humerus ......................... 14.54 NA 11.12 2.50 NA 28.16 090 

23221 ......... ............ A Partial removal of humerus ......................... 17.71 NA 12.01 2.33 NA 32.05 090 

23222 ......... ............ A Partial removal of humerus ......................... 23.88 NA 16.10 3.90 NA 43.88 090 

23330 ......... ............ A Remove shoulder foreign body ................... 1.85 3.75 1.88 0.24 5.84 3.97 010 

23331 ......... ............ A Remove shoulder foreign body ................... 7.37 NA 7.01 1.14 NA 15.52 090 

23332 ......... ............ A Remove shoulder foreign body ................... 11.60 NA 9.53 1.85 NA 22.98 090 

23350 ......... ............ A Injection for shoulder x-ray .......................... 1.00 3.52 0.33 0.06 4.58 1.39 000 

23395 ......... ............ A Muscle transfer,shoulder/arm ...................... 16.82 NA 12.97 2.56 NA 32.35 090 

23397 ......... ............ A Muscle transfers .......................................... 16.11 NA 11.57 2.62 NA 30.30 090 

23400 ......... ............ A Fixation of shoulder blade ........................... 13.52 NA 10.38 2.07 NA 25.97 090 

23405 ......... ............ A Incision of tendon & muscle ........................ 8.36 NA 7.15 1.29 NA 16.80 090 

23406 ......... ............ A Incise tendon(s) & muscle(s) ....................... 10.77 NA 8.60 1.72 NA 21.09 090 

23410 ......... ............ A Repair rotator cuff, acute ............................. 12.43 NA 9.61 1.95 NA 23.99 090 

23412 ......... ............ A Repair rotator cuff, chronic .......................... 13.29 NA 10.10 2.08 NA 25.47 090 

23415 ......... ............ A Release of shoulder ligament ...................... 9.96 NA 8.15 1.70 NA 19.81 090 

23420 ......... ............ A Repair of shoulder ....................................... 13.28 NA 11.06 2.10 NA 26.44 090 

23430 ......... ............ A Repair biceps tendon ................................... 9.97 NA 8.32 1.57 NA 19.86 090 

23440 ......... ............ A Remove/transplant tendon ........................... 10.46 NA 8.49 1.63 NA 20.58 090 

23450 ......... ............ A Repair shoulder capsule .............................. 13.38 NA 10.06 2.12 NA 25.56 090 

23455 ......... ............ A Repair shoulder capsule .............................. 14.35 NA 10.65 2.26 NA 27.26 090 

23460 ......... ............ A Repair shoulder capsule .............................. 15.35 NA 11.58 2.43 NA 29.36 090 

23462 ......... ............ A Repair shoulder capsule .............................. 15.28 NA 10.97 2.42 NA 28.67 090 

23465 ......... ............ A Repair shoulder capsule .............................. 15.83 NA 11.52 2.51 NA 29.86 090 

23466 ......... ............ A Repair shoulder capsule .............................. 14.20 NA 11.53 2.25 NA 27.98 090 

23470 ......... ............ A Reconstruct shoulder joint ........................... 17.12 NA 12.23 2.70 NA 32.05 090 

23472 ......... ............ A Reconstruct shoulder joint ........................... 21.07 NA 14.38 3.29 NA 38.74 090 

23480 ......... ............ A Revision of collar bone ................................ 11.16 NA 8.98 1.89 NA 22.03 090 

23485 ......... ............ A Revision of collar bone ................................ 13.41 NA 10.10 2.12 NA 25.63 090 

23490 ......... ............ A Reinforce clavicle ......................................... 11.84 NA 9.04 1.44 NA 22.32 090 

23491 ......... ............ A Reinforce shoulder bones ............................ 14.19 NA 10.91 2.29 NA 27.39 090 

23500 ......... ............ A Treat clavicle fracture .................................. 2.08 2.87 2.54 0.29 5.24 4.91 090 

23505 ......... ............ A Treat clavicle fracture .................................. 3.68 4.41 3.85 0.58 8.67 8.11 090 

23515 ......... ............ A Treat clavicle fracture .................................. 7.40 NA 6.70 1.16 NA 15.26 090 

23520 ......... ............ A Treat clavicle dislocation ............................. 2.16 2.86 2.75 0.32 5.34 5.23 090 

23525 ......... ............ A Treat clavicle dislocation ............................. 3.59 4.57 3.96 0.42 8.58 7.97 090 

23530 ......... ............ A Treat clavicle dislocation ............................. 7.30 NA 6.12 1.21 NA 14.63 090 

23532 ......... ............ A Treat clavicle dislocation ............................. 8.00 NA 7.11 1.17 NA 16.28 090 

23540 ......... ............ A Treat clavicle dislocation ............................. 2.23 2.87 2.41 0.27 5.37 4.91 090 

23545 ......... ............ A Treat clavicle dislocation ............................. 3.25 4.20 3.39 0.42 7.87 7.06 090 

23550 ......... ............ A Treat clavicle dislocation ............................. 7.23 NA 6.55 1.14 NA 14.92 090 

23552 ......... ............ A Treat clavicle dislocation ............................. 8.44 NA 7.46 1.27 NA 17.17 090 

23570 ......... ............ A Treat shoulder blade fx ................................ 2.23 3.01 2.90 0.35 5.59 5.48 090 

23575 ......... ............ A Treat shoulder blade fx ................................ 4.05 4.88 4.32 0.66 9.59 9.03 090 

23585 ......... ............ A Treat scapula fracture .................................. 8.95 NA 7.80 1.44 NA 18.19 090 

23600 ......... ............ A Treat humerus fracture ................................ 2.93 4.54 3.57 0.46 7.93 6.96 090 

23605 ......... ............ A Treat humerus fracture ................................ 4.86 6.14 5.11 0.81 11.81 10.78 090 

23615 ......... ............ A Treat humerus fracture ................................ 9.34 NA 8.97 1.51 NA 19.82 090 

23616 ......... ............ A Treat humerus fracture ................................ 21.24 NA 14.28 3.37 NA 38.89 090 

47592

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

23620 ......... ............ A Treat humerus fracture ................................ 2.40 3.61 3.00 0.38 6.39 5.78 090 

23625 ......... ............ A Treat humerus fracture ................................ 3.92 4.93 4.28 0.64 9.49 8.84 090 

23630 ......... ............ A Treat humerus fracture ................................ 7.34 NA 6.77 1.18 NA 15.29 090 

23650 ......... ............ A Treat shoulder dislocation ........................... 3.38 3.80 2.81 0.30 7.48 6.49 090 

23655 ......... ............ A Treat shoulder dislocation ........................... 4.56 NA 4.24 0.62 NA 9.42 090 

23660 ......... ............ A Treat shoulder dislocation ........................... 7.48 NA 6.53 1.22 NA 15.23 090 

23665 ......... ............ A Treat dislocation/fracture ............................. 4.46 5.33 4.72 0.70 10.49 9.88 090 

23670 ......... ............ A Treat dislocation/fracture ............................. 7.89 NA 7.00 1.25 NA 16.14 090 

23675 ......... ............ A Treat dislocation/fracture ............................. 6.04 6.83 5.82 0.97 13.84 12.83 090 

23680 ......... ............ A Treat dislocation/fracture ............................. 10.04 NA 8.27 1.61 NA 19.92 090 

23700 ......... ............ A Fixation of shoulder ..................................... 2.52 NA 2.17 0.43 NA 5.12 010 

23800 ......... ............ A Fusion of shoulder joint ............................... 14.14 NA 10.68 2.34 NA 27.16 090 

23802 ......... ............ A Fusion of shoulder joint ............................... 16.58 NA 10.41 2.45 NA 29.44 090 

23900 ......... ............ A Amputation of arm & girdle .......................... 19.69 NA 12.03 3.04 NA 34.76 090 

23920 ......... ............ A Amputation at shoulder joint ........................ 14.59 NA 10.26 2.21 NA 27.06 090 

23921 ......... ............ A Amputation follow-up surgery ...................... 5.48 NA 5.09 0.90 NA 11.47 090 

23930 ......... ............ A Drainage of arm lesion ................................ 2.94 6.36 2.31 0.41 9.71 5.66 010 

23931 ......... ............ A Drainage of arm bursa ................................. 1.79 5.93 2.17 0.26 7.98 4.22 010 

23935 ......... ............ A Drain arm/elbow bone lesion ....................... 6.08 NA 6.43 0.98 NA 13.49 090 

24000 ......... ............ A Exploratory elbow surgery ........................... 5.81 NA 5.50 0.93 NA 12.24 090 

24006 ......... ............ A Release elbow joint ..................................... 9.30 NA 7.85 1.48 NA 18.63 090 

24065 ......... ............ A Biopsy arm/elbow soft tissue ....................... 2.08 3.22 1.75 0.22 5.52 4.05 010 

24066 ......... ............ A Biopsy arm/elbow soft tissue ....................... 5.20 8.95 4.14 0.77 14.92 10.11 090 

24075 ......... ............ A Remove arm/elbow lesion ........................... 3.91 7.37 3.41 0.54 11.82 7.86 090 

24076 ......... ............ A Remove arm/elbow lesion ........................... 6.29 NA 5.17 0.91 NA 12.37 090 

24077 ......... ............ A Remove tumor of arm/elbow ....................... 11.74 NA 8.85 1.67 NA 22.26 090 

24100 ......... ............ A Biopsy elbow joint lining .............................. 4.92 NA 4.64 0.78 NA 10.34 090 

24101 ......... ............ A Explore/treat elbow joint .............................. 6.12 NA 6.02 1.01 NA 13.15 090 

24102 ......... ............ A Remove elbow joint lining ............................ 8.02 NA 6.97 1.27 NA 16.26 090 

24105 ......... ............ A Removal of elbow bursa .............................. 3.60 NA 4.50 0.60 NA 8.70 090 

24110 ......... ............ A Remove humerus lesion .............................. 7.38 NA 6.93 1.21 NA 15.52 090 

24115 ......... ............ A Remove/graft bone lesion ............................ 9.62 NA 7.54 1.36 NA 18.52 090 

24116 ......... ............ A Remove/graft bone lesion ............................ 11.79 NA 9.31 2.05 NA 23.15 090 

24120 ......... ............ A Remove elbow lesion .................................. 6.64 NA 6.02 1.07 NA 13.73 090 

24125 ......... ............ A Remove/graft bone lesion ............................ 7.88 NA 6.27 0.73 NA 14.88 090 

24126 ......... ............ A Remove/graft bone lesion ............................ 8.30 NA 7.10 1.13 NA 16.53 090 

24130 ......... ............ A Removal of head of radius .......................... 6.24 NA 6.11 1.03 NA 13.38 090 

24134 ......... ............ A Removal of arm bone lesion ....................... 9.72 NA 9.38 1.52 NA 20.62 090 

24136 ......... ............ A Remove radius bone lesion ......................... 7.98 NA 7.41 1.29 NA 16.68 090 

24138 ......... ............ A Remove elbow bone lesion ......................... 8.04 NA 7.86 1.29 NA 17.19 090 

24140 ......... ............ A Partial removal of arm bone ........................ 9.17 NA 9.76 1.45 NA 20.38 090 

24145 ......... ............ A Partial removal of radius .............................. 7.57 NA 8.27 1.22 NA 17.06 090 

24147 ......... ............ A Partial removal of elbow .............................. 7.53 NA 8.80 1.26 NA 17.59 090 

24149 ......... ............ A Radical resection of elbow .......................... 14.18 NA 11.65 2.23 NA 28.06 090 

24150 ......... ............ A Extensive humerus surgery ......................... 13.25 NA 10.35 2.15 NA 25.75 090 

24151 ......... ............ A Extensive humerus surgery ......................... 15.56 NA 11.94 1.27 NA 28.77 090 

24152 ......... ............ A Extensive radius surgery ............................. 10.04 NA 7.99 1.01 NA 19.04 090 

24153 ......... ............ A Extensive radius surgery ............................. 11.52 NA 5.74 0.70 NA 17.96 090 

24155 ......... ............ A Removal of elbow joint ................................ 11.71 NA 8.51 1.82 NA 22.04 090 

24160 ......... ............ A Remove elbow joint implant ........................ 7.82 NA 6.88 1.26 NA 15.96 090 

24164 ......... ............ A Remove radius head implant ....................... 6.22 NA 5.76 1.01 NA 12.99 090 

24200 ......... ............ A Removal of arm foreign body ...................... 1.76 3.45 1.63 0.19 5.40 3.58 010 

24201 ......... ............ A Removal of arm foreign body ...................... 4.55 9.85 4.23 0.68 15.08 9.46 090 

24220 ......... ............ A Injection for elbow x-ray .............................. 1.31 3.71 0.44 0.08 5.10 1.83 000 

24300 ......... ............ A Manipulate elbow w/anesth ......................... 3.74 NA 5.62 0.63 NA 9.99 090 

24301 ......... ............ A Muscle/tendon transfer ................................ 10.18 NA 8.32 1.64 NA 20.14 090 

24305 ......... ............ A Arm tendon lengthening .............................. 7.44 NA 6.83 1.13 NA 15.40 090 

24310 ......... ............ A Revision of arm tendon ............................... 5.97 NA 5.91 0.91 NA 12.79 090 

24320 ......... ............ A Repair of arm tendon ................................... 10.54 NA 7.93 1.72 NA 20.19 090 

24330 ......... ............ A Revision of arm muscles ............................. 9.59 NA 8.02 1.51 NA 19.12 090 

24331 ......... ............ A Revision of arm muscles ............................. 10.63 NA 8.75 1.33 NA 20.71 090 

24332 ......... ............ A Tenolysis, triceps ......................................... 7.44 NA 6.70 1.19 NA 15.33 090 

24340 ......... ............ A Repair of biceps tendon .............................. 7.88 NA 7.07 1.27 NA 16.22 090 

24341 ......... ............ A Repair arm tendon/muscle .......................... 7.89 NA 7.97 1.26 NA 17.12 090 

24342 ......... ............ A Repair of ruptured tendon ........................... 10.60 NA 8.61 1.69 NA 20.90 090 

24343 ......... ............ A Repr elbow lat ligmnt w/tiss ......................... 8.64 NA 8.07 1.39 NA 18.10 090 

24344 ......... ............ A Reconstruct elbow lat ligmnt ....................... 13.98 NA 11.43 2.25 NA 27.66 090 

24345 ......... ............ A Repr elbw med ligmnt w/tissu ..................... 8.64 NA 7.95 1.40 NA 17.99 090 

24346 ......... ............ A Reconstruct elbow med ligmnt .................... 13.98 NA 11.25 2.04 NA 27.27 090 

24350 ......... ............ A Repair of tennis elbow ................................. 5.24 NA 5.68 0.86 NA 11.78 090 

24351 ......... ............ A Repair of tennis elbow ................................. 5.90 NA 6.02 0.98 NA 12.90 090 

24352 ......... ............ A Repair of tennis elbow ................................. 6.42 NA 6.28 1.09 NA 13.79 090 

24354 ......... ............ A Repair of tennis elbow ................................. 6.47 NA 6.24 1.11 NA 13.82 090 

24356 ......... ............ A Revision of tennis elbow .............................. 6.67 NA 6.42 1.08 NA 14.17 090 

24360 ......... ............ A Reconstruct elbow joint ............................... 12.32 NA 9.46 1.92 NA 23.70 090 

47593

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

24361 ......... ............ A Reconstruct elbow joint ............................... 14.06 NA 10.56 2.10 NA 26.72 090 

24362 ......... ............ A Reconstruct elbow joint ............................... 14.97 NA 10.04 2.30 NA 27.31 090 

24363 ......... ............ A Replace elbow joint ..................................... 18.46 NA 13.69 2.84 NA 34.99 090 

24365 ......... ............ A Reconstruct head of radius ......................... 8.38 NA 7.19 1.39 NA 16.96 090 

24366 ......... ............ A Reconstruct head of radius ......................... 9.12 NA 7.53 1.47 NA 18.12 090 

24400 ......... ............ A Revision of humerus .................................... 11.04 NA 9.14 1.82 NA 22.00 090 

24410 ......... ............ A Revision of humerus .................................... 14.80 NA 10.60 2.57 NA 27.97 090 

24420 ......... ............ A Revision of humerus .................................... 13.42 NA 10.90 2.07 NA 26.39 090 

24430 ......... ............ A Repair of humerus ....................................... 12.79 NA 9.97 2.04 NA 24.80 090 

24435 ......... ............ A Repair humerus with graft ........................... 13.15 NA 11.12 2.10 NA 26.37 090 

24470 ......... ............ A Revision of elbow joint ................................. 8.73 NA 7.80 0.77 NA 17.30 090 

24495 ......... ............ A Decompression of forearm .......................... 8.11 NA 8.94 1.18 NA 18.23 090 

24498 ......... ............ A Reinforce humerus ...................................... 11.90 NA 9.50 1.93 NA 23.33 090 

24500 ......... ............ A Treat humerus fracture ................................ 3.21 4.86 3.71 0.48 8.55 7.40 090 

24505 ......... ............ A Treat humerus fracture ................................ 5.16 6.59 5.39 0.86 12.61 11.41 090 

24515 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.55 1.88 NA 23.06 090 

24516 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.31 1.88 NA 22.82 090 

24530 ......... ............ A Treat humerus fracture ................................ 3.49 5.20 4.05 0.55 9.24 8.09 090 

24535 ......... ............ A Treat humerus fracture ................................ 6.86 7.83 6.62 1.16 15.85 14.64 090 

24538 ......... ............ A Treat humerus fracture ................................ 9.42 NA 8.89 1.51 NA 19.82 090 

24545 ......... ............ A Treat humerus fracture ................................ 10.44 NA 8.60 1.70 NA 20.74 090 

24546 ......... ............ A Treat humerus fracture ................................ 15.67 NA 11.50 2.52 NA 29.69 090 

24560 ......... ............ A Treat humerus fracture ................................ 2.80 4.49 3.22 0.39 7.68 6.41 090 

24565 ......... ............ A Treat humerus fracture ................................ 5.55 6.62 5.52 0.94 13.11 12.01 090 

24566 ......... ............ A Treat humerus fracture ................................ 7.78 NA 8.34 1.33 NA 17.45 090 

24575 ......... ............ A Treat humerus fracture ................................ 10.64 NA 8.44 1.70 NA 20.78 090 

24576 ......... ............ A Treat humerus fracture ................................ 2.86 4.77 3.73 0.42 8.05 7.01 090 

24577 ......... ............ A Treat humerus fracture ................................ 5.78 6.92 5.83 0.97 13.67 12.58 090 

24579 ......... ............ A Treat humerus fracture ................................ 11.58 NA 9.02 1.89 NA 22.49 090 

24582 ......... ............ A Treat humerus fracture ................................ 8.54 NA 9.26 1.48 NA 19.28 090 

24586 ......... ............ A Treat elbow fracture ..................................... 15.19 NA 11.26 2.45 NA 28.90 090 

24587 ......... ............ A Treat elbow fracture ..................................... 15.14 NA 11.05 2.23 NA 28.42 090 

24600 ......... ............ A Treat elbow dislocation ................................ 4.22 4.86 3.53 0.47 9.55 8.22 090 

24605 ......... ............ A Treat elbow dislocation ................................ 5.41 NA 5.41 0.87 NA 11.69 090 

24615 ......... ............ A Treat elbow dislocation ................................ 9.41 NA 7.87 1.53 NA 18.81 090 

24620 ......... ............ A Treat elbow fracture ..................................... 6.97 NA 6.27 1.07 NA 14.31 090 

24635 ......... ............ A Treat elbow fracture ..................................... 13.17 NA 14.21 2.17 NA 29.55 090 

24640 ......... ............ A Treat elbow dislocation ................................ 1.20 1.85 0.81 0.13 3.18 2.14 010 

24650 ......... ............ A Treat radius fracture .................................... 2.16 3.79 2.78 0.33 6.28 5.27 090 

24655 ......... ............ A Treat radius fracture .................................... 4.39 5.95 4.80 0.70 11.04 9.89 090 

24665 ......... ............ A Treat radius fracture .................................... 8.13 NA 7.69 1.35 NA 17.17 090 

24666 ......... ............ A Treat radius fracture .................................... 9.48 NA 8.25 1.55 NA 19.28 090 

24670 ......... ............ A Treat ulnar fracture ...................................... 2.54 4.11 3.09 0.38 7.03 6.01 090 

24675 ......... ............ A Treat ulnar fracture ...................................... 4.71 6.00 4.97 0.77 11.48 10.45 090 

24685 ......... ............ A Treat ulnar fracture ...................................... 8.79 NA 7.72 1.43 NA 17.94 090 

24800 ......... ............ A Fusion of elbow joint .................................... 11.18 NA 8.87 1.63 NA 21.68 090 

24802 ......... ............ A Fusion/graft of elbow joint ........................... 13.67 NA 10.49 2.16 NA 26.32 090 

24900 ......... ............ A Amputation of upper arm ............................. 9.59 NA 7.49 1.44 NA 18.52 090 

24920 ......... ............ A Amputation of upper arm ............................. 9.53 NA 7.71 1.48 NA 18.72 090 

24925 ......... ............ A Amputation follow-up surgery ...................... 7.06 NA 6.44 1.12 NA 14.62 090 

24930 ......... ............ A Amputation follow-up surgery ...................... 10.23 NA 7.66 1.53 NA 19.42 090 

24931 ......... ............ A Amputate upper arm & implant ................... 12.70 NA 6.10 1.88 NA 20.68 090 

24935 ......... ............ A Revision of amputation ................................ 15.54 NA 8.40 2.05 NA 25.99 090 

25000 ......... ............ A Incision of tendon sheath ............................ 3.37 NA 6.96 0.53 NA 10.86 090 

25001 ......... ............ A Incise flexor carpi radialis ............................ 3.37 NA 4.16 0.52 NA 8.05 090 

25020 ......... ............ A Decompress forearm 1 space ..................... 5.91 NA 9.84 0.95 NA 16.70 090 

25023 ......... ............ A Decompress forearm 1 space ..................... 12.94 NA 15.33 1.91 NA 30.18 090 

25024 ......... ............ A Decompress forearm 2 spaces ................... 9.49 NA 7.51 1.10 NA 18.10 090 

25025 ......... ............ A Decompress forearm 2 spaces ................... 16.52 NA 9.99 1.79 NA 28.30 090 

25028 ......... ............ A Drainage of forearm lesion .......................... 5.24 NA 8.40 0.78 NA 14.42 090 

25031 ......... ............ A Drainage of forearm bursa .......................... 4.13 NA 8.21 0.63 NA 12.97 090 

25035 ......... ............ A Treat forearm bone lesion ........................... 7.35 NA 13.88 1.21 NA 22.44 090 

25040 ......... ............ A Explore/treat wrist joint ................................ 7.17 NA 7.40 1.15 NA 15.72 090 

25065 ......... ............ A Biopsy forearm soft tissues ......................... 1.99 3.23 1.90 0.20 5.42 4.09 010 

25066 ......... ............ A Biopsy forearm soft tissues ......................... 4.12 NA 7.18 0.62 NA 11.92 090 

25075 ......... ............ A Removel forearm lesion subcu .................... 3.73 NA 6.06 0.52 NA 10.31 090 

25076 ......... ............ A Removel forearm lesion deep ..................... 4.91 NA 9.83 0.74 NA 15.48 090 

25077 ......... ............ A Remove tumor, forearm/wrist ...................... 9.75 NA 12.53 1.38 NA 23.66 090 

25085 ......... ............ A Incision of wrist capsule .............................. 5.49 NA 7.40 0.84 NA 13.73 090 

25100 ......... ............ A Biopsy of wrist joint ...................................... 3.89 NA 5.49 0.58 NA 9.96 090 

25101 ......... ............ A Explore/treat wrist joint ................................ 4.68 NA 6.06 0.51 NA 11.25 090 

25105 ......... ............ A Remove wrist joint lining .............................. 5.84 NA 7.58 0.91 NA 14.33 090 

25107 ......... ............ A Remove wrist joint cartilage ........................ 6.42 NA 8.54 0.97 NA 15.93 090 

25110 ......... ............ A Remove wrist tendon lesion ........................ 3.91 NA 7.20 0.60 NA 11.71 090 

25111 ......... ............ A Remove wrist tendon lesion ........................ 3.38 NA 4.89 0.52 NA 8.79 090 

47594

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

25112 ......... ............ A Reremove wrist tendon lesion ..................... 4.52 NA 5.49 0.70 NA 10.71 090 

25115 ......... ............ A Remove wrist/forearm lesion ....................... 8.81 NA 14.32 1.31 NA 24.44 090 

25116 ......... ............ A Remove wrist/forearm lesion ....................... 7.10 NA 13.40 1.08 NA 21.58 090 

25118 ......... ............ A Excise wrist tendon sheath .......................... 4.36 NA 5.97 0.68 NA 11.01 090 

25119 ......... ............ A Partial removal of ulna ................................. 6.03 NA 7.86 0.90 NA 14.79 090 

25120 ......... ............ A Removal of forearm lesion .......................... 6.09 NA 12.28 0.99 NA 19.36 090 

25125 ......... ............ A Remove/graft forearm lesion ....................... 7.47 NA 13.08 1.14 NA 21.69 090 

25126 ......... ............ A Remove/graft forearm lesion ....................... 7.54 NA 13.15 1.16 NA 21.85 090 

25130 ......... ............ A Removal of wrist lesion ............................... 5.25 NA 6.61 0.81 NA 12.67 090 

25135 ......... ............ A Remove & graft wrist lesion ........................ 6.88 NA 7.64 0.93 NA 15.45 090 

25136 ......... ............ A Remove & graft wrist lesion ........................ 5.96 NA 6.77 0.89 NA 13.62 090 

25145 ......... ............ A Remove forearm bone lesion ...................... 6.36 NA 12.33 0.91 NA 19.60 090 

25150 ......... ............ A Partial removal of ulna ................................. 7.08 NA 8.50 1.11 NA 16.69 090 

25151 ......... ............ A Partial removal of radius .............................. 7.38 NA 12.93 1.12 NA 21.43 090 

25170 ......... ............ A Extensive forearm surgery ........................... 11.07 NA 15.29 1.69 NA 28.05 090 

25210 ......... ............ A Removal of wrist bone ................................. 5.94 NA 7.00 0.87 NA 13.81 090 

25215 ......... ............ A Removal of wrist bones ............................... 7.88 NA 9.00 1.20 NA 18.08 090 

25230 ......... ............ A Partial removal of radius .............................. 5.22 NA 6.31 0.78 NA 12.31 090 

25240 ......... ............ A Partial removal of ulna ................................. 5.16 NA 7.18 0.80 NA 13.14 090 

25246 ......... ............ A Injection for wrist x-ray ................................ 1.45 3.48 0.48 0.09 5.02 2.02 000 

25248 ......... ............ A Remove forearm foreign body ..................... 5.13 NA 8.64 0.70 NA 14.47 090 

25250 ......... ............ A Removal of wrist prosthesis ........................ 6.59 NA 6.09 0.95 NA 13.63 090 

25251 ......... ............ A Removal of wrist prosthesis ........................ 9.56 NA 7.91 1.27 NA 18.74 090 

25259 ......... ............ A Manipulate wrist w/anesthes ....................... 3.74 NA 5.62 0.62 NA 9.98 090 

25260 ......... ............ A Repair forearm tendon/muscle .................... 7.79 NA 13.77 1.17 NA 22.73 090 

25263 ......... ............ A Repair forearm tendon/muscle .................... 7.81 NA 13.67 1.11 NA 22.59 090 

25265 ......... ............ A Repair forearm tendon/muscle .................... 9.87 NA 14.56 1.36 NA 25.79 090 

25270 ......... ............ A Repair forearm tendon/muscle .................... 5.99 NA 12.45 0.92 NA 19.36 090 

25272 ......... ............ A Repair forearm tendon/muscle .................... 7.03 NA 13.15 1.10 NA 21.28 090 

25274 ......... ............ A Repair forearm tendon/muscle .................... 8.74 NA 13.88 1.28 NA 23.90 090 

25275 ......... ............ A Repair forearm tendon sheath ..................... 8.49 NA 7.49 1.19 NA 17.17 090 

25280 ......... ............ A Revise wrist/forearm tendon ........................ 7.21 NA 12.88 1.07 NA 21.16 090 

25290 ......... ............ A Incise wrist/forearm tendon ......................... 5.28 NA 15.12 0.81 NA 21.21 090 

25295 ......... ............ A Release wrist/forearm tendon ...................... 6.54 NA 12.45 0.95 NA 19.94 090 

25300 ......... ............ A Fusion of tendons at wrist ........................... 8.79 NA 8.61 1.15 NA 18.55 090 

25301 ......... ............ A Fusion of tendons at wrist ........................... 8.39 NA 8.26 1.24 NA 17.89 090 

25310 ......... ............ A Transplant forearm tendon .......................... 8.13 NA 13.29 1.17 NA 22.59 090 

25312 ......... ............ A Transplant forearm tendon .......................... 9.56 NA 14.17 1.37 NA 25.10 090 

25315 ......... ............ A Revise palsy hand tendon(s) ....................... 10.18 NA 14.74 1.52 NA 26.44 090 

25316 ......... ............ A Revise palsy hand tendon(s) ....................... 12.31 NA 16.51 2.07 NA 30.89 090 

25320 ......... ............ A Repair/revise wrist joint ............................... 10.75 NA 11.40 1.58 NA 23.73 090 

25332 ......... ............ A Revise wrist joint .......................................... 11.39 NA 9.15 1.72 NA 22.26 090 

25335 ......... ............ A Realignment of hand ................................... 12.86 NA 11.80 2.00 NA 26.66 090 

25337 ......... ............ A Reconstruct ulna/radioulnar ......................... 10.15 NA 11.24 1.57 NA 22.96 090 

25350 ......... ............ A Revision of radius ........................................ 8.77 NA 14.12 1.36 NA 24.25 090 

25355 ......... ............ A Revision of radius ........................................ 10.15 NA 14.74 1.39 NA 26.28 090 

25360 ......... ............ A Revision of ulna ........................................... 8.42 NA 14.01 1.36 NA 23.79 090 

25365 ......... ............ A Revise radius & ulna ................................... 12.38 NA 15.77 2.03 NA 30.18 090 

25370 ......... ............ A Revise radius or ulna ................................... 13.34 NA 16.19 2.27 NA 31.80 090 

25375 ......... ............ A Revise radius & ulna ................................... 13.02 NA 16.55 2.22 NA 31.79 090 

25390 ......... ............ A Shorten radius or ulna ................................. 10.38 NA 14.74 1.55 NA 26.67 090 

25391 ......... ............ A Lengthen radius or ulna ............................... 13.63 NA 16.70 2.17 NA 32.50 090 

25392 ......... ............ A Shorten radius & ulna .................................. 13.93 NA 16.09 2.15 NA 32.17 090 

25393 ......... ............ A Lengthen radius & ulna ............................... 15.85 NA 17.71 2.76 NA 36.32 090 

25394 ......... ............ A Repair carpal bone, shorten ........................ 10.38 NA 8.05 1.31 NA 19.74 090 

25400 ......... ............ A Repair radius or ulna ................................... 10.90 NA 15.32 1.73 NA 27.95 090 

25405 ......... ............ A Repair/graft radius or ulna ........................... 14.36 NA 17.42 2.27 NA 34.05 090 

25415 ......... ............ A Repair radius & ulna .................................... 13.33 NA 16.64 2.07 NA 32.04 090 

25420 ......... ............ A Repair/graft radius & ulna ............................ 16.31 NA 18.41 2.58 NA 37.30 090 

25425 ......... ............ A Repair/graft radius or ulna ........................... 13.19 NA 21.64 1.91 NA 36.74 090 

25426 ......... ............ A Repair/graft radius & ulna ............................ 15.80 NA 16.70 1.39 NA 33.89 090 

25430 ......... ............ A Vasc graft into carpal bone ......................... 9.24 NA 7.21 1.25 NA 17.70 090 

25431 ......... ............ A Repair nonunion carpal bone ...................... 10.42 NA 8.33 1.69 NA 20.44 090 

25440 ......... ............ A Repair/graft wrist bone ................................ 10.42 NA 9.51 1.50 NA 21.43 090 

25441 ......... ............ A Reconstruct wrist joint ................................. 12.88 NA 9.98 2.06 NA 24.92 090 

25442 ......... ............ A Reconstruct wrist joint ................................. 10.83 NA 8.86 1.51 NA 21.20 090 

25443 ......... ............ A Reconstruct wrist joint ................................. 10.37 NA 8.75 1.66 NA 20.78 090 

25444 ......... ............ A Reconstruct wrist joint ................................. 11.13 NA 9.01 1.53 NA 21.67 090 

25445 ......... ............ A Reconstruct wrist joint ................................. 9.68 NA 7.97 1.52 NA 19.17 090 

25446 ......... ............ A Wrist replacement ........................................ 16.53 NA 11.90 2.43 NA 30.86 090 

25447 ......... ............ A Repair wrist joint(s) ...................................... 10.35 NA 8.63 1.53 NA 20.51 090 

25449 ......... ............ A Remove wrist joint implant .......................... 14.47 NA 10.64 2.08 NA 27.19 090 

25450 ......... ............ A Revision of wrist joint ................................... 7.86 NA 10.31 1.22 NA 19.39 090 

25455 ......... ............ A Revision of wrist joint ................................... 9.48 NA 11.25 1.21 NA 21.94 090 

25490 ......... ............ A Reinforce radius ........................................... 9.53 NA 13.89 1.38 NA 24.80 090 

47595

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

25491 ......... ............ A Reinforce ulna .............................................. 9.95 NA 14.66 1.52 NA 26.13 090 

25492 ......... ............ A Reinforce radius and ulna ........................... 12.31 NA 15.43 2.14 NA 29.88 090 

25500 ......... ............ A Treat fracture of radius ................................ 2.45 3.59 2.74 0.33 6.37 5.52 090 

25505 ......... ............ A Treat fracture of radius ................................ 5.20 6.54 5.43 0.82 12.56 11.45 090 

25515 ......... ............ A Treat fracture of radius ................................ 9.17 NA 7.65 1.47 NA 18.29 090 

25520 ......... ............ A Treat fracture of radius ................................ 6.25 6.86 6.06 1.02 14.13 13.33 090 

25525 ......... ............ A Treat fracture of radius ................................ 12.22 NA 10.16 1.97 NA 24.35 090 

25526 ......... ............ A Treat fracture of radius ................................ 12.96 NA 13.63 2.04 NA 28.63 090 

25530 ......... ............ A Treat fracture of ulna ................................... 2.09 3.77 2.88 0.32 6.18 5.29 090 

25535 ......... ............ A Treat fracture of ulna ................................... 5.13 6.02 5.29 0.83 11.98 11.25 090 

25545 ......... ............ A Treat fracture of ulna ................................... 8.89 NA 7.85 1.43 NA 18.17 090 

25560 ......... ............ A Treat fracture radius & ulna ......................... 2.44 3.71 2.64 0.33 6.48 5.41 090 

25565 ......... ............ A Treat fracture radius & ulna ......................... 5.62 6.70 5.43 0.90 13.22 11.95 090 

25574 ......... ............ A Treat fracture radius & ulna ......................... 7.00 NA 7.37 1.14 NA 15.51 090 

25575 ......... ............ A Treat fracture radius/ulna ............................ 10.43 NA 9.66 1.67 NA 21.76 090 

25600 ......... ............ A Treat fracture radius/ulna ............................ 2.63 4.09 2.99 0.39 7.11 6.01 090 

25605 ......... ............ A Treat fracture radius/ulna ............................ 5.80 7.22 6.21 0.96 13.98 12.97 090 

25611 ......... ............ A Treat fracture radius/ulna ............................ 7.76 NA 9.11 1.32 NA 18.19 090 

25620 ......... ............ A Treat fracture radius/ulna ............................ 8.54 NA 7.47 1.35 NA 17.36 090 

25622 ......... ............ A Treat wrist bone fracture ............................. 2.61 4.27 3.13 0.39 7.27 6.13 090 

25624 ......... ............ A Treat wrist bone fracture ............................. 4.52 6.30 5.08 0.72 11.54 10.32 090 

25628 ......... ............ A Treat wrist bone fracture ............................. 8.42 NA 8.04 1.30 NA 17.76 090 

25630 ......... ............ A Treat wrist bone fracture ............................. 2.88 4.19 2.97 0.43 7.50 6.28 090 

25635 ......... ............ A Treat wrist bone fracture ............................. 4.38 5.94 3.93 0.65 10.97 8.96 090 

25645 ......... ............ A Treat wrist bone fracture ............................. 7.24 NA 6.99 1.12 NA 15.35 090 

25650 ......... ............ A Treat wrist bone fracture ............................. 3.05 4.31 3.21 0.41 7.77 6.67 090 

25651 ......... ............ A Pin ulnar styloid fracture .............................. 5.35 NA 5.42 0.73 NA 11.50 090 

25652 ......... ............ A Treat fracture ulnar styloid ........................... 7.59 NA 6.94 1.19 NA 15.72 090 

25660 ......... ............ A Treat wrist dislocation .................................. 4.75 NA 4.76 0.64 NA 10.15 090 

25670 ......... ............ A Treat wrist dislocation .................................. 7.91 NA 7.27 1.23 NA 16.41 090 

25671 ......... ............ A Pin radioulnar dislocation ............................ 5.99 NA 6.07 0.93 NA 12.99 090 

25675 ......... ............ A Treat wrist dislocation .................................. 4.66 5.67 4.67 0.61 10.94 9.94 090 

25676 ......... ............ A Treat wrist dislocation .................................. 8.03 NA 7.53 1.34 NA 16.90 090 

25680 ......... ............ A Treat wrist fracture ....................................... 5.98 NA 4.85 0.73 NA 11.56 090 

25685 ......... ............ A Treat wrist fracture ....................................... 9.77 NA 8.05 1.53 NA 19.35 090 

25690 ......... ............ A Treat wrist dislocation .................................. 5.49 NA 5.57 0.89 NA 11.95 090 

25695 ......... ............ A Treat wrist dislocation .................................. 8.33 NA 7.38 1.32 NA 17.03 090 

25800 ......... ............ A Fusion of wrist joint ...................................... 9.75 NA 9.20 1.31 NA 20.26 090 

25805 ......... ............ A Fusion/graft of wrist joint ............................. 11.26 NA 10.35 1.79 NA 23.40 090 

25810 ......... ............ A Fusion/graft of wrist joint ............................. 10.55 NA 10.01 1.60 NA 22.16 090 

25820 ......... ............ A Fusion of hand bones .................................. 7.44 NA 7.99 1.11 NA 16.54 090 

25825 ......... ............ A Fuse hand bones with graft ......................... 9.26 NA 9.34 1.34 NA 19.94 090 

25830 ......... ............ A Fusion, radioulnar jnt/ulna ........................... 10.04 NA 14.57 1.39 NA 26.00 090 

25900 ......... ............ A Amputation of forearm ................................. 9.00 NA 12.73 1.36 NA 23.09 090 

25905 ......... ............ A Amputation of forearm ................................. 9.11 NA 12.65 1.28 NA 23.04 090 

25907 ......... ............ A Amputation follow-up surgery ...................... 7.79 NA 12.07 1.20 NA 21.06 090 

25909 ......... ............ A Amputation follow-up surgery ...................... 8.95 NA 12.60 1.21 NA 22.76 090 

25915 ......... ............ A Amputation of forearm ................................. 17.05 NA 19.33 1.13 NA 37.51 090 

25920 ......... ............ A Amputate hand at wrist ................................ 8.67 NA 8.07 1.33 NA 18.07 090 

25922 ......... ............ A Amputate hand at wrist ................................ 7.41 NA 7.30 1.29 NA 16.00 090 

25924 ......... ............ A Amputation follow-up surgery ...................... 8.45 NA 8.31 1.47 NA 18.23 090 

25927 ......... ............ A Amputation of hand ..................................... 8.79 NA 12.00 1.34 NA 22.13 090 

25929 ......... ............ A Amputation follow-up surgery ...................... 7.58 NA 6.15 1.27 NA 15.00 090 

25931 ......... ............ A Amputation follow-up surgery ...................... 7.80 NA 11.93 1.04 NA 20.77 090 

26010 ......... ............ A Drainage of finger abscess .......................... 1.54 5.60 1.64 0.17 7.31 3.35 010 

26011 ......... ............ A Drainage of finger abscess .......................... 2.19 8.81 2.32 0.32 11.32 4.83 010 

26020 ......... ............ A Drain hand tendon sheath ........................... 4.66 NA 5.73 0.72 NA 11.11 090 

26025 ......... ............ A Drainage of palm bursa ............................... 4.81 NA 5.52 0.74 NA 11.07 090 

26030 ......... ............ A Drainage of palm bursa(s) ........................... 5.92 NA 6.16 0.92 NA 13.00 090 

26034 ......... ............ A Treat hand bone lesion ................................ 6.22 NA 6.34 0.97 NA 13.53 090 

26035 ......... ............ A Decompress fingers/hand ............................ 9.50 NA 8.28 1.40 NA 19.18 090 

26037 ......... ............ A Decompress fingers/hand ............................ 7.24 NA 6.74 1.09 NA 15.07 090 

26040 ......... ............ A Release palm contracture ............................ 3.33 NA 4.04 0.54 NA 7.91 090 

26045 ......... ............ A Release palm contracture ............................ 5.55 NA 5.63 0.93 NA 12.11 090 

26055 ......... ............ A Incise finger tendon sheath ......................... 2.69 14.17 3.93 0.43 17.29 7.05 090 

26060 ......... ............ A Incision of finger tendon .............................. 2.81 NA 3.50 0.44 NA 6.75 090 

26070 ......... ............ A Explore/treat hand joint ................................ 3.68 NA 3.38 0.47 NA 7.53 090 

26075 ......... ............ A Explore/treat finger joint ............................... 3.78 NA 3.79 0.52 NA 8.09 090 

26080 ......... ............ A Explore/treat finger joint ............................... 4.23 NA 4.85 0.65 NA 9.73 090 

26100 ......... ............ A Biopsy hand joint lining ................................ 3.66 NA 4.13 0.54 NA 8.33 090 

26105 ......... ............ A Biopsy finger joint lining ............................... 3.70 NA 4.22 0.58 NA 8.50 090 

26110 ......... ............ A Biopsy finger joint lining ............................... 3.52 NA 4.03 0.53 NA 8.08 090 

26115 ......... ............ A Removel hand lesion subcut ....................... 3.85 13.01 4.76 0.59 17.45 9.20 090 

26116 ......... ............ A Removel hand lesion, deep ......................... 5.52 NA 5.99 0.82 NA 12.33 090 

26117 ......... ............ A Remove tumor, hand/finger ......................... 8.54 NA 7.05 1.24 NA 16.83 090 

47596

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

26121 ......... ............ A Release palm contracture ............................ 7.53 NA 6.95 1.17 NA 15.65 090 

26123 ......... ............ A Release palm contracture ............................ 9.28 NA 8.85 1.42 NA 19.55 090 

26125 ......... ............ A Release palm contracture ............................ 4.60 NA 2.44 0.70 NA 7.74 ZZZ 

26130 ......... ............ A Remove wrist joint lining .............................. 5.41 NA 5.33 0.97 NA 11.71 090 

26135 ......... ............ A Revise finger joint, each .............................. 6.95 NA 6.45 1.01 NA 14.41 090 

26140 ......... ............ A Revise finger joint, each .............................. 6.16 NA 6.03 0.92 NA 13.11 090 

26145 ......... ............ A Tendon excision, palm/finger ....................... 6.31 NA 6.04 0.98 NA 13.33 090 

26160 ......... ............ A Remove tendon sheath lesion ..................... 3.15 12.36 4.12 0.48 15.99 7.75 090 

26170 ......... ............ A Removal of palm tendon, each ................... 4.76 NA 4.93 0.71 NA 10.40 090 

26180 ......... ............ A Removal of finger tendon ............................ 5.17 NA 5.40 0.81 NA 11.38 090 

26185 ......... ............ A Remove finger bone .................................... 5.24 NA 6.02 0.72 NA 11.98 090 

26200 ......... ............ A Remove hand bone lesion ........................... 5.50 NA 5.35 0.87 NA 11.72 090 

26205 ......... ............ A Remove/graft bone lesion ............................ 7.69 NA 6.88 1.20 NA 15.77 090 

26210 ......... ............ A Removal of finger lesion .............................. 5.14 NA 5.41 0.79 NA 11.34 090 

26215 ......... ............ A Remove/graft finger lesion ........................... 7.09 NA 6.30 1.10 NA 14.49 090 

26230 ......... ............ A Partial removal of hand bone ...................... 6.32 NA 5.90 0.95 NA 13.17 090 

26235 ......... ............ A Partial removal, finger bone ........................ 6.18 NA 5.80 0.93 NA 12.91 090 

26236 ......... ............ A Partial removal, finger bone ........................ 5.31 NA 5.32 0.80 NA 11.43 090 

26250 ......... ............ A Extensive hand surgery ............................... 7.54 NA 6.42 1.21 NA 15.17 090 

26255 ......... ............ A Extensive hand surgery ............................... 12.41 NA 9.38 1.47 NA 23.26 090 

26260 ......... ............ A Extensive finger surgery .............................. 7.02 NA 6.17 1.05 NA 14.24 090 

26261 ......... ............ A Extensive finger surgery .............................. 9.08 NA 6.20 1.29 NA 16.57 090 

26262 ......... ............ A Partial removal of finger .............................. 5.66 NA 5.32 0.85 NA 11.83 090 

26320 ......... ............ A Removal of implant from hand .................... 3.97 NA 4.31 0.59 NA 8.87 090 

26340 ......... ............ A Manipulate finger w/anesth .......................... 2.50 NA 4.87 0.39 NA 7.76 090 

26350 ......... ............ A Repair finger/hand tendon ........................... 5.98 NA 15.28 0.85 NA 22.11 090 

26352 ......... ............ A Repair/graft hand tendon ............................. 7.67 NA 15.84 1.19 NA 24.70 090 

26356 ......... ............ A Repair finger/hand tendon ........................... 8.06 NA 18.75 1.22 NA 28.03 090 

26357 ......... ............ A Repair finger/hand tendon ........................... 8.57 NA 16.30 1.33 NA 26.20 090 

26358 ......... ............ A Repair/graft hand tendon ............................. 9.13 NA 17.19 1.34 NA 27.66 090 

26370 ......... ............ A Repair finger/hand tendon ........................... 7.10 NA 15.70 1.09 NA 23.89 090 

26372 ......... ............ A Repair/graft hand tendon ............................. 8.75 NA 17.07 1.27 NA 27.09 090 

26373 ......... ............ A Repair finger/hand tendon ........................... 8.15 NA 16.64 1.30 NA 26.09 090 

26390 ......... ............ A Revise hand/finger tendon ........................... 9.18 NA 13.77 1.35 NA 24.30 090 

26392 ......... ............ A Repair/graft hand tendon ............................. 10.24 NA 17.43 1.49 NA 29.16 090 

26410 ......... ............ A Repair hand tendon ..................................... 4.62 NA 12.40 0.72 NA 17.74 090 

26412 ......... ............ A Repair/graft hand tendon ............................. 6.30 NA 13.72 0.98 NA 21.00 090 

26415 ......... ............ A Excision, hand/finger tendon ....................... 8.33 NA 12.22 1.06 NA 21.61 090 

26416 ......... ............ A Graft hand or finger tendon ......................... 9.36 NA 15.03 1.18 NA 25.57 090 

26418 ......... ............ A Repair finger tendon .................................... 4.24 NA 12.78 0.65 NA 17.67 090 

26420 ......... ............ A Repair/graft finger tendon ............................ 6.76 NA 14.05 1.05 NA 21.86 090 

26426 ......... ............ A Repair finger/hand tendon ........................... 6.14 NA 13.57 0.96 NA 20.67 090 

26428 ......... ............ A Repair/graft finger tendon ............................ 7.20 NA 14.32 1.10 NA 22.62 090 

26432 ......... ............ A Repair finger tendon .................................... 4.01 NA 10.55 0.62 NA 15.18 090 

26433 ......... ............ A Repair finger tendon .................................... 4.55 NA 11.22 0.70 NA 16.47 090 

26434 ......... ............ A Repair/graft finger tendon ............................ 6.08 NA 11.92 0.88 NA 18.88 090 

26437 ......... ............ A Realignment of tendons ............................... 5.81 NA 11.84 0.89 NA 18.54 090 

26440 ......... ............ A Release palm/finger tendon ......................... 5.01 NA 13.94 0.76 NA 19.71 090 

26442 ......... ............ A Release palm & finger tendon ..................... 8.15 NA 16.43 1.16 NA 25.74 090 

26445 ......... ............ A Release hand/finger tendon ........................ 4.30 NA 13.70 0.66 NA 18.66 090 

26449 ......... ............ A Release forearm/hand tendon ..................... 6.99 NA 16.21 1.03 NA 24.23 090 

26450 ......... ............ A Incision of palm tendon ............................... 3.66 NA 7.53 0.58 NA 11.77 090 

26455 ......... ............ A Incision of finger tendon .............................. 3.63 NA 7.46 0.55 NA 11.64 090 

26460 ......... ............ A Incise hand/finger tendon ............................ 3.45 NA 7.28 0.51 NA 11.24 090 

26471 ......... ............ A Fusion of finger tendons .............................. 5.72 NA 11.52 0.88 NA 18.12 090 

26474 ......... ............ A Fusion of finger tendons .............................. 5.31 NA 11.69 0.74 NA 17.74 090 

26476 ......... ............ A Tendon lengthening ..................................... 5.17 NA 11.23 0.79 NA 17.19 090 

26477 ......... ............ A Tendon shortening ....................................... 5.14 NA 11.40 0.77 NA 17.31 090 

26478 ......... ............ A Lengthening of hand tendon ........................ 5.79 NA 12.09 0.94 NA 18.82 090 

26479 ......... ............ A Shortening of hand tendon .......................... 5.73 NA 11.94 0.90 NA 18.57 090 

26480 ......... ............ A Transplant hand tendon ............................... 6.68 NA 15.43 1.00 NA 23.11 090 

26483 ......... ............ A Transplant/graft hand tendon ...................... 8.28 NA 15.89 1.22 NA 25.39 090 

26485 ......... ............ A Transplant palm tendon ............................... 7.69 NA 15.77 1.09 NA 24.55 090 

26489 ......... ............ A Transplant/graft palm tendon ....................... 9.54 NA 12.39 1.18 NA 23.11 090 

26490 ......... ............ A Revise thumb tendon ................................... 8.40 NA 13.04 1.17 NA 22.61 090 

26492 ......... ............ A Tendon transfer with graft ........................... 9.61 NA 13.84 1.39 NA 24.84 090 

26494 ......... ............ A Hand tendon/muscle transfer ...................... 8.46 NA 13.47 1.21 NA 23.14 090 

26496 ......... ............ A Revise thumb tendon ................................... 9.58 NA 13.47 1.38 NA 24.43 090 

26497 ......... ............ A Finger tendon transfer ................................. 9.56 NA 13.82 1.46 NA 24.84 090 

26498 ......... ............ A Finger tendon transfer ................................. 13.98 NA 16.40 1.95 NA 32.33 090 

26499 ......... ............ A Revision of finger ......................................... 8.97 NA 13.40 1.30 NA 23.67 090 

26500 ......... ............ A Hand tendon reconstruction ........................ 5.95 NA 11.98 0.89 NA 18.82 090 

26502 ......... ............ A Hand tendon reconstruction ........................ 7.13 NA 12.45 1.03 NA 20.61 090 

26504 ......... ............ A Hand tendon reconstruction ........................ 7.46 NA 12.85 1.18 NA 21.49 090 

26508 ......... ............ A Release thumb contracture ......................... 6.00 NA 11.97 0.94 NA 18.91 090 

47597

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

26510 ......... ............ A Thumb tendon transfer ................................ 5.42 NA 11.65 0.77 NA 17.84 090 

26516 ......... ............ A Fusion of knuckle joint ................................. 7.14 NA 12.50 1.04 NA 20.68 090 

26517 ......... ............ A Fusion of knuckle joints ............................... 8.82 NA 13.82 1.49 NA 24.13 090 

26518 ......... ............ A Fusion of knuckle joints ............................... 9.01 NA 13.63 1.52 NA 24.16 090 

26520 ......... ............ A Release knuckle contracture ....................... 5.29 NA 14.38 0.80 NA 20.47 090 

26525 ......... ............ A Release finger contracture .......................... 5.32 NA 14.49 0.81 NA 20.62 090 

26530 ......... ............ A Revise knuckle joint ..................................... 6.68 NA 6.13 1.03 NA 13.84 090 

26531 ......... ............ A Revise knuckle with implant ........................ 7.90 NA 7.10 1.15 NA 16.15 090 

26535 ......... ............ A Revise finger joint ........................................ 5.23 NA 3.74 0.58 NA 9.55 090 

26536 ......... ............ A Revise/implant finger joint ........................... 6.36 NA 9.63 0.89 NA 16.88 090 

26540 ......... ............ A Repair hand joint ......................................... 6.42 NA 12.22 0.97 NA 19.61 090 

26541 ......... ............ A Repair hand joint with graft ......................... 8.61 NA 13.69 1.23 NA 23.53 090 

26542 ......... ............ A Repair hand joint with graft ......................... 6.77 NA 12.25 0.98 NA 20.00 090 

26545 ......... ............ A Reconstruct finger joint ................................ 6.91 NA 12.66 1.01 NA 20.58 090 

26546 ......... ............ A Repair nonunion hand ................................. 8.91 NA 15.14 1.33 NA 25.38 090 

26548 ......... ............ A Reconstruct finger joint ................................ 8.02 NA 13.25 1.16 NA 22.43 090 

26550 ......... ............ A Construct thumb replacement ..................... 21.21 NA 18.11 2.98 NA 42.30 090 

26551 ......... ............ A Great toe-hand transfer ............................... 46.51 NA 33.36 5.65 NA 85.52 090 

26553 ......... ............ A Single transfer, toe-hand ............................. 46.20 NA 22.83 3.49 NA 72.52 090 

26554 ......... ............ A Double transfer, toe-hand ............................ 54.87 NA 37.75 9.36 NA 101.98 090 

26555 ......... ............ A Positional change of finger .......................... 16.61 NA 18.47 2.26 NA 37.34 090 

26556 ......... ............ A Toe joint transfer .......................................... 47.19 NA 33.81 8.04 NA 89.04 090 

26560 ......... ............ A Repair of web finger .................................... 5.37 NA 10.18 0.76 NA 16.31 090 

26561 ......... ............ A Repair of web finger .................................... 10.90 NA 12.81 1.53 NA 25.24 090 

26562 ......... ............ A Repair of web finger .................................... 14.98 NA 17.46 1.18 NA 33.62 090 

26565 ......... ............ A Correct metacarpal flaw ............................... 6.73 NA 12.32 0.96 NA 20.01 090 

26567 ......... ............ A Correct finger deformity ............................... 6.81 NA 12.25 1.02 NA 20.08 090 

26568 ......... ............ A Lengthen metacarpal/finger ......................... 9.07 NA 15.87 1.34 NA 26.28 090 

26580 ......... ............ A Repair hand deformity ................................. 18.15 NA 14.01 1.88 NA 34.04 090 

26587 ......... ............ A Reconstruct extra finger .............................. 14.03 NA 9.06 1.46 NA 24.55 090 

26590 ......... ............ A Repair finger deformity ................................ 17.93 NA 14.31 1.62 NA 33.86 090 

26591 ......... ............ A Repair muscles of hand ............................... 3.25 NA 10.31 0.49 NA 14.05 090 

26593 ......... ............ A Release muscles of hand ............................ 5.30 NA 11.38 0.77 NA 17.45 090 

26596 ......... ............ A Excision constricting tissue .......................... 8.94 NA 9.00 1.38 NA 19.32 090 

26600 ......... ............ A Treat metacarpal fracture ............................ 1.96 3.61 2.68 0.29 5.86 4.93 090 

26605 ......... ............ A Treat metacarpal fracture ............................ 2.85 4.56 3.65 0.45 7.86 6.95 090 

26607 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.38 0.84 NA 12.57 090 

26608 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.54 0.88 NA 12.77 090 

26615 ......... ............ A Treat metacarpal fracture ............................ 5.32 NA 5.73 0.85 NA 11.90 090 

26641 ......... ............ A Treat thumb dislocation ............................... 3.93 4.60 3.58 0.43 8.96 7.94 090 

26645 ......... ............ A Treat thumb fracture .................................... 4.40 5.18 4.20 0.62 10.20 9.22 090 

26650 ......... ............ A Treat thumb fracture .................................... 5.71 NA 6.95 0.94 NA 13.60 090 

26665 ......... ............ A Treat thumb fracture .................................... 7.59 NA 6.99 1.19 NA 15.77 090 

26670 ......... ............ A Treat hand dislocation ................................. 3.68 4.29 2.99 0.39 8.36 7.06 090 

26675 ......... ............ A Treat hand dislocation ................................. 4.63 5.48 4.48 0.72 10.83 9.83 090 

26676 ......... ............ A Pin hand dislocation .................................... 5.51 NA 6.99 0.88 NA 13.38 090 

26685 ......... ............ A Treat hand dislocation ................................. 6.97 NA 6.44 1.05 NA 14.46 090 

26686 ......... ............ A Treat hand dislocation ................................. 7.93 NA 7.21 1.21 NA 16.35 090 

26700 ......... ............ A Treat knuckle dislocation ............................. 3.68 3.79 2.91 0.34 7.81 6.93 090 

26705 ......... ............ A Treat knuckle dislocation ............................. 4.18 5.35 4.31 0.61 10.14 9.10 090 

26706 ......... ............ A Pin knuckle dislocation ................................ 5.11 NA 5.27 0.77 NA 11.15 090 

26715 ......... ............ A Treat knuckle dislocation ............................. 5.73 NA 5.91 0.89 NA 12.53 090 

26720 ......... ............ A Treat finger fracture, each ........................... 1.66 2.79 2.09 0.22 4.67 3.97 090 

26725 ......... ............ A Treat finger fracture, each ........................... 3.33 4.77 3.51 0.50 8.60 7.34 090 

26727 ......... ............ A Treat finger fracture, each ........................... 5.22 NA 6.60 0.84 NA 12.66 090 

26735 ......... ............ A Treat finger fracture, each ........................... 5.97 NA 6.06 0.94 NA 12.97 090 

26740 ......... ............ A Treat finger fracture, each ........................... 1.94 3.14 2.71 0.30 5.38 4.95 090 

26742 ......... ............ A Treat finger fracture, each ........................... 3.84 4.99 3.89 0.56 9.39 8.29 090 

26746 ......... ............ A Treat finger fracture, each ........................... 5.80 NA 6.12 0.91 NA 12.83 090 

26750 ......... ............ A Treat finger fracture, each ........................... 1.70 2.49 2.05 0.20 4.39 3.95 090 

26755 ......... ............ A Treat finger fracture, each ........................... 3.10 4.43 3.02 0.41 7.94 6.53 090 

26756 ......... ............ A Pin finger fracture, each .............................. 4.38 NA 6.23 0.69 NA 11.30 090 

26765 ......... ............ A Treat finger fracture, each ........................... 4.16 NA 4.96 0.62 NA 9.74 090 

26770 ......... ............ A Treat finger dislocation ................................ 3.02 3.46 2.46 0.27 6.75 5.75 090 

26775 ......... ............ A Treat finger dislocation ................................ 3.70 5.20 3.84 0.49 9.39 8.03 090 

26776 ......... ............ A Pin finger dislocation ................................... 4.79 NA 6.40 0.73 NA 11.92 090 

26785 ......... ............ A Treat finger dislocation ................................ 4.20 NA 4.99 0.67 NA 9.86 090 

26820 ......... ............ A Thumb fusion with graft ............................... 8.25 NA 13.49 1.36 NA 23.10 090 

26841 ......... ............ A Fusion of thumb ........................................... 7.12 NA 13.39 1.17 NA 21.68 090 

26842 ......... ............ A Thumb fusion with graft ............................... 8.23 NA 13.57 1.24 NA 23.04 090 

26843 ......... ............ A Fusion of hand joint ..................................... 7.60 NA 12.53 1.21 NA 21.34 090 

26844 ......... ............ A Fusion/graft of hand joint ............................. 8.72 NA 13.55 1.29 NA 23.56 090 

26850 ......... ............ A Fusion of knuckle ......................................... 6.96 NA 12.41 1.05 NA 20.42 090 

26852 ......... ............ A Fusion of knuckle with graft ......................... 8.45 NA 13.14 1.23 NA 22.82 090 

26860 ......... ............ A Fusion of finger joint .................................... 4.68 NA 11.42 0.73 NA 16.83 090 

47598

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

26861 ......... ............ A Fusion of finger jnt, add-on ......................... 1.74 NA 0.93 0.24 NA 2.91 ZZZ 

26862 ......... ............ A Fusion/graft of finger joint ............................ 7.36 NA 12.63 1.05 NA 21.04 090 

26863 ......... ............ A Fuse/graft added joint .................................. 3.89 NA 2.10 0.56 NA 6.55 ZZZ 

26910 ......... ............ A Amputate metacarpal bone ......................... 7.59 NA 11.57 1.13 NA 20.29 090 

26951 ......... ............ A Amputation of finger/thumb ......................... 4.58 NA 10.48 0.70 NA 15.76 090 

26952 ......... ............ A Amputation of finger/thumb ......................... 6.30 NA 12.05 0.94 NA 19.29 090 

26990 ......... ............ A Drainage of pelvis lesion ............................. 7.47 NA 7.75 1.18 NA 16.40 090 

26991 ......... ............ A Drainage of pelvis bursa .............................. 6.67 11.17 5.43 1.07 18.91 13.17 090 

26992 ......... ............ A Drainage of bone lesion .............................. 13.00 NA 11.06 2.06 NA 26.12 090 

27000 ......... ............ A Incision of hip tendon .................................. 5.61 NA 5.46 0.96 NA 12.03 090 

27001 ......... ............ A Incision of hip tendon .................................. 6.93 NA 6.33 1.16 NA 14.42 090 

27003 ......... ............ A Incision of hip tendon .................................. 7.33 NA 6.74 1.18 NA 15.25 090 

27005 ......... ............ A Incision of hip tendon .................................. 9.65 NA 8.04 1.58 NA 19.27 090 

27006 ......... ............ A Incision of hip tendons ................................. 9.67 NA 8.21 1.56 NA 19.44 090 

27025 ......... ............ A Incision of hip/thigh fascia ........................... 11.14 NA 8.75 1.75 NA 21.64 090 

27030 ......... ............ A Drainage of hip joint .................................... 12.99 NA 9.85 2.10 NA 24.94 090 

27033 ......... ............ A Exploration of hip joint ................................. 13.37 NA 10.12 2.20 NA 25.69 090 

27035 ......... ............ A Denervation of hip joint ................................ 16.66 NA 12.61 2.43 NA 31.70 090 

27036 ......... ............ A Excision of hip joint/muscle ......................... 12.86 NA 10.28 2.11 NA 25.25 090 

27040 ......... ............ A Biopsy of soft tissues ................................... 2.87 5.25 2.01 0.30 8.42 5.18 010 

27041 ......... ............ A Biopsy of soft tissues ................................... 9.88 NA 6.79 1.30 NA 17.97 090 

27047 ......... ............ A Remove hip/pelvis lesion ............................. 7.44 7.14 4.78 1.00 15.58 13.22 090 

27048 ......... ............ A Remove hip/pelvis lesion ............................. 6.24 NA 5.12 0.89 NA 12.25 090 

27049 ......... ............ A Remove tumor, hip/pelvis ............................ 13.64 NA 8.93 1.95 NA 24.52 090 

27050 ......... ............ A Biopsy of sacroiliac joint .............................. 4.35 NA 4.64 0.66 NA 9.65 090 

27052 ......... ............ A Biopsy of hip joint ........................................ 6.22 NA 6.09 0.98 NA 13.29 090 

27054 ......... ............ A Removal of hip joint lining ........................... 8.53 NA 7.59 1.35 NA 17.47 090 

27060 ......... ............ A Removal of ischial bursa ............................. 5.42 NA 4.94 0.78 NA 11.14 090 

27062 ......... ............ A Remove femur lesion/bursa ......................... 5.36 NA 5.40 0.91 NA 11.67 090 

27065 ......... ............ A Removal of hip bone lesion ......................... 5.89 NA 5.71 0.90 NA 12.50 090 

27066 ......... ............ A Removal of hip bone lesion ......................... 10.31 NA 8.73 1.60 NA 20.64 090 

27067 ......... ............ A Remove/graft hip bone lesion ...................... 13.81 NA 10.92 2.25 NA 26.98 090 

27070 ......... ............ A Partial removal of hip bone ......................... 10.70 NA 9.98 1.67 NA 22.35 090 

27071 ......... ............ A Partial removal of hip bone ......................... 11.44 NA 10.98 1.82 NA 24.24 090 

27075 ......... ............ A Extensive hip surgery .................................. 34.95 NA 19.82 5.16 NA 59.93 090 

27076 ......... ............ A Extensive hip surgery .................................. 22.09 NA 15.05 3.43 NA 40.57 090 

27077 ......... ............ A Extensive hip surgery .................................. 39.94 NA 23.29 5.61 NA 68.84 090 

27078 ......... ............ A Extensive hip surgery .................................. 13.42 NA 10.70 2.12 NA 26.24 090 

27079 ......... ............ A Extensive hip surgery .................................. 13.73 NA 10.31 2.00 NA 26.04 090 

27080 ......... ............ A Removal of tail bone .................................... 6.38 NA 5.17 0.92 NA 12.47 090 

27086 ......... ............ A Remove hip foreign body ............................ 1.87 4.57 1.82 0.22 6.66 3.91 010 

27087 ......... ............ A Remove hip foreign body ............................ 8.53 NA 6.85 1.29 NA 16.67 090 

27090 ......... ............ A Removal of hip prosthesis ........................... 11.13 NA 8.76 1.81 NA 21.70 090 

27091 ......... ............ A Removal of hip prosthesis ........................... 22.11 NA 13.97 3.49 NA 39.57 090 

27093 ......... ............ A Injection for hip x-ray ................................... 1.30 4.50 0.48 0.12 5.92 1.90 000 

27095 ......... ............ A Injection for hip x-ray ................................... 1.50 5.81 0.52 0.13 7.44 2.15 000 

27096 ......... ............ A Inject sacroiliac joint .................................... 1.40 3.95 0.33 0.10 5.45 1.83 000 

27097 ......... ............ A Revision of hip tendon ................................. 8.79 NA 6.63 1.49 NA 16.91 090 

27098 ......... ............ A Transfer tendon to pelvis ............................. 8.82 NA 7.26 0.91 NA 16.99 090 

27100 ......... ............ A Transfer of abdominal muscle ..................... 11.06 NA 8.97 1.76 NA 21.79 090 

27105 ......... ............ A Transfer of spinal muscle ............................ 11.75 NA 9.41 1.32 NA 22.48 090 

27110 ......... ............ A Transfer of iliopsoas muscle ........................ 13.24 NA 9.48 1.82 NA 24.54 090 

27111 ......... ............ A Transfer of iliopsoas muscle ........................ 12.13 NA 9.36 2.11 NA 23.60 090 

27120 ......... ............ A Reconstruction of hip socket ....................... 17.98 NA 11.83 2.73 NA 32.54 090 

27122 ......... ............ A Reconstruction of hip socket ....................... 14.96 NA 11.02 2.42 NA 28.40 090 

27125 ......... ............ A Partial hip replacement ................................ 14.67 NA 10.60 2.32 NA 27.59 090 

27130 ......... ............ A Total hip arthroplasty ................................... 20.09 NA 13.28 3.11 NA 36.48 090 

27132 ......... ............ A Total hip arthroplasty ................................... 23.27 NA 15.60 3.64 NA 42.51 090 

27134 ......... ............ A Revise hip joint replacement ....................... 28.48 NA 17.76 4.44 NA 50.68 090 

27137 ......... ............ A Revise hip joint replacement ....................... 21.14 NA 13.90 3.35 NA 38.39 090 

27138 ......... ............ A Revise hip joint replacement ....................... 22.14 NA 14.37 3.51 NA 40.02 090 

27140 ......... ............ A Transplant femur ridge ................................ 12.22 NA 9.61 1.97 NA 23.80 090 

27146 ......... ............ A Incision of hip bone ..................................... 17.40 NA 12.49 2.61 NA 32.50 090 

27147 ......... ............ A Revision of hip bone .................................... 20.55 NA 13.51 2.80 NA 36.86 090 

27151 ......... ............ A Incision of hip bones .................................... 22.48 NA 8.26 3.57 NA 34.31 090 

27156 ......... ............ A Revision of hip bones .................................. 24.59 NA 16.32 3.52 NA 44.43 090 

27158 ......... ............ A Revision of pelvis ......................................... 19.71 NA 11.30 3.14 NA 34.15 090 

27161 ......... ............ A Incision of neck of femur ............................. 16.68 NA 12.29 2.77 NA 31.74 090 

27165 ......... ............ A Incision/fixation of femur .............................. 17.88 NA 13.07 2.82 NA 33.77 090 

27170 ......... ............ A Repair/graft femur head/neck ...................... 16.05 NA 11.49 2.56 NA 30.10 090 

27175 ......... ............ A Treat slipped epiphysis ................................ 8.45 NA 6.75 1.47 NA 16.67 090 

27176 ......... ............ A Treat slipped epiphysis ................................ 12.03 NA 9.14 2.00 NA 23.17 090 

27177 ......... ............ A Treat slipped epiphysis ................................ 15.06 NA 10.99 2.49 NA 28.54 090 

27178 ......... ............ A Treat slipped epiphysis ................................ 11.97 NA 8.53 2.08 NA 22.58 090 

27179 ......... ............ A Revise head/neck of femur .......................... 12.96 NA 10.09 2.25 NA 25.30 090 

47599

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

27181 ......... ............ A Treat slipped epiphysis ................................ 14.66 NA 10.31 2.28 NA 27.25 090 

27185 ......... ............ A Revision of femur epiphysis ........................ 9.17 NA 7.78 1.59 NA 18.54 090 

27187 ......... ............ A Reinforce hip bones ..................................... 13.52 NA 10.55 2.16 NA 26.23 090 

27193 ......... ............ A Treat pelvic ring fracture .............................. 5.55 5.32 5.17 0.93 11.80 11.65 090 

27194 ......... ............ A Treat pelvic ring fracture .............................. 9.64 NA 7.64 1.62 NA 18.90 090 

27200 ......... ............ A Treat tail bone fracture ................................ 1.84 2.23 2.17 0.26 4.33 4.27 090 

27202 ......... ............ A Treat tail bone fracture ................................ 7.03 NA 17.13 0.93 NA 25.09 090 

27215 ......... ............ A Treat pelvic fracture(s) ................................. 10.03 NA 7.30 1.78 NA 19.11 090 

27216 ......... ............ A Treat pelvic ring fracture .............................. 15.17 NA 9.91 2.49 NA 27.57 090 

27217 ......... ............ A Treat pelvic ring fracture .............................. 14.09 NA 10.34 2.23 NA 26.66 090 

27218 ......... ............ A Treat pelvic ring fracture .............................. 20.12 NA 11.62 3.23 NA 34.97 090 

27220 ......... ............ A Treat hip socket fracture .............................. 6.17 5.71 5.62 1.05 12.93 12.84 090 

27222 ......... ............ A Treat hip socket fracture .............................. 12.68 NA 10.04 2.17 NA 24.89 090 

27226 ......... ............ A Treat hip wall fracture .................................. 14.89 NA 8.03 2.46 NA 25.38 090 

27227 ......... ............ A Treat hip fracture(s) ..................................... 23.41 NA 15.53 3.73 NA 42.67 090 

27228 ......... ............ A Treat hip fracture(s) ..................................... 27.12 NA 17.75 4.44 NA 49.31 090 

27230 ......... ............ A Treat thigh fracture ...................................... 5.49 5.51 5.11 0.90 11.90 11.50 090 

27232 ......... ............ A Treat thigh fracture ...................................... 10.66 NA 7.34 1.78 NA 19.78 090 

27235 ......... ............ A Treat thigh fracture ...................................... 12.14 NA 9.57 2.08 NA 23.79 090 

27236 ......... ............ A Treat thigh fracture ...................................... 15.58 NA 11.04 2.49 NA 29.11 090 

27238 ......... ............ A Treat thigh fracture ...................................... 5.51 NA 5.27 0.86 NA 11.64 090 

27240 ......... ............ A Treat thigh fracture ...................................... 12.48 NA 9.58 2.06 NA 24.12 090 

27244 ......... ............ A Treat thigh fracture ...................................... 15.92 NA 11.42 2.57 NA 29.91 090 

27245 ......... ............ A Treat thigh fracture ...................................... 20.28 NA 13.85 3.24 NA 37.37 090 

27246 ......... ............ A Treat thigh fracture ...................................... 4.70 4.45 4.42 0.80 9.95 9.92 090 

27248 ......... ............ A Treat thigh fracture ...................................... 10.43 NA 8.35 1.68 NA 20.46 090 

27250 ......... ............ A Treat hip dislocation .................................... 6.94 NA 4.75 0.61 NA 12.30 090 

27252 ......... ............ A Treat hip dislocation .................................... 10.37 NA 7.53 1.58 NA 19.48 090 

27253 ......... ............ A Treat hip dislocation .................................... 12.90 NA 9.89 1.91 NA 24.70 090 

27254 ......... ............ A Treat hip dislocation .................................... 18.23 NA 12.17 2.97 NA 33.37 090 

27256 ......... ............ A Treat hip dislocation .................................... 4.11 3.52 2.09 0.43 8.06 6.63 010 

27257 ......... ............ A Treat hip dislocation .................................... 5.21 NA 2.82 0.67 NA 8.70 010 

27258 ......... ............ A Treat hip dislocation .................................... 15.41 NA 11.10 2.51 NA 29.02 090 

27259 ......... ............ A Treat hip dislocation .................................... 21.52 NA 14.33 3.35 NA 39.20 090 

27265 ......... ............ A Treat hip dislocation .................................... 5.04 NA 4.91 0.64 NA 10.59 090 

27266 ......... ............ A Treat hip dislocation .................................... 7.48 NA 6.46 1.26 NA 15.20 090 

27275 ......... ............ A Manipulation of hip joint ............................... 2.27 NA 2.10 0.38 NA 4.75 010 

27280 ......... ............ A Fusion of sacroiliac joint .............................. 13.37 NA 10.55 2.21 NA 26.13 090 

27282 ......... ............ A Fusion of pubic bones ................................. 11.32 NA 8.34 1.26 NA 20.92 090 

27284 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 15.00 3.26 NA 41.67 090 

27286 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 16.02 3.54 NA 42.97 090 

27290 ......... ............ A Amputation of leg at hip .............................. 23.25 NA 14.33 3.33 NA 40.91 090 

27295 ......... ............ A Amputation of leg at hip .............................. 18.62 NA 11.64 2.77 NA 33.03 090 

27301 ......... ............ A Drain thigh/knee lesion ................................ 6.48 10.12 5.14 1.00 17.60 12.62 090 

27303 ......... ............ A Drainage of bone lesion .............................. 8.27 NA 7.54 1.35 NA 17.16 090 

27305 ......... ............ A Incise thigh tendon & fascia ........................ 5.91 NA 5.50 0.92 NA 12.33 090 

27306 ......... ............ A Incision of thigh tendon ............................... 4.61 NA 4.97 0.79 NA 10.37 090 

27307 ......... ............ A Incision of thigh tendons .............................. 5.79 NA 5.69 1.01 NA 12.49 090 

27310 ......... ............ A Exploration of knee joint .............................. 9.26 NA 7.75 1.51 NA 18.52 090 

27315 ......... ............ A Partial removal, thigh nerve ......................... 6.96 NA 4.91 1.21 NA 13.08 090 

27320 ......... ............ A Partial removal, thigh nerve ......................... 6.29 NA 5.19 0.94 NA 12.42 090 

27323 ......... ............ A Biopsy, thigh soft tissues ............................. 2.28 3.52 1.88 0.27 6.07 4.43 010 

27324 ......... ............ A Biopsy, thigh soft tissues ............................. 4.89 NA 4.45 0.73 NA 10.07 090 

27327 ......... ............ A Removal of thigh lesion ............................... 4.46 6.01 3.73 0.63 11.10 8.82 090 

27328 ......... ............ A Removal of thigh lesion ............................... 5.56 NA 4.65 0.83 NA 11.04 090 

27329 ......... ............ A Remove tumor, thigh/knee .......................... 14.12 NA 9.68 2.05 NA 25.85 090 

27330 ......... ............ A Biopsy, knee joint lining ............................... 4.96 NA 4.72 0.85 NA 10.53 090 

27331 ......... ............ A Explore/treat knee joint ................................ 5.87 NA 5.68 0.95 NA 12.50 090 

27332 ......... ............ A Removal of knee cartilage ........................... 8.26 NA 7.26 1.38 NA 16.90 090 

27333 ......... ............ A Removal of knee cartilage ........................... 7.29 NA 6.81 1.17 NA 15.27 090 

27334 ......... ............ A Remove knee joint lining ............................. 8.69 NA 7.58 1.41 NA 17.68 090 

27335 ......... ............ A Remove knee joint lining ............................. 9.99 NA 8.39 1.61 NA 19.99 090 

27340 ......... ............ A Removal of kneecap bursa .......................... 4.17 NA 4.69 0.71 NA 9.57 090 

27345 ......... ............ A Removal of knee cyst .................................. 5.91 NA 5.77 0.95 NA 12.63 090 

27347 ......... ............ A Remove knee cyst ....................................... 5.77 NA 5.58 0.94 NA 12.29 090 

27350 ......... ............ A Removal of kneecap .................................... 8.16 NA 7.38 1.31 NA 16.85 090 

27355 ......... ............ A Remove femur lesion ................................... 7.64 NA 7.03 1.20 NA 15.87 090 

27356 ......... ............ A Remove femur lesion/graft .......................... 9.47 NA 8.11 1.58 NA 19.16 090 

27357 ......... ............ A Remove femur lesion/graft .......................... 10.51 NA 8.94 1.81 NA 21.26 090 

27358 ......... ............ A Remove femur lesion/fixation ...................... 4.73 NA 2.52 0.76 NA 8.01 ZZZ 

27360 ......... ............ A Partial removal, leg bone(s) ........................ 10.48 NA 10.15 1.68 NA 22.31 090 

27365 ......... ............ A Extensive leg surgery .................................. 16.25 NA 11.89 2.70 NA 30.84 090 

27370 ......... ............ A Injection for knee x-ray ................................ 0.96 3.76 0.32 0.07 4.79 1.35 000 

27372 ......... ............ A Removal of foreign body ............................. 5.06 10.10 4.69 0.77 15.93 10.52 090 

27380 ......... ............ A Repair of kneecap tendon ........................... 7.15 NA 7.37 1.16 NA 15.68 090 

47600

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

27381 ......... ............ A Repair/graft kneecap tendon ....................... 10.32 NA 9.17 1.63 NA 21.12 090 

27385 ......... ............ A Repair of thigh muscle ................................. 7.75 NA 7.71 1.27 NA 16.73 090 

27386 ......... ............ A Repair/graft of thigh muscle ........................ 10.54 NA 9.61 1.69 NA 21.84 090 

27390 ......... ............ A Incision of thigh tendon ............................... 5.32 NA 5.43 0.84 NA 11.59 090 

27391 ......... ............ A Incision of thigh tendons .............................. 7.19 NA 6.83 1.19 NA 15.21 090 

27392 ......... ............ A Incision of thigh tendons .............................. 9.19 NA 7.94 1.52 NA 18.65 090 

27393 ......... ............ A Lengthening of thigh tendon ........................ 6.38 NA 6.04 0.98 NA 13.40 090 

27394 ......... ............ A Lengthening of thigh tendons ...................... 8.49 NA 7.49 1.37 NA 17.35 090 

27395 ......... ............ A Lengthening of thigh tendons ...................... 11.71 NA 9.63 1.80 NA 23.14 090 

27396 ......... ............ A Transplant of thigh tendon ........................... 7.85 NA 7.29 1.13 NA 16.27 090 

27397 ......... ............ A Transplants of thigh tendons ....................... 11.26 NA 9.27 1.50 NA 22.03 090 

27400 ......... ............ A Revise thigh muscles/tendons ..................... 9.01 NA 7.52 1.47 NA 18.00 090 

27403 ......... ............ A Repair of knee cartilage .............................. 8.32 NA 7.33 1.34 NA 16.99 090 

27405 ......... ............ A Repair of knee ligament .............................. 8.64 NA 7.66 1.41 NA 17.71 090 

27407 ......... ............ A Repair of knee ligament .............................. 10.26 NA 8.48 1.65 NA 20.39 090 

27409 ......... ............ A Repair of knee ligaments ............................. 12.88 NA 10.10 2.18 NA 25.16 090 

27418 ......... ............ A Repair degenerated kneecap ...................... 10.83 NA 9.05 1.70 NA 21.58 090 

27420 ......... ............ A Revision of unstable kneecap ..................... 9.82 NA 8.25 1.55 NA 19.62 090 

27422 ......... ............ A Revision of unstable kneecap ..................... 9.77 NA 8.25 1.55 NA 19.57 090 

27424 ......... ............ A Revision/removal of kneecap ...................... 9.80 NA 8.22 1.54 NA 19.56 090 

27425 ......... ............ A Lat retinacular release open ........................ 5.21 NA 5.67 0.89 NA 11.77 090 

27427 ......... ............ A Reconstruction, knee ................................... 9.35 NA 7.95 1.47 NA 18.77 090 

27428 ......... ............ A Reconstruction, knee ................................... 13.98 NA 11.37 2.30 NA 27.65 090 

27429 ......... ............ A Reconstruction, knee ................................... 15.50 NA 12.61 2.61 NA 30.72 090 

27430 ......... ............ A Revision of thigh muscles ............................ 9.66 NA 8.15 1.53 NA 19.34 090 

27435 ......... ............ A Incision of knee joint .................................... 9.48 NA 8.59 1.45 NA 19.52 090 

27437 ......... ............ A Revise kneecap ........................................... 8.45 NA 7.23 1.51 NA 17.19 090 

27438 ......... ............ A Revise kneecap with implant ....................... 11.21 NA 8.52 1.80 NA 21.53 090 

27440 ......... ............ A Revision of knee joint .................................. 10.41 NA 6.01 1.56 NA 17.98 090 

27441 ......... ............ A Revision of knee joint .................................. 10.80 NA 6.71 1.66 NA 19.17 090 

27442 ......... ............ A Revision of knee joint .................................. 11.87 NA 8.90 1.86 NA 22.63 090 

27443 ......... ............ A Revision of knee joint .................................. 10.91 NA 8.70 1.67 NA 21.28 090 

27445 ......... ............ A Revision of knee joint .................................. 17.65 NA 12.32 2.80 NA 32.77 090 

27446 ......... ............ A Revision of knee joint .................................. 15.82 NA 11.25 2.44 NA 29.51 090 

27447 ......... ............ A Total knee arthroplasty ................................ 21.45 NA 14.57 3.35 NA 39.37 090 

27448 ......... ............ A Incision of thigh ............................................ 11.04 NA 8.86 1.67 NA 21.57 090 

27450 ......... ............ A Incision of thigh ............................................ 13.96 NA 10.81 2.26 NA 27.03 090 

27454 ......... ............ A Realignment of thigh bone .......................... 17.53 NA 12.73 2.84 NA 33.10 090 

27455 ......... ............ A Realignment of knee .................................... 12.80 NA 10.02 2.06 NA 24.88 090 

27457 ......... ............ A Realignment of knee .................................... 13.43 NA 10.06 2.21 NA 25.70 090 

27465 ......... ............ A Shortening of thigh bone ............................. 13.85 NA 10.55 2.31 NA 26.71 090 

27466 ......... ............ A Lengthening of thigh bone ........................... 16.31 NA 12.12 2.57 NA 31.00 090 

27468 ......... ............ A Shorten/lengthen thighs ............................... 18.94 NA 12.62 2.90 NA 34.46 090 

27470 ......... ............ A Repair of thigh ............................................. 16.05 NA 12.08 2.57 NA 30.70 090 

27472 ......... ............ A Repair/graft of thigh ..................................... 17.69 NA 12.96 2.85 NA 33.50 090 

27475 ......... ............ A Surgery to stop leg growth .......................... 8.63 NA 7.40 1.50 NA 17.53 090 

27477 ......... ............ A Surgery to stop leg growth .......................... 9.84 NA 7.90 1.72 NA 19.46 090 

27479 ......... ............ A Surgery to stop leg growth .......................... 12.78 NA 10.03 2.22 NA 25.03 090 

27485 ......... ............ A Surgery to stop leg growth .......................... 8.83 NA 7.56 1.71 NA 18.10 090 

27486 ......... ............ A Revise/replace knee joint ............................ 19.24 NA 13.46 2.99 NA 35.69 090 

27487 ......... ............ A Revise/replace knee joint ............................ 25.23 NA 16.52 3.90 NA 45.65 090 

27488 ......... ............ A Removal of knee prosthesis ........................ 15.72 NA 11.68 2.49 NA 29.89 090 

27495 ......... ............ A Reinforce thigh ............................................. 15.53 NA 11.71 2.52 NA 29.76 090 

27496 ......... ............ A Decompression of thigh/knee ...................... 6.10 NA 5.85 0.96 NA 12.91 090 

27497 ......... ............ A Decompression of thigh/knee ...................... 7.16 NA 5.77 1.00 NA 13.93 090 

27498 ......... ............ A Decompression of thigh/knee ...................... 7.98 NA 6.16 1.27 NA 15.41 090 

27499 ......... ............ A Decompression of thigh/knee ...................... 8.99 NA 7.12 1.32 NA 17.43 090 

27500 ......... ............ A Treatment of thigh fracture .......................... 5.91 6.11 4.99 0.95 12.97 11.85 090 

27501 ......... ............ A Treatment of thigh fracture .......................... 5.91 6.02 5.38 1.01 12.94 12.30 090 

27502 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.35 1.73 NA 20.64 090 

27503 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.52 1.80 NA 20.88 090 

27506 ......... ............ A Treatment of thigh fracture .......................... 17.42 NA 12.93 2.83 NA 33.18 090 

27507 ......... ............ A Treatment of thigh fracture .......................... 13.97 NA 10.04 2.24 NA 26.25 090 

27508 ......... ............ A Treatment of thigh fracture .......................... 5.82 6.45 5.48 0.95 13.22 12.25 090 

27509 ......... ............ A Treatment of thigh fracture .......................... 7.70 NA 8.03 1.30 NA 17.03 090 

27510 ......... ............ A Treatment of thigh fracture .......................... 9.12 NA 7.34 1.54 NA 18.00 090 

27511 ......... ............ A Treatment of thigh fracture .......................... 13.62 NA 11.29 2.20 NA 27.11 090 

27513 ......... ............ A Treatment of thigh fracture .......................... 17.89 NA 13.95 2.91 NA 34.75 090 

27514 ......... ............ A Treatment of thigh fracture .......................... 17.27 NA 13.42 2.76 NA 33.45 090 

27516 ......... ............ A Treat thigh fx growth plate ........................... 5.36 6.35 5.51 0.89 12.60 11.76 090 

27517 ......... ............ A Treat thigh fx growth plate ........................... 8.77 NA 7.44 1.28 NA 17.49 090 

27519 ......... ............ A Treat thigh fx growth plate ........................... 15.00 NA 11.71 2.42 NA 29.13 090 

27520 ......... ............ A Treat kneecap fracture ................................ 2.86 4.54 3.46 0.44 7.84 6.76 090 

27524 ......... ............ A Treat kneecap fracture ................................ 9.99 NA 8.31 1.62 NA 19.92 090 

27530 ......... ............ A Treat knee fracture ...................................... 3.77 5.31 4.43 0.62 9.70 8.82 090 

47601

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

27532 ......... ............ A Treat knee fracture ...................................... 7.29 7.35 6.45 1.25 15.89 14.99 090 

27535 ......... ............ A Treat knee fracture ...................................... 11.48 NA 10.20 1.78 NA 23.46 090 

27536 ......... ............ A Treat knee fracture ...................................... 15.63 NA 11.67 2.56 NA 29.86 090 

27538 ......... ............ A Treat knee fracture(s) .................................. 4.86 6.13 5.20 0.81 11.80 10.87 090 

27540 ......... ............ A Treat knee fracture ...................................... 13.08 NA 9.60 2.11 NA 24.79 090 

27550 ......... ............ A Treat knee dislocation ................................. 5.75 6.02 4.96 0.73 12.50 11.44 090 

27552 ......... ............ A Treat knee dislocation ................................. 7.89 NA 7.08 1.34 NA 16.31 090 

27556 ......... ............ A Treat knee dislocation ................................. 14.39 NA 11.79 2.32 NA 28.50 090 

27557 ......... ............ A Treat knee dislocation ................................. 16.74 NA 13.25 2.83 NA 32.82 090 

27558 ......... ............ A Treat knee dislocation ................................. 17.69 NA 13.18 2.82 NA 33.69 090 

27560 ......... ............ A Treat kneecap dislocation ............................ 3.81 4.84 3.24 0.39 9.04 7.44 090 

27562 ......... ............ A Treat kneecap dislocation ............................ 5.78 NA 4.88 0.75 NA 11.41 090 

27566 ......... ............ A Treat kneecap dislocation ............................ 12.21 NA 9.41 2.03 NA 23.65 090 

27570 ......... ............ A Fixation of knee joint ................................... 1.74 NA 1.77 0.30 NA 3.81 010 

27580 ......... ............ A Fusion of knee ............................................. 19.34 NA 14.85 3.09 NA 37.28 090 

27590 ......... ............ A Amputate leg at thigh .................................. 12.01 NA 7.08 1.68 NA 20.77 090 

27591 ......... ............ A Amputate leg at thigh .................................. 12.66 NA 9.04 1.95 NA 23.65 090 

27592 ......... ............ A Amputate leg at thigh .................................. 10.00 NA 6.61 1.41 NA 18.02 090 

27594 ......... ............ A Amputation follow-up surgery ...................... 6.91 NA 5.49 1.02 NA 13.42 090 

27596 ......... ............ A Amputation follow-up surgery ...................... 10.58 NA 7.27 1.55 NA 19.40 090 

27598 ......... ............ A Amputate lower leg at knee ......................... 10.51 NA 7.40 1.48 NA 19.39 090 

27600 ......... ............ A Decompression of lower leg ........................ 5.64 NA 4.76 0.84 NA 11.24 090 

27601 ......... ............ A Decompression of lower leg ........................ 5.63 NA 5.09 0.86 NA 11.58 090 

27602 ......... ............ A Decompression of lower leg ........................ 7.34 NA 5.32 1.06 NA 13.72 090 

27603 ......... ............ A Drain lower leg lesion .................................. 4.93 7.53 4.17 0.71 13.17 9.81 090 

27604 ......... ............ A Drain lower leg bursa .................................. 4.46 6.10 3.96 0.67 11.23 9.09 090 

27605 ......... ............ A Incision of achilles tendon ........................... 2.87 7.67 2.32 0.36 10.90 5.55 010 

27606 ......... ............ A Incision of achilles tendon ........................... 4.13 NA 3.36 0.66 NA 8.15 010 

27607 ......... ............ A Treat lower leg bone lesion ......................... 7.96 NA 6.89 1.25 NA 16.10 090 

27610 ......... ............ A Explore/treat ankle joint ............................... 8.33 NA 7.28 1.34 NA 16.95 090 

27612 ......... ............ A Exploration of ankle joint ............................. 7.32 NA 6.31 0.97 NA 14.60 090 

27613 ......... ............ A Biopsy lower leg soft tissue ......................... 2.17 3.24 1.80 0.22 5.63 4.19 010 

27614 ......... ............ A Biopsy lower leg soft tissue ......................... 5.65 7.15 4.44 0.75 13.55 10.84 090 

27615 ......... ............ A Remove tumor, lower leg ............................ 12.54 NA 10.73 1.75 NA 25.02 090 

27618 ......... ............ A Remove lower leg lesion ............................. 5.08 6.03 4.00 0.68 11.79 9.76 090 

27619 ......... ............ A Remove lower leg lesion ............................. 8.39 9.53 5.95 1.16 19.08 15.50 090 

27620 ......... ............ A Explore/treat ankle joint ............................... 5.97 NA 5.68 0.87 NA 12.52 090 

27625 ......... ............ A Remove ankle joint lining ............................ 8.29 NA 6.75 1.14 NA 16.18 090 

27626 ......... ............ A Remove ankle joint lining ............................ 8.90 NA 7.21 1.33 NA 17.44 090 

27630 ......... ............ A Removal of tendon lesion ............................ 4.79 7.60 4.38 0.67 13.06 9.84 090 

27635 ......... ............ A Remove lower leg bone lesion .................... 7.77 NA 7.09 1.25 NA 16.11 090 

27637 ......... ............ A Remove/graft leg bone lesion ...................... 9.84 NA 8.61 1.61 NA 20.06 090 

27638 ......... ............ A Remove/graft leg bone lesion ...................... 10.55 NA 8.63 1.70 NA 20.88 090 

27640 ......... ............ A Partial removal of tibia ................................. 11.35 NA 11.05 1.78 NA 24.18 090 

27641 ......... ............ A Partial removal of fibula ............................... 9.23 NA 9.03 1.39 NA 19.65 090 

27645 ......... ............ A Extensive lower leg surgery ........................ 14.15 NA 12.52 2.12 NA 28.79 090 

27646 ......... ............ A Extensive lower leg surgery ........................ 12.64 NA 11.52 1.83 NA 25.99 090 

27647 ......... ............ A Extensive ankle/heel surgery ....................... 12.22 NA 8.03 1.23 NA 21.48 090 

27648 ......... ............ A Injection for ankle x-ray ............................... 0.96 3.57 0.33 0.07 4.60 1.36 000 

27650 ......... ............ A Repair achilles tendon ................................. 9.68 NA 7.69 1.44 NA 18.81 090 

27652 ......... ............ A Repair/graft achilles tendon ......................... 10.31 NA 8.20 1.51 NA 20.02 090 

27654 ......... ............ A Repair of achilles tendon ............................. 10.00 NA 7.43 1.32 NA 18.75 090 

27656 ......... ............ A Repair leg fascia defect ............................... 4.56 8.58 3.78 0.62 13.76 8.96 090 

27658 ......... ............ A Repair of leg tendon, each .......................... 4.97 NA 4.56 0.70 NA 10.23 090 

27659 ......... ............ A Repair of leg tendon, each .......................... 6.80 NA 5.64 0.97 NA 13.41 090 

27664 ......... ............ A Repair of leg tendon, each .......................... 4.58 NA 4.55 0.68 NA 9.81 090 

27665 ......... ............ A Repair of leg tendon, each .......................... 5.39 NA 4.97 0.82 NA 11.18 090 

27675 ......... ............ A Repair lower leg tendons ............................. 7.17 NA 5.97 0.94 NA 14.08 090 

27676 ......... ............ A Repair lower leg tendons ............................. 8.41 NA 6.96 0.91 NA 16.28 090 

27680 ......... ............ A Release of lower leg tendon ........................ 5.73 NA 5.37 0.87 NA 11.97 090 

27681 ......... ............ A Release of lower leg tendons ...................... 6.81 NA 6.15 1.06 NA 14.02 090 

27685 ......... ............ A Revision of lower leg tendon ....................... 6.49 7.29 5.46 0.82 14.60 12.77 090 

27686 ......... ............ A Revise lower leg tendons ............................ 7.45 NA 6.48 1.21 NA 15.14 090 

27687 ......... ............ A Revision of calf tendon ................................ 6.23 NA 5.62 0.89 NA 12.74 090 

27690 ......... ............ A Revise lower leg tendon .............................. 8.70 NA 6.65 1.16 NA 16.51 090 

27691 ......... ............ A Revise lower leg tendon .............................. 9.95 NA 8.02 1.46 NA 19.43 090 

27692 ......... ............ A Revise additional leg tendon ....................... 1.87 NA 0.92 0.28 NA 3.07 ZZZ 

27695 ......... ............ A Repair of ankle ligament .............................. 6.50 NA 6.14 1.01 NA 13.65 090 

27696 ......... ............ A Repair of ankle ligaments ............................ 8.26 NA 6.71 1.10 NA 16.07 090 

27698 ......... ............ A Repair of ankle ligament .............................. 9.35 NA 7.16 1.29 NA 17.80 090 

27700 ......... ............ A Revision of ankle joint ................................. 9.28 NA 5.67 1.03 NA 15.98 090 

27702 ......... ............ A Reconstruct ankle joint ................................ 13.65 NA 10.44 2.15 NA 26.24 090 

27703 ......... ............ A Reconstruction, ankle joint .......................... 15.85 NA 11.21 2.48 NA 29.54 090 

27704 ......... ............ A Removal of ankle implant ............................ 7.61 NA 5.59 1.22 NA 14.42 090 

27705 ......... ............ A Incision of tibia ............................................. 10.36 NA 8.45 1.60 NA 20.41 090 

47602

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

27707 ......... ............ A Incision of fibula ........................................... 4.36 NA 5.24 0.74 NA 10.34 090 

27709 ......... ............ A Incision of tibia & fibula ............................... 9.94 NA 8.39 1.54 NA 19.87 090 

27712 ......... ............ A Realignment of lower leg ............................. 14.23 NA 10.97 2.22 NA 27.42 090 

27715 ......... ............ A Revision of lower leg ................................... 14.37 NA 11.09 2.38 NA 27.84 090 

27720 ......... ............ A Repair of tibia .............................................. 11.77 NA 9.71 1.90 NA 23.38 090 

27722 ......... ............ A Repair/graft of tibia ...................................... 11.80 NA 9.46 1.94 NA 23.20 090 

27724 ......... ............ A Repair/graft of tibia ...................................... 18.17 NA 12.68 2.93 NA 33.78 090 

27725 ......... ............ A Repair of lower leg ...................................... 15.57 NA 12.18 2.53 NA 30.28 090 

27727 ......... ............ A Repair of lower leg ...................................... 13.99 NA 10.68 2.22 NA 26.89 090 

27730 ......... ............ A Repair of tibia epiphysis .............................. 7.40 NA 6.42 1.29 NA 15.11 090 

27732 ......... ............ A Repair of fibula epiphysis ............................ 5.31 NA 4.93 0.57 NA 10.81 090 

27734 ......... ............ A Repair lower leg epiphyses ......................... 8.47 NA 6.61 0.68 NA 15.76 090 

27740 ......... ............ A Repair of leg epiphyses ............................... 9.29 NA 7.98 1.58 NA 18.85 090 

27742 ......... ............ A Repair of leg epiphyses ............................... 10.28 3.88 3.88 0.68 14.84 14.84 090 

27745 ......... ............ A Reinforce tibia .............................................. 10.05 NA 8.44 1.70 NA 20.19 090 

27750 ......... ............ A Treatment of tibia fracture ........................... 3.19 4.76 3.86 0.51 8.46 7.56 090 

27752 ......... ............ A Treatment of tibia fracture ........................... 5.83 6.64 5.66 0.99 13.46 12.48 090 

27756 ......... ............ A Treatment of tibia fracture ........................... 6.77 NA 6.79 1.09 NA 14.65 090 

27758 ......... ............ A Treatment of tibia fracture ........................... 11.65 NA 9.41 1.82 NA 22.88 090 

27759 ......... ............ A Treatment of tibia fracture ........................... 13.74 NA 10.54 2.23 NA 26.51 090 

27760 ......... ............ A Treatment of ankle fracture ......................... 3.01 4.68 3.62 0.44 8.13 7.07 090 

27762 ......... ............ A Treatment of ankle fracture ......................... 5.24 6.33 5.27 0.80 12.37 11.31 090 

27766 ......... ............ A Treatment of ankle fracture ......................... 8.35 NA 7.36 1.41 NA 17.12 090 

27780 ......... ............ A Treatment of fibula fracture ......................... 2.65 4.19 3.24 0.39 7.23 6.28 090 

27781 ......... ............ A Treatment of fibula fracture ......................... 4.39 5.49 4.64 0.71 10.59 9.74 090 

27784 ......... ............ A Treatment of fibula fracture ......................... 7.10 NA 6.65 1.18 NA 14.93 090 

27786 ......... ............ A Treatment of ankle fracture ......................... 2.84 4.46 3.36 0.43 7.73 6.63 090 

27788 ......... ............ A Treatment of ankle fracture ......................... 4.44 5.63 4.65 0.71 10.78 9.80 090 

27792 ......... ............ A Treatment of ankle fracture ......................... 7.65 NA 7.10 1.28 NA 16.03 090 

27808 ......... ............ A Treatment of ankle fracture ......................... 2.83 4.80 3.71 0.44 8.07 6.98 090 

27810 ......... ............ A Treatment of ankle fracture ......................... 5.12 6.23 5.15 0.81 12.16 11.08 090 

27814 ......... ............ A Treatment of ankle fracture ......................... 10.66 NA 8.75 1.71 NA 21.12 090 

27816 ......... ............ A Treatment of ankle fracture ......................... 2.89 4.39 3.43 0.41 7.69 6.73 090 

27818 ......... ............ A Treatment of ankle fracture ......................... 5.49 6.37 5.17 0.80 12.66 11.46 090 

27822 ......... ............ A Treatment of ankle fracture ......................... 10.98 NA 10.80 1.79 NA 23.57 090 

27823 ......... ............ A Treatment of ankle fracture ......................... 12.98 NA 11.64 2.11 NA 26.73 090 

27824 ......... ............ A Treat lower leg fracture ............................... 2.89 4.59 3.57 0.44 7.92 6.90 090 

27825 ......... ............ A Treat lower leg fracture ............................... 6.18 6.59 5.37 1.00 13.77 12.55 090 

27826 ......... ............ A Treat lower leg fracture ............................... 8.53 NA 9.01 1.36 NA 18.90 090 

27827 ......... ............ A Treat lower leg fracture ............................... 14.04 NA 12.90 2.31 NA 29.25 090 

27828 ......... ............ A Treat lower leg fracture ............................... 16.21 NA 14.06 2.65 NA 32.92 090 

27829 ......... ............ A Treat lower leg joint ..................................... 5.48 NA 6.92 0.89 NA 13.29 090 

27830 ......... ............ A Treat lower leg dislocation ........................... 3.78 4.41 3.87 0.49 8.68 8.14 090 

27831 ......... ............ A Treat lower leg dislocation ........................... 4.55 NA 4.58 0.75 NA 9.88 090 

27832 ......... ............ A Treat lower leg dislocation ........................... 6.48 NA 6.36 1.07 NA 13.91 090 

27840 ......... ............ A Treat ankle dislocation ................................. 4.57 NA 3.91 0.45 NA 8.93 090 

27842 ......... ............ A Treat ankle dislocation ................................. 6.20 NA 5.18 0.92 NA 12.30 090 

27846 ......... ............ A Treat ankle dislocation ................................. 9.78 NA 8.12 1.61 NA 19.51 090 

27848 ......... ............ A Treat ankle dislocation ................................. 11.18 NA 9.84 1.74 NA 22.76 090 

27860 ......... ............ A Fixation of ankle joint ................................... 2.34 NA 1.98 0.37 NA 4.69 010 

27870 ......... ............ A Fusion of ankle joint, open .......................... 13.89 NA 10.75 2.04 NA 26.68 090 

27871 ......... ............ A Fusion of tibiofibular joint ............................. 9.16 NA 7.85 1.47 NA 18.48 090 

27880 ......... ............ A Amputation of lower leg ............................... 11.83 NA 7.48 1.67 NA 20.98 090 

27881 ......... ............ A Amputation of lower leg ............................... 12.32 NA 9.16 1.89 NA 23.37 090 

27882 ......... ............ A Amputation of lower leg ............................... 8.93 NA 6.90 1.26 NA 17.09 090 

27884 ......... ............ A Amputation follow-up surgery ...................... 8.20 NA 6.15 1.21 NA 15.56 090 

27886 ......... ............ A Amputation follow-up surgery ...................... 9.31 NA 6.89 1.38 NA 17.58 090 

27888 ......... ............ A Amputation of foot at ankle ......................... 9.66 NA 7.76 1.43 NA 18.85 090 

27889 ......... ............ A Amputation of foot at ankle ......................... 9.97 NA 6.76 1.40 NA 18.13 090 

27892 ......... ............ A Decompression of leg .................................. 7.38 NA 5.92 1.01 NA 14.31 090 

27893 ......... ............ A Decompression of leg .................................. 7.34 NA 5.83 1.08 NA 14.25 090 

27894 ......... ............ A Decompression of leg .................................. 10.47 NA 8.01 1.58 NA 20.06 090 

28001 ......... ............ A Drainage of bursa of foot ............................. 2.73 2.98 1.95 0.23 5.94 4.91 010 

28002 ......... ............ A Treatment of foot infection ........................... 4.61 4.99 3.76 0.51 10.11 8.88 010 

28003 ......... ............ A Treatment of foot infection ........................... 8.40 6.24 5.22 0.93 15.57 14.55 090 

28005 ......... ............ A Treat foot bone lesion .................................. 8.67 NA 6.57 0.95 NA 16.19 090 

28008 ......... ............ A Incision of foot fascia ................................... 4.44 4.56 3.21 0.43 9.43 8.08 090 

28010 ......... ............ A Incision of toe tendon .................................. 2.84 2.38 2.38 0.27 5.49 5.49 090 

28011 ......... ............ A Incision of toe tendons ................................ 4.13 NA 3.30 0.47 NA 7.90 090 

28020 ......... ............ A Exploration of foot joint ................................ 5.00 6.03 4.13 0.64 11.67 9.77 090 

28022 ......... ............ A Exploration of foot joint ................................ 4.66 5.20 3.85 0.49 10.35 9.00 090 

28024 ......... ............ A Exploration of toe joint ................................. 4.37 5.22 3.92 0.43 10.02 8.72 090 

28030 ......... ............ A Removal of foot nerve ................................. 6.14 NA 3.61 0.55 NA 10.30 090 

28035 ......... ............ A Decompression of tibia nerve ...................... 5.08 5.85 4.09 0.57 11.50 9.74 090 

28043 ......... ............ A Excision of foot lesion .................................. 3.53 3.82 3.17 0.37 7.72 7.07 090 

47603

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

28045 ......... ............ A Excision of foot lesion .................................. 4.71 5.38 3.60 0.49 10.58 8.80 090 

28046 ......... ............ A Resection of tumor, foot .............................. 10.16 8.76 6.47 1.17 20.09 17.80 090 

28050 ......... ............ A Biopsy of foot joint lining ............................. 4.24 4.89 3.59 0.55 9.68 8.38 090 

28052 ......... ............ A Biopsy of foot joint lining ............................. 3.93 4.92 3.43 0.42 9.27 7.78 090 

28054 ......... ............ A Biopsy of toe joint lining .............................. 3.44 4.73 3.22 0.34 8.51 7.00 090 

28060 ......... ............ A Partial removal, foot fascia .......................... 5.22 5.47 3.87 0.53 11.22 9.62 090 

28062 ......... ............ A Removal of foot fascia ................................. 6.51 6.53 4.01 0.61 13.65 11.13 090 

28070 ......... ............ A Removal of foot joint lining .......................... 5.09 5.22 3.81 0.56 10.87 9.46 090 

28072 ......... ............ A Removal of foot joint lining .......................... 4.57 5.53 4.29 0.63 10.73 9.49 090 

28080 ......... ............ A Removal of foot lesion ................................. 3.57 5.12 3.68 0.35 9.04 7.60 090 

28086 ......... ............ A Excise foot tendon sheath ........................... 4.77 7.98 4.68 0.69 13.44 10.14 090 

28088 ......... ............ A Excise foot tendon sheath ........................... 3.85 5.76 3.89 0.51 10.12 8.25 090 

28090 ......... ............ A Removal of foot lesion ................................. 4.40 5.15 3.44 0.46 10.01 8.30 090 

28092 ......... ............ A Removal of toe lesions ................................ 3.63 5.22 3.52 0.40 9.25 7.55 090 

28100 ......... ............ A Removal of ankle/heel lesion ...................... 5.65 7.98 4.69 0.70 14.33 11.04 090 

28102 ......... ............ A Remove/graft foot lesion .............................. 7.72 NA 6.24 0.88 NA 14.84 090 

28103 ......... ............ A Remove/graft foot lesion .............................. 6.49 NA 4.61 0.70 NA 11.80 090 

28104 ......... ............ A Removal of foot lesion ................................. 5.11 5.49 3.92 0.56 11.16 9.59 090 

28106 ......... ............ A Remove/graft foot lesion .............................. 7.15 NA 4.75 0.64 NA 12.54 090 

28107 ......... ............ A Remove/graft foot lesion .............................. 5.55 6.54 4.20 0.54 12.63 10.29 090 

28108 ......... ............ A Removal of toe lesions ................................ 4.15 4.59 3.25 0.37 9.11 7.77 090 

28110 ......... ............ A Part removal of metatarsal .......................... 4.07 5.22 3.22 0.41 9.70 7.70 090 

28111 ......... ............ A Part removal of metatarsal .......................... 5.00 6.28 3.65 0.55 11.83 9.20 090 

28112 ......... ............ A Part removal of metatarsal .......................... 4.48 5.80 3.56 0.51 10.79 8.55 090 

28113 ......... ............ A Part removal of metatarsal .......................... 4.78 6.07 4.32 0.49 11.34 9.59 090 

28114 ......... ............ A Removal of metatarsal heads ...................... 9.78 11.63 8.37 1.23 22.64 19.38 090 

28116 ......... ............ A Revision of foot ............................................ 7.74 6.80 5.17 0.83 15.37 13.74 090 

28118 ......... ............ A Removal of heel bone ................................. 5.95 6.25 4.34 0.69 12.89 10.98 090 

28119 ......... ............ A Removal of heel spur .................................. 5.38 5.43 3.72 0.52 11.33 9.62 090 

28120 ......... ............ A Part removal of ankle/heel ........................... 5.39 7.30 4.41 0.66 13.35 10.46 090 

28122 ......... ............ A Partial removal of foot bone ........................ 7.28 6.84 5.26 0.76 14.88 13.30 090 

28124 ......... ............ A Partial removal of toe .................................. 4.80 5.00 3.65 0.42 10.22 8.87 090 

28126 ......... ............ A Partial removal of toe .................................. 3.51 4.21 2.99 0.32 8.04 6.82 090 

28130 ......... ............ A Removal of ankle bone ................................ 8.10 NA 6.92 1.12 NA 16.14 090 

28140 ......... ............ A Removal of metatarsal ................................. 6.90 7.22 4.76 0.79 14.91 12.45 090 

28150 ......... ............ A Removal of toe ............................................ 4.08 4.84 3.28 0.41 9.33 7.77 090 

28153 ......... ............ A Partial removal of toe .................................. 3.65 4.31 2.68 0.34 8.30 6.67 090 

28160 ......... ............ A Partial removal of toe .................................. 3.73 4.57 3.33 0.37 8.67 7.43 090 

28171 ......... ............ A Extensive foot surgery ................................. 9.59 NA 5.86 0.83 NA 16.28 090 

28173 ......... ............ A Extensive foot surgery ................................. 8.79 7.59 5.19 0.85 17.23 14.83 090 

28175 ......... ............ A Extensive foot surgery ................................. 6.04 5.70 3.70 0.53 12.27 10.27 090 

28190 ......... ............ A Removal of foot foreign body ...................... 1.96 3.40 1.49 0.17 5.53 3.62 010 

28192 ......... ............ A Removal of foot foreign body ...................... 4.63 5.49 3.64 0.46 10.58 8.73 090 

28193 ......... ............ A Removal of foot foreign body ...................... 5.72 5.61 3.93 0.56 11.89 10.21 090 

28200 ......... ............ A Repair of foot tendon ................................... 4.59 5.10 3.55 0.48 10.17 8.62 090 

28202 ......... ............ A Repair/graft of foot tendon ........................... 6.83 7.40 4.49 0.64 14.87 11.96 090 

28208 ......... ............ A Repair of foot tendon ................................... 4.36 4.82 3.30 0.42 9.60 8.08 090 

28210 ......... ............ A Repair/graft of foot tendon ........................... 6.34 6.22 4.02 0.64 13.20 11.00 090 

28220 ......... ............ A Release of foot tendon ................................ 4.52 4.67 3.42 0.40 9.59 8.34 090 

28222 ......... ............ A Release of foot tendons .............................. 5.61 5.24 4.12 0.49 11.34 10.22 090 

28225 ......... ............ A Release of foot tendon ................................ 3.65 4.28 2.90 0.33 8.26 6.88 090 

28226 ......... ............ A Release of foot tendons .............................. 4.52 4.80 3.74 0.45 9.77 8.71 090 

28230 ......... ............ A Incision of foot tendon(s) ............................. 4.23 4.67 3.66 0.42 9.32 8.31 090 

28232 ......... ............ A Incision of toe tendon .................................. 3.38 4.53 3.31 0.34 8.25 7.03 090 

28234 ......... ............ A Incision of foot tendon ................................. 3.36 4.68 3.35 0.34 8.38 7.05 090 

28238 ......... ............ A Revision of foot tendon ................................ 7.72 7.25 4.93 0.81 15.78 13.46 090 

28240 ......... ............ A Release of big toe ....................................... 4.35 4.64 3.48 0.45 9.44 8.28 090 

28250 ......... ............ A Revision of foot fascia ................................. 5.91 5.63 4.13 0.68 12.22 10.72 090 

28260 ......... ............ A Release of midfoot joint ............................... 7.95 6.34 4.99 0.92 15.21 13.86 090 

28261 ......... ............ A Revision of foot tendon ................................ 11.71 8.62 7.29 1.12 21.45 20.12 090 

28262 ......... ............ A Revision of foot and ankle ........................... 15.81 13.56 10.90 2.43 31.80 29.14 090 

28264 ......... ............ A Release of midfoot joint ............................... 10.33 7.74 7.28 1.28 19.35 18.89 090 

28270 ......... ............ A Release of foot contracture ......................... 4.75 4.89 3.73 0.46 10.10 8.94 090 

28272 ......... ............ A Release of toe joint, each ............................ 3.79 4.18 2.85 0.31 8.28 6.95 090 

28280 ......... ............ A Fusion of toes .............................................. 5.18 6.25 4.48 0.63 12.06 10.29 090 

28285 ......... ............ A Repair of hammertoe ................................... 4.58 4.87 3.42 0.44 9.89 8.44 090 

28286 ......... ............ A Repair of hammertoe ................................... 4.55 4.79 3.25 0.41 9.75 8.21 090 

28288 ......... ............ A Partial removal of foot bone ........................ 4.73 5.94 4.88 0.53 11.20 10.14 090 

28289 ......... ............ A Repair hallux rigidus .................................... 7.03 7.98 5.75 0.87 15.88 13.65 090 

28290 ......... ............ A Correction of bunion .................................... 5.65 6.26 4.72 0.69 12.60 11.06 090 

28292 ......... ............ A Correction of bunion .................................... 7.03 7.48 5.54 0.67 15.18 13.24 090 

28293 ......... ............ A Correction of bunion .................................... 9.14 10.63 6.10 0.79 20.56 16.03 090 

28294 ......... ............ A Correction of bunion .................................... 8.55 7.45 4.72 0.81 16.81 14.08 090 

28296 ......... ............ A Correction of bunion .................................... 9.17 8.16 5.41 0.88 18.21 15.46 090 

28297 ......... ............ A Correction of bunion .................................... 9.17 8.95 6.25 1.08 19.20 16.50 090 

47604

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

28298 ......... ............ A Correction of bunion .................................... 7.93 7.23 5.00 0.80 15.96 13.73 090 

28299 ......... ............ A Correction of bunion .................................... 10.56 8.77 6.06 1.01 20.34 17.63 090 

28300 ......... ............ A Incision of heel bone ................................... 9.53 NA 7.02 1.36 NA 17.91 090 

28302 ......... ............ A Incision of ankle bone .................................. 9.54 NA 6.88 1.59 NA 18.01 090 

28304 ......... ............ A Incision of midfoot bones ............................. 9.15 8.37 5.93 1.05 18.57 16.13 090 

28305 ......... ............ A Incise/graft midfoot bones ........................... 10.48 4.63 4.63 0.87 15.98 15.98 090 

28306 ......... ............ A Incision of metatarsal ................................... 5.85 7.37 4.41 0.69 13.91 10.95 090 

28307 ......... ............ A Incision of metatarsal ................................... 6.32 11.75 5.49 0.82 18.89 12.63 090 

28308 ......... ............ A Incision of metatarsal ................................... 5.28 6.27 3.90 0.53 12.08 9.71 090 

28309 ......... ............ A Incision of metatarsals ................................. 12.76 NA 8.22 1.70 NA 22.68 090 

28310 ......... ............ A Revision of big toe ....................................... 5.42 6.48 4.13 0.53 12.43 10.08 090 

28312 ......... ............ A Revision of toe ............................................. 4.54 6.21 4.28 0.51 11.26 9.33 090 

28313 ......... ............ A Repair deformity of toe ................................ 5.00 6.67 5.64 0.63 12.30 11.27 090 

28315 ......... ............ A Removal of sesamoid bone ......................... 4.85 6.03 3.80 0.46 11.34 9.11 090 

28320 ......... ............ A Repair of foot bones .................................... 9.17 NA 6.93 1.27 NA 17.37 090 

28322 ......... ............ A Repair of metatarsals .................................. 8.33 10.27 6.50 1.16 19.76 15.99 090 

28340 ......... ............ A Resect enlarged toe tissue .......................... 6.97 7.26 4.56 0.58 14.81 12.11 090 

28341 ......... ............ A Resect enlarged toe .................................... 8.40 7.45 5.10 0.72 16.57 14.22 090 

28344 ......... ............ A Repair extra toe(s) ....................................... 4.25 6.93 3.86 0.51 11.69 8.62 090 

28345 ......... ............ A Repair webbed toe(s) .................................. 5.91 7.19 4.97 0.54 13.64 11.42 090 

28360 ......... ............ A Reconstruct cleft foot ................................... 13.32 NA 10.75 1.90 NA 25.97 090 

28400 ......... ............ A Treatment of heel fracture ........................... 2.16 3.63 3.06 0.32 6.11 5.54 090 

28405 ......... ............ A Treatment of heel fracture ........................... 4.56 4.83 4.61 0.71 10.10 9.88 090 

28406 ......... ............ A Treatment of heel fracture ........................... 6.30 NA 6.98 1.03 NA 14.31 090 

28415 ......... ............ A Treat heel fracture ....................................... 15.95 NA 13.42 2.44 NA 31.81 090 

28420 ......... ............ A Treat/graft heel fracture ............................... 16.62 NA 13.08 2.65 NA 32.35 090 

28430 ......... ............ A Treatment of ankle fracture ......................... 2.09 3.39 2.58 0.29 5.77 4.96 090 

28435 ......... ............ A Treatment of ankle fracture ......................... 3.39 3.90 3.74 0.48 7.77 7.61 090 

28436 ......... ............ A Treatment of ankle fracture ......................... 4.70 NA 6.10 0.76 NA 11.56 090 

28445 ......... ............ A Treat ankle fracture ..................................... 15.60 NA 11.26 2.40 NA 29.26 090 

28450 ......... ............ A Treat midfoot fracture, each ........................ 1.90 3.11 2.50 0.25 5.26 4.65 090 

28455 ......... ............ A Treat midfoot fracture, each ........................ 3.09 3.43 3.43 0.41 6.93 6.93 090 

28456 ......... ............ A Treat midfoot fracture .................................. 2.68 NA 4.38 0.43 NA 7.49 090 

28465 ......... ............ A Treat midfoot fracture, each ........................ 7.00 NA 6.48 0.97 NA 14.45 090 

28470 ......... ............ A Treat metatarsal fracture ............................. 1.99 3.12 2.46 0.27 5.38 4.72 090 

28475 ......... ............ A Treat metatarsal fracture ............................. 2.97 3.33 3.21 0.38 6.68 6.56 090 

28476 ......... ............ A Treat metatarsal fracture ............................. 3.37 NA 5.18 0.51 NA 9.06 090 

28485 ......... ............ A Treat metatarsal fracture ............................. 5.70 NA 5.67 0.72 NA 12.09 090 

28490 ......... ............ A Treat big toe fracture ................................... 1.09 2.01 1.67 0.12 3.22 2.88 090 

28495 ......... ............ A Treat big toe fracture ................................... 1.58 2.18 2.08 0.16 3.92 3.82 090 

28496 ......... ............ A Treat big toe fracture ................................... 2.33 9.78 3.77 0.31 12.42 6.41 090 

28505 ......... ............ A Treat big toe fracture ................................... 3.80 9.77 4.81 0.49 14.06 9.10 090 

28510 ......... ............ A Treatment of toe fracture ............................. 1.09 1.53 1.53 0.11 2.73 2.73 090 

28515 ......... ............ A Treatment of toe fracture ............................. 1.46 1.89 1.89 0.14 3.49 3.49 090 

28525 ......... ............ A Treat toe fracture ......................................... 3.32 9.36 4.36 0.41 13.09 8.09 090 

28530 ......... ............ A Treat sesamoid bone fracture ..................... 1.06 1.45 1.45 0.10 2.61 2.61 090 

28531 ......... ............ A Treat sesamoid bone fracture ..................... 2.35 8.98 2.61 0.23 11.56 5.19 090 

28540 ......... ............ A Treat foot dislocation ................................... 2.04 2.41 2.41 0.19 4.64 4.64 090 

28545 ......... ............ A Treat foot dislocation ................................... 2.45 2.35 2.35 0.36 5.16 5.16 090 

28546 ......... ............ A Treat foot dislocation ................................... 3.20 8.03 5.00 0.41 11.64 8.61 090 

28555 ......... ............ A Repair foot dislocation ................................. 6.29 11.58 6.67 0.90 18.77 13.86 090 

28570 ......... ............ A Treat foot dislocation ................................... 1.66 2.42 2.34 0.20 4.28 4.20 090 

28575 ......... ............ A Treat foot dislocation ................................... 3.31 3.74 3.74 0.56 7.61 7.61 090 

28576 ......... ............ A Treat foot dislocation ................................... 4.16 10.32 5.68 0.59 15.07 10.43 090 

28585 ......... ............ A Repair foot dislocation ................................. 7.98 8.27 6.65 1.01 17.26 15.64 090 

28600 ......... ............ A Treat foot dislocation ................................... 1.89 2.82 2.69 0.24 4.95 4.82 090 

28605 ......... ............ A Treat foot dislocation ................................... 2.71 3.14 3.14 0.39 6.24 6.24 090 

28606 ......... ............ A Treat foot dislocation ................................... 4.89 15.93 6.18 0.78 21.60 11.85 090 

28615 ......... ............ A Repair foot dislocation ................................. 7.76 NA 8.16 1.21 NA 17.13 090 

28630 ......... ............ A Treat toe dislocation .................................... 1.70 1.57 1.01 0.17 3.44 2.88 010 

28635 ......... ............ A Treat toe dislocation .................................... 1.91 2.02 1.53 0.19 4.12 3.63 010 

28636 ......... ............ A Treat toe dislocation .................................... 2.77 3.87 2.62 0.38 7.02 5.77 010 

28645 ......... ............ A Repair toe dislocation .................................. 4.21 5.81 3.59 0.44 10.46 8.24 090 

28660 ......... ............ A Treat toe dislocation .................................... 1.23 1.26 0.81 0.12 2.61 2.16 010 

28665 ......... ............ A Treat toe dislocation .................................... 1.92 NA 1.43 0.22 NA 3.57 010 

28666 ......... ............ A Treat toe dislocation .................................... 2.66 5.90 2.57 0.38 8.94 5.61 010 

28675 ......... ............ A Repair of toe dislocation .............................. 2.92 8.85 3.88 0.40 12.17 7.20 090 

28705 ......... ............ A Fusion of foot bones .................................... 18.77 NA 12.65 2.77 NA 34.19 090 

28715 ......... ............ A Fusion of foot bones .................................... 13.08 NA 9.98 1.93 NA 24.99 090 

28725 ......... ............ A Fusion of foot bones .................................... 11.59 NA 8.50 1.66 NA 21.75 090 

28730 ......... ............ A Fusion of foot bones .................................... 10.74 NA 8.71 1.44 NA 20.89 090 

28735 ......... ............ A Fusion of foot bones .................................... 10.83 NA 8.08 1.44 NA 20.35 090 

28737 ......... ............ A Revision of foot bones ................................. 9.63 NA 7.07 1.12 NA 17.82 090 

28740 ......... ............ A Fusion of foot bones .................................... 8.01 11.72 6.66 1.03 20.76 15.70 090 

28750 ......... ............ A Fusion of big toe joint .................................. 7.29 13.06 6.84 1.04 21.39 15.17 090 

47605

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

28755 ......... ............ A Fusion of big toe joint .................................. 4.73 7.02 4.04 0.52 12.27 9.29 090 

28760 ......... ............ A Fusion of big toe joint .................................. 7.74 8.24 5.81 0.81 16.79 14.36 090 

28800 ......... ............ A Amputation of midfoot .................................. 8.20 NA 6.12 1.04 NA 15.36 090 

28805 ......... ............ A Amputation thru metatarsal ......................... 8.38 NA 5.93 1.10 NA 15.41 090 

28810 ......... ............ A Amputation toe & metatarsal ....................... 6.20 NA 4.78 0.81 NA 11.79 090 

28820 ......... ............ A Amputation of toe ........................................ 4.40 8.56 4.15 0.55 13.51 9.10 090 

28825 ......... ............ A Partial amputation of toe ............................. 3.58 8.01 3.87 0.44 12.03 7.89 090 

29000 ......... ............ A Application of body cast .............................. 2.25 3.00 1.73 0.47 5.72 4.45 000 

29010 ......... ............ A Application of body cast .............................. 2.06 3.29 1.77 0.36 5.71 4.19 000 

29015 ......... ............ A Application of body cast .............................. 2.41 2.97 1.60 0.26 5.64 4.27 000 

29020 ......... ............ A Application of body cast .............................. 2.11 3.19 1.42 0.21 5.51 3.74 000 

29025 ......... ............ A Application of body cast .............................. 2.40 3.19 1.84 0.44 6.03 4.68 000 

29035 ......... ............ A Application of body cast .............................. 1.77 3.61 1.58 0.29 5.67 3.64 000 

29040 ......... ............ A Application of body cast .............................. 2.22 2.49 1.52 0.18 4.89 3.92 000 

29044 ......... ............ A Application of body cast .............................. 2.12 3.97 1.90 0.37 6.46 4.39 000 

29046 ......... ............ A Application of body cast .............................. 2.41 3.27 2.08 0.40 6.08 4.89 000 

29049 ......... ............ A Application of figure eight ............................ 0.89 1.30 0.53 0.11 2.30 1.53 000 

29055 ......... ............ A Application of shoulder cast ........................ 1.78 2.98 1.47 0.28 5.04 3.53 000 

29058 ......... ............ A Application of shoulder cast ........................ 1.31 1.56 0.73 0.16 3.03 2.20 000 

29065 ......... ............ A Application of long arm cast ........................ 0.87 1.32 0.75 0.14 2.33 1.76 000 

29075 ......... ............ A Application of forearm cast .......................... 0.77 1.26 0.68 0.12 2.15 1.57 000 

29085 ......... ............ A Apply hand/wrist cast ................................... 0.87 1.28 0.63 0.13 2.28 1.63 000 

29086 ......... ............ A Apply finger cast .......................................... 0.62 0.96 0.50 0.08 1.66 1.20 000 

29105 ......... ............ A Apply long arm splint ................................... 0.87 1.23 0.51 0.12 2.22 1.50 000 

29125 ......... ............ A Apply forearm splint ..................................... 0.59 1.02 0.39 0.07 1.68 1.05 000 

29126 ......... ............ A Apply forearm splint ..................................... 0.77 1.21 0.46 0.06 2.04 1.29 000 

29130 ......... ............ A Application of finger splint ........................... 0.50 0.47 0.17 0.06 1.03 0.73 000 

29131 ......... ............ A Application of finger splint ........................... 0.55 0.74 0.24 0.03 1.32 0.82 000 

29200 ......... ............ A Strapping of chest ........................................ 0.65 0.73 0.35 0.05 1.43 1.05 000 

29220 ......... ............ A Strapping of low back .................................. 0.64 0.73 0.39 0.05 1.42 1.08 000 

29240 ......... ............ A Strapping of shoulder .................................. 0.71 0.86 0.37 0.06 1.63 1.14 000 

29260 ......... ............ A Strapping of elbow or wrist .......................... 0.55 0.75 0.33 0.05 1.35 0.93 000 

29280 ......... ............ A Strapping of hand or finger .......................... 0.51 0.81 0.33 0.03 1.35 0.87 000 

29305 ......... ............ A Application of hip cast ................................. 2.03 3.34 1.76 0.33 5.70 4.12 000 

29325 ......... ............ A Application of hip casts ................................ 2.32 3.52 1.95 0.39 6.23 4.66 000 

29345 ......... ............ A Application of long leg cast ......................... 1.40 1.76 1.06 0.23 3.39 2.69 000 

29355 ......... ............ A Application of long leg cast ......................... 1.53 1.71 1.12 0.24 3.48 2.89 000 

29358 ......... ............ A Apply long leg cast brace ............................ 1.43 2.06 1.09 0.23 3.72 2.75 000 

29365 ......... ............ A Application of long leg cast ......................... 1.18 1.65 0.95 0.20 3.03 2.33 000 

29405 ......... ............ A Apply short leg cast ..................................... 0.86 1.22 0.71 0.13 2.21 1.70 000 

29425 ......... ............ A Apply short leg cast ..................................... 1.01 1.23 0.74 0.13 2.37 1.88 000 

29435 ......... ............ A Apply short leg cast ..................................... 1.18 1.55 0.92 0.19 2.92 2.29 000 

29440 ......... ............ A Addition of walker to cast ............................ 0.57 0.69 0.27 0.08 1.34 0.92 000 

29445 ......... ............ A Apply rigid leg cast ...................................... 1.78 1.80 0.96 0.24 3.82 2.98 000 

29450 ......... ............ A Application of leg cast ................................. 2.08 1.47 1.10 0.19 3.74 3.37 000 

29505 ......... ............ A Application, long leg splint ........................... 0.69 1.18 0.46 0.07 1.94 1.22 000 

29515 ......... ............ A Application lower leg splint .......................... 0.73 0.87 0.47 0.08 1.68 1.28 000 

29520 ......... ............ A Strapping of hip ........................................... 0.54 0.87 0.47 0.02 1.43 1.03 000 

29530 ......... ............ A Strapping of knee ........................................ 0.57 0.79 0.33 0.05 1.41 0.95 000 

29540 ......... ............ A Strapping of ankle and/or ft ......................... 0.51 0.42 0.31 0.04 0.97 0.86 000 

29550 ......... ............ A Strapping of toes ......................................... 0.47 0.42 0.28 0.04 0.93 0.79 000 

29580 ......... ............ A Application of paste boot ............................. 0.57 0.65 0.36 0.06 1.28 0.99 000 

29590 ......... ............ A Application of foot splint .............................. 0.76 0.51 0.29 0.06 1.33 1.11 000 

29700 ......... ............ A Removal/revision of cast ............................. 0.57 0.89 0.28 0.07 1.53 0.92 000 

29705 ......... ............ A Removal/revision of cast ............................. 0.76 0.82 0.38 0.11 1.69 1.25 000 

29710 ......... ............ A Removal/revision of cast ............................. 1.34 1.53 0.70 0.20 3.07 2.24 000 

29715 ......... ............ A Removal/revision of cast ............................. 0.94 1.17 0.40 0.13 2.24 1.47 000 

29720 ......... ............ A Repair of body cast ..................................... 0.68 1.16 0.39 0.11 1.95 1.18 000 

29730 ......... ............ A Windowing of cast ....................................... 0.75 0.81 0.35 0.11 1.67 1.21 000 

29740 ......... ............ A Wedging of cast ........................................... 1.12 1.15 0.49 0.16 2.43 1.77 000 

29750 ......... ............ A Wedging of clubfoot cast ............................. 1.26 1.06 0.58 0.19 2.51 2.03 000 

29800 ......... ............ A Jaw arthroscopy/surgery .............................. 6.42 NA 7.06 0.99 NA 14.47 090 

29804 ......... ............ A Jaw arthroscopy/surgery .............................. 8.13 NA 7.84 1.30 NA 17.27 090 

29805 ......... ............ A Shoulder arthroscopy, dx ............................. 5.88 NA 5.84 1.01 NA 12.73 090 

29806 ......... ............ A Shoulder arthroscopy/surgery ...................... 14.35 NA 11.08 2.42 NA 27.85 090 

29807 ......... ............ A Shoulder arthroscopy/surgery ...................... 13.88 NA 10.91 2.35 NA 27.14 090 

29819 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.77 1.26 NA 15.64 090 

29820 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.06 NA 6.21 1.17 NA 14.44 090 

29821 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.71 NA 6.79 1.24 NA 15.74 090 

29822 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.42 NA 6.67 1.20 NA 15.29 090 

29823 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.16 NA 7.21 1.30 NA 16.67 090 

29824 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.24 NA 7.47 1.30 NA 17.01 090 

29825 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.75 1.12 NA 15.48 090 

29826 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.98 NA 7.52 1.42 NA 17.92 090 

29827 ......... ............ A Arthroscop rotator cuff repr ......................... 15.34 NA 11.52 2.08 NA 28.94 090 

47606

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

29830 ......... ............ A Elbow arthroscopy ....................................... 5.75 NA 5.33 0.87 NA 11.95 090 

29834 ......... ............ A Elbow arthroscopy/surgery .......................... 6.27 NA 5.82 1.02 NA 13.11 090 

29835 ......... ............ A Elbow arthroscopy/surgery .......................... 6.47 NA 5.87 1.12 NA 13.46 090 

29836 ......... ............ A Elbow arthroscopy/surgery .......................... 7.54 NA 6.77 1.08 NA 15.39 090 

29837 ......... ............ A Elbow arthroscopy/surgery .......................... 6.86 NA 6.12 1.11 NA 14.09 090 

29838 ......... ............ A Elbow arthroscopy/surgery .......................... 7.70 NA 6.87 1.23 NA 15.80 090 

29840 ......... ............ A Wrist arthroscopy ......................................... 5.53 NA 5.31 0.82 NA 11.66 090 

29843 ......... ............ A Wrist arthroscopy/surgery ............................ 6.00 NA 5.62 0.90 NA 12.52 090 

29844 ......... ............ A Wrist arthroscopy/surgery ............................ 6.36 NA 5.81 0.99 NA 13.16 090 

29845 ......... ............ A Wrist arthroscopy/surgery ............................ 7.51 NA 6.47 0.99 NA 14.97 090 

29846 ......... ............ A Wrist arthroscopy/surgery ............................ 6.74 NA 6.04 1.04 NA 13.82 090 

29847 ......... ............ A Wrist arthroscopy/surgery ............................ 7.07 NA 6.18 1.07 NA 14.32 090 

29848 ......... ............ A Wrist endoscopy/surgery ............................. 5.43 NA 5.59 0.87 NA 11.89 090 

29850 ......... ............ A Knee arthroscopy/surgery ............................ 8.18 NA 5.06 0.84 NA 14.08 090 

29851 ......... ............ A Knee arthroscopy/surgery ............................ 13.08 NA 9.78 2.04 NA 24.90 090 

29855 ......... ............ A Tibial arthroscopy/surgery ........................... 10.60 NA 8.75 1.71 NA 21.06 090 

29856 ......... ............ A Tibial arthroscopy/surgery ........................... 14.12 NA 10.65 2.46 NA 27.23 090 

29860 ......... ............ A Hip arthroscopy, dx ...................................... 8.04 NA 6.94 1.23 NA 16.21 090 

29861 ......... ............ A Hip arthroscopy/surgery ............................... 9.14 NA 7.34 1.45 NA 17.93 090 

29862 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.55 1.62 NA 20.06 090 

29863 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.49 1.56 NA 19.94 090 

29870 ......... ............ A Knee arthroscopy, dx ................................... 5.06 NA 4.88 0.85 NA 10.79 090 

29871 ......... ............ A Knee arthroscopy/drainage .......................... 6.54 NA 5.86 1.12 NA 13.52 090 

29873 ......... ............ A Knee arthroscopy/surgery ............................ 5.99 NA 6.57 0.89 NA 13.45 090 

29874 ......... ............ A Knee arthroscopy/surgery ............................ 7.04 NA 6.06 1.10 NA 14.20 090 

29875 ......... ............ A Knee arthroscopy/surgery ............................ 6.30 NA 5.84 1.05 NA 13.19 090 

29876 ......... ............ A Knee arthroscopy/surgery ............................ 7.91 NA 7.01 1.36 NA 16.28 090 

29877 ......... ............ A Knee arthroscopy/surgery ............................ 7.34 NA 6.73 1.25 NA 15.32 090 

29879 ......... ............ A Knee arthroscopy/surgery ............................ 8.03 NA 7.10 1.36 NA 16.49 090 

29880 ......... ............ A Knee arthroscopy/surgery ............................ 8.49 NA 7.35 1.43 NA 17.27 090 

29881 ......... ............ A Knee arthroscopy/surgery ............................ 7.75 NA 6.95 1.31 NA 16.01 090 

29882 ......... ............ A Knee arthroscopy/surgery ............................ 8.64 NA 7.23 1.48 NA 17.35 090 

29883 ......... ............ A Knee arthroscopy/surgery ............................ 11.03 NA 9.04 1.88 NA 21.95 090 

29884 ......... ............ A Knee arthroscopy/surgery ............................ 7.32 NA 6.68 1.21 NA 15.21 090 

29885 ......... ............ A Knee arthroscopy/surgery ............................ 9.08 NA 7.95 1.48 NA 18.51 090 

29886 ......... ............ A Knee arthroscopy/surgery ............................ 7.53 NA 6.83 1.29 NA 15.65 090 

29887 ......... ............ A Knee arthroscopy/surgery ............................ 9.03 NA 7.92 1.51 NA 18.46 090 

29888 ......... ............ A Knee arthroscopy/surgery ............................ 13.88 NA 10.18 2.22 NA 26.28 090 

29889 ......... ............ A Knee arthroscopy/surgery ............................ 15.98 NA 12.41 2.67 NA 31.06 090 

29891 ......... ............ A Ankle arthroscopy/surgery ........................... 8.39 NA 7.50 1.28 NA 17.17 090 

29892 ......... ............ A Ankle arthroscopy/surgery ........................... 8.99 NA 7.72 1.16 NA 17.87 090 

29893 ......... ............ A Scope, plantar fasciotomy ........................... 5.21 6.27 3.98 0.45 11.93 9.64 090 

29894 ......... ............ A Ankle arthroscopy/surgery ........................... 7.20 NA 5.46 0.99 NA 13.65 090 

29895 ......... ............ A Ankle arthroscopy/surgery ........................... 6.98 NA 5.46 0.96 NA 13.40 090 

29897 ......... ............ A Ankle arthroscopy/surgery ........................... 7.17 NA 5.87 1.10 NA 14.14 090 

29898 ......... ............ A Ankle arthroscopy/surgery ........................... 8.31 NA 6.18 1.11 NA 15.60 090 

29899 ......... ............ A Ankle arthroscopy/surgery ........................... 13.89 NA 10.55 2.04 NA 26.48 090 

29900 ......... ............ A Mcp joint arthroscopy, dx ............................ 5.41 NA 5.81 0.87 NA 12.09 090 

29901 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.12 NA 6.20 0.97 NA 13.29 090 

29902 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.69 NA 6.46 0.84 NA 13.99 090 

30000 ......... ............ A Drainage of nose lesion ............................... 1.43 4.09 1.40 0.12 5.64 2.95 010 

30020 ......... ............ A Drainage of nose lesion ............................... 1.43 3.28 1.47 0.12 4.83 3.02 010 

30100 ......... ............ A Intranasal biopsy .......................................... 0.94 1.97 0.82 0.08 2.99 1.84 000 

30110 ......... ............ A Removal of nose polyp(s) ............................ 1.63 3.24 1.57 0.14 5.01 3.34 010 

30115 ......... ............ A Removal of nose polyp(s) ............................ 4.34 NA 5.76 0.42 NA 10.52 090 

30117 ......... ............ A Removal of intranasal lesion ....................... 3.16 13.13 4.62 0.26 16.55 8.04 090 

30118 ......... ............ A Removal of intranasal lesion ....................... 9.68 NA 9.19 0.82 NA 19.69 090 

30120 ......... ............ A Revision of nose .......................................... 5.26 6.48 5.99 0.56 12.30 11.81 090 

30124 ......... ............ A Removal of nose lesion ............................... 3.10 NA 3.62 0.30 NA 7.02 090 

30125 ......... ............ A Removal of nose lesion ............................... 7.15 NA 8.32 0.58 NA 16.05 090 

30130 ......... ............ A Removal of turbinate bones ........................ 3.37 NA 5.58 0.32 NA 9.27 090 

30140 ......... ............ A Removal of turbinate bones ........................ 3.42 NA 6.19 0.36 NA 9.97 090 

30150 ......... ............ A Partial removal of nose ................................ 9.13 NA 10.99 0.91 NA 21.03 090 

30160 ......... ............ A Removal of nose .......................................... 9.57 NA 10.19 0.87 NA 20.63 090 

30200 ......... ............ A Injection treatment of nose .......................... 0.78 1.62 0.74 0.06 2.46 1.58 000 

30210 ......... ............ A Nasal sinus therapy ..................................... 1.08 2.10 1.31 0.09 3.27 2.48 010 

30220 ......... ............ A Insert nasal septal button ............................ 1.54 4.23 1.53 0.12 5.89 3.19 010 

30300 ......... ............ A Remove nasal foreign body ......................... 1.04 4.64 1.93 0.08 5.76 3.05 010 

30310 ......... ............ A Remove nasal foreign body ......................... 1.96 NA 3.09 0.17 NA 5.22 010 

30320 ......... ............ A Remove nasal foreign body ......................... 4.51 NA 7.03 0.37 NA 11.91 090 

30400 ......... ............ R Reconstruction of nose ................................ 9.82 NA 15.46 1.02 NA 26.30 090 

30410 ......... ............ R Reconstruction of nose ................................ 12.96 NA 18.32 1.47 NA 32.75 090 

30420 ......... ............ R Reconstruction of nose ................................ 15.86 NA 17.87 1.48 NA 35.21 090 

30430 ......... ............ R Revision of nose .......................................... 7.20 NA 15.95 0.79 NA 23.94 090 

30435 ......... ............ R Revision of nose .......................................... 11.69 NA 19.28 1.33 NA 32.30 090 

47607

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

30450 ......... ............ R Revision of nose .......................................... 18.62 NA 21.82 1.89 NA 42.33 090 

30460 ......... ............ A Revision of nose .......................................... 9.95 NA 9.94 0.91 NA 20.80 090 

30462 ......... ............ A Revision of nose .......................................... 19.54 NA 20.20 1.90 NA 41.64 090 

30465 ......... ............ A Repair nasal stenosis .................................. 11.62 NA 11.99 1.10 NA 24.71 090 

30520 ......... ............ A Repair of nasal septum ............................... 5.69 NA 6.65 0.47 NA 12.81 090 

30540 ......... ............ A Repair nasal defect ...................................... 7.74 NA 9.29 0.64 NA 17.67 090 

30545 ......... ............ A Repair nasal defect ...................................... 11.36 NA 11.87 0.81 NA 24.04 090 

30560 ......... ............ A Release of nasal adhesions ........................ 1.26 4.78 2.13 0.10 6.14 3.49 010 

30580 ......... ............ A Repair upper jaw fistula ............................... 6.68 7.76 5.78 0.87 15.31 13.33 090 

30600 ......... ............ A Repair mouth/nose fistula ............................ 6.01 7.53 5.02 0.61 14.15 11.64 090 

30620 ......... ............ A Intranasal reconstruction ............................. 5.96 NA 8.81 0.56 NA 15.33 090 

30630 ......... ............ A Repair nasal septum defect ......................... 7.11 NA 7.94 0.61 NA 15.66 090 

30801 ......... ............ A Cauterization, inner nose ............................. 1.09 4.14 1.93 0.09 5.32 3.11 010 

30802 ......... ............ A Cauterization, inner nose ............................. 2.03 4.61 2.35 0.17 6.81 4.55 010 

30901 ......... ............ A Control of nosebleed ................................... 1.21 1.36 0.32 0.11 2.68 1.64 000 

30903 ......... ............ A Control of nosebleed ................................... 1.54 2.71 0.50 0.13 4.38 2.17 000 

30905 ......... ............ A Control of nosebleed ................................... 1.97 3.51 0.76 0.17 5.65 2.90 000 

30906 ......... ............ A Repeat control of nosebleed ....................... 2.45 3.89 1.20 0.20 6.54 3.85 000 

30915 ......... ............ A Ligation, nasal sinus artery .......................... 7.19 NA 6.69 0.60 NA 14.48 090 

30920 ......... ............ A Ligation, upper jaw artery ............................ 9.82 NA 8.96 0.80 NA 19.58 090 

30930 ......... ............ A Therapy, fracture of nose ............................ 1.26 NA 1.62 0.12 NA 3.00 010 

31000 ......... ............ A Irrigation, maxillary sinus ............................. 1.15 2.85 1.40 0.10 4.10 2.65 010 

31002 ......... ............ A Irrigation, sphenoid sinus ............................. 1.91 NA 3.26 0.16 NA 5.33 010 

31020 ......... ............ A Exploration, maxillary sinus ......................... 2.94 8.54 5.18 0.28 11.76 8.40 090 

31030 ......... ............ A Exploration, maxillary sinus ......................... 5.91 11.51 6.66 0.58 18.00 13.15 090 

31032 ......... ............ A Explore sinus, remove polyps ..................... 6.56 NA 7.22 0.61 NA 14.39 090 

31040 ......... ............ A Exploration behind upper jaw ...................... 9.41 NA 9.85 0.90 NA 20.16 090 

31050 ......... ............ A Exploration, sphenoid sinus ......................... 5.27 NA 6.35 0.57 NA 12.19 090 

31051 ......... ............ A Sphenoid sinus surgery ............................... 7.10 NA 8.24 0.69 NA 16.03 090 

31070 ......... ............ A Exploration of frontal sinus .......................... 4.27 NA 5.93 0.39 NA 10.59 090 

31075 ......... ............ A Exploration of frontal sinus .......................... 9.15 NA 9.72 0.80 NA 19.67 090 

31080 ......... ............ A Removal of frontal sinus .............................. 11.40 NA 13.54 1.36 NA 26.30 090 

31081 ......... ............ A Removal of frontal sinus .............................. 12.73 NA 13.99 2.47 NA 29.19 090 

31084 ......... ............ A Removal of frontal sinus .............................. 13.49 NA 13.50 1.23 NA 28.22 090 

31085 ......... ............ A Removal of frontal sinus .............................. 14.18 NA 13.94 1.74 NA 29.86 090 

31086 ......... ............ A Removal of frontal sinus .............................. 12.84 NA 13.26 1.11 NA 27.21 090 

31087 ......... ............ A Removal of frontal sinus .............................. 13.08 NA 12.51 1.28 NA 26.87 090 

31090 ......... ............ A Exploration of sinuses ................................. 9.52 NA 12.54 0.94 NA 23.00 090 

31200 ......... ............ A Removal of ethmoid sinus ........................... 4.96 NA 9.24 0.31 NA 14.51 090 

31201 ......... ............ A Removal of ethmoid sinus ........................... 8.36 NA 9.16 0.82 NA 18.34 090 

31205 ......... ............ A Removal of ethmoid sinus ........................... 10.22 NA 11.89 0.73 NA 22.84 090 

31225 ......... ............ A Removal of upper jaw .................................. 19.20 NA 17.81 1.69 NA 38.70 090 

31230 ......... ............ A Removal of upper jaw .................................. 21.91 NA 19.35 1.89 NA 43.15 090 

31231 ......... ............ A Nasal endoscopy, dx ................................... 1.10 3.38 0.88 0.09 4.57 2.07 000 

31233 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.18 4.31 1.47 0.19 6.68 3.84 000 

31235 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.64 4.91 1.72 0.27 7.82 4.63 000 

31237 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.98 5.19 1.88 0.28 8.45 5.14 000 

31238 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.26 5.23 2.08 0.27 8.76 5.61 000 

31239 ......... ............ A Nasal/sinus endoscopy, surg ....................... 8.69 NA 8.01 0.62 NA 17.32 010 

31240 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.61 NA 1.73 0.25 NA 4.59 000 

31254 ......... ............ A Revision of ethmoid sinus ........................... 4.64 NA 2.84 0.46 NA 7.94 000 

31255 ......... ............ A Removal of ethmoid sinus ........................... 6.95 NA 4.10 0.74 NA 11.79 000 

31256 ......... ............ A Exploration maxillary sinus .......................... 3.29 NA 2.11 0.34 NA 5.74 000 

31267 ......... ............ A Endoscopy, maxillary sinus ......................... 5.45 NA 3.29 0.56 NA 9.30 000 

31276 ......... ............ A Sinus endoscopy, surgical ........................... 8.84 NA 5.11 0.92 NA 14.87 000 

31287 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.91 NA 2.45 0.40 NA 6.76 000 

31288 ......... ............ A Nasal/sinus endoscopy, surg ....................... 4.57 NA 2.80 0.47 NA 7.84 000 

31290 ......... ............ A Nasal/sinus endoscopy, surg ....................... 17.21 NA 12.04 1.41 NA 30.66 010 

31291 ......... ............ A Nasal/sinus endoscopy, surg ....................... 18.16 NA 12.46 1.74 NA 32.36 010 

31292 ......... ............ A Nasal/sinus endoscopy, surg ....................... 14.74 NA 10.60 1.27 NA 26.61 010 

31293 ......... ............ A Nasal/sinus endoscopy, surg ....................... 16.19 NA 11.37 1.17 NA 28.73 010 

31294 ......... ............ A Nasal/sinus endoscopy, surg ....................... 19.03 NA 12.86 1.42 NA 33.31 010 

31300 ......... ............ A Removal of larynx lesion ............................. 14.27 NA 14.99 1.21 NA 30.47 090 

31320 ......... ............ A Diagnostic incision, larynx ........................... 5.25 NA 10.34 0.46 NA 16.05 090 

31360 ......... ............ A Removal of larynx ........................................ 17.05 NA 16.72 1.44 NA 35.21 090 

31365 ......... ............ A Removal of larynx ........................................ 24.12 NA 20.35 2.03 NA 46.50 090 

31367 ......... ............ A Partial removal of larynx .............................. 21.83 NA 21.88 1.81 NA 45.52 090 

31368 ......... ............ A Partial removal of larynx .............................. 27.05 NA 25.47 2.26 NA 54.78 090 

31370 ......... ............ A Partial removal of larynx .............................. 21.35 NA 22.26 1.77 NA 45.38 090 

31375 ......... ............ A Partial removal of larynx .............................. 20.18 NA 20.41 1.65 NA 42.24 090 

31380 ......... ............ A Partial removal of larynx .............................. 20.18 NA 20.60 1.64 NA 42.42 090 

31382 ......... ............ A Partial removal of larynx .............................. 20.49 NA 21.61 1.72 NA 43.82 090 

31390 ......... ............ A Removal of larynx & pharynx ...................... 27.49 NA 24.37 2.32 NA 54.18 090 

31395 ......... ............ A Reconstruct larynx & pharynx ..................... 31.04 NA 28.28 2.61 NA 61.93 090 

31400 ......... ............ A Revision of larynx ........................................ 10.29 NA 13.80 0.84 NA 24.93 090 

47608

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

31420 ......... ............ A Removal of epiglottis ................................... 10.20 NA 9.54 0.83 NA 20.57 090 

31500 ......... ............ A Insert emergency airway ............................. 2.33 NA 0.55 0.18 NA 3.06 000 

31502 ......... ............ A Change of windpipe airway ......................... 0.65 0.31 0.28 0.05 1.01 0.98 000 

31505 ......... ............ A Diagnostic laryngoscopy .............................. 0.61 1.45 0.62 0.05 2.11 1.28 000 

31510 ......... ............ A Laryngoscopy with biopsy ........................... 1.92 3.32 1.25 0.17 5.41 3.34 000 

31511 ......... ............ A Remove foreign body, larynx ....................... 2.16 3.12 1.06 0.19 5.47 3.41 000 

31512 ......... ............ A Removal of larynx lesion ............................. 2.07 3.20 1.36 0.17 5.44 3.60 000 

31513 ......... ............ A Injection into vocal cord ............................... 2.10 NA 1.46 0.17 NA 3.73 000 

31515 ......... ............ A Laryngoscopy for aspiration ........................ 1.80 3.63 1.07 0.14 5.57 3.01 000 

31520 ......... ............ A Diagnostic laryngoscopy .............................. 2.56 NA 1.56 0.20 NA 4.32 000 

31525 ......... ............ A Diagnostic laryngoscopy .............................. 2.63 3.65 1.66 0.22 6.50 4.51 000 

31526 ......... ............ A Diagnostic laryngoscopy .............................. 2.57 NA 1.71 0.21 NA 4.49 000 

31527 ......... ............ A Laryngoscopy for treatment ......................... 3.27 NA 1.87 0.27 NA 5.41 000 

31528 ......... ............ A Laryngoscopy and dilation ........................... 2.37 NA 1.46 0.20 NA 4.03 000 

31529 ......... ............ A Laryngoscopy and dilation ........................... 2.68 NA 1.71 0.22 NA 4.61 000 

31530 ......... ............ A Operative laryngoscopy ............................... 3.38 NA 1.95 0.29 NA 5.62 000 

31531 ......... ............ A Operative laryngoscopy ............................... 3.58 NA 2.27 0.29 NA 6.14 000 

31535 ......... ............ A Operative laryngoscopy ............................... 3.16 NA 1.99 0.26 NA 5.41 000 

31536 ......... ............ A Operative laryngoscopy ............................... 3.55 NA 2.24 0.29 NA 6.08 000 

31540 ......... ............ A Operative laryngoscopy ............................... 4.12 NA 2.54 0.34 NA 7.00 000 

31541 ......... ............ A Operative laryngoscopy ............................... 4.52 NA 2.77 0.37 NA 7.66 000 

31560 ......... ............ A Operative laryngoscopy ............................... 5.45 NA 3.15 0.44 NA 9.04 000 

31561 ......... ............ A Operative laryngoscopy ............................... 5.99 NA 3.36 0.40 NA 9.75 000 

31570 ......... ............ A Laryngoscopy with injection ......................... 3.86 5.67 2.38 0.31 9.84 6.55 000 

31571 ......... ............ A Laryngoscopy with injection ......................... 4.26 NA 2.59 0.35 NA 7.20 000 

31575 ......... ............ A Diagnostic laryngoscopy .............................. 1.10 1.90 0.89 0.09 3.09 2.08 000 

31576 ......... ............ A Laryngoscopy with biopsy ........................... 1.97 3.66 1.29 0.15 5.78 3.41 000 

31577 ......... ............ A Remove foreign body, larynx ....................... 2.47 3.76 1.53 0.20 6.43 4.20 000 

31578 ......... ............ A Removal of larynx lesion ............................. 2.84 4.28 1.52 0.23 7.35 4.59 000 

31579 ......... ............ A Diagnostic laryngoscopy .............................. 2.26 3.78 1.48 0.19 6.23 3.93 000 

31580 ......... ............ A Revision of larynx ........................................ 12.36 NA 15.92 1.00 NA 29.28 090 

31582 ......... ............ A Revision of larynx ........................................ 21.59 NA 25.84 1.76 NA 49.19 090 

31584 ......... ............ A Treat larynx fracture .................................... 19.61 NA 18.15 1.57 NA 39.33 090 

31585 ......... ............ A Treat larynx fracture .................................... 4.63 NA 6.70 0.49 NA 11.82 090 

31586 ......... ............ A Treat larynx fracture .................................... 8.02 NA 10.86 0.65 NA 19.53 090 

31587 ......... ............ A Revision of larynx ........................................ 11.97 NA 9.26 0.99 NA 22.22 090 

31588 ......... ............ A Revision of larynx ........................................ 13.09 NA 13.60 1.05 NA 27.74 090 

31590 ......... ............ A Reinnervate larynx ....................................... 6.96 NA 15.54 0.85 NA 23.35 090 

31595 ......... ............ A Larynx nerve surgery ................................... 8.33 NA 10.58 0.79 NA 19.70 090 

31600 ......... ............ A Incision of windpipe ..................................... 7.17 NA 3.18 0.80 NA 11.15 000 

31601 ......... ............ A Incision of windpipe ..................................... 4.44 NA 2.39 0.47 NA 7.30 000 

31603 ......... ............ A Incision of windpipe ..................................... 4.14 NA 1.71 0.45 NA 6.30 000 

31605 ......... ............ A Incision of windpipe ..................................... 3.57 NA 1.18 0.39 NA 5.14 000 

31610 ......... ............ A Incision of windpipe ..................................... 8.75 NA 8.27 0.80 NA 17.82 090 

31611 ......... ............ A Surgery/speech prosthesis .......................... 5.63 NA 6.11 0.47 NA 12.21 090 

31612 ......... ............ A Puncture/clear windpipe .............................. 0.91 1.10 0.35 0.08 2.09 1.34 000 

31613 ......... ............ A Repair windpipe opening ............................. 4.58 NA 5.99 0.45 NA 11.02 090 

31614 ......... ............ A Repair windpipe opening ............................. 7.11 NA 8.71 0.62 NA 16.44 090 

31615 ......... ............ A Visualization of windpipe ............................. 2.09 2.59 1.20 0.16 4.84 3.45 000 

31622 ......... ............ A Dx bronchoscope/wash ............................... 2.78 5.71 1.06 0.19 8.68 4.03 000 

31623 ......... ............ A Dx bronchoscope/brush ............................... 2.88 6.51 1.05 0.16 9.55 4.09 000 

31624 ......... ............ A Dx bronchoscope/lavage ............................. 2.88 5.85 1.05 0.16 8.89 4.09 000 

31625 ......... ............ A Bronchoscopy w/biopsy(s) ........................... 3.36 5.91 1.21 0.20 9.47 4.77 000 

31628 ......... ............ A Bronchoscopy/lung bx, each ....................... 3.80 6.13 1.30 0.19 10.12 5.29 000 

31629 ......... ............ A Bronchoscopy/needle bx, each ................... 4.09 13.50 1.40 0.17 17.76 5.66 000 

31630 ......... ............ A Bronchoscopy dilate/fx repr ......................... 3.81 NA 1.70 0.35 NA 5.86 000 

31631 ......... ............ A Bronchoscopy, dilate w/stent ....................... 4.36 NA 1.74 0.37 NA 6.47 000 

31632 ......... ............ A Bronchoscopy/lung bx, add-l ....................... 1.03 0.83 0.31 0.19 2.05 1.53 ZZZ 

31633 ......... ............ A Bronchoscopy/needle bx add-l .................... 1.32 0.93 0.40 0.17 2.42 1.89 ZZZ 

31635 ......... ............ A Bronchoscopy w/fb removal ........................ 3.67 6.17 1.43 0.27 10.11 5.37 000 

31640 ......... ............ A Bronchoscopy w/tumor excise ..................... 4.93 NA 2.07 0.44 NA 7.44 000 

31641 ......... ............ A Bronchoscopy, treat blockage ..................... 5.02 NA 1.88 0.37 NA 7.27 000 

31643 ......... ............ A Diag bronchoscope/catheter ........................ 3.49 NA 1.23 0.20 NA 4.92 000 

31645 ......... ............ A Bronchoscopy, clear airways ....................... 3.16 5.21 1.13 0.18 8.55 4.47 000 

31646 ......... ............ A Bronchoscopy, reclear airway ..................... 2.72 4.93 1.00 0.16 7.81 3.88 000 

31656 ......... ............ A Bronchoscopy, inj for x-ray .......................... 2.17 6.44 0.83 0.13 8.74 3.13 000 

31700 ......... ............ A Insertion of airway catheter ......................... 1.34 2.17 0.69 0.08 3.59 2.11 000 

31708 ......... ............ A Instill airway contrast dye ............................ 1.41 2.12 0.46 0.07 3.60 1.94 000 

31710 ......... ............ A Insertion of airway catheter ......................... 1.30 NA 0.41 0.09 NA 1.80 000 

31715 ......... ............ A Injection for bronchus x-ray ......................... 1.11 NA 0.34 0.07 NA 1.52 000 

31717 ......... ............ A Bronchial brush biopsy ................................ 2.12 8.66 0.79 0.10 10.88 3.01 000 

31720 ......... ............ A Clearance of airways ................................... 1.06 0.33 0.33 0.08 1.47 1.47 000 

31725 ......... ............ A Clearance of airways ................................... 1.96 0.65 0.58 0.13 2.74 2.67 000 

31730 ......... ............ A Intro, windpipe wire/tube .............................. 2.85 2.20 0.99 0.22 5.27 4.06 000 

31750 ......... ............ A Repair of windpipe ....................................... 13.00 NA 17.58 1.14 NA 31.72 090 

47609

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

31755 ......... ............ A Repair of windpipe ....................................... 15.91 NA 24.51 1.41 NA 41.83 090 

31760 ......... ............ A Repair of windpipe ....................................... 22.32 NA 10.76 3.08 NA 36.16 090 

31766 ......... ............ A Reconstruction of windpipe ......................... 30.38 NA 13.67 4.53 NA 48.58 090 

31770 ......... ............ A Repair/graft of bronchus .............................. 22.48 NA 10.28 2.76 NA 35.52 090 

31775 ......... ............ A Reconstruct bronchus .................................. 23.50 NA 11.82 3.06 NA 38.38 090 

31780 ......... ............ A Reconstruct windpipe .................................. 17.69 NA 11.07 1.72 NA 30.48 090 

31781 ......... ............ A Reconstruct windpipe .................................. 23.49 NA 12.15 2.51 NA 38.15 090 

31785 ......... ............ A Remove windpipe lesion .............................. 17.20 NA 10.20 1.54 NA 28.94 090 

31786 ......... ............ A Remove windpipe lesion .............................. 23.94 NA 13.12 3.33 NA 40.39 090 

31800 ......... ............ A Repair of windpipe injury ............................. 7.42 NA 9.29 0.76 NA 17.47 090 

31805 ......... ............ A Repair of windpipe injury ............................. 13.11 NA 7.25 1.78 NA 22.14 090 

31820 ......... ............ A Closure of windpipe lesion .......................... 4.48 5.66 3.65 0.40 10.54 8.53 090 

31825 ......... ............ A Repair of windpipe defect ............................ 6.80 7.66 5.37 0.58 15.04 12.75 090 

31830 ......... ............ A Revise windpipe scar ................................... 4.49 5.76 3.98 0.43 10.68 8.90 090 

32000 ......... ............ A Drainage of chest ........................................ 1.54 3.10 0.48 0.09 4.73 2.11 000 

32002 ......... ............ A Treatment of collapsed lung ........................ 2.19 3.24 1.06 0.13 5.56 3.38 000 

32005 ......... ............ A Treat lung lining chemically ......................... 2.19 6.50 0.70 0.22 8.91 3.11 000 

32020 ......... ............ A Insertion of chest tube ................................. 3.97 NA 1.35 0.42 NA 5.74 000 

32035 ......... ............ A Exploration of chest ..................................... 8.66 NA 5.88 1.18 NA 15.72 090 

32036 ......... ............ A Exploration of chest ..................................... 9.67 NA 6.46 1.32 NA 17.45 090 

32095 ......... ............ A Biopsy through chest wall ............................ 8.35 NA 5.38 1.10 NA 14.83 090 

32100 ......... ............ A Exploration/biopsy of chest .......................... 15.22 NA 7.84 2.03 NA 25.09 090 

32110 ......... ............ A Explore/repair chest ..................................... 22.97 NA 10.74 3.01 NA 36.72 090 

32120 ......... ............ A Re-exploration of chest ................................ 11.52 NA 7.10 1.54 NA 20.16 090 

32124 ......... ............ A Explore chest free adhesions ...................... 12.70 NA 7.23 1.77 NA 21.70 090 

32140 ......... ............ A Removal of lung lesion(s) ............................ 13.91 NA 7.70 1.88 NA 23.49 090 

32141 ......... ............ A Remove/treat lung lesions ........................... 13.98 NA 7.57 1.86 NA 23.41 090 

32150 ......... ............ A Removal of lung lesion(s) ............................ 14.13 NA 7.63 1.88 NA 23.64 090 

32151 ......... ............ A Remove lung foreign body .......................... 14.19 NA 8.03 1.61 NA 23.83 090 

32160 ......... ............ A Open chest heart massage ......................... 9.29 NA 5.28 1.20 NA 15.77 090 

32200 ......... ............ A Drain, open, lung lesion ............................... 15.27 NA 8.62 1.25 NA 25.14 090 

32201 ......... ............ A Drain, percut, lung lesion ............................. 3.99 21.04 1.30 0.24 25.27 5.53 000 

32215 ......... ............ A Treat chest lining ......................................... 11.31 NA 6.92 1.50 NA 19.73 090 

32220 ......... ............ A Release of lung ............................................ 23.96 NA 12.96 3.20 NA 40.12 090 

32225 ......... ............ A Partial release of lung .................................. 13.94 NA 7.68 1.86 NA 23.48 090 

32310 ......... ............ A Removal of chest lining ............................... 13.42 NA 7.41 1.77 NA 22.60 090 

32320 ......... ............ A Free/remove chest lining ............................. 23.96 NA 12.16 3.23 NA 39.35 090 

32400 ......... ............ A Needle biopsy chest lining ........................... 1.76 2.14 0.55 0.10 4.00 2.41 000 

32402 ......... ............ A Open biopsy chest lining ............................. 7.55 NA 5.14 1.00 NA 13.69 090 

32405 ......... ............ A Biopsy, lung or mediastinum ....................... 1.93 0.67 0.63 0.12 2.72 2.68 000 

32420 ......... ............ A Puncture/clear lung ...................................... 2.18 NA 0.68 0.14 NA 3.00 000 

32440 ......... ............ A Removal of lung ........................................... 24.96 NA 12.89 3.33 NA 41.18 090 

32442 ......... ............ A Sleeve pneumonectomy .............................. 26.20 NA 14.75 3.14 NA 44.09 090 

32445 ......... ............ A Removal of lung ........................................... 25.05 NA 14.06 3.55 NA 42.66 090 

32480 ......... ............ A Partial removal of lung ................................. 23.71 NA 12.05 3.16 NA 38.92 090 

32482 ......... ............ A Bilobectomy ................................................. 24.96 NA 12.90 3.30 NA 41.16 090 

32484 ......... ............ A Segmentectomy ........................................... 20.66 NA 11.38 2.82 NA 34.86 090 

32486 ......... ............ A Sleeve lobectomy ........................................ 23.88 NA 13.24 3.36 NA 40.48 090 

32488 ......... ............ A Completion pneumonectomy ....................... 25.67 NA 13.78 3.55 NA 43.00 090 

32491 ......... ............ R Lung volume reduction ................................ 21.22 NA 12.62 3.11 NA 36.95 090 

32500 ......... ............ A Partial removal of lung ................................. 21.97 NA 12.35 2.92 NA 37.24 090 

32501 ......... ............ A Repair bronchus add-on .............................. 4.68 NA 1.53 0.64 NA 6.85 ZZZ 

32520 ......... ............ A Remove lung & revise chest ....................... 21.65 NA 11.31 2.91 NA 35.87 090 

32522 ......... ............ A Remove lung & revise chest ....................... 24.16 NA 12.11 3.29 NA 39.56 090 

32525 ......... ............ A Remove lung & revise chest ....................... 26.46 NA 12.79 3.49 NA 42.74 090 

32540 ......... ............ A Removal of lung lesion ................................ 14.62 NA 9.63 1.96 NA 26.21 090 

32601 ......... ............ A Thoracoscopy, diagnostic ............................ 5.45 NA 2.35 0.73 NA 8.53 000 

32602 ......... ............ A Thoracoscopy, diagnostic ............................ 5.95 NA 2.51 0.80 NA 9.26 000 

32603 ......... ............ A Thoracoscopy, diagnostic ............................ 7.80 NA 3.03 1.09 NA 11.92 000 

32604 ......... ............ A Thoracoscopy, diagnostic ............................ 8.77 NA 3.44 1.12 NA 13.33 000 

32605 ......... ............ A Thoracoscopy, diagnostic ............................ 6.92 NA 2.90 0.91 NA 10.73 000 

32606 ......... ............ A Thoracoscopy, diagnostic ............................ 8.39 NA 3.33 0.85 NA 12.57 000 

32650 ......... ............ A Thoracoscopy, surgical ................................ 10.73 NA 6.76 1.44 NA 18.93 090 

32651 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.23 1.75 NA 21.87 090 

32652 ......... ............ A Thoracoscopy, surgical ................................ 18.63 NA 10.14 2.53 NA 31.30 090 

32653 ......... ............ A Thoracoscopy, surgical ................................ 12.85 NA 6.97 1.76 NA 21.58 090 

32654 ......... ............ A Thoracoscopy, surgical ................................ 12.42 NA 7.53 1.64 NA 21.59 090 

32655 ......... ............ A Thoracoscopy, surgical ................................ 13.08 NA 7.24 1.75 NA 22.07 090 

32656 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.93 1.80 NA 22.62 090 

32657 ......... ............ A Thoracoscopy, surgical ................................ 13.63 NA 7.68 1.86 NA 23.17 090 

32658 ......... ............ A Thoracoscopy, surgical ................................ 11.61 NA 7.35 1.62 NA 20.58 090 

32659 ......... ............ A Thoracoscopy, surgical ................................ 11.57 NA 7.45 1.55 NA 20.57 090 

32660 ......... ............ A Thoracoscopy, surgical ................................ 17.40 NA 9.47 1.87 NA 28.74 090 

32661 ......... ............ A Thoracoscopy, surgical ................................ 13.23 NA 7.79 1.77 NA 22.79 090 

32662 ......... ............ A Thoracoscopy, surgical ................................ 16.42 NA 8.81 2.26 NA 27.49 090 

47610

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

32663 ......... ............ A Thoracoscopy, surgical ................................ 18.44 NA 10.75 2.56 NA 31.75 090 

32664 ......... ............ A Thoracoscopy, surgical ................................ 14.18 NA 7.63 2.06 NA 23.87 090 

32665 ......... ............ A Thoracoscopy, surgical ................................ 15.52 NA 8.13 2.03 NA 25.68 090 

32800 ......... ............ A Repair lung hernia ....................................... 13.67 NA 7.45 1.91 NA 23.03 090 

32810 ......... ............ A Close chest after drainage .......................... 13.03 NA 7.55 1.83 NA 22.41 090 

32815 ......... ............ A Close bronchial fistula ................................. 23.12 NA 10.99 3.11 NA 37.22 090 

32820 ......... ............ A Reconstruct injured chest ............................ 21.45 NA 12.22 3.02 NA 36.69 090 

32851 ......... ............ A Lung transplant, single ................................ 38.57 NA 27.68 5.44 NA 71.69 090 

32852 ......... ............ A Lung transplant with bypass ........................ 41.74 NA 33.18 5.79 NA 80.71 090 

32853 ......... ............ A Lung transplant, double ............................... 47.74 NA 31.75 6.35 NA 85.84 090 

32854 ......... ............ A Lung transplant with bypass ........................ 50.90 NA 34.78 7.07 NA 92.75 090 

32900 ......... ............ A Removal of rib(s) ......................................... 20.24 NA 9.90 2.79 NA 32.93 090 

32905 ......... ............ A Revise & repair chest wall ........................... 20.72 NA 10.14 2.87 NA 33.73 090 

32906 ......... ............ A Revise & repair chest wall ........................... 26.73 NA 12.08 3.74 NA 42.55 090 

32940 ......... ............ A Revision of lung ........................................... 19.40 NA 9.49 2.66 NA 31.55 090 

32960 ......... ............ A Therapeutic pneumothorax .......................... 1.84 1.76 0.57 0.19 3.79 2.60 000 

32997 ......... ............ A Total lung lavage ......................................... 5.99 NA 1.90 0.42 NA 8.31 000 

33010 ......... ............ A Drainage of heart sac .................................. 2.24 NA 0.78 0.15 NA 3.17 000 

33011 ......... ............ A Repeat drainage of heart sac ...................... 2.24 NA 0.81 0.17 NA 3.22 000 

33015 ......... ............ A Incision of heart sac .................................... 6.79 NA 4.95 0.64 NA 12.38 090 

33020 ......... ............ A Incision of heart sac .................................... 12.59 NA 6.80 1.62 NA 21.01 090 

33025 ......... ............ A Incision of heart sac .................................... 12.07 NA 6.36 1.60 NA 20.03 090 

33030 ......... ............ A Partial removal of heart sac ........................ 18.68 NA 9.54 2.53 NA 30.75 090 

33031 ......... ............ A Partial removal of heart sac ........................ 21.76 NA 10.05 2.89 NA 34.70 090 

33050 ......... ............ A Removal of heart sac lesion ........................ 14.34 NA 7.86 1.83 NA 24.03 090 

33120 ......... ............ A Removal of heart lesion ............................... 24.52 NA 11.62 3.25 NA 39.39 090 

33130 ......... ............ A Removal of heart lesion ............................... 21.36 NA 10.14 2.80 NA 34.30 090 

33140 ......... ............ A Heart revascularize (tmr) ............................. 19.97 NA 10.89 2.66 NA 33.52 090 

33141 ......... ............ A Heart tmr w/other procedure ....................... 4.83 NA 1.57 0.62 NA 7.02 ZZZ 

33200 ......... ............ A Insertion of heart pacemaker ....................... 12.46 NA 6.94 1.52 NA 20.92 090 

33201 ......... ............ A Insertion of heart pacemaker ....................... 10.16 NA 6.69 1.18 NA 18.03 090 

33206 ......... ............ A Insertion of heart pacemaker ....................... 6.66 NA 4.54 0.54 NA 11.74 090 

33207 ......... ............ A Insertion of heart pacemaker ....................... 8.03 NA 4.73 0.63 NA 13.39 090 

33208 ......... ............ A Insertion of heart pacemaker ....................... 8.12 NA 4.84 0.60 NA 13.56 090 

33210 ......... ............ A Insertion of heart electrode .......................... 3.30 NA 1.25 0.20 NA 4.75 000 

33211 ......... ............ A Insertion of heart electrode .......................... 3.39 NA 1.31 0.23 NA 4.93 000 

33212 ......... ............ A Insertion of pulse generator ......................... 5.51 NA 3.40 0.47 NA 9.38 090 

33213 ......... ............ A Insertion of pulse generator ......................... 6.36 NA 3.76 0.50 NA 10.62 090 

33214 ......... ............ A Upgrade of pacemaker system ................... 7.74 NA 4.97 0.58 NA 13.29 090 

33215 ......... ............ A Reposition pacing-defib lead ....................... 4.75 NA 3.18 0.39 NA 8.32 090 

33216 ......... ............ A Insert lead pace-defib, one .......................... 5.77 NA 4.28 0.39 NA 10.44 090 

33217 ......... ............ A Insert lead pace-defib, dual ......................... 5.74 NA 4.31 0.43 NA 10.48 090 

33218 ......... ............ A Repair lead pace-defib, one ........................ 5.43 NA 4.34 0.43 NA 10.20 090 

33220 ......... ............ A Repair lead pace-defib, dual ....................... 5.51 NA 4.31 0.43 NA 10.25 090 

33222 ......... ............ A Revise pocket, pacemaker .......................... 4.95 NA 4.34 0.42 NA 9.71 090 

33223 ......... ............ A Revise pocket, pacing-defib ........................ 6.45 NA 4.61 0.47 NA 11.53 090 

33224 ......... ............ A Insert pacing lead & connect ....................... 9.04 NA 3.99 0.43 NA 13.46 000 

33225 ......... ............ A L ventric pacing lead add-on ....................... 8.33 NA 3.25 0.43 NA 12.01 ZZZ 

33226 ......... ............ A Reposition l ventric lead .............................. 8.68 NA 3.81 0.43 NA 12.92 000 

33233 ......... ............ A Removal of pacemaker system ................... 3.29 NA 3.28 0.24 NA 6.81 090 

33234 ......... ............ A Removal of pacemaker system ................... 7.81 NA 4.92 0.60 NA 13.33 090 

33235 ......... ............ A Removal pacemaker electrode .................... 9.39 NA 6.82 0.76 NA 16.97 090 

33236 ......... ............ A Remove electrode/thoracotomy ................... 12.58 NA 7.45 1.72 NA 21.75 090 

33237 ......... ............ A Remove electrode/thoracotomy ................... 13.69 NA 7.79 1.63 NA 23.11 090 

33238 ......... ............ A Remove electrode/thoracotomy ................... 15.20 NA 8.22 1.94 NA 25.36 090 

33240 ......... ............ A Insert pulse generator .................................. 7.59 NA 4.63 0.50 NA 12.72 090 

33241 ......... ............ A Remove pulse generator ............................. 3.24 NA 2.97 0.22 NA 6.43 090 

33243 ......... ............ A Remove eltrd/thoracotomy ........................... 22.61 NA 11.45 2.80 NA 36.86 090 

33244 ......... ............ A Remove eltrd, transven ............................... 13.74 NA 8.90 1.02 NA 23.66 090 

33245 ......... ............ A Insert epic eltrd pace-defib .......................... 14.28 NA 7.99 1.85 NA 24.12 090 

33246 ......... ............ A Insert epic eltrd/generator ............................ 20.68 NA 10.35 2.46 NA 33.49 090 

33249 ......... ............ A Eltrd/insert pace-defib .................................. 14.21 NA 8.44 0.86 NA 23.51 090 

33250 ......... ............ A Ablate heart dysrhythm focus ...................... 21.82 NA 11.05 2.79 NA 35.66 090 

33251 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.68 2.87 NA 39.39 090 

33253 ......... ............ A Reconstruct atria .......................................... 31.01 NA 13.84 4.04 NA 48.89 090 

33261 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.79 2.82 NA 39.45 090 

33282 ......... ............ A Implant pat-active ht record ......................... 4.16 NA 4.07 0.25 NA 8.48 090 

33284 ......... ............ A Remove pat-active ht record ....................... 2.50 NA 3.55 0.16 NA 6.21 090 

33300 ......... ............ A Repair of heart wound ................................. 17.89 NA 9.25 2.33 NA 29.47 090 

33305 ......... ............ A Repair of heart wound ................................. 21.41 NA 10.64 2.79 NA 34.84 090 

33310 ......... ............ A Exploratory heart surgery ............................ 18.48 NA 9.60 2.58 NA 30.66 090 

33315 ......... ............ A Exploratory heart surgery ............................ 22.34 NA 10.90 2.87 NA 36.11 090 

33320 ......... ............ A Repair major blood vessel(s) ....................... 16.76 NA 8.25 1.83 NA 26.84 090 

33321 ......... ............ A Repair major vessel ..................................... 20.17 NA 9.81 2.69 NA 32.67 090 

33322 ......... ............ A Repair major blood vessel(s) ....................... 20.59 NA 10.38 2.65 NA 33.62 090 

47611

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

33330 ......... ............ A Insert major vessel graft .............................. 21.40 NA 10.28 2.65 NA 34.33 090 

33332 ......... ............ A Insert major vessel graft .............................. 23.92 NA 10.53 3.11 NA 37.56 090 

33335 ......... ............ A Insert major vessel graft .............................. 29.96 NA 13.35 3.86 NA 47.17 090 

33400 ......... ............ A Repair of aortic valve ................................... 28.46 NA 15.65 3.69 NA 47.80 090 

33401 ......... ............ A Valvuloplasty, open ...................................... 23.87 NA 13.50 1.30 NA 38.67 090 

33403 ......... ............ A Valvuloplasty, w/cp bypass .......................... 24.85 NA 14.30 3.53 NA 42.68 090 

33404 ......... ............ A Prepare heart-aorta conduit ......................... 28.50 NA 14.53 4.02 NA 47.05 090 

33405 ......... ............ A Replacement of aortic valve ........................ 34.95 NA 18.28 4.55 NA 57.78 090 

33406 ......... ............ A Replacement of aortic valve ........................ 37.44 NA 19.11 4.93 NA 61.48 090 

33410 ......... ............ A Replacement of aortic valve ........................ 32.41 NA 16.58 4.05 NA 53.04 090 

33411 ......... ............ A Replacement of aortic valve ........................ 36.20 NA 18.74 4.86 NA 59.80 090 

33412 ......... ............ A Replacement of aortic valve ........................ 41.94 NA 20.40 5.61 NA 67.95 090 

33413 ......... ............ A Replacement of aortic valve ........................ 43.43 NA 20.80 5.94 NA 70.17 090 

33414 ......... ............ A Repair of aortic valve ................................... 30.30 NA 14.15 4.00 NA 48.45 090 

33415 ......... ............ A Revision, subvalvular tissue ........................ 27.11 NA 12.05 3.56 NA 42.72 090 

33416 ......... ............ A Revise ventricle muscle ............................... 30.30 NA 13.52 4.14 NA 47.96 090 

33417 ......... ............ A Repair of aortic valve ................................... 28.49 NA 13.63 3.96 NA 46.08 090 

33420 ......... ............ A Revision of mitral valve ............................... 22.67 NA 9.61 1.89 NA 34.17 090 

33422 ......... ............ A Revision of mitral valve ............................... 25.90 NA 13.64 3.39 NA 42.93 090 

33425 ......... ............ A Repair of mitral valve ................................... 26.96 NA 13.05 3.59 NA 43.60 090 

33426 ......... ............ A Repair of mitral valve ................................... 32.95 NA 17.13 4.25 NA 54.33 090 

33427 ......... ............ A Repair of mitral valve ................................... 39.94 NA 19.35 5.27 NA 64.56 090 

33430 ......... ............ A Replacement of mitral valve ........................ 33.45 NA 17.29 4.36 NA 55.10 090 

33460 ......... ............ A Revision of tricuspid valve ........................... 23.56 NA 11.32 3.23 NA 38.11 090 

33463 ......... ............ A Valvuloplasty, tricuspid ................................ 25.58 NA 12.92 3.36 NA 41.86 090 

33464 ......... ............ A Valvuloplasty, tricuspid ................................ 27.29 NA 13.53 3.52 NA 44.34 090 

33465 ......... ............ A Replace tricuspid valve ................................ 28.75 NA 12.98 3.88 NA 45.61 090 

33468 ......... ............ A Revision of tricuspid valve ........................... 30.07 NA 13.68 4.35 NA 48.10 090 

33470 ......... ............ A Revision of pulmonary valve ....................... 20.78 NA 10.71 2.01 NA 33.50 090 

33471 ......... ............ A Valvotomy, pulmonary valve ........................ 22.22 NA 9.77 3.31 NA 35.30 090 

33472 ......... ............ A Revision of pulmonary valve ....................... 22.22 NA 11.89 3.11 NA 37.22 090 

33474 ......... ............ A Revision of pulmonary valve ....................... 23.01 NA 10.89 2.70 NA 36.60 090 

33475 ......... ............ A Replacement, pulmonary valve ................... 32.95 NA 15.41 4.30 NA 52.66 090 

33476 ......... ............ A Revision of heart chamber .......................... 25.73 NA 11.97 2.97 NA 40.67 090 

33478 ......... ............ A Revision of heart chamber .......................... 26.70 NA 13.06 3.85 NA 43.61 090 

33496 ......... ............ A Repair, prosth valve clot .............................. 27.21 NA 12.76 3.60 NA 43.57 090 

33500 ......... ............ A Repair heart vessel fistula ........................... 25.51 NA 11.47 3.33 NA 40.31 090 

33501 ......... ............ A Repair heart vessel fistula ........................... 17.75 NA 8.29 2.04 NA 28.08 090 

33502 ......... ............ A Coronary artery correction ........................... 21.01 NA 11.10 2.11 NA 34.22 090 

33503 ......... ............ A Coronary artery graft ................................... 21.75 NA 9.78 1.84 NA 33.37 090 

33504 ......... ............ A Coronary artery graft ................................... 24.62 NA 11.84 3.32 NA 39.78 090 

33505 ......... ............ A Repair artery w/tunnel ................................. 26.80 NA 12.93 2.67 NA 42.40 090 

33506 ......... ............ A Repair artery, translocation ......................... 35.45 NA 14.59 3.85 NA 53.89 090 

33508 ......... ............ A Endoscopic vein harvest .............................. 0.31 NA 0.10 0.88 NA 1.29 ZZZ 

33510 ......... ............ A CABG, vein, single ...................................... 28.96 NA 16.33 3.75 NA 49.04 090 

33511 ......... ............ A CABG, vein, two .......................................... 29.96 NA 17.07 3.83 NA 50.86 090 

33512 ......... ............ A CABG, vein, three ........................................ 31.75 NA 17.60 4.13 NA 53.48 090 

33513 ......... ............ A CABG, vein, four .......................................... 31.95 NA 17.78 4.16 NA 53.89 090 

33514 ......... ............ A CABG, vein, five .......................................... 32.70 NA 18.05 4.00 NA 54.75 090 

33516 ......... ............ A Cabg, vein, six or more ............................... 34.95 NA 18.79 4.51 NA 58.25 090 

33517 ......... ............ A CABG, artery-vein, single ............................ 2.57 NA 0.84 0.33 NA 3.74 ZZZ 

33518 ......... ............ A CABG, artery-vein, two ................................ 4.84 NA 1.58 0.63 NA 7.05 ZZZ 

33519 ......... ............ A CABG, artery-vein, three ............................. 7.11 NA 2.32 0.92 NA 10.35 ZZZ 

33521 ......... ............ A CABG, artery-vein, four ............................... 9.39 NA 3.07 1.20 NA 13.66 ZZZ 

33522 ......... ............ A CABG, artery-vein, five ................................ 11.65 NA 3.80 1.49 NA 16.94 ZZZ 

33523 ......... ............ A Cabg, art-vein, six or more .......................... 13.93 NA 4.52 1.81 NA 20.26 ZZZ 

33530 ......... ............ A Coronary artery, bypass/reop ...................... 5.85 NA 1.90 0.77 NA 8.52 ZZZ 

33533 ......... ............ A CABG, arterial, single .................................. 29.96 NA 16.46 3.86 NA 50.28 090 

33534 ......... ............ A CABG, arterial, two ...................................... 32.15 NA 17.70 4.13 NA 53.98 090 

33535 ......... ............ A CABG, arterial, three ................................... 34.45 NA 18.13 4.43 NA 57.01 090 

33536 ......... ............ A Cabg, arterial, four or more ......................... 37.44 NA 18.28 4.60 NA 60.32 090 

33542 ......... ............ A Removal of heart lesion ............................... 28.81 NA 13.01 3.79 NA 45.61 090 

33545 ......... ............ A Repair of heart damage ............................... 36.72 NA 15.64 4.81 NA 57.17 090 

33572 ......... ............ A Open coronary endarterectomy ................... 4.44 NA 1.45 0.58 NA 6.47 ZZZ 

33600 ......... ............ A Closure of valve ........................................... 29.47 NA 12.55 4.13 NA 46.15 090 

33602 ......... ............ A Closure of valve ........................................... 28.50 NA 12.46 3.25 NA 44.21 090 

33606 ......... ............ A Anastomosis/artery-aorta ............................. 30.69 NA 13.69 4.33 NA 48.71 090 

33608 ......... ............ A Repair anomaly w/conduit ........................... 31.04 NA 14.11 4.41 NA 49.56 090 

33610 ......... ............ A Repair by enlargement ................................ 30.56 NA 13.66 4.56 NA 48.78 090 

33611 ......... ............ A Repair double ventricle ................................ 33.95 NA 14.15 4.11 NA 52.21 090 

33612 ......... ............ A Repair double ventricle ................................ 34.95 NA 15.17 5.18 NA 55.30 090 

33615 ......... ............ A Repair, modified fontan ............................... 33.95 NA 13.27 2.90 NA 50.12 090 

33617 ......... ............ A Repair single ventricle ................................. 36.94 NA 16.02 4.88 NA 57.84 090 

33619 ......... ............ A Repair single ventricle ................................. 44.93 NA 20.82 3.60 NA 69.35 090 

33641 ......... ............ A Repair heart septum defect ......................... 21.36 NA 9.59 2.73 NA 33.68 090 

47612

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

33645 ......... ............ A Revision of heart veins ................................ 24.78 NA 11.78 3.26 NA 39.82 090 

33647 ......... ............ A Repair heart septum defects ....................... 28.69 NA 13.79 3.12 NA 45.60 090 

33660 ......... ............ A Repair of heart defects ................................ 29.96 NA 13.50 3.88 NA 47.34 090 

33665 ......... ............ A Repair of heart defects ................................ 28.56 NA 13.85 4.21 NA 46.62 090 

33670 ......... ............ A Repair of heart chambers ............................ 34.95 NA 13.20 3.47 NA 51.62 090 

33681 ......... ............ A Repair heart septum defect ......................... 30.56 NA 14.69 4.03 NA 49.28 090 

33684 ......... ............ A Repair heart septum defect ......................... 29.61 NA 13.63 4.08 NA 47.32 090 

33688 ......... ............ A Repair heart septum defect ......................... 30.57 NA 10.52 4.39 NA 45.48 090 

33690 ......... ............ A Reinforce pulmonary artery ......................... 19.52 NA 10.19 2.66 NA 32.37 090 

33692 ......... ............ A Repair of heart defects ................................ 30.70 NA 13.94 4.58 NA 49.22 090 

33694 ......... ............ A Repair of heart defects ................................ 33.95 NA 14.23 3.71 NA 51.89 090 

33697 ......... ............ A Repair of heart defects ................................ 35.95 NA 14.87 4.32 NA 55.14 090 

33702 ......... ............ A Repair of heart defects ................................ 26.50 NA 12.58 4.00 NA 43.08 090 

33710 ......... ............ A Repair of heart defects ................................ 29.67 NA 14.00 3.01 NA 46.68 090 

33720 ......... ............ A Repair of heart defect .................................. 26.52 NA 12.29 3.60 NA 42.41 090 

33722 ......... ............ A Repair of heart defect .................................. 28.37 NA 13.88 4.33 NA 46.58 090 

33730 ......... ............ A Repair heart-vein defect(s) .......................... 34.20 NA 14.13 4.32 NA 52.65 090 

33732 ......... ............ A Repair heart-vein defect .............................. 28.12 NA 13.41 2.88 NA 44.41 090 

33735 ......... ............ A Revision of heart chamber .......................... 21.36 NA 9.06 1.56 NA 31.98 090 

33736 ......... ............ A Revision of heart chamber .......................... 23.48 NA 11.87 2.50 NA 37.85 090 

33737 ......... ............ A Revision of heart chamber .......................... 21.73 NA 10.95 3.30 NA 35.98 090 

33750 ......... ............ A Major vessel shunt ....................................... 21.38 NA 10.24 2.56 NA 34.18 090 

33755 ......... ............ A Major vessel shunt ....................................... 21.76 NA 8.82 3.24 NA 33.82 090 

33762 ......... ............ A Major vessel shunt ....................................... 21.76 NA 10.17 3.18 NA 35.11 090 

33764 ......... ............ A Major vessel shunt & graft ........................... 21.76 NA 10.25 2.15 NA 34.16 090 

33766 ......... ............ A Major vessel shunt ....................................... 22.73 NA 11.68 3.39 NA 37.80 090 

33767 ......... ............ A Major vessel shunt ....................................... 24.46 NA 11.75 2.74 NA 38.95 090 

33770 ......... ............ A Repair great vessels defect ......................... 36.94 NA 14.69 5.42 NA 57.05 090 

33771 ......... ............ A Repair great vessels defect ......................... 34.60 NA 12.42 5.63 NA 52.65 090 

33774 ......... ............ A Repair great vessels defect ......................... 30.93 NA 14.75 4.70 NA 50.38 090 

33775 ......... ............ A Repair great vessels defect ......................... 32.15 NA 15.02 5.23 NA 52.40 090 

33776 ......... ............ A Repair great vessels defect ......................... 33.99 NA 15.80 5.52 NA 55.31 090 

33777 ......... ............ A Repair great vessels defect ......................... 33.41 NA 14.87 5.44 NA 53.72 090 

33778 ......... ............ A Repair great vessels defect ......................... 39.94 NA 16.89 5.83 NA 62.66 090 

33779 ......... ............ A Repair great vessels defect ......................... 36.16 NA 15.39 1.74 NA 53.29 090 

33780 ......... ............ A Repair great vessels defect ......................... 41.69 NA 19.06 5.15 NA 65.90 090 

33781 ......... ............ A Repair great vessels defect ......................... 36.40 NA 13.48 5.92 NA 55.80 090 

33786 ......... ............ A Repair arterial trunk ..................................... 38.94 NA 16.70 2.03 NA 57.67 090 

33788 ......... ............ A Revision of pulmonary artery ....................... 26.58 NA 11.95 4.02 NA 42.55 090 

33800 ......... ............ A Aortic suspension ........................................ 16.22 NA 8.16 2.28 NA 26.66 090 

33802 ......... ............ A Repair vessel defect .................................... 17.63 NA 9.24 1.66 NA 28.53 090 

33803 ......... ............ A Repair vessel defect .................................... 19.57 NA 9.78 3.17 NA 32.52 090 

33813 ......... ............ A Repair septal defect ..................................... 20.62 NA 10.93 1.13 NA 32.68 090 

33814 ......... ............ A Repair septal defect ..................................... 25.73 NA 12.66 3.56 NA 41.95 090 

33820 ......... ............ A Revise major vessel .................................... 16.27 NA 8.39 2.19 NA 26.85 090 

33822 ......... ............ A Revise major vessel .................................... 17.29 NA 8.98 1.92 NA 28.19 090 

33824 ......... ............ A Revise major vessel .................................... 19.49 NA 10.01 2.91 NA 32.41 090 

33840 ......... ............ A Remove aorta constriction ........................... 20.60 NA 10.31 2.45 NA 33.36 090 

33845 ......... ............ A Remove aorta constriction ........................... 22.09 NA 11.36 3.13 NA 36.58 090 

33851 ......... ............ A Remove aorta constriction ........................... 21.24 NA 10.71 2.81 NA 34.76 090 

33852 ......... ............ A Repair septal defect ..................................... 23.67 NA 11.38 2.55 NA 37.60 090 

33853 ......... ............ A Repair septal defect ..................................... 31.67 NA 14.84 4.13 NA 50.64 090 

33860 ......... ............ A Ascending aortic graft .................................. 37.94 NA 16.46 5.05 NA 59.45 090 

33861 ......... ............ A Ascending aortic graft .................................. 41.94 NA 17.72 5.45 NA 65.11 090 

33863 ......... ............ A Ascending aortic graft .................................. 44.93 NA 18.70 5.46 NA 69.09 090 

33870 ......... ............ A Transverse aortic arch graft ........................ 43.93 NA 18.39 5.96 NA 68.28 090 

33875 ......... ............ A Thoracic aortic graft ..................................... 33.01 NA 14.11 4.43 NA 51.55 090 

33877 ......... ............ A Thoracoabdominal graft ............................... 42.54 NA 16.33 5.46 NA 64.33 090 

33910 ......... ............ A Remove lung artery emboli ......................... 24.55 NA 11.45 3.32 NA 39.32 090 

33915 ......... ............ A Remove lung artery emboli ......................... 20.99 NA 9.64 1.73 NA 32.36 090 

33916 ......... ............ A Surgery of great vessel ............................... 25.79 NA 11.37 3.47 NA 40.63 090 

33917 ......... ............ A Repair pulmonary artery .............................. 24.46 NA 12.21 3.25 NA 39.92 090 

33918 ......... ............ A Repair pulmonary atresia ............................ 26.41 NA 12.13 4.12 NA 42.66 090 

33919 ......... ............ A Repair pulmonary atresia ............................ 39.94 NA 17.52 4.45 NA 61.91 090 

33920 ......... ............ A Repair pulmonary atresia ............................ 31.90 NA 13.85 3.50 NA 49.25 090 

33922 ......... ............ A Transect pulmonary artery ........................... 23.48 NA 10.92 3.25 NA 37.65 090 

33924 ......... ............ A Remove pulmonary shunt ............................ 5.49 NA 1.83 0.70 NA 8.02 ZZZ 

33935 ......... ............ R Transplantation, heart/lung .......................... 60.87 NA 28.77 9.19 NA 98.83 090 

33945 ......... ............ R Transplantation of heart ............................... 42.04 NA 21.38 5.91 NA 69.33 090 

33960 ......... ............ A External circulation assist ............................ 19.33 NA 4.90 2.46 NA 26.69 000 

33961 ......... ............ A External circulation assist ............................ 10.91 NA 3.61 1.08 NA 15.60 ZZZ 

33967 ......... ............ A Insert ia percut device ................................. 4.84 NA 1.83 0.35 NA 7.02 000 

33968 ......... ............ A Remove aortic assist device ........................ 0.64 NA 0.23 0.06 NA 0.93 000 

33970 ......... ............ A Aortic circulation assist ................................ 6.74 NA 2.28 0.81 NA 9.83 000 

33971 ......... ............ A Aortic circulation assist ................................ 9.68 NA 6.03 1.21 NA 16.92 090 

47613

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

33973 ......... ............ A Insert balloon device .................................... 9.75 NA 3.30 1.18 NA 14.23 000 

33974 ......... ............ A Remove intra-aortic balloon ......................... 14.39 NA 7.91 1.71 NA 24.01 090 

33975 ......... ............ A Implant ventricular device ............................ 20.97 NA 6.27 2.95 NA 30.19 XXX 

33976 ......... ............ A Implant ventricular device ............................ 22.97 NA 7.53 2.73 NA 33.23 XXX 

33977 ......... ............ A Remove ventricular device .......................... 19.26 NA 11.08 2.68 NA 33.02 090 

33978 ......... ............ A Remove ventricular device .......................... 21.70 NA 11.75 3.03 NA 36.48 090 

33979 ......... ............ A Insert intracorporeal device ......................... 45.93 NA 14.89 4.80 NA 65.62 XXX 

33980 ......... ............ A Remove intracorporeal device ..................... 56.17 NA 25.22 5.55 NA 86.94 090 

34001 ......... ............ A Removal of artery clot ................................. 12.89 NA 6.71 1.76 NA 21.36 090 

34051 ......... ............ A Removal of artery clot ................................. 15.19 NA 7.77 2.20 NA 25.16 090 

34101 ......... ............ A Removal of artery clot ................................. 9.99 NA 5.35 1.36 NA 16.70 090 

34111 ......... ............ A Removal of arm artery clot .......................... 9.99 NA 5.35 1.36 NA 16.70 090 

34151 ......... ............ A Removal of artery clot ................................. 24.96 NA 10.39 3.34 NA 38.69 090 

34201 ......... ............ A Removal of artery clot ................................. 10.01 NA 5.41 1.38 NA 16.80 090 

34203 ......... ............ A Removal of leg artery clot ........................... 16.48 NA 8.05 2.25 NA 26.78 090 

34401 ......... ............ A Removal of vein clot .................................... 24.96 NA 10.65 3.00 NA 38.61 090 

34421 ......... ............ A Removal of vein clot .................................... 11.98 NA 6.28 1.48 NA 19.74 090 

34451 ......... ............ A Removal of vein clot .................................... 26.96 NA 11.42 3.65 NA 42.03 090 

34471 ......... ............ A Removal of vein clot .................................... 10.16 NA 5.31 0.88 NA 16.35 090 

34490 ......... ............ A Removal of vein clot .................................... 9.85 NA 5.43 1.34 NA 16.62 090 

34501 ......... ............ A Repair valve, femoral vein ........................... 15.98 NA 8.50 2.31 NA 26.79 090 

34502 ......... ............ A Reconstruct vena cava ................................ 26.91 NA 12.28 3.41 NA 42.60 090 

34510 ......... ............ A Transposition of vein valve .......................... 18.92 NA 9.43 2.39 NA 30.74 090 

34520 ......... ............ A Cross-over vein graft ................................... 17.92 NA 8.48 1.63 NA 28.03 090 

34530 ......... ............ A Leg vein fusion ............................................ 16.62 NA 8.61 2.16 NA 27.39 090 

34800 ......... ............ A Endovasc abdo repair w/tube ...................... 20.72 NA 9.15 2.35 NA 32.22 090 

34802 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.77 2.34 NA 35.08 090 

34804 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.79 2.35 NA 35.11 090 

34805 ......... ............ A Endovasc abdo repair w/pros ...................... 21.85 NA 9.66 1.99 NA 33.50 090 

34808 ......... ............ A Endovasc abdo occlud device ..................... 4.12 NA 1.37 0.50 NA 5.99 ZZZ 

34812 ......... ............ A Xpose for endoprosth, femorl ...................... 6.74 NA 2.23 1.09 NA 10.06 000 

34813 ......... ............ A Femoral endovas graft add-on .................... 4.79 NA 1.57 0.65 NA 7.01 ZZZ 

34820 ......... ............ A Xpose for endoprosth, iliac .......................... 9.74 NA 3.23 1.35 NA 14.32 000 

34825 ......... ............ A Endovasc extend prosth, init ....................... 11.98 NA 6.13 1.29 NA 19.40 090 

34826 ......... ............ A Endovasc exten prosth, add-l ...................... 4.12 NA 1.37 0.45 NA 5.94 ZZZ 

34830 ......... ............ A Open aortic tube prosth repr ....................... 32.54 NA 13.68 3.75 NA 49.97 090 

34831 ......... ............ A Open aortoiliac prosth repr .......................... 35.29 NA 11.73 3.95 NA 50.97 090 

34832 ......... ............ A Open aortofemor prosth repr ....................... 35.29 NA 14.60 4.05 NA 53.94 090 

34833 ......... ............ A Xpose for endoprosth, iliac .......................... 11.98 NA 4.42 0.84 NA 17.24 000 

34834 ......... ............ A Xpose, endoprosth, brachial ........................ 5.34 NA 2.19 0.59 NA 8.12 000 

34900 ......... ............ A Endovasc iliac repr w/graft .......................... 16.36 NA 7.59 1.80 NA 25.75 090 

35001 ......... ............ A Repair defect of artery ................................. 19.61 NA 9.54 2.64 NA 31.79 090 

35002 ......... ............ A Repair artery rupture, neck .......................... 20.97 NA 9.68 2.38 NA 33.03 090 

35005 ......... ............ A Repair defect of artery ................................. 18.09 NA 8.83 2.29 NA 29.21 090 

35011 ......... ............ A Repair defect of artery ................................. 17.97 NA 7.97 2.42 NA 28.36 090 

35013 ......... ............ A Repair artery rupture, arm ........................... 21.97 NA 9.66 2.98 NA 34.61 090 

35021 ......... ............ A Repair defect of artery ................................. 19.62 NA 9.41 2.43 NA 31.46 090 

35022 ......... ............ A Repair artery rupture, chest ......................... 23.15 NA 9.86 2.32 NA 35.33 090 

35045 ......... ............ A Repair defect of arm artery ......................... 17.54 NA 7.53 2.38 NA 27.45 090 

35081 ......... ............ A Repair defect of artery ................................. 27.97 NA 11.44 3.66 NA 43.07 090 

35082 ......... ............ A Repair artery rupture, aorta ......................... 38.44 NA 15.27 5.10 NA 58.81 090 

35091 ......... ............ A Repair defect of artery ................................. 35.35 NA 13.55 4.76 NA 53.66 090 

35092 ......... ............ A Repair artery rupture, aorta ......................... 44.93 NA 17.61 5.97 NA 68.51 090 

35102 ......... ............ A Repair defect of artery ................................. 30.71 NA 12.34 4.09 NA 47.14 090 

35103 ......... ............ A Repair artery rupture, groin ......................... 40.44 NA 15.82 5.49 NA 61.75 090 

35111 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.45 3.35 NA 38.76 090 

35112 ......... ............ A Repair artery rupture,spleen ........................ 29.96 NA 11.95 3.89 NA 45.80 090 

35121 ......... ............ A Repair defect of artery ................................. 29.96 NA 12.35 4.05 NA 46.36 090 

35122 ......... ............ A Repair artery rupture, belly .......................... 34.95 NA 13.78 4.48 NA 53.21 090 

35131 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.73 3.49 NA 39.18 090 

35132 ......... ............ A Repair artery rupture, groin ......................... 29.96 NA 12.36 4.07 NA 46.39 090 

35141 ......... ............ A Repair defect of artery ................................. 19.97 NA 8.90 2.72 NA 31.59 090 

35142 ......... ............ A Repair artery rupture, thigh ......................... 23.27 NA 10.35 3.11 NA 36.73 090 

35151 ......... ............ A Repair defect of artery ................................. 22.61 NA 9.98 3.04 NA 35.63 090 

35152 ......... ............ A Repair artery rupture, knee ......................... 25.58 NA 11.36 3.35 NA 40.29 090 

35161 ......... ............ A Repair defect of artery ................................. 18.73 NA 9.13 2.48 NA 30.34 090 

35162 ......... ............ A Repair artery rupture ................................... 19.75 NA 9.56 2.75 NA 32.06 090 

35180 ......... ............ A Repair blood vessel lesion .......................... 13.60 NA 6.94 1.97 NA 22.51 090 

35182 ......... ............ A Repair blood vessel lesion .......................... 29.96 NA 12.78 4.09 NA 46.83 090 

35184 ......... ............ A Repair blood vessel lesion .......................... 17.97 NA 8.29 2.45 NA 28.71 090 

35188 ......... ............ A Repair blood vessel lesion .......................... 14.26 NA 7.62 1.98 NA 23.86 090 

35189 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 11.94 3.68 NA 43.58 090 

35190 ......... ............ A Repair blood vessel lesion .......................... 12.73 NA 6.47 1.71 NA 20.91 090 

35201 ......... ............ A Repair blood vessel lesion .......................... 16.12 NA 7.98 2.13 NA 26.23 090 

35206 ......... ............ A Repair blood vessel lesion .......................... 13.23 NA 6.57 1.83 NA 21.63 090 

47614

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

35207 ......... ............ A Repair blood vessel lesion .......................... 10.13 NA 7.53 1.46 NA 19.12 090 

35211 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.64 2.89 NA 35.62 090 

35216 ......... ............ A Repair blood vessel lesion .......................... 18.72 NA 8.99 2.49 NA 30.20 090 

35221 ......... ............ A Repair blood vessel lesion .......................... 24.35 NA 9.92 3.20 NA 37.47 090 

35226 ......... ............ A Repair blood vessel lesion .......................... 14.48 NA 7.46 1.89 NA 23.83 090 

35231 ......... ............ A Repair blood vessel lesion .......................... 19.97 NA 9.75 2.74 NA 32.46 090 

35236 ......... ............ A Repair blood vessel lesion .......................... 17.08 NA 7.90 2.35 NA 27.33 090 

35241 ......... ............ A Repair blood vessel lesion .......................... 23.09 NA 11.14 3.00 NA 37.23 090 

35246 ......... ............ A Repair blood vessel lesion .......................... 26.41 NA 11.43 3.21 NA 41.05 090 

35251 ......... ............ A Repair blood vessel lesion .......................... 30.15 NA 11.77 3.99 NA 45.91 090 

35256 ......... ............ A Repair blood vessel lesion .......................... 18.33 NA 8.37 2.51 NA 29.21 090 

35261 ......... ............ A Repair blood vessel lesion .......................... 17.77 NA 8.00 2.41 NA 28.18 090 

35266 ......... ............ A Repair blood vessel lesion .......................... 14.89 NA 7.01 1.98 NA 23.88 090 

35271 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.53 2.99 NA 35.61 090 

35276 ......... ............ A Repair blood vessel lesion .......................... 24.21 NA 11.22 3.24 NA 38.67 090 

35281 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 11.69 3.73 NA 43.38 090 

35286 ......... ............ A Repair blood vessel lesion .......................... 16.14 NA 8.07 2.22 NA 26.43 090 

35301 ......... ............ A Rechanneling of artery ................................ 18.67 NA 8.44 2.52 NA 29.63 090 

35311 ......... ............ A Rechanneling of artery ................................ 26.96 NA 11.73 3.47 NA 42.16 090 

35321 ......... ............ A Rechanneling of artery ................................ 15.98 NA 7.37 2.18 NA 25.53 090 

35331 ......... ............ A Rechanneling of artery ................................ 26.16 NA 11.22 3.56 NA 40.94 090 

35341 ......... ............ A Rechanneling of artery ................................ 25.07 NA 10.85 3.44 NA 39.36 090 

35351 ......... ............ A Rechanneling of artery ................................ 22.97 NA 9.58 3.16 NA 35.71 090 

35355 ......... ............ A Rechanneling of artery ................................ 18.47 NA 8.08 2.51 NA 29.06 090 

35361 ......... ............ A Rechanneling of artery ................................ 28.16 NA 11.69 3.84 NA 43.69 090 

35363 ......... ............ A Rechanneling of artery ................................ 30.15 NA 12.56 4.16 NA 46.87 090 

35371 ......... ............ A Rechanneling of artery ................................ 14.70 NA 6.94 2.01 NA 23.65 090 

35372 ......... ............ A Rechanneling of artery ................................ 17.97 NA 8.04 2.47 NA 28.48 090 

35381 ......... ............ A Rechanneling of artery ................................ 15.79 NA 7.81 2.14 NA 25.74 090 

35390 ......... ............ A Reoperation, carotid add-on ........................ 3.19 NA 1.06 0.43 NA 4.68 ZZZ 

35400 ......... ............ A Angioscopy .................................................. 3.00 NA 1.11 0.42 NA 4.53 ZZZ 

35450 ......... ............ A Repair arterial blockage ............................... 10.05 NA 3.55 1.24 NA 14.84 000 

35452 ......... ............ A Repair arterial blockage ............................... 6.90 NA 2.60 0.82 NA 10.32 000 

35454 ......... ............ A Repair arterial blockage ............................... 6.03 NA 2.31 0.82 NA 9.16 000 

35456 ......... ............ A Repair arterial blockage ............................... 7.34 NA 2.76 0.99 NA 11.09 000 

35458 ......... ............ A Repair arterial blockage ............................... 9.48 NA 3.46 1.21 NA 14.15 000 

35459 ......... ............ A Repair arterial blockage ............................... 8.62 NA 3.16 1.16 NA 12.94 000 

35460 ......... ............ A Repair venous blockage .............................. 6.03 NA 2.26 0.82 NA 9.11 000 

35470 ......... ............ A Repair arterial blockage ............................... 8.62 90.69 3.34 0.70 100.01 12.66 000 

35471 ......... ............ A Repair arterial blockage ............................... 10.05 102.73 3.94 0.69 113.47 14.68 000 

35472 ......... ............ A Repair arterial blockage ............................... 6.90 65.72 2.74 0.59 73.21 10.23 000 

35473 ......... ............ A Repair arterial blockage ............................... 6.03 61.03 2.42 0.51 67.57 8.96 000 

35474 ......... ............ A Repair arterial blockage ............................... 7.35 89.50 2.89 0.56 97.41 10.80 000 

35475 ......... ............ R Repair arterial blockage ............................... 9.48 56.75 3.55 0.63 66.86 13.66 000 

35476 ......... ............ A Repair venous blockage .............................. 6.03 45.31 2.35 0.39 51.73 8.77 000 

35480 ......... ............ A Atherectomy, open ....................................... 11.06 NA 4.03 1.27 NA 16.36 000 

35481 ......... ............ A Atherectomy, open ....................................... 7.60 NA 2.87 0.99 NA 11.46 000 

35482 ......... ............ A Atherectomy, open ....................................... 6.64 NA 2.56 0.85 NA 10.05 000 

35483 ......... ............ A Atherectomy, open ....................................... 8.09 NA 3.02 1.05 NA 12.16 000 

35484 ......... ............ A Atherectomy, open ....................................... 10.42 NA 3.76 1.28 NA 15.46 000 

35485 ......... ............ A Atherectomy, open ....................................... 9.48 NA 3.53 1.30 NA 14.31 000 

35490 ......... ............ A Atherectomy, percutaneous ......................... 11.06 NA 4.69 0.63 NA 16.38 000 

35491 ......... ............ A Atherectomy, percutaneous ......................... 7.60 NA 3.28 0.51 NA 11.39 000 

35492 ......... ............ A Atherectomy, percutaneous ......................... 6.64 NA 3.19 0.42 NA 10.25 000 

35493 ......... ............ A Atherectomy, percutaneous ......................... 8.09 NA 3.80 0.57 NA 12.46 000 

35494 ......... ............ A Atherectomy, percutaneous ......................... 10.42 NA 4.45 0.79 NA 15.66 000 

35495 ......... ............ A Atherectomy, percutaneous ......................... 9.48 NA 4.38 0.69 NA 14.55 000 

35500 ......... ............ A Harvest vein for bypass ............................... 6.44 NA 2.02 0.88 NA 9.34 ZZZ 

35501 ......... ............ A Artery bypass graft ...................................... 19.16 NA 8.46 2.67 NA 30.29 090 

35506 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.45 2.69 NA 31.78 090 

35507 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.41 2.66 NA 31.71 090 

35508 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.43 2.43 NA 30.48 090 

35509 ......... ............ A Artery bypass graft ...................................... 18.04 NA 8.75 2.47 NA 29.26 090 

35510 ......... ............ A Artery bypass graft ...................................... 22.97 NA 10.16 2.10 NA 35.23 090 

35511 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.34 2.38 NA 32.89 090 

35512 ......... ............ A Artery bypass graft ...................................... 22.47 NA 9.99 2.10 NA 34.56 090 

35515 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.27 2.50 NA 30.39 090 

35516 ......... ............ A Artery bypass graft ...................................... 16.30 NA 6.80 2.19 NA 25.29 090 

35518 ......... ............ A Artery bypass graft ...................................... 21.17 NA 8.96 2.84 NA 32.97 090 

35521 ......... ............ A Artery bypass graft ...................................... 22.17 NA 9.82 2.98 NA 34.97 090 

35522 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.74 2.10 NA 33.57 090 

35525 ......... ............ A Artery bypass graft ...................................... 20.60 NA 9.36 2.10 NA 32.06 090 

35526 ......... ............ A Artery bypass graft ...................................... 29.91 NA 12.49 2.43 NA 44.83 090 

35531 ......... ............ A Artery bypass graft ...................................... 36.15 NA 14.46 5.00 NA 55.61 090 

35533 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.71 3.59 NA 43.26 090 

47615

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

35536 ......... ............ A Artery bypass graft ...................................... 31.65 NA 12.92 4.36 NA 48.93 090 

35541 ......... ............ A Artery bypass graft ...................................... 25.76 NA 11.19 3.49 NA 40.44 090 

35546 ......... ............ A Artery bypass graft ...................................... 25.50 NA 10.85 2.66 NA 39.01 090 

35548 ......... ............ A Artery bypass graft ...................................... 21.54 NA 9.41 2.84 NA 33.79 090 

35549 ......... ............ A Artery bypass graft ...................................... 23.31 NA 10.37 3.18 NA 36.86 090 

35551 ......... ............ A Artery bypass graft ...................................... 26.63 NA 11.48 3.71 NA 41.82 090 

35556 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.71 2.86 NA 34.30 090 

35558 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.53 2.83 NA 33.53 090 

35560 ......... ............ A Artery bypass graft ...................................... 31.95 NA 13.29 4.40 NA 49.64 090 

35563 ......... ............ A Artery bypass graft ...................................... 24.16 NA 10.50 3.39 NA 38.05 090 

35565 ......... ............ A Artery bypass graft ...................................... 23.17 NA 10.12 3.14 NA 36.43 090 

35566 ......... ............ A Artery bypass graft ...................................... 26.88 NA 11.37 3.63 NA 41.88 090 

35571 ......... ............ A Artery bypass graft ...................................... 24.02 NA 10.84 3.26 NA 38.12 090 

35572 ......... ............ A Harvest femoropopliteal vein ....................... 6.81 NA 2.23 0.76 NA 9.80 ZZZ 

35582 ......... ............ A Vein bypass graft ......................................... 27.09 NA 11.55 3.32 NA 41.96 090 

35583 ......... ............ A Vein bypass graft ......................................... 22.34 NA 10.15 2.97 NA 35.46 090 

35585 ......... ............ A Vein bypass graft ......................................... 28.35 NA 12.23 3.81 NA 44.39 090 

35587 ......... ............ A Vein bypass graft ......................................... 24.71 NA 11.44 3.34 NA 39.49 090 

35600 ......... ............ A Harvest artery for cabg ................................ 4.94 NA 1.62 0.64 NA 7.20 ZZZ 

35601 ......... ............ A Artery bypass graft ...................................... 17.47 NA 8.61 2.36 NA 28.44 090 

35606 ......... ............ A Artery bypass graft ...................................... 18.68 NA 9.00 2.52 NA 30.20 090 

35612 ......... ............ A Artery bypass graft ...................................... 15.74 NA 7.88 2.10 NA 25.72 090 

35616 ......... ............ A Artery bypass graft ...................................... 15.68 NA 8.10 2.18 NA 25.96 090 

35621 ......... ............ A Artery bypass graft ...................................... 19.97 NA 8.67 2.76 NA 31.40 090 

35623 ......... ............ A Bypass graft, not vein .................................. 23.96 NA 10.48 3.30 NA 37.74 090 

35626 ......... ............ A Artery bypass graft ...................................... 27.71 NA 11.96 3.80 NA 43.47 090 

35631 ......... ............ A Artery bypass graft ...................................... 33.95 NA 13.81 4.64 NA 52.40 090 

35636 ......... ............ A Artery bypass graft ...................................... 29.46 NA 12.28 3.84 NA 45.58 090 

35641 ......... ............ A Artery bypass graft ...................................... 24.53 NA 11.05 3.28 NA 38.86 090 

35642 ......... ............ A Artery bypass graft ...................................... 17.95 NA 8.67 1.88 NA 28.50 090 

35645 ......... ............ A Artery bypass graft ...................................... 17.44 NA 8.27 2.21 NA 27.92 090 

35646 ......... ............ A Artery bypass graft ...................................... 30.95 NA 13.08 4.20 NA 48.23 090 

35647 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.76 3.78 NA 43.50 090 

35650 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.35 2.55 NA 29.87 090 

35651 ......... ............ A Artery bypass graft ...................................... 25.00 NA 10.73 3.08 NA 38.81 090 

35654 ......... ............ A Artery bypass graft ...................................... 24.96 NA 10.63 3.40 NA 38.99 090 

35656 ......... ............ A Artery bypass graft ...................................... 19.50 NA 8.60 2.61 NA 30.71 090 

35661 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.91 2.56 NA 30.44 090 

35663 ......... ............ A Artery bypass graft ...................................... 21.97 NA 9.96 2.99 NA 34.92 090 

35665 ......... ............ A Artery bypass graft ...................................... 20.97 NA 9.43 2.84 NA 33.24 090 

35666 ......... ............ A Artery bypass graft ...................................... 22.16 NA 10.64 3.00 NA 35.80 090 

35671 ......... ............ A Artery bypass graft ...................................... 19.30 NA 9.36 2.62 NA 31.28 090 

35681 ......... ............ A Composite bypass graft ............................... 1.60 NA 0.53 0.20 NA 2.33 ZZZ 

35682 ......... ............ A Composite bypass graft ............................... 7.19 NA 2.38 0.95 NA 10.52 ZZZ 

35683 ......... ............ A Composite bypass graft ............................... 8.49 NA 2.81 1.10 NA 12.40 ZZZ 

35685 ......... ............ A Bypass graft patency/patch ......................... 4.04 NA 1.35 0.56 NA 5.95 ZZZ 

35686 ......... ............ A Bypass graft/av fist patency ........................ 3.34 NA 1.12 0.47 NA 4.93 ZZZ 

35691 ......... ............ A Arterial transposition .................................... 18.02 NA 8.39 2.46 NA 28.87 090 

35693 ......... ............ A Arterial transposition .................................... 15.34 NA 7.71 2.07 NA 25.12 090 

35694 ......... ............ A Arterial transposition .................................... 19.13 NA 8.59 2.63 NA 30.35 090 

35695 ......... ............ A Arterial transposition .................................... 19.13 NA 8.54 2.70 NA 30.37 090 

35697 ......... ............ A Reimplant artery each ................................. 3.00 NA 1.02 0.41 NA 4.43 ZZZ 

35700 ......... ............ A Reoperation, bypass graft ........................... 3.08 NA 1.02 0.42 NA 4.52 ZZZ 

35701 ......... ............ A Exploration, carotid artery ............................ 8.49 NA 5.15 1.16 NA 14.80 090 

35721 ......... ............ A Exploration, femoral artery .......................... 7.17 NA 4.45 0.99 NA 12.61 090 

35741 ......... ............ A Exploration popliteal artery .......................... 7.99 NA 4.68 1.08 NA 13.75 090 

35761 ......... ............ A Exploration of artery/vein ............................. 5.36 NA 4.04 0.73 NA 10.13 090 

35800 ......... ............ A Explore neck vessels ................................... 7.01 NA 4.65 0.93 NA 12.59 090 

35820 ......... ............ A Explore chest vessels .................................. 12.86 NA 7.18 1.72 NA 21.76 090 

35840 ......... ............ A Explore abdominal vessels .......................... 9.76 NA 5.28 1.27 NA 16.31 090 

35860 ......... ............ A Explore limb vessels .................................... 5.54 NA 4.03 0.75 NA 10.32 090 

35870 ......... ............ A Repair vessel graft defect ............................ 22.14 NA 9.75 2.89 NA 34.78 090 

35875 ......... ............ A Removal of clot in graft ............................... 10.11 NA 5.20 1.36 NA 16.67 090 

35876 ......... ............ A Removal of clot in graft ............................... 16.97 NA 7.54 2.28 NA 26.79 090 

35879 ......... ............ A Revise graft w/vein ...................................... 15.98 NA 7.71 2.16 NA 25.85 090 

35881 ......... ............ A Revise graft w/vein ...................................... 17.97 NA 8.68 2.42 NA 29.07 090 

35901 ......... ............ A Excision, graft, neck .................................... 8.18 NA 5.32 1.09 NA 14.59 090 

35903 ......... ............ A Excision, graft, extremity ............................. 9.38 NA 6.18 1.27 NA 16.83 090 

35905 ......... ............ A Excision, graft, thorax .................................. 31.20 NA 13.18 4.40 NA 48.78 090 

35907 ......... ............ A Excision, graft, abdomen ............................. 34.95 NA 14.15 4.76 NA 53.86 090 

36000 ......... ............ A Place needle in vein .................................... 0.18 0.60 0.05 0.01 0.79 0.24 XXX 

36002 ......... ............ A Pseudoaneurysm injection trt ...................... 1.96 2.87 0.97 0.18 5.01 3.11 000 

36005 ......... ............ A Injection ext venography .............................. 0.95 7.89 0.31 0.06 8.90 1.32 000 

36010 ......... ............ A Place catheter in vein .................................. 2.43 20.07 0.79 0.20 22.70 3.42 XXX 

36011 ......... ............ A Place catheter in vein .................................. 3.14 28.80 1.06 0.24 32.18 4.44 XXX 

47616

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

36012 ......... ............ A Place catheter in vein .................................. 3.51 19.13 1.19 0.23 22.87 4.93 XXX 

36013 ......... ............ A Place catheter in artery ............................... 2.52 22.22 0.69 0.25 24.99 3.46 XXX 

36014 ......... ............ A Place catheter in artery ............................... 3.02 20.50 1.03 0.20 23.72 4.25 XXX 

36015 ......... ............ A Place catheter in artery ............................... 3.51 24.30 1.19 0.22 28.03 4.92 XXX 

36100 ......... ............ A Establish access to artery ........................... 3.02 12.32 1.11 0.28 15.62 4.41 XXX 

36120 ......... ............ A Establish access to artery ........................... 2.01 10.85 0.64 0.15 13.01 2.80 XXX 

36140 ......... ............ A Establish access to artery ........................... 2.01 13.05 0.64 0.16 15.22 2.81 XXX 

36145 ......... ............ A Artery to vein shunt ..................................... 2.01 12.75 0.66 0.13 14.89 2.80 XXX 

36160 ......... ............ A Establish access to aorta ............................ 2.52 13.81 0.84 0.25 16.58 3.61 XXX 

36200 ......... ............ A Place catheter in aorta ................................ 3.02 16.90 1.01 0.23 20.15 4.26 XXX 

36215 ......... ............ A Place catheter in artery ............................... 4.67 27.75 1.60 0.31 32.73 6.58 XXX 

36216 ......... ............ A Place catheter in artery ............................... 5.27 29.86 1.79 0.36 35.49 7.42 XXX 

36217 ......... ............ A Place catheter in artery ............................... 6.29 56.62 2.17 0.44 63.35 8.90 XXX 

36218 ......... ............ A Place catheter in artery ............................... 1.01 5.18 0.34 0.07 6.26 1.42 ZZZ 

36245 ......... ............ A Place catheter in artery ............................... 4.67 33.09 1.68 0.33 38.09 6.68 XXX 

36246 ......... ............ A Place catheter in artery ............................... 5.27 30.97 1.81 0.38 36.62 7.46 XXX 

36247 ......... ............ A Place catheter in artery ............................... 6.29 50.83 2.14 0.47 57.59 8.90 XXX 

36248 ......... ............ A Place catheter in artery ............................... 1.01 4.12 0.34 0.07 5.20 1.42 ZZZ 

36260 ......... ............ A Insertion of infusion pump ........................... 9.70 NA 4.91 1.26 NA 15.87 090 

36261 ......... ............ A Revision of infusion pump ........................... 5.44 NA 3.68 0.62 NA 9.74 090 

36262 ......... ............ A Removal of infusion pump ........................... 4.01 NA 2.75 0.52 NA 7.28 090 

36400 ......... ............ A Bl draw < 3 yrs fem/jugular ......................... 0.38 0.28 0.09 0.03 0.69 0.50 XXX 

36405 ......... ............ A Bl draw < 3 yrs scalp vein ........................... 0.31 0.26 0.08 0.02 0.59 0.41 XXX 

36406 ......... ............ A Bl draw < 3 yrs other vein ........................... 0.18 0.29 0.05 0.01 0.48 0.24 XXX 

36410 ......... ............ A Non-routine bl draw > 3 yrs ......................... 0.18 0.30 0.05 0.01 0.49 0.24 XXX 

36420 ......... ............ A Vein access cutdown < 1 yr ........................ 1.01 0.34 0.27 0.06 1.41 1.34 XXX 

36425 ......... ............ A Vein access cutdown > 1 yr ........................ 0.76 NA 0.22 0.06 NA 1.04 XXX 

36430 ......... ............ A Blood transfusion service ............................ 0.00 1.00 NA 0.06 1.06 NA XXX 

36440 ......... ............ A Bl push transfuse, 2 yr or < ......................... 1.03 NA 0.29 0.07 NA 1.39 XXX 

36450 ......... ............ A Bl exchange/transfuse, nb ........................... 2.23 NA 0.70 0.10 NA 3.03 XXX 

36455 ......... ............ A Bl exchange/transfuse non-nb ..................... 2.43 NA 1.01 0.14 NA 3.58 XXX 

36460 ......... ............ A Transfusion service, fetal ............................. 6.58 NA 2.24 0.88 NA 9.70 XXX 

36470 ......... ............ A Injection therapy of vein .............................. 1.09 2.69 0.73 0.13 3.91 1.95 010 

36471 ......... ............ A Injection therapy of veins ............................. 1.57 3.08 0.96 0.19 4.84 2.72 010 

36481 ......... ............ A Insertion of catheter, vein ............................ 6.98 6.04 2.58 0.48 13.50 10.04 000 

36500 ......... ............ A Insertion of catheter, vein ............................ 3.51 NA 1.36 0.24 NA 5.11 000 

36510 ......... ............ A Insertion of catheter, vein ............................ 1.09 3.95 0.61 0.08 5.12 1.78 000 

36511 ......... ............ A Apheresis wbc ............................................. 1.74 NA 0.73 0.08 NA 2.55 000 

36512 ......... ............ A Apheresis rbc ............................................... 1.74 NA 0.74 0.08 NA 2.56 000 

36513 ......... ............ A Apheresis platelets ...................................... 1.74 NA 0.73 0.08 NA 2.55 000 

36514 ......... ............ A Apheresis plasma ........................................ 1.74 17.69 0.71 0.08 19.51 2.53 000 

36515 ......... ............ A Apheresis, adsorp/reinfuse .......................... 1.74 65.03 0.65 0.08 66.85 2.47 000 

36516 ......... ............ A Apheresis, selective ..................................... 1.22 84.13 0.48 0.08 85.43 1.78 000 

36522 ......... ............ A Photopheresis .............................................. 1.67 30.87 1.13 0.14 32.68 2.94 000 

36550 ......... ............ A Declot vascular device ................................. 0.00 0.40 NA 0.37 0.77 NA XXX 

36555 ......... ............ A Insert non-tunnel cv cath ............................. 2.68 5.80 0.80 0.12 8.60 3.60 000 

36556 ......... ............ A Insert non-tunnel cv cath ............................. 2.50 5.75 0.74 0.19 8.44 3.43 000 

36557 ......... ............ A Insert tunneled cv cath ................................ 5.09 21.23 2.64 0.58 26.90 8.31 010 

36558 ......... ............ A Insert tunneled cv cath ................................ 4.79 21.12 2.54 0.58 26.49 7.91 010 

36560 ......... ............ A Insert tunneled cv cath ................................ 6.24 29.79 3.03 0.58 36.61 9.85 010 

36561 ......... ............ A Insert tunneled cv cath ................................ 5.99 29.70 2.94 0.58 36.27 9.51 010 

36563 ......... ............ A Insert tunneled cv cath ................................ 6.19 26.76 2.98 0.83 33.78 10.00 010 

36565 ......... ............ A Insert tunneled cv cath ................................ 5.99 24.81 2.94 0.58 31.38 9.51 010 

36566 ......... ............ A Insert tunneled cv cath ................................ 6.49 25.60 3.11 0.58 32.67 10.18 010 

36568 ......... ............ A Insert tunneled cv cath ................................ 1.92 7.60 0.58 0.12 9.64 2.62 000 

36569 ......... ............ A Insert tunneled cv cath ................................ 1.82 7.42 0.57 0.19 9.43 2.58 000 

36570 ......... ............ A Insert tunneled cv cath ................................ 5.31 33.30 2.72 0.58 39.19 8.61 010 

36571 ......... ............ A Insert tunneled cv cath ................................ 5.29 33.38 2.71 0.58 39.25 8.58 010 

36575 ......... ............ A Repair tunneled cv cath ............................... 0.67 4.07 0.26 0.22 4.96 1.15 000 

36576 ......... ............ A Repair tunneled cv cath ............................... 3.19 6.98 1.83 0.21 10.38 5.23 010 

36578 ......... ............ A Replace tunneled cv cath ............................ 3.49 11.20 2.30 0.21 14.90 6.00 010 

36580 ......... ............ A Replace tunneled cv cath ............................ 1.31 7.08 0.41 0.19 8.58 1.91 000 

36581 ......... ............ A Replace tunneled cv cath ............................ 3.43 19.63 1.91 0.21 23.27 5.55 010 

36582 ......... ............ A Replace tunneled cv cath ............................ 5.19 26.19 2.85 0.21 31.59 8.25 010 

36583 ......... ............ A Replace tunneled cv cath ............................ 5.24 26.21 2.87 0.20 31.65 8.31 010 

36584 ......... ............ A Replace tunneled cv cath ............................ 1.20 7.11 0.55 0.19 8.50 1.94 000 

36585 ......... ............ A Replace tunneled cv cath ............................ 4.79 28.01 2.72 0.21 33.01 7.72 010 

36589 ......... ............ A Removal tunneled cv cath ........................... 2.27 2.24 1.39 0.25 4.76 3.91 010 

36590 ......... ............ A Removal tunneled cv cath ........................... 3.30 3.38 1.72 0.43 7.11 5.45 010 

36595 ......... ............ A Mech remov tunneled cv cath ..................... 3.59 17.42 1.45 0.33 21.34 5.37 000 

36596 ......... ............ A Mech remov tunneled cv cath ..................... 0.75 3.71 0.50 0.39 4.85 1.64 000 

36597 ......... ............ A Reposition venous catheter ......................... 1.21 2.41 0.44 0.08 3.70 1.73 000 

36600 ......... ............ A Withdrawal of arterial blood ......................... 0.32 0.49 0.09 0.02 0.83 0.43 XXX 

36620 ......... ............ A Insertion catheter, artery .............................. 1.15 NA 0.23 0.07 NA 1.45 000 

36625 ......... ............ A Insertion catheter, artery .............................. 2.11 NA 0.53 0.21 NA 2.85 000 

47617

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

36640 ......... ............ A Insertion catheter, artery .............................. 2.10 NA 1.05 0.22 NA 3.37 000 

36660 ......... ............ A Insertion catheter, artery .............................. 1.40 NA 0.44 0.09 NA 1.93 000 

36680 ......... ............ A Insert needle, bone cavity ........................... 1.20 NA 0.49 0.13 NA 1.82 000 

36800 ......... ............ A Insertion of cannula ..................................... 2.43 NA 1.80 0.23 NA 4.46 000 

36810 ......... ............ A Insertion of cannula ..................................... 3.96 NA 1.68 0.47 NA 6.11 000 

36815 ......... ............ A Insertion of cannula ..................................... 2.62 NA 1.17 0.33 NA 4.12 000 

36819 ......... ............ A Av fusion/uppr arm vein ............................... 13.98 NA 6.36 1.87 NA 22.21 090 

36820 ......... ............ A Av fusion/forearm vein ................................. 13.98 NA 6.37 1.88 NA 22.23 090 

36821 ......... ............ A Av fusion direct any site .............................. 8.92 NA 4.67 1.18 NA 14.77 090 

36822 ......... ............ A Insertion of cannula(s) ................................. 5.41 NA 4.41 0.73 NA 10.55 090 

36823 ......... ............ A Insertion of cannula(s) ................................. 20.97 NA 9.38 2.64 NA 32.99 090 

36825 ......... ............ A Artery-vein autograft .................................... 9.83 NA 5.07 1.29 NA 16.19 090 

36830 ......... ............ A Artery-vein nonautograft .............................. 11.98 NA 5.25 1.60 NA 18.83 090 

36831 ......... ............ A Open thrombect av fistula ........................... 7.99 NA 3.94 1.07 NA 13.00 090 

36832 ......... ............ A Av fistula revision, open .............................. 10.48 NA 4.74 1.39 NA 16.61 090 

36833 ......... ............ A Av fistula revision ......................................... 11.93 NA 5.21 1.60 NA 18.74 090 

36834 ......... ............ A Repair A-V aneurysm .................................. 9.92 NA 4.79 1.34 NA 16.05 090 

36835 ......... ............ A Artery to vein shunt ..................................... 7.14 NA 4.34 0.99 NA 12.47 090 

36838 ......... ............ A Dist revas ligation, hemo ............................. 20.60 NA 9.37 2.99 NA 32.96 090 

36860 ......... ............ A External cannula declotting ......................... 2.01 1.77 0.67 0.13 3.91 2.81 000 

36861 ......... ............ A Cannula declotting ....................................... 2.52 NA 1.49 0.25 NA 4.26 000 

36870 ......... ............ A Percut thrombect av fistula .......................... 5.15 32.39 3.14 0.33 37.87 8.62 090 

37140 ......... ............ A Revision of circulation .................................. 23.56 NA 10.46 1.71 NA 35.73 090 

37145 ......... ............ A Revision of circulation .................................. 24.57 NA 10.87 2.99 NA 38.43 090 

37160 ......... ............ A Revision of circulation .................................. 21.57 NA 9.25 2.79 NA 33.61 090 

37180 ......... ............ A Revision of circulation .................................. 24.57 NA 10.29 3.12 NA 37.98 090 

37181 ......... ............ A Splice spleen/kidney veins .......................... 26.64 NA 10.99 3.37 NA 41.00 090 

37182 ......... ............ A Insert hepatic shunt (tips) ............................ 16.97 NA 6.04 0.59 NA 23.60 000 

37183 ......... ............ A Remove hepatic shunt (tips) ........................ 7.99 NA 3.01 0.59 NA 11.59 000 

37195 ......... ............ A Thrombolytic therapy, stroke ....................... 0.00 8.04 NA 0.46 8.50 NA XXX 

37200 ......... ............ A Transcatheter biopsy ................................... 4.55 NA 1.49 0.27 NA 6.31 000 

37201 ......... ............ A Transcatheter therapy infuse ....................... 4.99 NA 2.54 0.35 NA 7.88 000 

37202 ......... ............ A Transcatheter therapy infuse ....................... 5.67 NA 3.02 0.53 NA 9.22 000 

37203 ......... ............ A Transcatheter retrieval ................................. 5.02 33.39 2.03 0.33 38.74 7.38 000 

37204 ......... ............ A Transcatheter occlusion ............................... 18.11 NA 5.89 1.37 NA 25.37 000 

37205 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.75 0.59 NA 12.61 000 

37206 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.43 0.31 NA 5.86 ZZZ 

37207 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.15 1.10 NA 12.52 000 

37208 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.38 0.55 NA 6.05 ZZZ 

37209 ......... ............ A Exchange arterial catheter ........................... 2.27 NA 0.74 0.16 NA 3.17 000 

37250 ......... ............ A Iv us first vessel add-on .............................. 2.10 NA 0.75 0.20 NA 3.05 ZZZ 

37251 ......... ............ A Iv us each add vessel add-on ..................... 1.60 NA 0.55 0.19 NA 2.34 ZZZ 

37500 ......... ............ A Endoscopy ligate perf veins ........................ 10.98 NA 6.88 0.48 NA 18.34 090 

37565 ......... ............ A Ligation of neck vein .................................... 10.86 NA 5.61 1.31 NA 17.78 090 

37600 ......... ............ A Ligation of neck artery ................................. 11.23 NA 6.62 1.30 NA 19.15 090 

37605 ......... ............ A Ligation of neck artery ................................. 13.09 NA 6.90 1.93 NA 21.92 090 

37606 ......... ............ A Ligation of neck artery ................................. 6.27 NA 4.56 0.94 NA 11.77 090 

37607 ......... ............ A Ligation of a-v fistula ................................... 6.15 NA 3.57 0.83 NA 10.55 090 

37609 ......... ............ A Temporal artery procedure .......................... 3.00 4.51 1.96 0.36 7.87 5.32 010 

37615 ......... ............ A Ligation of neck artery ................................. 5.72 NA 4.10 0.69 NA 10.51 090 

37616 ......... ............ A Ligation of chest artery ................................ 16.47 NA 8.10 2.19 NA 26.76 090 

37617 ......... ............ A Ligation of abdomen artery .......................... 22.03 NA 9.17 2.85 NA 34.05 090 

37618 ......... ............ A Ligation of extremity artery .......................... 4.83 NA 3.62 0.65 NA 9.10 090 

37620 ......... ............ A Revision of major vein ................................. 10.54 NA 5.70 0.94 NA 17.18 090 

37650 ......... ............ A Revision of major vein ................................. 7.79 NA 4.69 1.05 NA 13.53 090 

37660 ......... ............ A Revision of major vein ................................. 20.97 NA 9.05 2.60 NA 32.62 090 

37700 ......... ............ A Revise leg vein ............................................ 3.72 NA 2.80 0.52 NA 7.04 090 

37720 ......... ............ A Removal of leg vein ..................................... 5.65 NA 3.71 0.79 NA 10.15 090 

37730 ......... ............ A Removal of leg veins ................................... 7.32 NA 4.26 0.97 NA 12.55 090 

37735 ......... ............ A Removal of leg veins/lesion ......................... 10.51 NA 5.50 1.48 NA 17.49 090 

37760 ......... ............ A Ligation, leg veins, open .............................. 10.45 NA 5.35 1.38 NA 17.18 090 

37765 ......... ............ A Phleb veins - extrem - to 20 ........................ 7.34 NA 4.61 0.48 NA 12.43 090 

37766 ......... ............ A Phleb veins - extrem 20+ ............................ 9.29 NA 5.31 0.48 NA 15.08 090 

37780 ......... ............ A Revision of leg vein ..................................... 3.83 NA 2.86 0.54 NA 7.23 090 

37785 ......... ............ A Ligate/divide/excise vein .............................. 3.83 5.22 2.73 0.53 9.58 7.09 090 

37788 ......... ............ A Revascularization, penis .............................. 21.98 NA 9.18 1.56 NA 32.72 090 

37790 ......... ............ A Penile venous occlusion .............................. 8.33 NA 4.47 0.62 NA 13.42 090 

38100 ......... ............ A Removal of spleen, total .............................. 14.48 NA 6.19 1.85 NA 22.52 090 

38101 ......... ............ A Removal of spleen, partial ........................... 15.29 NA 6.54 2.01 NA 23.84 090 

38102 ......... ............ A Removal of spleen, total .............................. 4.79 NA 1.63 0.61 NA 7.03 ZZZ 

38115 ......... ............ A Repair of ruptured spleen ............................ 15.80 NA 6.65 1.97 NA 24.42 090 

38120 ......... ............ A Laparoscopy, splenectomy .......................... 16.97 NA 7.38 2.18 NA 26.53 090 

38200 ......... ............ A Injection for spleen x-ray ............................. 2.64 NA 0.89 0.17 NA 3.70 000 

38205 ......... ............ R Harvest allogenic stem cells ........................ 1.50 NA 0.68 0.06 NA 2.24 000 

38206 ......... ............ R Harvest auto stem cells ............................... 1.50 NA 0.67 0.06 NA 2.23 000 

47618

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

38220 ......... ............ A Bone marrow aspiration ............................... 1.08 3.97 0.52 0.06 5.11 1.66 XXX 

38221 ......... ............ A Bone marrow biopsy .................................... 1.37 4.19 0.65 0.07 5.63 2.09 XXX 

38230 ......... ............ R Bone marrow collection ............................... 4.53 NA 3.27 0.33 NA 8.13 010 

38240 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.03 0.11 NA 3.38 XXX 

38241 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.04 0.11 NA 3.39 XXX 

38242 ......... ............ A Lymphocyte infuse transplant ...................... 1.71 NA 0.78 0.07 NA 2.56 000 

38300 ......... ............ A Drainage, lymph node lesion ....................... 1.99 4.36 2.06 0.22 6.57 4.27 010 

38305 ......... ............ A Drainage, lymph node lesion ....................... 5.99 NA 4.47 0.60 NA 11.06 090 

38308 ......... ............ A Incision of lymph channels .......................... 6.44 NA 3.76 0.85 NA 11.05 090 

38380 ......... ............ A Thoracic duct procedure .............................. 7.45 NA 5.68 0.80 NA 13.93 090 

38381 ......... ............ A Thoracic duct procedure .............................. 12.86 NA 6.90 1.81 NA 21.57 090 

38382 ......... ............ A Thoracic duct procedure .............................. 10.06 NA 5.79 1.40 NA 17.25 090 

38500 ......... ............ A Biopsy/removal, lymph nodes ...................... 3.74 3.71 2.08 0.48 7.93 6.30 010 

38505 ......... ............ A Needle biopsy, lymph nodes ....................... 1.14 2.06 0.79 0.10 3.30 2.03 000 

38510 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.42 5.54 3.48 0.74 12.70 10.64 010 

38520 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.66 NA 4.06 0.84 NA 11.56 090 

38525 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.06 NA 3.33 0.79 NA 10.18 090 

38530 ......... ............ A Biopsy/removal, lymph nodes ...................... 7.97 NA 4.43 1.06 NA 13.46 090 

38542 ......... ............ A Explore deep node(s), neck ........................ 5.90 NA 4.48 0.63 NA 11.01 090 

38550 ......... ............ A Removal, neck/armpit lesion ....................... 6.91 NA 3.96 0.87 NA 11.74 090 

38555 ......... ............ A Removal, neck/armpit lesion ....................... 14.12 NA 8.57 1.67 NA 24.36 090 

38562 ......... ............ A Removal, pelvic lymph nodes ...................... 10.47 NA 5.79 1.21 NA 17.47 090 

38564 ......... ............ A Removal, abdomen lymph nodes ................ 10.81 NA 5.27 1.31 NA 17.39 090 

38570 ......... ............ A Laparoscopy, lymph node biop ................... 9.24 NA 3.97 1.12 NA 14.33 010 

38571 ......... ............ A Laparoscopy, lymphadenectomy ................. 14.66 NA 5.64 1.20 NA 21.50 010 

38572 ......... ............ A Laparoscopy, lymphadenectomy ................. 16.57 NA 7.07 1.89 NA 25.53 010 

38700 ......... ............ A Removal of lymph nodes, neck ................... 8.23 NA 6.22 0.76 NA 15.21 090 

38720 ......... ............ A Removal of lymph nodes, neck ................... 13.59 NA 9.35 1.24 NA 24.18 090 

38724 ......... ............ A Removal of lymph nodes, neck ................... 14.52 NA 9.82 1.32 NA 25.66 090 

38740 ......... ............ A Remove armpit lymph nodes ....................... 10.01 NA 4.98 1.30 NA 16.29 090 

38745 ......... ............ A Remove armpit lymph nodes ....................... 13.08 NA 6.14 1.68 NA 20.90 090 

38746 ......... ............ A Remove thoracic lymph nodes .................... 4.88 NA 1.61 0.67 NA 7.16 ZZZ 

38747 ......... ............ A Remove abdominal lymph nodes ................ 4.88 NA 1.66 0.62 NA 7.16 ZZZ 

38760 ......... ............ A Remove groin lymph nodes ......................... 12.93 NA 6.16 1.65 NA 20.74 090 

38765 ......... ............ A Remove groin lymph nodes ......................... 19.95 NA 8.85 2.44 NA 31.24 090 

38770 ......... ............ A Remove pelvis lymph nodes ....................... 13.21 NA 5.76 1.37 NA 20.34 090 

38780 ......... ............ A Remove abdomen lymph nodes .................. 16.57 NA 8.22 1.88 NA 26.67 090 

38790 ......... ............ A Inject for lymphatic x-ray ............................. 1.29 7.42 0.76 0.13 8.84 2.18 000 

38792 ......... ............ A Identify sentinel node ................................... 0.52 NA 0.44 0.06 NA 1.02 000 

38794 ......... ............ A Access thoracic lymph duct ......................... 4.44 NA 3.43 0.21 NA 8.08 090 

39000 ......... ............ A Exploration of chest ..................................... 6.09 NA 4.68 0.83 NA 11.60 090 

39010 ......... ............ A Exploration of chest ..................................... 11.77 NA 6.64 1.59 NA 20.00 090 

39200 ......... ............ A Removal chest lesion .................................. 13.60 NA 6.78 1.82 NA 22.20 090 

39220 ......... ............ A Removal chest lesion .................................. 17.39 NA 8.50 2.23 NA 28.12 090 

39400 ......... ............ A Visualization of chest ................................... 5.60 NA 4.85 0.79 NA 11.24 010 

39501 ......... ............ A Repair diaphragm laceration ....................... 13.17 NA 6.48 1.68 NA 21.33 090 

39502 ......... ............ A Repair paraesophageal hernia .................... 16.31 NA 7.16 2.10 NA 25.57 090 

39503 ......... ............ A Repair of diaphragm hernia ......................... 94.86 NA 33.37 11.59 NA 139.82 090 

39520 ......... ............ A Repair of diaphragm hernia ......................... 16.08 NA 8.06 2.10 NA 26.24 090 

39530 ......... ............ A Repair of diaphragm hernia ......................... 15.39 NA 7.15 1.97 NA 24.51 090 

39531 ......... ............ A Repair of diaphragm hernia ......................... 16.40 NA 7.40 2.10 NA 25.90 090 

39540 ......... ............ A Repair of diaphragm hernia ......................... 13.30 NA 6.25 1.67 NA 21.22 090 

39541 ......... ............ A Repair of diaphragm hernia ......................... 14.39 NA 6.60 1.86 NA 22.85 090 

39545 ......... ............ A Revision of diaphragm ................................. 13.35 NA 7.57 1.81 NA 22.73 090 

39560 ......... ............ A Resect diaphragm, simple ........................... 11.98 NA 6.31 1.55 NA 19.84 090 

39561 ......... ............ A Resect diaphragm, complex ........................ 17.47 NA 9.35 2.27 NA 29.09 090 

40490 ......... ............ A Biopsy of lip ................................................. 1.22 1.63 0.61 0.11 2.96 1.94 000 

40500 ......... ............ A Partial excision of lip .................................... 4.27 6.90 4.33 0.45 11.62 9.05 090 

40510 ......... ............ A Partial excision of lip .................................... 4.69 6.61 4.01 0.51 11.81 9.21 090 

40520 ......... ............ A Partial excision of lip .................................... 4.66 7.53 4.10 0.55 12.74 9.31 090 

40525 ......... ............ A Reconstruct lip with flap .............................. 7.54 NA 6.29 0.88 NA 14.71 090 

40527 ......... ............ A Reconstruct lip with flap .............................. 9.12 NA 7.33 1.01 NA 17.46 090 

40530 ......... ............ A Partial removal of lip .................................... 5.39 7.81 4.57 0.60 13.80 10.56 090 

40650 ......... ............ A Repair lip ...................................................... 3.63 6.79 3.32 0.39 10.81 7.34 090 

40652 ......... ............ A Repair lip ...................................................... 4.25 7.74 4.27 0.53 12.52 9.05 090 

40654 ......... ............ A Repair lip ...................................................... 5.30 8.59 4.93 0.67 14.56 10.90 090 

40700 ......... ............ A Repair cleft lip/nasal .................................... 12.77 NA 9.06 1.08 NA 22.91 090 

40701 ......... ............ A Repair cleft lip/nasal .................................... 15.83 NA 11.30 2.36 NA 29.49 090 

40702 ......... ............ A Repair cleft lip/nasal .................................... 13.02 NA 8.27 0.92 NA 22.21 090 

40720 ......... ............ A Repair cleft lip/nasal .................................... 13.53 NA 9.86 1.74 NA 25.13 090 

40761 ......... ............ A Repair cleft lip/nasal .................................... 14.70 NA 10.24 1.70 NA 26.64 090 

40800 ......... ............ A Drainage of mouth lesion ............................ 1.17 2.97 1.77 0.12 4.26 3.06 010 

40801 ......... ............ A Drainage of mouth lesion ............................ 2.53 4.01 2.74 0.32 6.86 5.59 010 

40804 ......... ............ A Removal, foreign body, mouth .................... 1.24 3.41 1.87 0.12 4.77 3.23 010 

40805 ......... ............ A Removal, foreign body, mouth .................... 2.69 4.48 2.81 0.29 7.46 5.79 010 

47619

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

40806 ......... ............ A Incision of lip fold ......................................... 0.31 1.83 0.50 0.03 2.17 0.84 000 

40808 ......... ............ A Biopsy of mouth lesion ................................ 0.96 2.65 1.48 0.10 3.71 2.54 010 

40810 ......... ............ A Excision of mouth lesion .............................. 1.31 2.88 1.66 0.13 4.32 3.10 010 

40812 ......... ............ A Excise/repair mouth lesion .......................... 2.31 3.71 2.40 0.28 6.30 4.99 010 

40814 ......... ............ A Excise/repair mouth lesion .......................... 3.41 4.94 3.89 0.40 8.75 7.70 090 

40816 ......... ............ A Excision of mouth lesion .............................. 3.66 5.17 3.99 0.39 9.22 8.04 090 

40818 ......... ............ A Excise oral mucosa for graft ........................ 2.41 5.17 3.97 0.21 7.79 6.59 090 

40819 ......... ............ A Excise lip or cheek fold ............................... 2.41 4.08 3.09 0.27 6.76 5.77 090 

40820 ......... ............ A Treatment of mouth lesion ........................... 1.28 3.93 2.44 0.12 5.33 3.84 010 

40830 ......... ............ A Repair mouth laceration .............................. 1.76 3.73 2.11 0.17 5.66 4.04 010 

40831 ......... ............ A Repair mouth laceration .............................. 2.46 4.65 3.05 0.28 7.39 5.79 010 

40840 ......... ............ R Reconstruction of mouth .............................. 8.72 9.77 6.96 0.98 19.47 16.66 090 

40842 ......... ............ R Reconstruction of mouth .............................. 8.72 10.04 6.78 0.94 19.70 16.44 090 

40843 ......... ............ R Reconstruction of mouth .............................. 12.08 11.93 7.80 1.39 25.40 21.27 090 

40844 ......... ............ R Reconstruction of mouth .............................. 15.99 15.74 11.55 2.12 33.85 29.66 090 

40845 ......... ............ R Reconstruction of mouth .............................. 18.55 17.03 13.19 2.02 37.60 33.76 090 

41000 ......... ............ A Drainage of mouth lesion ............................ 1.30 2.32 1.41 0.12 3.74 2.83 010 

41005 ......... ............ A Drainage of mouth lesion ............................ 1.26 3.33 1.73 0.15 4.74 3.14 010 

41006 ......... ............ A Drainage of mouth lesion ............................ 3.24 4.79 3.16 0.34 8.37 6.74 090 

41007 ......... ............ A Drainage of mouth lesion ............................ 3.10 5.11 3.02 0.34 8.55 6.46 090 

41008 ......... ............ A Drainage of mouth lesion ............................ 3.36 4.67 3.20 0.44 8.47 7.00 090 

41009 ......... ............ A Drainage of mouth lesion ............................ 3.58 4.96 3.56 0.45 8.99 7.59 090 

41010 ......... ............ A Incision of tongue fold ................................. 1.06 3.44 1.60 0.09 4.59 2.75 010 

41015 ......... ............ A Drainage of mouth lesion ............................ 3.95 5.39 4.14 0.49 9.83 8.58 090 

41016 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.60 4.22 0.51 10.17 8.79 090 

41017 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.62 4.30 0.53 10.21 8.89 090 

41018 ......... ............ A Drainage of mouth lesion ............................ 5.09 6.13 4.58 0.65 11.87 10.32 090 

41100 ......... ............ A Biopsy of tongue .......................................... 1.63 2.42 1.42 0.15 4.20 3.20 010 

41105 ......... ............ A Biopsy of tongue .......................................... 1.42 2.30 1.32 0.13 3.85 2.87 010 

41108 ......... ............ A Biopsy of floor of mouth .............................. 1.05 2.07 1.13 0.10 3.22 2.28 010 

41110 ......... ............ A Excision of tongue lesion ............................. 1.51 2.99 1.64 0.13 4.63 3.28 010 

41112 ......... ............ A Excision of tongue lesion ............................. 2.73 4.46 3.22 0.28 7.47 6.23 090 

41113 ......... ............ A Excision of tongue lesion ............................. 3.19 4.73 3.46 0.35 8.27 7.00 090 

41114 ......... ............ A Excision of tongue lesion ............................. 8.46 NA 7.18 0.84 NA 16.48 090 

41115 ......... ............ A Excision of tongue fold ................................ 1.74 3.28 1.85 0.19 5.21 3.78 010 

41116 ......... ............ A Excision of mouth lesion .............................. 2.44 4.35 2.80 0.23 7.02 5.47 090 

41120 ......... ............ A Partial removal of tongue ............................ 9.76 NA 15.31 0.84 NA 25.91 090 

41130 ......... ............ A Partial removal of tongue ............................ 11.13 NA 16.19 0.96 NA 28.28 090 

41135 ......... ............ A Tongue and neck surgery ............................ 23.06 NA 23.23 2.01 NA 48.30 090 

41140 ......... ............ A Removal of tongue ...................................... 25.46 NA 26.66 2.50 NA 54.62 090 

41145 ......... ............ A Tongue removal, neck surgery .................... 30.01 NA 30.53 2.59 NA 63.13 090 

41150 ......... ............ A Tongue, mouth, jaw surgery ........................ 23.01 NA 24.70 2.05 NA 49.76 090 

41153 ......... ............ A Tongue, mouth, neck surgery ...................... 23.73 NA 25.01 2.10 NA 50.84 090 

41155 ......... ............ A Tongue, jaw, & neck surgery ....................... 27.68 NA 26.79 2.44 NA 56.91 090 

41250 ......... ............ A Repair tongue laceration ............................. 1.91 2.76 1.19 0.18 4.85 3.28 010 

41251 ......... ............ A Repair tongue laceration ............................. 2.27 3.27 1.56 0.22 5.76 4.05 010 

41252 ......... ............ A Repair tongue laceration ............................. 2.97 3.89 2.26 0.31 7.17 5.54 010 

41500 ......... ............ A Fixation of tongue ........................................ 3.70 NA 7.45 0.32 NA 11.47 090 

41510 ......... ............ A Tongue to lip surgery ................................... 3.41 NA 7.99 0.38 NA 11.78 090 

41520 ......... ............ A Reconstruction, tongue fold ......................... 2.73 4.62 3.61 0.27 7.62 6.61 090 

41800 ......... ............ A Drainage of gum lesion ............................... 1.17 2.59 1.29 0.12 3.88 2.58 010 

41805 ......... ............ A Removal foreign body, gum ........................ 1.24 2.67 2.22 0.15 4.06 3.61 010 

41806 ......... ............ A Removal foreign body,jawbone ................... 2.69 3.58 3.03 0.35 6.62 6.07 010 

41822 ......... ............ R Excision of gum lesion ................................. 2.31 3.88 1.86 0.34 6.53 4.51 010 

41823 ......... ............ R Excision of gum lesion ................................. 3.30 5.56 4.00 0.44 9.30 7.74 090 

41825 ......... ............ A Excision of gum lesion ................................. 1.31 3.06 2.24 0.15 4.52 3.70 010 

41826 ......... ............ A Excision of gum lesion ................................. 2.31 2.43 2.10 0.30 5.04 4.71 010 

41827 ......... ............ A Excision of gum lesion ................................. 3.41 5.51 3.66 0.37 9.29 7.44 090 

41828 ......... ............ R Excision of gum lesion ................................. 3.09 3.80 2.96 0.44 7.33 6.49 010 

41830 ......... ............ R Removal of gum tissue ................................ 3.34 4.95 3.62 0.45 8.74 7.41 010 

41872 ......... ............ R Repair gum .................................................. 2.59 5.01 3.45 0.22 7.82 6.26 090 

41874 ......... ............ R Repair tooth socket ...................................... 3.09 4.83 3.17 0.45 8.37 6.71 090 

42000 ......... ............ A Drainage mouth roof lesion ......................... 1.23 2.57 1.26 0.11 3.91 2.60 010 

42100 ......... ............ A Biopsy roof of mouth ................................... 1.31 2.08 1.36 0.13 3.52 2.80 010 

42104 ......... ............ A Excision lesion, mouth roof ......................... 1.64 2.53 1.55 0.16 4.33 3.35 010 

42106 ......... ............ A Excision lesion, mouth roof ......................... 2.10 3.22 2.44 0.25 5.57 4.79 010 

42107 ......... ............ A Excision lesion, mouth roof ......................... 4.43 5.70 3.94 0.46 10.59 8.83 090 

42120 ......... ............ A Remove palate/lesion .................................. 6.16 NA 11.77 0.53 NA 18.46 090 

42140 ......... ............ A Excision of uvula .......................................... 1.62 3.72 2.09 0.13 5.47 3.84 090 

42145 ......... ............ A Repair palate, pharynx/uvula ....................... 8.04 NA 7.49 0.66 NA 16.19 090 

42160 ......... ............ A Treatment mouth roof lesion ....................... 1.80 4.25 2.29 0.16 6.21 4.25 010 

42180 ......... ............ A Repair palate ............................................... 2.50 3.07 2.10 0.21 5.78 4.81 010 

42182 ......... ............ A Repair palate ............................................... 3.82 3.87 3.02 0.40 8.09 7.24 010 

42200 ......... ............ A Reconstruct cleft palate ............................... 11.98 NA 10.20 1.22 NA 23.40 090 

42205 ......... ............ A Reconstruct cleft palate ............................... 13.27 NA 10.06 1.44 NA 24.77 090 

47620

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

42210 ......... ............ A Reconstruct cleft palate ............................... 14.48 NA 11.44 2.00 NA 27.92 090 

42215 ......... ............ A Reconstruct cleft palate ............................... 8.81 NA 9.05 1.31 NA 19.17 090 

42220 ......... ............ A Reconstruct cleft palate ............................... 7.01 NA 6.77 0.49 NA 14.27 090 

42225 ......... ............ A Reconstruct cleft palate ............................... 9.53 NA 16.94 0.97 NA 27.44 090 

42226 ......... ............ A Lengthening of palate .................................. 9.99 NA 14.63 0.89 NA 25.51 090 

42227 ......... ............ A Lengthening of palate .................................. 9.51 NA 15.40 1.02 NA 25.93 090 

42235 ......... ............ A Repair palate ............................................... 7.86 NA 11.86 0.82 NA 20.54 090 

42260 ......... ............ A Repair nose to lip fistula .............................. 9.79 10.17 7.06 0.98 20.94 17.83 090 

42280 ......... ............ A Preparation, palate mold ............................. 1.54 1.95 1.14 0.21 3.70 2.89 010 

42281 ......... ............ A Insertion, palate prosthesis .......................... 1.93 2.62 1.87 0.16 4.71 3.96 010 

42300 ......... ............ A Drainage of salivary gland ........................... 1.93 2.82 1.81 0.17 4.92 3.91 010 

42305 ......... ............ A Drainage of salivary gland ........................... 6.06 NA 4.72 0.53 NA 11.31 090 

42310 ......... ............ A Drainage of salivary gland ........................... 1.56 2.26 1.54 0.15 3.97 3.25 010 

42320 ......... ............ A Drainage of salivary gland ........................... 2.35 3.26 2.09 0.23 5.84 4.67 010 

42325 ......... ............ A Create salivary cyst drain ............................ 2.75 4.61 2.31 0.22 7.58 5.28 090 

42326 ......... ............ A Create salivary cyst drain ............................ 3.77 5.89 3.16 0.23 9.89 7.16 090 

42330 ......... ............ A Removal of salivary stone ........................... 2.21 3.14 1.84 0.19 5.54 4.24 010 

42335 ......... ............ A Removal of salivary stone ........................... 3.31 4.90 3.14 0.30 8.51 6.75 090 

42340 ......... ............ A Removal of salivary stone ........................... 4.59 6.04 3.93 0.41 11.04 8.93 090 

42400 ......... ............ A Biopsy of salivary gland ............................... 0.78 1.65 0.72 0.06 2.49 1.56 000 

42405 ......... ............ A Biopsy of salivary gland ............................... 3.29 4.02 2.45 0.29 7.60 6.03 010 

42408 ......... ............ A Excision of salivary cyst .............................. 4.53 5.90 3.61 0.42 10.85 8.56 090 

42409 ......... ............ A Drainage of salivary cyst ............................. 2.81 4.52 2.76 0.23 7.56 5.80 090 

42410 ......... ............ A Excise parotid gland/lesion .......................... 9.33 NA 6.21 0.93 NA 16.47 090 

42415 ......... ............ A Excise parotid gland/lesion .......................... 16.86 NA 10.84 1.49 NA 29.19 090 

42420 ......... ............ A Excise parotid gland/lesion .......................... 19.56 NA 12.35 1.72 NA 33.63 090 

42425 ......... ............ A Excise parotid gland/lesion .......................... 13.00 NA 8.60 1.14 NA 22.74 090 

42426 ......... ............ A Excise parotid gland/lesion .......................... 21.23 NA 12.99 1.86 NA 36.08 090 

42440 ......... ............ A Excise submaxillary gland ........................... 6.96 NA 4.79 0.61 NA 12.36 090 

42450 ......... ............ A Excise sublingual gland ............................... 4.61 5.89 4.24 0.42 10.92 9.27 090 

42500 ......... ............ A Repair salivary duct ..................................... 4.29 5.67 4.18 0.41 10.37 8.88 090 

42505 ......... ............ A Repair salivary duct ..................................... 6.17 7.12 5.35 0.56 13.85 12.08 090 

42507 ......... ............ A Parotid duct diversion .................................. 6.10 NA 6.53 0.49 NA 13.12 090 

42508 ......... ............ A Parotid duct diversion .................................. 9.09 NA 8.34 0.74 NA 18.17 090 

42509 ......... ............ A Parotid duct diversion .................................. 11.52 NA 10.17 1.50 NA 23.19 090 

42510 ......... ............ A Parotid duct diversion .................................. 8.14 NA 7.78 0.66 NA 16.58 090 

42550 ......... ............ A Injection for salivary x-ray ............................ 1.25 3.25 0.41 0.08 4.58 1.74 000 

42600 ......... ............ A Closure of salivary fistula ............................ 4.81 6.57 4.12 0.40 11.78 9.33 090 

42650 ......... ............ A Dilation of salivary duct ............................... 0.77 1.10 0.71 0.07 1.94 1.55 000 

42660 ......... ............ A Dilation of salivary duct ............................... 1.13 1.35 0.85 0.09 2.57 2.07 000 

42665 ......... ............ A Ligation of salivary duct ............................... 2.53 4.16 2.59 0.21 6.90 5.33 090 

42700 ......... ............ A Drainage of tonsil abscess .......................... 1.62 2.65 1.71 0.13 4.40 3.46 010 

42720 ......... ............ A Drainage of throat abscess ......................... 5.41 4.82 3.78 0.48 10.71 9.67 010 

42725 ......... ............ A Drainage of throat abscess ......................... 10.70 NA 8.21 0.96 NA 19.87 090 

42800 ......... ............ A Biopsy of throat ............................................ 1.39 2.18 1.40 0.12 3.69 2.91 010 

42802 ......... ............ A Biopsy of throat ............................................ 1.54 4.77 2.06 0.13 6.44 3.73 010 

42804 ......... ............ A Biopsy of upper nose/throat ........................ 1.24 3.74 1.73 0.10 5.08 3.07 010 

42806 ......... ............ A Biopsy of upper nose/throat ........................ 1.58 4.08 1.93 0.13 5.79 3.64 010 

42808 ......... ............ A Excise pharynx lesion .................................. 2.30 3.09 1.93 0.19 5.58 4.42 010 

42809 ......... ............ A Remove pharynx foreign body .................... 1.81 2.33 1.35 0.16 4.30 3.32 010 

42810 ......... ............ A Excision of neck cyst ................................... 3.25 5.71 3.54 0.31 9.27 7.10 090 

42815 ......... ............ A Excision of neck cyst ................................... 7.06 NA 6.40 0.63 NA 14.09 090 

42820 ......... ............ A Remove tonsils and adenoids ..................... 3.90 NA 3.29 0.33 NA 7.52 090 

42821 ......... ............ A Remove tonsils and adenoids ..................... 4.28 NA 3.50 0.35 NA 8.13 090 

42825 ......... ............ A Removal of tonsils ....................................... 3.41 NA 3.17 0.28 NA 6.86 090 

42826 ......... ............ A Removal of tonsils ....................................... 3.37 NA 3.03 0.28 NA 6.68 090 

42830 ......... ............ A Removal of adenoids ................................... 2.57 NA 2.56 0.21 NA 5.34 090 

42831 ......... ............ A Removal of adenoids ................................... 2.71 NA 2.84 0.22 NA 5.77 090 

42835 ......... ............ A Removal of adenoids ................................... 2.30 NA 2.46 0.21 NA 4.97 090 

42836 ......... ............ A Removal of adenoids ................................... 3.18 NA 2.95 0.26 NA 6.39 090 

42842 ......... ............ A Extensive surgery of throat .......................... 8.75 NA 10.99 0.72 NA 20.46 090 

42844 ......... ............ A Extensive surgery of throat .......................... 14.29 NA 16.23 1.24 NA 31.76 090 

42845 ......... ............ A Extensive surgery of throat .......................... 24.25 NA 23.17 2.07 NA 49.49 090 

42860 ......... ............ A Excision of tonsil tags .................................. 2.22 NA 2.40 0.19 NA 4.81 090 

42870 ......... ............ A Excision of lingual tonsil .............................. 5.39 NA 8.57 0.45 NA 14.41 090 

42890 ......... ............ A Partial removal of pharynx ........................... 12.92 NA 14.15 1.10 NA 28.17 090 

42892 ......... ............ A Revision of pharyngeal walls ....................... 15.81 NA 17.17 1.33 NA 34.31 090 

42894 ......... ............ A Revision of pharyngeal walls ....................... 22.85 NA 22.01 1.91 NA 46.77 090 

42900 ......... ............ A Repair throat wound .................................... 5.24 NA 3.66 0.55 NA 9.45 010 

42950 ......... ............ A Reconstruction of throat .............................. 8.09 NA 11.85 0.72 NA 20.66 090 

42953 ......... ............ A Repair throat, esophagus ............................ 8.95 NA 17.22 0.88 NA 27.05 090 

42955 ......... ............ A Surgical opening of throat ........................... 7.38 NA 10.69 0.70 NA 18.77 090 

42960 ......... ............ A Control throat bleeding ................................ 2.33 NA 1.95 0.18 NA 4.46 010 

42961 ......... ............ A Control throat bleeding ................................ 5.58 NA 4.96 0.46 NA 11.00 090 

42962 ......... ............ A Control throat bleeding ................................ 7.13 NA 5.91 0.62 NA 13.66 090 

47621

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

42970 ......... ............ A Control nose/throat bleeding ....................... 5.42 NA 4.22 0.40 NA 10.04 090 

42971 ......... ............ A Control nose/throat bleeding ....................... 6.20 NA 5.12 0.54 NA 11.86 090 

42972 ......... ............ A Control nose/throat bleeding ....................... 7.19 NA 5.69 0.59 NA 13.47 090 

43020 ......... ............ A Incision of esophagus .................................. 8.08 NA 5.41 0.92 NA 14.41 090 

43030 ......... ............ A Throat muscle surgery ................................. 7.68 NA 5.48 0.70 NA 13.86 090 

43045 ......... ............ A Incision of esophagus .................................. 20.09 NA 10.71 2.22 NA 33.02 090 

43100 ......... ............ A Excision of esophagus lesion ...................... 9.18 NA 6.23 0.98 NA 16.39 090 

43101 ......... ............ A Excision of esophagus lesion ...................... 16.22 NA 7.89 2.09 NA 26.20 090 

43107 ......... ............ A Removal of esophagus ................................ 39.94 NA 17.05 5.03 NA 62.02 090 

43108 ......... ............ A Removal of esophagus ................................ 34.14 NA 14.21 4.27 NA 52.62 090 

43112 ......... ............ A Removal of esophagus ................................ 43.43 NA 18.14 5.61 NA 67.18 090 

43113 ......... ............ A Removal of esophagus ................................ 35.22 NA 15.11 4.43 NA 54.76 090 

43116 ......... ............ A Partial removal of esophagus ...................... 31.17 NA 16.69 3.02 NA 50.88 090 

43117 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.29 4.98 NA 61.21 090 

43118 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 13.79 4.27 NA 51.21 090 

43121 ......... ............ A Partial removal of esophagus ...................... 29.15 NA 12.68 4.06 NA 45.89 090 

43122 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.40 5.11 NA 61.45 090 

43123 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 14.10 4.49 NA 51.74 090 

43124 ......... ............ A Removal of esophagus ................................ 27.28 NA 13.09 3.28 NA 43.65 090 

43130 ......... ............ A Removal of esophagus pouch ..................... 11.73 NA 7.57 1.22 NA 20.52 090 

43135 ......... ............ A Removal of esophagus pouch ..................... 16.08 NA 8.11 2.16 NA 26.35 090 

43200 ......... ............ A Esophagus endoscopy ................................ 1.59 4.15 1.07 0.13 5.87 2.79 000 

43201 ......... ............ A Esoph scope w/submucous inj .................... 2.09 4.61 1.10 0.13 6.83 3.32 000 

43202 ......... ............ A Esophagus endoscopy, biopsy .................... 1.89 5.59 0.94 0.16 7.64 2.99 000 

43204 ......... ............ A Esoph scope w/sclerosis inj ........................ 3.76 NA 1.52 0.30 NA 5.58 000 

43205 ......... ............ A Esophagus endoscopy/ligation .................... 3.78 NA 1.52 0.29 NA 5.59 000 

43215 ......... ............ A Esophagus endoscopy ................................ 2.60 NA 1.20 0.23 NA 4.03 000 

43216 ......... ............ A Esophagus endoscopy/lesion ...................... 2.40 NA 1.19 0.20 NA 3.79 000 

43217 ......... ............ A Esophagus endoscopy ................................ 2.90 7.02 1.19 0.25 10.17 4.34 000 

43219 ......... ............ A Esophagus endoscopy ................................ 2.80 NA 1.35 0.23 NA 4.38 000 

43220 ......... ............ A Esoph endoscopy, dilation ........................... 2.10 NA 0.97 0.17 NA 3.24 000 

43226 ......... ............ A Esoph endoscopy, dilation ........................... 2.34 NA 1.03 0.19 NA 3.56 000 

43227 ......... ............ A Esoph endoscopy, repair ............................. 3.59 NA 1.45 0.28 NA 5.32 000 

43228 ......... ............ A Esoph endoscopy, ablation ......................... 3.76 NA 1.55 0.35 NA 5.66 000 

43231 ......... ............ A Esoph endoscopy w/us exam ...................... 3.19 NA 1.31 0.23 NA 4.73 000 

43232 ......... ............ A Esoph endoscopy w/us fn bx ...................... 4.47 NA 1.81 0.31 NA 6.59 000 

43234 ......... ............ A Upper GI endoscopy, exam ......................... 2.01 5.37 0.87 0.17 7.55 3.05 000 

43235 ......... ............ A Uppr gi endoscopy, diagnosis ..................... 2.39 5.22 1.02 0.19 7.80 3.60 000 

43236 ......... ............ A Uppr gi scope w/submuc inj ........................ 2.92 6.45 1.22 0.19 9.56 4.33 000 

43237 ......... ............ A Endoscopic us exam, esoph ....................... 3.98 NA 1.59 0.43 NA 6.00 000 

43238 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 5.02 NA 1.96 0.43 NA 7.41 000 

43239 ......... ............ A Upper GI endoscopy, biopsy ....................... 2.87 5.77 1.19 0.23 8.87 4.29 000 

43240 ......... ............ A Esoph endoscope w/drain cyst .................... 6.85 NA 2.60 0.54 NA 9.99 000 

43241 ......... ............ A Upper GI endoscopy with tube .................... 2.59 NA 1.10 0.21 NA 3.90 000 

43242 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 7.30 NA 2.73 0.53 NA 10.56 000 

43243 ......... ............ A Upper gi endoscopy & inject ....................... 4.56 NA 1.79 0.34 NA 6.69 000 

43244 ......... ............ A Upper GI endoscopy/ligation ....................... 5.04 NA 1.96 0.37 NA 7.37 000 

43245 ......... ............ A Uppr gi scope dilate strictr ........................... 3.18 NA 1.30 0.28 NA 4.76 000 

43246 ......... ............ A Place gastrostomy tube ............................... 4.32 NA 1.69 0.34 NA 6.35 000 

43247 ......... ............ A Operative upper GI endoscopy ................... 3.38 NA 1.37 0.27 NA 5.02 000 

43248 ......... ............ A Uppr gi endoscopy/guide wire ..................... 3.15 NA 1.31 0.24 NA 4.70 000 

43249 ......... ............ A Esoph endoscopy, dilation ........................... 2.90 NA 1.21 0.22 NA 4.33 000 

43250 ......... ............ A Upper GI endoscopy/tumor ......................... 3.20 NA 1.31 0.26 NA 4.77 000 

43251 ......... ............ A Operative upper GI endoscopy ................... 3.69 NA 1.48 0.29 NA 5.46 000 

43255 ......... ............ A Operative upper GI endoscopy ................... 4.81 NA 1.88 0.36 NA 7.05 000 

43256 ......... ............ A Uppr gi endoscopy w stent .......................... 4.34 NA 1.71 0.37 NA 6.42 000 

43258 ......... ............ A Operative upper GI endoscopy ................... 4.54 NA 1.78 0.35 NA 6.67 000 

43259 ......... ............ A Endoscopic ultrasound exam ...................... 5.19 NA 1.99 0.36 NA 7.54 000 

43260 ......... ............ A Endo cholangiopancreatograph ................... 5.95 NA 2.28 0.44 NA 8.67 000 

43261 ......... ............ A Endo cholangiopancreatograph ................... 6.26 NA 2.39 0.46 NA 9.11 000 

43262 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.55 NA 10.71 000 

43263 ......... ............ A Endo cholangiopancreatograph ................... 7.28 NA 2.76 0.55 NA 10.59 000 

43264 ......... ............ A Endo cholangiopancreatograph ................... 8.89 NA 3.31 0.66 NA 12.86 000 

43265 ......... ............ A Endo cholangiopancreatograph ................... 10.00 NA 3.69 0.74 NA 14.43 000 

43267 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.56 NA 10.72 000 

43268 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.88 0.55 NA 10.81 000 

43269 ......... ............ A Endo cholangiopancreatograph ................... 8.20 NA 3.07 0.61 NA 11.88 000 

43271 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.77 0.54 NA 10.69 000 

43272 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.78 0.55 NA 10.71 000 

43280 ......... ............ A Laparoscopy, fundoplasty ............................ 17.22 NA 7.28 2.20 NA 26.70 090 

43300 ......... ............ A Repair of esophagus ................................... 9.13 NA 6.45 1.01 NA 16.59 090 

43305 ......... ............ A Repair esophagus and fistula ...................... 17.36 NA 10.72 1.53 NA 29.61 090 

43310 ......... ............ A Repair of esophagus ................................... 25.35 NA 11.08 3.44 NA 39.87 090 

43312 ......... ............ A Repair esophagus and fistula ...................... 28.38 NA 11.93 3.43 NA 43.74 090 

43313 ......... ............ A Esophagoplasty congenital .......................... 45.21 NA 18.82 6.55 NA 70.58 090 

47622

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

43314 ......... ............ A Tracheo-esophagoplasty cong .................... 50.19 NA 19.15 6.67 NA 76.01 090 

43320 ......... ............ A Fuse esophagus & stomach ........................ 19.90 NA 9.21 2.41 NA 31.52 090 

43324 ......... ............ A Revise esophagus & stomach ..................... 20.54 NA 8.77 2.59 NA 31.90 090 

43325 ......... ............ A Revise esophagus & stomach ..................... 20.03 NA 8.79 2.54 NA 31.36 090 

43326 ......... ............ A Revise esophagus & stomach ..................... 19.71 NA 9.29 2.63 NA 31.63 090 

43330 ......... ............ A Repair of esophagus ................................... 19.74 NA 8.54 2.51 NA 30.79 090 

43331 ......... ............ A Repair of esophagus ................................... 20.10 NA 9.79 2.65 NA 32.54 090 

43340 ......... ............ A Fuse esophagus & intestine ........................ 19.58 NA 8.97 2.49 NA 31.04 090 

43341 ......... ............ A Fuse esophagus & intestine ........................ 20.82 NA 10.03 2.89 NA 33.74 090 

43350 ......... ............ A Surgical opening, esophagus ...................... 15.76 NA 8.46 1.78 NA 26.00 090 

43351 ......... ............ A Surgical opening, esophagus ...................... 18.32 NA 9.79 2.46 NA 30.57 090 

43352 ......... ............ A Surgical opening, esophagus ...................... 15.24 NA 8.39 1.85 NA 25.48 090 

43360 ......... ............ A Gastrointestinal repair .................................. 35.65 NA 15.07 4.26 NA 54.98 090 

43361 ......... ............ A Gastrointestinal repair .................................. 40.44 NA 16.88 4.52 NA 61.84 090 

43400 ......... ............ A Ligate esophagus veins ............................... 21.17 NA 9.45 2.04 NA 32.66 090 

43401 ......... ............ A Esophagus surgery for veins ....................... 22.06 NA 9.49 2.61 NA 34.16 090 

43405 ......... ............ A Ligate/staple esophagus .............................. 19.98 NA 9.57 2.56 NA 32.11 090 

43410 ......... ............ A Repair esophagus wound ............................ 13.45 NA 7.64 1.63 NA 22.72 090 

43415 ......... ............ A Repair esophagus wound ............................ 24.96 NA 11.73 3.34 NA 40.03 090 

43420 ......... ............ A Repair esophagus opening .......................... 14.33 NA 7.45 1.38 NA 23.16 090 

43425 ......... ............ A Repair esophagus opening .......................... 21.00 NA 9.97 2.62 NA 33.59 090 

43450 ......... ............ A Dilate esophagus ......................................... 1.38 2.67 0.69 0.11 4.16 2.18 000 

43453 ......... ............ A Dilate esophagus ......................................... 1.51 6.11 0.73 0.11 7.73 2.35 000 

43456 ......... ............ A Dilate esophagus ......................................... 2.57 13.83 1.10 0.20 16.60 3.87 000 

43458 ......... ............ A Dilate esophagus ......................................... 3.06 6.69 1.28 0.25 10.00 4.59 000 

43460 ......... ............ A Pressure treatment esophagus ................... 3.79 NA 1.48 0.31 NA 5.58 000 

43500 ......... ............ A Surgical opening of stomach ....................... 11.03 NA 4.98 1.39 NA 17.40 090 

43501 ......... ............ A Surgical repair of stomach ........................... 20.01 NA 8.31 2.57 NA 30.89 090 

43502 ......... ............ A Surgical repair of stomach ........................... 23.10 NA 9.45 2.75 NA 35.30 090 

43510 ......... ............ A Surgical opening of stomach ....................... 13.06 NA 6.61 1.54 NA 21.21 090 

43520 ......... ............ A Incision of pyloric muscle ............................ 9.98 NA 5.27 1.30 NA 16.55 090 

43600 ......... ............ A Biopsy of stomach ....................................... 1.91 NA 0.66 0.15 NA 2.72 000 

43605 ......... ............ A Biopsy of stomach ....................................... 11.96 NA 5.28 1.54 NA 18.78 090 

43610 ......... ............ A Excision of stomach lesion .......................... 14.58 NA 6.16 1.88 NA 22.62 090 

43611 ......... ............ A Excision of stomach lesion .......................... 17.81 NA 7.56 2.30 NA 27.67 090 

43620 ......... ............ A Removal of stomach .................................... 29.99 NA 11.80 3.85 NA 45.64 090 

43621 ......... ............ A Removal of stomach .................................... 30.68 NA 11.98 3.94 NA 46.60 090 

43622 ......... ............ A Removal of stomach .................................... 32.48 NA 12.58 4.17 NA 49.23 090 

43631 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.15 2.90 NA 34.61 090 

43632 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.15 2.90 NA 34.61 090 

43633 ......... ............ A Removal of stomach, partial ........................ 23.07 NA 9.32 2.96 NA 35.35 090 

43634 ......... ............ A Removal of stomach, partial ........................ 25.08 NA 10.08 3.13 NA 38.29 090 

43635 ......... ............ A Removal of stomach, partial ........................ 2.06 NA 0.70 0.27 NA 3.03 ZZZ 

43638 ......... ............ A Removal of stomach, partial ........................ 28.96 NA 11.87 3.72 NA 44.55 090 

43639 ......... ............ A Removal of stomach, partial ........................ 29.61 NA 11.68 3.78 NA 45.07 090 

43640 ......... ............ A Vagotomy & pylorus repair .......................... 16.99 NA 7.26 2.19 NA 26.44 090 

43641 ......... ............ A Vagotomy & pylorus repair .......................... 17.24 NA 7.37 2.16 NA 26.77 090 

43651 ......... ............ A Laparoscopy, vagus nerve .......................... 10.13 NA 4.76 1.32 NA 16.21 090 

43652 ......... ............ A Laparoscopy, vagus nerve .......................... 12.13 NA 5.75 1.51 NA 19.39 090 

43653 ......... ............ A Laparoscopy, gastrostomy ........................... 7.72 NA 4.19 0.98 NA 12.89 090 

43750 ......... ............ A Place gastrostomy tube ............................... 4.48 NA 2.19 0.43 NA 7.10 010 

43752 ......... ............ A Nasal/orogastric w/stent .............................. 0.68 0.23 0.22 0.02 0.93 0.92 000 

43760 ......... ............ A Change gastrostomy tube ........................... 1.10 2.10 0.45 0.09 3.29 1.64 000 

43761 ......... ............ A Reposition gastrostomy tube ....................... 2.01 1.19 0.66 0.14 3.34 2.81 000 

43800 ......... ............ A Reconstruction of pylorus ............................ 13.67 NA 5.91 1.76 NA 21.34 090 

43810 ......... ............ A Fusion of stomach and bowel ..................... 14.63 NA 6.19 1.91 NA 22.73 090 

43820 ......... ............ A Fusion of stomach and bowel ..................... 15.35 NA 6.42 1.96 NA 23.73 090 

43825 ......... ............ A Fusion of stomach and bowel ..................... 19.19 NA 8.01 2.45 NA 29.65 090 

43830 ......... ............ A Place gastrostomy tube ............................... 9.52 NA 4.85 1.18 NA 15.55 090 

43831 ......... ............ A Place gastrostomy tube ............................... 7.83 NA 4.52 1.00 NA 13.35 090 

43832 ......... ............ A Place gastrostomy tube ............................... 15.58 NA 6.86 1.94 NA 24.38 090 

43840 ......... ............ A Repair of stomach lesion ............................. 15.54 NA 6.77 2.00 NA 24.31 090 

43842 ......... ............ A Gastroplasty for obesity ............................... 18.44 NA 7.95 2.40 NA 28.79 090 

43843 ......... ............ A Gastroplasty for obesity ............................... 18.62 NA 7.91 2.45 NA 28.98 090 

43846 ......... ............ A Gastric bypass for obesity ........................... 24.01 NA 10.17 3.09 NA 37.27 090 

43847 ......... ............ A Gastric bypass for obesity ........................... 26.88 NA 11.07 3.49 NA 41.44 090 

43848 ......... ............ A Revision gastroplasty ................................... 29.35 NA 11.99 3.80 NA 45.14 090 

43850 ......... ............ A Revise stomach-bowel fusion ...................... 24.68 NA 9.81 3.17 NA 37.66 090 

43855 ......... ............ A Revise stomach-bowel fusion ...................... 26.12 NA 10.32 3.43 NA 39.87 090 

43860 ......... ............ A Revise stomach-bowel fusion ...................... 24.96 NA 9.97 3.19 NA 38.12 090 

43865 ......... ............ A Revise stomach-bowel fusion ...................... 26.48 NA 10.50 3.46 NA 40.44 090 

43870 ......... ............ A Repair stomach opening .............................. 9.68 NA 4.53 1.21 NA 15.42 090 

43880 ......... ............ A Repair stomach-bowel fistula ...................... 24.61 NA 9.90 3.11 NA 37.62 090 

44005 ......... ............ A Freeing of bowel adhesion .......................... 16.21 NA 6.73 2.06 NA 25.00 090 

44010 ......... ............ A Incision of small bowel ................................ 12.50 NA 5.46 1.60 NA 19.56 090 

47623

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

44015 ......... ............ A Insert needle cath bowel ............................. 2.62 NA 0.88 0.33 NA 3.83 ZZZ 

44020 ......... ............ A Explore small intestine ................................. 13.97 NA 5.94 1.77 NA 21.68 090 

44021 ......... ............ A Decompress small bowel ............................. 14.06 NA 5.98 1.78 NA 21.82 090 

44025 ......... ............ A Incision of large bowel ................................. 14.26 NA 6.03 1.81 NA 22.10 090 

44050 ......... ............ A Reduce bowel obstruction ........................... 14.01 NA 5.96 1.79 NA 21.76 090 

44055 ......... ............ A Correct malrotation of bowel ....................... 21.97 NA 8.73 2.81 NA 33.51 090 

44100 ......... ............ A Biopsy of bowel ........................................... 2.01 NA 0.71 0.17 NA 2.89 000 

44110 ......... ............ A Excise intestine lesion(s) ............................. 11.79 NA 5.24 1.48 NA 18.51 090 

44111 ......... ............ A Excision of bowel lesion(s) .......................... 14.27 NA 6.12 1.80 NA 22.19 090 

44120 ......... ............ A Removal of small intestine .......................... 16.97 NA 7.08 2.13 NA 26.18 090 

44121 ......... ............ A Removal of small intestine .......................... 4.44 NA 1.52 0.55 NA 6.51 ZZZ 

44125 ......... ............ A Removal of small intestine .......................... 17.51 NA 7.26 2.19 NA 26.96 090 

44126 ......... ............ A Enterectomy w/o taper, cong ....................... 35.45 NA 14.10 4.60 NA 54.15 090 

44127 ......... ............ A Enterectomy w/taper, cong .......................... 40.94 NA 15.69 5.41 NA 62.04 090 

44128 ......... ............ A Enterectomy cong, add-on .......................... 4.44 NA 1.53 0.59 NA 6.56 ZZZ 

44130 ......... ............ A Bowel to bowel fusion .................................. 14.47 NA 6.22 1.80 NA 22.49 090 

44139 ......... ............ A Mobilization of colon .................................... 2.23 NA 0.76 0.28 NA 3.27 ZZZ 

44140 ......... ............ A Partial removal of colon ............................... 20.97 NA 8.64 2.62 NA 32.23 090 

44141 ......... ............ A Partial removal of colon ............................... 19.48 NA 10.04 2.42 NA 31.94 090 

44143 ......... ............ A Partial removal of colon ............................... 22.96 NA 10.69 2.91 NA 36.56 090 

44144 ......... ............ A Partial removal of colon ............................... 21.50 NA 9.62 2.71 NA 33.83 090 

44145 ......... ............ A Partial removal of colon ............................... 26.38 NA 10.80 3.22 NA 40.40 090 

44146 ......... ............ A Partial removal of colon ............................... 27.50 NA 12.85 3.35 NA 43.70 090 

44147 ......... ............ A Partial removal of colon ............................... 20.68 NA 8.68 2.48 NA 31.84 090 

44150 ......... ............ A Removal of colon ......................................... 23.91 NA 12.03 2.98 NA 38.92 090 

44151 ......... ............ A Removal of colon/ileostomy ......................... 26.84 NA 13.39 3.39 NA 43.62 090 

44152 ......... ............ A Removal of colon/ileostomy ......................... 27.79 NA 11.59 3.40 NA 42.78 090 

44153 ......... ............ A Removal of colon/ileostomy ......................... 30.54 NA 14.38 3.30 NA 48.22 090 

44155 ......... ............ A Removal of colon/ileostomy ......................... 27.82 NA 13.30 3.25 NA 44.37 090 

44156 ......... ............ A Removal of colon/ileostomy ......................... 30.74 NA 15.03 3.95 NA 49.72 090 

44160 ......... ............ A Removal of colon ......................................... 18.59 NA 7.74 2.31 NA 28.64 090 

44200 ......... ............ A Laparoscopy, enterolysis ............................. 14.42 NA 6.19 1.75 NA 22.36 090 

44201 ......... ............ A Laparoscopy, jejunostomy ........................... 9.77 NA 4.66 1.25 NA 15.68 090 

44202 ......... ............ A Lap resect s/intestine singl .......................... 22.01 NA 8.92 2.71 NA 33.64 090 

44203 ......... ............ A Lap resect s/intestine, addl .......................... 4.44 NA 1.49 0.56 NA 6.49 ZZZ 

44204 ......... ............ A Laparo partial colectomy ............................. 25.04 NA 9.94 3.05 NA 38.03 090 

44205 ......... ............ A Lap colectomy part w/ileum ......................... 22.20 NA 8.83 2.69 NA 33.72 090 

44206 ......... ............ A Lap part colectomy w/stoma ........................ 26.96 NA 11.22 2.91 NA 41.09 090 

44207 ......... ............ A L colectomy/coloproctostomy ...................... 29.96 NA 11.46 3.22 NA 44.64 090 

44208 ......... ............ A L colectomy/coloproctostomy ...................... 31.95 NA 13.09 3.35 NA 48.39 090 

44210 ......... ............ A Laparo total proctocolectomy ...................... 27.96 NA 11.83 2.98 NA 42.77 090 

44211 ......... ............ A Laparo total proctocolectomy ...................... 34.95 NA 14.61 3.35 NA 52.91 090 

44212 ......... ............ A Laparo total proctocolectomy ...................... 32.45 NA 13.59 3.25 NA 49.29 090 

44300 ......... ............ A Open bowel to skin ...................................... 12.09 NA 5.49 1.55 NA 19.13 090 

44310 ......... ............ A Ileostomy/jejunostomy ................................. 15.93 NA 6.69 1.94 NA 24.56 090 

44312 ......... ............ A Revision of ileostomy ................................... 8.01 NA 3.99 0.90 NA 12.90 090 

44314 ......... ............ A Revision of ileostomy ................................... 15.03 NA 6.55 1.73 NA 23.31 090 

44316 ......... ............ A Devise bowel pouch .................................... 21.06 NA 8.54 2.41 NA 32.01 090 

44320 ......... ............ A Colostomy .................................................... 17.61 NA 7.65 2.21 NA 27.47 090 

44322 ......... ............ A Colostomy with biopsies .............................. 11.96 NA 8.59 1.51 NA 22.06 090 

44340 ......... ............ A Revision of colostomy .................................. 7.71 NA 4.27 0.97 NA 12.95 090 

44345 ......... ............ A Revision of colostomy .................................. 15.41 NA 6.88 1.92 NA 24.21 090 

44346 ......... ............ A Revision of colostomy .................................. 16.96 NA 7.38 2.07 NA 26.41 090 

44360 ......... ............ A Small bowel endoscopy ............................... 2.59 NA 1.10 0.19 NA 3.88 000 

44361 ......... ............ A Small bowel endoscopy/biopsy ................... 2.87 NA 1.20 0.21 NA 4.28 000 

44363 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.38 0.26 NA 5.13 000 

44364 ......... ............ A Small bowel endoscopy ............................... 3.73 NA 1.49 0.28 NA 5.50 000 

44365 ......... ............ A Small bowel endoscopy ............................... 3.31 NA 1.36 0.25 NA 4.92 000 

44366 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.73 0.32 NA 6.45 000 

44369 ......... ............ A Small bowel endoscopy ............................... 4.51 NA 1.73 0.34 NA 6.58 000 

44370 ......... ............ A Small bowel endoscopy/stent ...................... 4.79 NA 1.97 0.36 NA 7.12 000 

44372 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.72 0.35 NA 6.47 000 

44373 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.42 0.26 NA 5.17 000 

44376 ......... ............ A Small bowel endoscopy ............................... 5.25 NA 2.02 0.41 NA 7.68 000 

44377 ......... ............ A Small bowel endoscopy/biopsy ................... 5.52 NA 2.13 0.40 NA 8.05 000 

44378 ......... ............ A Small bowel endoscopy ............................... 7.12 NA 2.69 0.53 NA 10.34 000 

44379 ......... ............ A S bowel endoscope w/stent ......................... 7.46 NA 2.91 0.55 NA 10.92 000 

44380 ......... ............ A Small bowel endoscopy ............................... 1.05 NA 0.55 0.08 NA 1.68 000 

44382 ......... ............ A Small bowel endoscopy ............................... 1.27 NA 0.63 0.12 NA 2.02 000 

44383 ......... ............ A Ileoscopy w/stent ......................................... 2.94 NA 1.27 0.24 NA 4.45 000 

44385 ......... ............ A Endoscopy of bowel pouch ......................... 1.82 3.35 0.75 0.15 5.32 2.72 000 

44386 ......... ............ A Endoscopy, bowel pouch/biop ..................... 2.12 6.68 0.88 0.19 8.99 3.19 000 

44388 ......... ............ A Colonoscopy ................................................ 2.82 5.14 1.15 0.26 8.22 4.23 000 

44389 ......... ............ A Colonoscopy with biopsy ............................. 3.13 6.70 1.27 0.27 10.10 4.67 000 

44390 ......... ............ A Colonoscopy for foreign body ...................... 3.82 7.19 1.49 0.30 11.31 5.61 000 

47624

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

44391 ......... ............ A Colonoscopy for bleeding ............................ 4.31 8.84 1.69 0.34 13.49 6.34 000 

44392 ......... ............ A Colonoscopy & polypectomy ....................... 3.81 6.66 1.49 0.34 10.81 5.64 000 

44393 ......... ............ A Colonoscopy, lesion removal ....................... 4.83 6.99 1.86 0.41 12.23 7.10 000 

44394 ......... ............ A Colonoscopy w/snare .................................. 4.42 7.90 1.72 0.39 12.71 6.53 000 

44397 ......... ............ A Colonoscopy w/stent .................................... 4.70 NA 1.78 0.42 NA 6.90 000 

44500 ......... ............ A Intro, gastrointestinal tube ........................... 0.49 NA 0.16 0.03 NA 0.68 000 

44602 ......... ............ A Suture, small intestine ................................. 16.01 NA 6.38 2.00 NA 24.39 090 

44603 ......... ............ A Suture, small intestine ................................. 18.63 NA 7.26 2.37 NA 28.26 090 

44604 ......... ............ A Suture, large intestine .................................. 16.01 NA 6.45 2.02 NA 24.48 090 

44605 ......... ............ A Repair of bowel lesion ................................. 19.50 NA 8.38 2.46 NA 30.34 090 

44615 ......... ............ A Intestinal stricturoplasty ............................... 15.91 NA 6.67 1.99 NA 24.57 090 

44620 ......... ............ A Repair bowel opening .................................. 12.18 NA 5.32 1.47 NA 18.97 090 

44625 ......... ............ A Repair bowel opening .................................. 15.03 NA 6.30 1.82 NA 23.15 090 

44626 ......... ............ A Repair bowel opening .................................. 25.32 NA 9.80 3.19 NA 38.31 090 

44640 ......... ............ A Repair bowel-skin fistula .............................. 21.62 NA 8.57 2.71 NA 32.90 090 

44650 ......... ............ A Repair bowel fistula ..................................... 22.54 NA 8.87 2.79 NA 34.20 090 

44660 ......... ............ A Repair bowel-bladder fistula ........................ 21.33 NA 8.33 2.21 NA 31.87 090 

44661 ......... ............ A Repair bowel-bladder fistula ........................ 24.77 NA 9.54 2.80 NA 37.11 090 

44680 ......... ............ A Surgical revision, intestine ........................... 15.38 NA 6.44 1.95 NA 23.77 090 

44700 ......... ............ A Suspend bowel w/prosthesis ....................... 16.09 NA 6.65 1.79 NA 24.53 090 

44701 ......... ............ A Intraop colon lavage add-on ........................ 3.10 NA 1.05 0.28 NA 4.43 ZZZ 

44800 ......... ............ A Excision of bowel pouch .............................. 11.21 NA 5.39 1.40 NA 18.00 090 

44820 ......... ............ A Excision of mesentery lesion ....................... 12.07 NA 5.48 1.53 NA 19.08 090 

44850 ......... ............ A Repair of mesentery .................................... 10.72 NA 5.00 1.35 NA 17.07 090 

44900 ......... ............ A Drain app abscess, open ............................. 10.12 NA 4.70 1.29 NA 16.11 090 

44901 ......... ............ A Drain app abscess, percut ........................... 3.37 28.20 1.11 0.22 31.79 4.70 000 

44950 ......... ............ A Appendectomy ............................................. 9.99 NA 4.31 1.27 NA 15.57 090 

44955 ......... ............ A Appendectomy add-on ................................. 1.53 NA 0.54 0.19 NA 2.26 ZZZ 

44960 ......... ............ A Appendectomy ............................................. 12.32 NA 5.34 1.59 NA 19.25 090 

44970 ......... ............ A Laparoscopy, appendectomy ....................... 8.69 NA 4.21 1.12 NA 14.02 090 

45000 ......... ............ A Drainage of pelvic abscess ......................... 4.51 NA 2.96 0.50 NA 7.97 090 

45005 ......... ............ A Drainage of rectal abscess .......................... 1.99 4.08 1.59 0.24 6.31 3.82 010 

45020 ......... ............ A Drainage of rectal abscess .......................... 4.71 NA 3.28 0.53 NA 8.52 090 

45100 ......... ............ A Biopsy of rectum .......................................... 3.67 NA 2.37 0.41 NA 6.45 090 

45108 ......... ............ A Removal of anorectal lesion ........................ 4.75 NA 2.78 0.59 NA 8.12 090 

45110 ......... ............ A Removal of rectum ...................................... 27.96 NA 12.39 3.35 NA 43.70 090 

45111 ......... ............ A Partial removal of rectum ............................ 16.46 NA 7.17 2.00 NA 25.63 090 

45112 ......... ............ A Removal of rectum ...................................... 30.49 NA 11.75 3.51 NA 45.75 090 

45113 ......... ............ A Partial proctectomy ...................................... 30.53 NA 12.59 3.53 NA 46.65 090 

45114 ......... ............ A Partial removal of rectum ............................ 27.28 NA 10.85 3.32 NA 41.45 090 

45116 ......... ............ A Partial removal of rectum ............................ 24.54 NA 10.01 2.90 NA 37.45 090 

45119 ......... ............ A Remove rectum w/reservoir ......................... 30.79 NA 12.44 3.30 NA 46.53 090 

45120 ......... ............ A Removal of rectum ...................................... 24.56 NA 10.12 3.04 NA 37.72 090 

45121 ......... ............ A Removal of rectum and colon ..................... 27.00 NA 11.10 3.37 NA 41.47 090 

45123 ......... ............ A Partial proctectomy ...................................... 16.68 NA 6.85 1.85 NA 25.38 090 

45126 ......... ............ A Pelvic exenteration ...................................... 45.09 NA 19.20 4.86 NA 69.15 090 

45130 ......... ............ A Excision of rectal prolapse .......................... 16.42 NA 6.76 1.75 NA 24.93 090 

45135 ......... ............ A Excision of rectal prolapse .......................... 19.25 NA 8.42 2.33 NA 30.00 090 

45136 ......... ............ A Excise ileoanal reservior .............................. 27.26 NA 12.45 2.93 NA 42.64 090 

45150 ......... ............ A Excision of rectal stricture ........................... 5.66 NA 2.97 0.58 NA 9.21 090 

45160 ......... ............ A Excision of rectal lesion ............................... 15.30 NA 6.64 1.64 NA 23.58 090 

45170 ......... ............ A Excision of rectal lesion ............................... 11.47 NA 5.24 1.35 NA 18.06 090 

45190 ......... ............ A Destruction, rectal tumor ............................. 9.73 NA 4.66 1.13 NA 15.52 090 

45300 ......... ............ A Proctosigmoidoscopy dx .............................. 0.38 1.55 0.29 0.04 1.97 0.71 000 

45303 ......... ............ A Proctosigmoidoscopy dilate ......................... 0.44 18.84 0.33 0.04 19.32 0.81 000 

45305 ......... ............ A Proctosigmoidoscopy w/bx .......................... 1.01 2.65 0.50 0.11 3.77 1.62 000 

45307 ......... ............ A Proctosigmoidoscopy fb ............................... 0.94 3.07 0.48 0.10 4.11 1.52 000 

45308 ......... ............ A Proctosigmoidoscopy removal ..................... 0.83 2.00 0.44 0.09 2.92 1.36 000 

45309 ......... ............ A Proctosigmoidoscopy removal ..................... 2.01 2.83 0.84 0.22 5.06 3.07 000 

45315 ......... ............ A Proctosigmoidoscopy removal ..................... 1.40 2.89 0.64 0.16 4.45 2.20 000 

45317 ......... ............ A Proctosigmoidoscopy bleed ......................... 1.50 2.44 0.66 0.15 4.09 2.31 000 

45320 ......... ............ A Proctosigmoidoscopy ablate ........................ 1.58 2.93 0.71 0.15 4.66 2.44 000 

45321 ......... ............ A Proctosigmoidoscopy volvul ........................ 1.17 NA 0.56 0.13 NA 1.86 000 

45327 ......... ............ A Proctosigmoidoscopy w/stent ...................... 1.65 NA 0.69 0.16 NA 2.50 000 

45330 ......... ............ A Diagnostic sigmoidoscopy ........................... 0.96 2.30 0.50 0.08 3.34 1.54 000 

45331 ......... ............ A Sigmoidoscopy and biopsy .......................... 1.15 3.11 0.59 0.09 4.35 1.83 000 

45332 ......... ............ A Sigmoidoscopy w/fb removal ....................... 1.79 5.05 0.80 0.15 6.99 2.74 000 

45333 ......... ............ A Sigmoidoscopy & polypectomy .................... 1.79 4.91 0.80 0.15 6.85 2.74 000 

45334 ......... ............ A Sigmoidoscopy for bleeding ........................ 2.73 NA 1.14 0.21 NA 4.08 000 

45335 ......... ............ A Sigmoidoscopy w/submuc inj ...................... 1.46 3.22 0.69 0.04 4.72 2.19 000 

45337 ......... ............ A Sigmoidoscopy & decompress .................... 2.36 NA 1.00 0.22 NA 3.58 000 

45338 ......... ............ A Sigmoidoscopy w/tumr remove ................... 2.34 5.24 1.00 0.20 7.78 3.54 000 

45339 ......... ............ A Sigmoidoscopy w/ablate tumr ...................... 3.14 3.47 1.28 0.26 6.87 4.68 000 

45340 ......... ............ A Sig w/balloon dilation ................................... 1.89 6.18 0.83 0.04 8.11 2.76 000 

45341 ......... ............ A Sigmoidoscopy w/ultrasound ....................... 2.60 NA 1.07 0.20 NA 3.87 000 

47625

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

45342 ......... ............ A Sigmoidoscopy w/us guide bx ..................... 4.05 NA 1.55 0.30 NA 5.90 000 

45345 ......... ............ A Sigmoidoscopy w/stent ................................ 2.92 NA 1.16 0.24 NA 4.32 000 

45355 ......... ............ A Surgical colonoscopy ................................... 3.51 NA 1.38 0.35 NA 5.24 000 

45378 ......... ............ A Diagnostic colonoscopy ............................... 3.69 6.20 1.47 0.24 10.13 5.40 000 

45378 ......... 53 ....... A Diagnostic colonoscopy ............................... 0.96 2.30 0.50 0.08 3.34 1.54 000 

45379 ......... ............ A Colonoscopy w/fb removal .......................... 4.68 7.75 1.81 0.38 12.81 6.87 000 

45380 ......... ............ A Colonoscopy and biopsy ............................. 4.43 7.26 1.73 0.35 12.04 6.51 000 

45381 ......... ............ A Colonoscopy, submucous inj ....................... 4.19 7.17 1.65 0.31 11.67 6.15 000 

45382 ......... ............ A Colonoscopy/control bleeding ...................... 5.68 10.01 2.18 0.43 16.12 8.29 000 

45383 ......... ............ A Lesion removal colonoscopy ....................... 5.86 7.99 2.22 0.48 14.33 8.56 000 

45384 ......... ............ A Lesion remove colonoscopy ........................ 4.69 6.85 1.82 0.38 11.92 6.89 000 

45385 ......... ............ A Lesion removal colonoscopy ....................... 5.30 7.86 2.03 0.42 13.58 7.75 000 

45386 ......... ............ A Colonoscopy dilate stricture ........................ 4.57 12.46 1.77 0.31 17.34 6.65 000 

45387 ......... ............ A Colonoscopy w/stent .................................... 5.90 NA 2.33 0.49 NA 8.72 000 

45500 ......... ............ A Repair of rectum .......................................... 7.28 NA 3.58 0.73 NA 11.59 090 

45505 ......... ............ A Repair of rectum .......................................... 7.57 NA 3.86 0.83 NA 12.26 090 

45520 ......... ............ A Treatment of rectal prolapse ....................... 0.55 1.65 0.37 0.05 2.25 0.97 000 

45540 ......... ............ A Correct rectal prolapse ................................ 16.25 NA 6.82 1.84 NA 24.91 090 

45541 ......... ............ A Correct rectal prolapse ................................ 13.38 NA 5.96 1.53 NA 20.87 090 

45550 ......... ............ A Repair rectum/remove sigmoid .................... 22.97 NA 9.23 2.61 NA 34.81 090 

45560 ......... ............ A Repair of rectocele ...................................... 10.56 NA 5.09 1.14 NA 16.79 090 

45562 ......... ............ A Exploration/repair of rectum ........................ 15.36 NA 7.00 1.81 NA 24.17 090 

45563 ......... ............ A Exploration/repair of rectum ........................ 23.43 NA 10.52 2.95 NA 36.90 090 

45800 ......... ............ A Repair rect/bladder fistula ............................ 17.74 NA 7.45 1.89 NA 27.08 090 

45805 ......... ............ A Repair fistula w/colostomy ........................... 20.75 NA 9.52 2.32 NA 32.59 090 

45820 ......... ............ A Repair rectourethral fistula .......................... 18.45 NA 7.64 1.66 NA 27.75 090 

45825 ......... ............ A Repair fistula w/colostomy ........................... 21.22 NA 9.83 2.15 NA 33.20 090 

45900 ......... ............ A Reduction of rectal prolapse ........................ 2.61 NA 1.51 0.29 NA 4.41 010 

45905 ......... ............ A Dilation of anal sphincter ............................. 2.30 NA 1.43 0.27 NA 4.00 010 

45910 ......... ............ A Dilation of rectal narrowing .......................... 2.80 NA 1.67 0.28 NA 4.75 010 

45915 ......... ............ A Remove rectal obstruction ........................... 3.14 4.36 2.10 0.30 7.80 5.54 010 

46020 ......... ............ A Placement of seton ...................................... 2.90 2.35 1.86 0.35 5.60 5.11 010 

46030 ......... ............ A Removal of rectal marker ............................ 1.23 1.35 0.71 0.14 2.72 2.08 010 

46040 ......... ............ A Incision of rectal abscess ............................ 4.95 5.52 3.61 0.60 11.07 9.16 090 

46045 ......... ............ A Incision of rectal abscess ............................ 4.31 NA 2.91 0.53 NA 7.75 090 

46050 ......... ............ A Incision of anal abscess .............................. 1.19 2.56 0.85 0.14 3.89 2.18 010 

46060 ......... ............ A Incision of rectal abscess ............................ 5.68 NA 3.28 0.67 NA 9.63 090 

46070 ......... ............ A Incision of anal septum ................................ 2.71 NA 1.86 0.20 NA 4.77 090 

46080 ......... ............ A Incision of anal sphincter ............................. 2.49 2.38 1.13 0.30 5.17 3.92 010 

46083 ......... ............ A Incise external hemorrhoid .......................... 1.40 2.55 0.94 0.15 4.10 2.49 010 

46200 ......... ............ A Removal of anal fissure ............................... 3.41 3.87 2.88 0.39 7.67 6.68 090 

46210 ......... ............ A Removal of anal crypt .................................. 2.67 5.16 2.64 0.31 8.14 5.62 090 

46211 ......... ............ A Removal of anal crypts ................................ 4.24 5.44 3.52 0.52 10.20 8.28 090 

46220 ......... ............ A Removal of anal tag .................................... 1.56 2.22 0.93 0.18 3.96 2.67 010 

46221 ......... ............ A Ligation of hemorrhoid(s) ............................. 2.04 2.65 1.75 0.22 4.91 4.01 010 

46230 ......... ............ A Removal of anal tags ................................... 2.57 3.00 1.27 0.29 5.86 4.13 010 

46250 ......... ............ A Hemorrhoidectomy ....................................... 3.88 5.34 2.62 0.46 9.68 6.96 090 

46255 ......... ............ A Hemorrhoidectomy ....................................... 4.59 5.87 2.84 0.57 11.03 8.00 090 

46257 ......... ............ A Remove hemorrhoids & fissure ................... 5.39 NA 2.89 0.64 NA 8.92 090 

46258 ......... ............ A Remove hemorrhoids & fistula .................... 5.72 NA 3.29 0.68 NA 9.69 090 

46260 ......... ............ A Hemorrhoidectomy ....................................... 6.36 NA 3.23 0.75 NA 10.34 090 

46261 ......... ............ A Remove hemorrhoids & fissure ................... 7.07 NA 3.64 0.81 NA 11.52 090 

46262 ......... ............ A Remove hemorrhoids & fistula .................... 7.49 NA 3.77 0.85 NA 12.11 090 

46270 ......... ............ A Removal of anal fistula ................................ 3.71 5.02 2.85 0.46 9.19 7.02 090 

46275 ......... ............ A Removal of anal fistula ................................ 4.55 4.65 2.98 0.51 9.71 8.04 090 

46280 ......... ............ A Removal of anal fistula ................................ 5.97 NA 3.29 0.66 NA 9.92 090 

46285 ......... ............ A Removal of anal fistula ................................ 4.08 3.76 2.75 0.45 8.29 7.28 090 

46288 ......... ............ A Repair anal fistula ........................................ 7.12 NA 3.71 0.79 NA 11.62 090 

46320 ......... ............ A Removal of hemorrhoid clot ........................ 1.61 2.14 0.86 0.17 3.92 2.64 010 

46500 ......... ............ A Injection into hemorrhoid(s) ......................... 1.61 2.12 1.16 0.16 3.89 2.93 010 

46600 ......... ............ A Diagnostic anoscopy .................................... 0.50 1.57 0.35 0.05 2.12 0.90 000 

46604 ......... ............ A Anoscopy and dilation ................................. 1.31 9.16 0.62 0.13 10.60 2.06 000 

46606 ......... ............ A Anoscopy and biopsy .................................. 0.81 3.81 0.43 0.09 4.71 1.33 000 

46608 ......... ............ A Anoscopy, remove for body ......................... 1.51 4.44 0.65 0.16 6.11 2.32 000 

46610 ......... ............ A Anoscopy, remove lesion ............................ 1.32 4.05 0.61 0.15 5.52 2.08 000 

46611 ......... ............ A Anoscopy ..................................................... 1.81 3.36 0.78 0.19 5.36 2.78 000 

46612 ......... ............ A Anoscopy, remove lesions ........................... 2.34 5.21 0.98 0.28 7.83 3.60 000 

46614 ......... ............ A Anoscopy, control bleeding ......................... 2.01 2.33 0.84 0.20 4.54 3.05 000 

46615 ......... ............ A Anoscopy ..................................................... 2.68 2.50 1.07 0.32 5.50 4.07 000 

46700 ......... ............ A Repair of anal stricture ................................ 9.12 NA 4.23 0.93 NA 14.28 090 

46705 ......... ............ A Repair of anal stricture ................................ 6.89 NA 3.72 0.91 NA 11.52 090 

46706 ......... ............ A Repr of anal fistula w/glue ........................... 2.39 NA 1.25 0.51 NA 4.15 010 

46715 ......... ............ A Repair of anovaginal fistula ......................... 7.19 NA 3.61 0.92 NA 11.72 090 

46716 ......... ............ A Repair of anovaginal fistula ......................... 15.05 NA 7.95 1.57 NA 24.57 090 

46730 ......... ............ A Construction of absent anus ........................ 26.71 NA 11.99 1.71 NA 40.41 090 

47626

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

46735 ......... ............ A Construction of absent anus ........................ 32.12 NA 13.51 3.18 NA 48.81 090 

46740 ......... ............ A Construction of absent anus ........................ 29.96 NA 13.16 2.89 NA 46.01 090 

46742 ......... ............ A Repair of imperforated anus ........................ 35.75 NA 17.47 4.73 NA 57.95 090 

46744 ......... ............ A Repair of cloacal anomaly ........................... 52.55 NA 21.07 3.83 NA 77.45 090 

46746 ......... ............ A Repair of cloacal anomaly ........................... 58.13 NA 25.05 3.03 NA 86.21 090 

46748 ......... ............ A Repair of cloacal anomaly ........................... 64.11 NA 23.66 3.34 NA 91.11 090 

46750 ......... ............ A Repair of anal sphincter .............................. 10.23 NA 5.08 1.13 NA 16.44 090 

46751 ......... ............ A Repair of anal sphincter .............................. 8.76 NA 5.50 0.94 NA 15.20 090 

46753 ......... ............ A Reconstruction of anus ................................ 8.28 NA 3.86 0.97 NA 13.11 090 

46754 ......... ............ A Removal of suture from anus ...................... 2.20 3.66 1.68 0.19 6.05 4.07 010 

46760 ......... ............ A Repair of anal sphincter .............................. 14.41 NA 7.09 1.57 NA 23.07 090 

46761 ......... ............ A Repair of anal sphincter .............................. 13.82 NA 6.04 1.48 NA 21.34 090 

46762 ......... ............ A Implant artificial sphincter ............................ 12.69 NA 5.53 1.24 NA 19.46 090 

46900 ......... ............ A Destruction, anal lesion(s) ........................... 1.91 2.59 1.28 0.18 4.68 3.37 010 

46910 ......... ............ A Destruction, anal lesion(s) ........................... 1.86 2.92 1.06 0.19 4.97 3.11 010 

46916 ......... ............ A Cryosurgery, anal lesion(s) .......................... 1.86 3.17 1.40 0.16 5.19 3.42 010 

46917 ......... ............ A Laser surgery, anal lesions ......................... 1.86 9.19 1.12 0.21 11.26 3.19 010 

46922 ......... ............ A Excision of anal lesion(s) ............................. 1.86 3.29 1.08 0.21 5.36 3.15 010 

46924 ......... ............ A Destruction, anal lesion(s) ........................... 2.76 8.72 1.36 0.27 11.75 4.39 010 

46934 ......... ............ A Destruction of hemorrhoids ......................... 3.50 5.10 2.97 0.31 8.91 6.78 090 

46935 ......... ............ A Destruction of hemorrhoids ......................... 2.43 3.49 1.21 0.22 6.14 3.86 010 

46936 ......... ............ A Destruction of hemorrhoids ......................... 3.68 4.89 2.50 0.36 8.93 6.54 090 

46937 ......... ............ A Cryotherapy of rectal lesion ......................... 2.69 2.77 1.23 0.28 5.74 4.20 010 

46938 ......... ............ A Cryotherapy of rectal lesion ......................... 4.65 4.00 3.06 0.58 9.23 8.29 090 

46940 ......... ............ A Treatment of anal fissure ............................. 2.32 1.99 1.09 0.22 4.53 3.63 010 

46942 ......... ............ A Treatment of anal fissure ............................. 2.04 1.83 1.02 0.19 4.06 3.25 010 

46945 ......... ............ A Ligation of hemorrhoids ............................... 1.84 3.36 2.49 0.19 5.39 4.52 090 

46946 ......... ............ A Ligation of hemorrhoids ............................... 2.58 3.79 2.40 0.26 6.63 5.24 090 

47000 ......... ............ A Needle biopsy of liver .................................. 1.90 3.07 0.63 0.12 5.09 2.65 000 

47001 ......... ............ A Needle biopsy, liver add-on ......................... 1.90 NA 0.65 0.24 NA 2.79 ZZZ 

47010 ......... ............ A Open drainage, liver lesion .......................... 15.99 NA 8.40 1.74 NA 26.13 090 

47011 ......... ............ A Percut drain, liver lesion .............................. 3.69 NA 1.20 0.23 NA 5.12 000 

47015 ......... ............ A Inject/aspirate liver cyst ............................... 15.09 NA 7.49 1.78 NA 24.36 090 

47100 ......... ............ A Wedge biopsy of liver .................................. 11.65 NA 6.04 1.48 NA 19.17 090 

47120 ......... ............ A Partial removal of liver ................................. 35.45 NA 15.15 4.53 NA 55.13 090 

47122 ......... ............ A Extensive removal of liver ........................... 55.05 NA 21.45 6.99 NA 83.49 090 

47125 ......... ............ A Partial removal of liver ................................. 49.12 NA 19.51 6.23 NA 74.86 090 

47130 ......... ............ A Partial removal of liver ................................. 53.27 NA 20.97 6.80 NA 81.04 090 

47135 ......... ............ R Transplantation of liver ................................ 81.40 NA 31.49 9.89 NA 122.78 090 

47136 ......... ............ R Transplantation of liver ................................ 68.50 NA 26.99 8.36 NA 103.85 090 

47140 ......... ............ A Partial removal, donor liver .......................... 54.92 NA 22.25 4.87 NA 82.04 090 

47141 ......... ............ A Partial removal, donor liver .......................... 67.40 NA 26.87 4.87 NA 99.14 090 

47142 ......... ............ A Partial removal, donor liver .......................... 74.89 NA 29.43 4.87 NA 109.19 090 

47300 ......... ............ A Surgery for liver lesion ................................. 15.06 NA 7.23 1.91 NA 24.20 090 

47350 ......... ............ A Repair liver wound ....................................... 19.53 NA 8.86 2.48 NA 30.87 090 

47360 ......... ............ A Repair liver wound ....................................... 26.88 NA 11.59 3.35 NA 41.82 090 

47361 ......... ............ A Repair liver wound ....................................... 47.05 NA 18.51 5.77 NA 71.33 090 

47362 ......... ............ A Repair liver wound ....................................... 18.48 NA 8.73 2.31 NA 29.52 090 

47370 ......... ............ A Laparo ablate liver tumor rf ......................... 19.66 NA 8.13 2.27 NA 30.06 090 

47371 ......... ............ A Laparo ablate liver cryosurg ........................ 19.66 NA 8.14 2.11 NA 29.91 090 

47380 ......... ............ A Open ablate liver tumor rf ............................ 22.97 NA 9.34 2.69 NA 35.00 090 

47381 ......... ............ A Open ablate liver tumor cryo ....................... 23.24 NA 9.58 2.39 NA 35.21 090 

47382 ......... ............ A Percut ablate liver rf .................................... 15.17 NA 6.06 0.80 NA 22.03 010 

47400 ......... ............ A Incision of liver duct ..................................... 32.44 NA 13.43 3.46 NA 49.33 090 

47420 ......... ............ A Incision of bile duct ...................................... 19.85 NA 8.75 2.54 NA 31.14 090 

47425 ......... ............ A Incision of bile duct ...................................... 19.80 NA 8.81 2.46 NA 31.07 090 

47460 ......... ............ A Incise bile duct sphincter ............................. 18.01 NA 8.38 2.00 NA 28.39 090 

47480 ......... ............ A Incision of gallbladder .................................. 10.80 NA 5.92 1.38 NA 18.10 090 

47490 ......... ............ A Incision of gallbladder .................................. 7.22 NA 5.58 0.44 NA 13.24 090 

47500 ......... ............ A Injection for liver x-rays ............................... 1.96 NA 0.64 0.12 NA 2.72 000 

47505 ......... ............ A Injection for liver x-rays ............................... 0.76 NA 0.25 0.05 NA 1.06 000 

47510 ......... ............ A Insert catheter, bile duct .............................. 7.82 NA 5.00 0.50 NA 13.32 090 

47511 ......... ............ A Insert bile duct drain .................................... 10.48 NA 5.07 0.64 NA 16.19 090 

47525 ......... ............ A Change bile duct catheter ........................... 5.54 12.22 2.80 0.33 18.09 8.67 010 

47530 ......... ............ A Revise/reinsert bile tube .............................. 5.84 25.23 3.70 0.38 31.45 9.92 090 

47550 ......... ............ A Bile duct endoscopy add-on ........................ 3.02 NA 1.02 0.39 NA 4.43 ZZZ 

47552 ......... ............ A Biliary endoscopy thru skin .......................... 6.03 NA 2.40 0.44 NA 8.87 000 

47553 ......... ............ A Biliary endoscopy thru skin .......................... 6.34 NA 2.06 0.41 NA 8.81 000 

47554 ......... ............ A Biliary endoscopy thru skin .......................... 9.05 NA 3.38 0.96 NA 13.39 000 

47555 ......... ............ A Biliary endoscopy thru skin .......................... 7.55 NA 2.45 0.46 NA 10.46 000 

47556 ......... ............ A Biliary endoscopy thru skin .......................... 8.55 NA 2.77 0.51 NA 11.83 000 

47560 ......... ............ A Laparoscopy w/cholangio ............................ 4.88 NA 1.66 0.59 NA 7.13 000 

47561 ......... ............ A Laparo w/cholangio/biopsy .......................... 5.17 NA 1.91 0.65 NA 7.73 000 

47562 ......... ............ A Laparoscopic cholecystectomy .................... 11.07 NA 4.98 1.42 NA 17.47 090 

47563 ......... ............ A Laparo cholecystectomy/graph .................... 11.92 NA 5.29 1.52 NA 18.73 090 

47627

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

47564 ......... ............ A Laparo cholecystectomy/explr ..................... 14.21 NA 5.94 1.82 NA 21.97 090 

47570 ......... ............ A Laparo cholecystoenterostomy .................... 12.56 NA 5.36 1.60 NA 19.52 090 

47600 ......... ............ A Removal of gallbladder ................................ 13.56 NA 6.15 1.73 NA 21.44 090 

47605 ......... ............ A Removal of gallbladder ................................ 14.67 NA 6.50 1.88 NA 23.05 090 

47610 ......... ............ A Removal of gallbladder ................................ 18.79 NA 7.94 2.41 NA 29.14 090 

47612 ......... ............ A Removal of gallbladder ................................ 18.75 NA 7.88 2.40 NA 29.03 090 

47620 ......... ............ A Removal of gallbladder ................................ 20.61 NA 8.52 2.68 NA 31.81 090 

47630 ......... ............ A Remove bile duct stone ............................... 9.10 NA 4.86 0.69 NA 14.65 090 

47700 ......... ............ A Exploration of bile ducts .............................. 15.60 NA 7.43 1.89 NA 24.92 090 

47701 ......... ............ A Bile duct revision ......................................... 27.77 NA 11.49 3.55 NA 42.81 090 

47711 ......... ............ A Excision of bile duct tumor .......................... 23.00 NA 9.92 2.93 NA 35.85 090 

47712 ......... ............ A Excision of bile duct tumor .......................... 30.19 NA 12.41 3.93 NA 46.53 090 

47715 ......... ............ A Excision of bile duct cyst ............................. 18.77 NA 8.42 2.38 NA 29.57 090 

47716 ......... ............ A Fusion of bile duct cyst ................................ 16.42 NA 7.83 2.08 NA 26.33 090 

47720 ......... ............ A Fuse gallbladder & bowel ............................ 15.89 NA 7.48 2.03 NA 25.40 090 

47721 ......... ............ A Fuse upper gi structures .............................. 19.09 NA 8.57 2.46 NA 30.12 090 

47740 ......... ............ A Fuse gallbladder & bowel ............................ 18.45 NA 8.38 2.43 NA 29.26 090 

47741 ......... ............ A Fuse gallbladder & bowel ............................ 21.31 NA 9.28 2.63 NA 33.22 090 

47760 ......... ............ A Fuse bile ducts and bowel ........................... 25.81 NA 10.84 3.32 NA 39.97 090 

47765 ......... ............ A Fuse liver ducts & bowel ............................. 24.84 NA 10.80 3.21 NA 38.85 090 

47780 ......... ............ A Fuse bile ducts and bowel ........................... 26.46 NA 11.20 3.43 NA 41.09 090 

47785 ......... ............ A Fuse bile ducts and bowel ........................... 31.13 NA 12.91 4.04 NA 48.08 090 

47800 ......... ............ A Reconstruction of bile ducts ........................ 23.27 NA 10.06 2.94 NA 36.27 090 

47801 ......... ............ A Placement, bile duct support ....................... 15.15 NA 8.15 1.24 NA 24.54 090 

47802 ......... ............ A Fuse liver duct & intestine ........................... 21.52 NA 9.68 2.73 NA 33.93 090 

47900 ......... ............ A Suture bile duct injury .................................. 19.87 NA 8.87 2.57 NA 31.31 090 

48000 ......... ............ A Drainage of abdomen .................................. 28.03 NA 11.49 3.40 NA 42.92 090 

48001 ......... ............ A Placement of drain, pancreas ...................... 35.40 NA 13.87 4.47 NA 53.74 090 

48005 ......... ............ A Resect/debride pancreas ............................. 42.11 NA 16.53 5.41 NA 64.05 090 

48020 ......... ............ A Removal of pancreatic stone ....................... 15.68 NA 7.29 2.12 NA 25.09 090 

48100 ......... ............ A Biopsy of pancreas, open ............................ 12.21 NA 5.61 1.54 NA 19.36 090 

48102 ......... ............ A Needle biopsy, pancreas ............................. 4.67 7.95 1.94 0.29 12.91 6.90 010 

48120 ......... ............ A Removal of pancreas lesion ........................ 15.83 NA 6.86 1.98 NA 24.67 090 

48140 ......... ............ A Partial removal of pancreas ......................... 22.91 NA 9.53 2.91 NA 35.35 090 

48145 ......... ............ A Partial removal of pancreas ......................... 23.98 NA 9.84 3.09 NA 36.91 090 

48146 ......... ............ A Pancreatectomy ........................................... 26.36 NA 11.98 3.40 NA 41.74 090 

48148 ......... ............ A Removal of pancreatic duct ......................... 17.31 NA 7.62 2.20 NA 27.13 090 

48150 ......... ............ A Partial removal of pancreas ......................... 47.93 NA 19.49 6.18 NA 73.60 090 

48152 ......... ............ A Pancreatectomy ........................................... 43.68 NA 18.20 5.68 NA 67.56 090 

48153 ......... ............ A Pancreatectomy ........................................... 47.82 NA 19.54 6.19 NA 73.55 090 

48154 ......... ............ A Pancreatectomy ........................................... 44.03 NA 18.23 5.74 NA 68.00 090 

48155 ......... ............ A Removal of pancreas ................................... 24.60 NA 11.69 3.14 NA 39.43 090 

48180 ......... ............ A Fuse pancreas and bowel ........................... 24.68 NA 10.16 3.22 NA 38.06 090 

48400 ......... ............ A Injection, intraop add-on .............................. 1.95 NA 0.64 0.16 NA 2.75 ZZZ 

48500 ......... ............ A Surgery of pancreatic cyst ........................... 15.26 NA 7.34 2.04 NA 24.64 090 

48510 ......... ............ A Drain pancreatic pseudocyst ....................... 14.29 NA 7.43 1.80 NA 23.52 090 

48511 ......... ............ A Drain pancreatic pseudocyst ....................... 3.99 21.20 1.30 0.25 25.44 5.54 000 

48520 ......... ............ A Fuse pancreas cyst and bowel .................... 15.57 NA 6.70 1.99 NA 24.26 090 

48540 ......... ............ A Fuse pancreas cyst and bowel .................... 19.69 NA 8.11 2.50 NA 30.30 090 

48545 ......... ............ A Pancreatorrhaphy ........................................ 18.15 NA 7.99 2.30 NA 28.44 090 

48547 ......... ............ A Duodenal exclusion ..................................... 25.79 NA 10.48 3.28 NA 39.55 090 

48554 ......... ............ R Transpl allograft pancreas ........................... 34.12 NA 18.29 4.19 NA 56.60 090 

48556 ......... ............ A Removal, allograft pancreas ........................ 15.69 NA 8.07 1.96 NA 25.72 090 

49000 ......... ............ A Exploration of abdomen ............................... 11.66 NA 5.38 1.44 NA 18.48 090 

49002 ......... ............ A Reopening of abdomen ............................... 10.47 NA 5.04 1.33 NA 16.84 090 

49010 ......... ............ A Exploration behind abdomen ....................... 12.26 NA 5.91 1.49 NA 19.66 090 

49020 ......... ............ A Drain abdominal abscess ............................ 22.81 NA 10.19 2.71 NA 35.71 090 

49021 ......... ............ A Drain abdominal abscess ............................ 3.37 21.58 1.11 0.21 25.16 4.69 000 

49040 ......... ............ A Drain, open, abdom abscess ....................... 13.50 NA 6.44 1.65 NA 21.59 090 

49041 ......... ............ A Drain, percut, abdom abscess ..................... 3.99 19.76 1.31 0.25 24.00 5.55 000 

49060 ......... ............ A Drain, open, retrop abscess ........................ 15.84 NA 7.44 1.64 NA 24.92 090 

49061 ......... ............ A Drain, percut, retroper absc ......................... 3.69 19.95 1.21 0.22 23.86 5.12 000 

49062 ......... ............ A Drain to peritoneal cavity ............................. 11.34 NA 5.46 1.40 NA 18.20 090 

49080 ......... ............ A Puncture, peritoneal cavity .......................... 1.35 4.15 0.45 0.09 5.59 1.89 000 

49081 ......... ............ A Removal of abdominal fluid ......................... 1.26 2.66 0.43 0.09 4.01 1.78 000 

49085 ......... ............ A Remove abdomen foreign body .................. 12.12 NA 5.51 1.43 NA 19.06 090 

49180 ......... ............ A Biopsy, abdominal mass .............................. 1.73 3.14 0.56 0.11 4.98 2.40 000 

49200 ......... ............ A Removal of abdominal lesion ...................... 10.23 NA 5.05 1.14 NA 16.42 090 

49201 ......... ............ A Remove abdom lesion, complex ................. 14.82 NA 7.06 1.77 NA 23.65 090 

49215 ......... ............ A Excise sacral spine tumor ........................... 33.45 NA 14.04 4.29 NA 51.78 090 

49220 ......... ............ A Multiple surgery, abdomen .......................... 14.86 NA 6.65 1.83 NA 23.34 090 

49250 ......... ............ A Excision of umbilicus ................................... 8.34 NA 4.30 1.05 NA 13.69 090 

49255 ......... ............ A Removal of omentum .................................. 11.12 NA 5.63 1.39 NA 18.14 090 

49320 ......... ............ A Diag laparo separate proc ........................... 5.09 NA 2.63 0.63 NA 8.35 010 

49321 ......... ............ A Laparoscopy, biopsy .................................... 5.39 NA 2.64 0.68 NA 8.71 010 

47628

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

49322 ......... ............ A Laparoscopy, aspiration ............................... 5.69 NA 2.99 0.70 NA 9.38 010 

49323 ......... ............ A Laparo drain lymphocele ............................. 9.47 NA 4.49 1.12 NA 15.08 090 

49400 ......... ............ A Air injection into abdomen ........................... 1.88 3.16 0.62 0.16 5.20 2.66 000 

49419 ......... ............ A Insrt abdom cath for chemotx ...................... 6.64 NA 3.55 0.70 NA 10.89 090 

49420 ......... ............ A Insert abdom drain, temp ............................ 2.22 NA 1.09 0.21 NA 3.52 000 

49421 ......... ............ A Insert abdom drain, perm ............................ 5.53 NA 3.17 0.70 NA 9.40 090 

49422 ......... ............ A Remove perm cannula/catheter .................. 6.24 NA 2.89 0.80 NA 9.93 010 

49423 ......... ............ A Exchange drainage catheter ........................ 1.46 14.40 0.52 0.09 15.95 2.07 000 

49424 ......... ............ A Assess cyst, contrast inject ......................... 0.76 3.92 0.29 0.05 4.73 1.10 000 

49425 ......... ............ A Insert abdomen-venous drain ...................... 11.35 NA 5.62 1.52 NA 18.49 090 

49426 ......... ............ A Revise abdomen-venous shunt ................... 9.62 NA 4.78 1.23 NA 15.63 090 

49427 ......... ............ A Injection, abdominal shunt ........................... 0.89 NA 0.30 0.06 NA 1.25 000 

49428 ......... ............ A Ligation of shunt .......................................... 6.05 NA 3.92 0.84 NA 10.81 010 

49429 ......... ............ A Removal of shunt ......................................... 7.39 NA 3.42 0.99 NA 11.80 010 

49491 ......... ............ A Rpr hern preemie reduc .............................. 11.11 NA 5.04 1.47 NA 17.62 090 

49492 ......... ............ A Rpr ing hern premie, blocked ...................... 14.01 NA 6.10 1.64 NA 21.75 090 

49495 ......... ............ A Rpr ing hernia baby, reduc .......................... 5.88 NA 2.97 0.78 NA 9.63 090 

49496 ......... ............ A Rpr ing hernia baby, blocked ...................... 8.78 NA 4.33 1.10 NA 14.21 090 

49500 ......... ............ A Rpr ing hernia, init, reduce .......................... 5.47 NA 3.13 0.62 NA 9.22 090 

49501 ......... ............ A Rpr ing hernia, init blocked .......................... 8.87 NA 4.21 1.13 NA 14.21 090 

49505 ......... ............ A Prp i/hern init reduc>5 yr ............................. 7.59 NA 3.75 0.99 NA 12.33 090 

49507 ......... ............ A Prp i/hern init block>5 yr ............................. 9.56 NA 4.50 1.24 NA 15.30 090 

49520 ......... ............ A Rerepair ing hernia, reduce ......................... 9.62 NA 4.46 1.24 NA 15.32 090 

49521 ......... ............ A Rerepair ing hernia, blocked ....................... 11.95 NA 5.25 1.56 NA 18.76 090 

49525 ......... ............ A Repair ing hernia, sliding ............................. 8.56 NA 4.10 1.09 NA 13.75 090 

49540 ......... ............ A Repair lumbar hernia ................................... 10.37 NA 4.77 1.34 NA 16.48 090 

49550 ......... ............ A Rpr rem hernia, init, reduce ......................... 8.62 NA 4.14 1.12 NA 13.88 090 

49553 ......... ............ A Rpr fem hernia, init blocked ........................ 9.43 NA 4.43 1.22 NA 15.08 090 

49555 ......... ............ A Rerepair fem hernia, reduce ........................ 9.02 NA 4.29 1.17 NA 14.48 090 

49557 ......... ............ A Rerepair fem hernia, blocked ...................... 11.13 NA 5.00 1.44 NA 17.57 090 

49560 ......... ............ A Rpr ventral hern init, reduc .......................... 11.55 NA 5.17 1.48 NA 18.20 090 

49561 ......... ............ A Rpr ventral hern init, block .......................... 14.23 NA 6.07 1.83 NA 22.13 090 

49565 ......... ............ A Rerepair ventrl hern, reduce ........................ 11.55 NA 5.24 1.48 NA 18.27 090 

49566 ......... ............ A Rerepair ventrl hern, block .......................... 14.38 NA 6.14 1.85 NA 22.37 090 

49568 ......... ............ A Hernia repair w/mesh .................................. 4.88 NA 1.67 0.63 NA 7.18 ZZZ 

49570 ......... ............ A Rpr epigastric hern, reduce ......................... 5.68 NA 3.18 0.73 NA 9.59 090 

49572 ......... ............ A Rpr epigastric hern, blocked ........................ 6.72 NA 3.48 0.86 NA 11.06 090 

49580 ......... ............ A Rpr umbil hern, reduc < 5 yr ....................... 4.10 NA 2.62 0.52 NA 7.24 090 

49582 ......... ............ A Rpr umbil hern, block < 5 yr ........................ 6.64 NA 3.51 0.86 NA 11.01 090 

49585 ......... ............ A Rpr umbil hern, reduc > 5 yr ....................... 6.22 NA 3.32 0.79 NA 10.33 090 

49587 ......... ............ A Rpr umbil hern, block > 5 yr ........................ 7.55 NA 3.75 0.97 NA 12.27 090 

49590 ......... ............ A Repair spigilian hernia ................................. 8.53 NA 4.11 1.09 NA 13.73 090 

49600 ......... ............ A Repair umbilical lesion ................................. 10.94 NA 5.35 1.31 NA 17.60 090 

49605 ......... ............ A Repair umbilical lesion ................................. 75.89 NA 28.48 9.95 NA 114.32 090 

49606 ......... ............ A Repair umbilical lesion ................................. 18.57 NA 7.72 2.43 NA 28.72 090 

49610 ......... ............ A Repair umbilical lesion ................................. 10.48 NA 5.24 0.57 NA 16.29 090 

49611 ......... ............ A Repair umbilical lesion ................................. 8.91 NA 7.31 0.78 NA 17.00 090 

49650 ......... ............ A Laparo hernia repair initial ........................... 6.26 NA 3.20 0.90 NA 10.36 090 

49651 ......... ............ A Laparo hernia repair recur ........................... 8.23 NA 4.06 1.10 NA 13.39 090 

49900 ......... ............ A Repair of abdominal wall ............................. 12.26 NA 6.23 1.55 NA 20.04 090 

49904 ......... ............ A Omental flap, extra-abdom .......................... 19.97 NA 15.17 2.52 NA 37.66 090 

49905 ......... ............ A Omental flap, intra-abdom ........................... 6.54 NA 2.29 0.79 NA 9.62 ZZZ 

50010 ......... ............ A Exploration of kidney ................................... 10.96 NA 5.21 0.93 NA 17.10 090 

50020 ......... ............ A Renal abscess, open drain .......................... 14.64 NA 7.73 1.27 NA 23.64 090 

50021 ......... ............ A Renal abscess, percut drain ........................ 3.37 21.89 1.10 0.20 25.46 4.67 000 

50040 ......... ............ A Drainage of kidney ....................................... 14.92 NA 6.80 1.03 NA 22.75 090 

50045 ......... ............ A Exploration of kidney ................................... 15.44 NA 6.59 1.24 NA 23.27 090 

50060 ......... ............ A Removal of kidney stone ............................. 19.27 NA 7.81 1.46 NA 28.54 090 

50065 ......... ............ A Incision of kidney ......................................... 20.76 NA 6.09 1.48 NA 28.33 090 

50070 ......... ............ A Incision of kidney ......................................... 20.29 NA 8.20 1.48 NA 29.97 090 

50075 ......... ............ A Removal of kidney stone ............................. 25.30 NA 9.88 1.93 NA 37.11 090 

50080 ......... ............ A Removal of kidney stone ............................. 14.69 NA 6.27 1.04 NA 22.00 090 

50081 ......... ............ A Removal of kidney stone ............................. 21.77 NA 8.74 1.57 NA 32.08 090 

50100 ......... ............ A Revise kidney blood vessels ....................... 16.07 NA 7.77 1.78 NA 25.62 090 

50120 ......... ............ A Exploration of kidney ................................... 15.89 NA 6.75 1.19 NA 23.83 090 

50125 ......... ............ A Explore and drain kidney ............................. 16.50 NA 6.96 1.34 NA 24.80 090 

50130 ......... ............ A Removal of kidney stone ............................. 17.26 NA 7.16 1.30 NA 25.72 090 

50135 ......... ............ A Exploration of kidney ................................... 19.15 NA 7.76 1.43 NA 28.34 090 

50200 ......... ............ A Biopsy of kidney .......................................... 2.63 NA 1.29 0.16 NA 4.08 000 

50205 ......... ............ A Biopsy of kidney .......................................... 11.29 NA 5.01 1.28 NA 17.58 090 

50220 ......... ............ A Remove kidney, open .................................. 17.12 NA 7.22 1.44 NA 25.78 090 

50225 ......... ............ A Removal kidney open, complex .................. 20.20 NA 8.13 1.58 NA 29.91 090 

50230 ......... ............ A Removal kidney open, radical ..................... 22.04 NA 8.56 1.70 NA 32.30 090 

50234 ......... ............ A Removal of kidney & ureter ......................... 22.37 NA 8.81 1.67 NA 32.85 090 

50236 ......... ............ A Removal of kidney & ureter ......................... 24.82 NA 10.23 1.88 NA 36.93 090 

47629

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

50240 ......... ............ A Partial removal of kidney ............................. 21.97 NA 8.99 1.66 NA 32.62 090 

50280 ......... ............ A Removal of kidney lesion ............................ 15.65 NA 6.67 1.29 NA 23.61 090 

50290 ......... ............ A Removal of kidney lesion ............................ 14.71 NA 6.45 1.22 NA 22.38 090 

50320 ......... ............ A Removal of donor kidney ............................. 22.18 NA 10.66 2.33 NA 35.17 090 

50340 ......... ............ A Removal of kidney ....................................... 12.13 NA 6.49 1.66 NA 20.28 090 

50360 ......... ............ A Transplantation of kidney ............................ 31.48 NA 15.48 3.73 NA 50.69 090 

50365 ......... ............ A Transplantation of kidney ............................ 36.75 NA 18.26 4.25 NA 59.26 090 

50370 ......... ............ A Remove transplanted kidney ....................... 13.70 NA 7.15 1.55 NA 22.40 090 

50380 ......... ............ A Reimplantation of kidney ............................. 20.73 NA 12.06 2.53 NA 35.32 090 

50390 ......... ............ A Drainage of kidney lesion ............................ 1.96 NA 0.64 0.12 NA 2.72 000 

50392 ......... ............ A Insert kidney drain ....................................... 3.37 NA 1.52 0.21 NA 5.10 000 

50393 ......... ............ A Insert ureteral tube ...................................... 4.15 NA 1.77 0.26 NA 6.18 000 

50394 ......... ............ A Injection for kidney x-ray ............................. 0.76 3.04 0.66 0.05 3.85 1.47 000 

50395 ......... ............ A Create passage to kidney ............................ 3.37 NA 1.50 0.21 NA 5.08 000 

50396 ......... ............ A Measure kidney pressure ............................ 2.09 NA 1.08 0.13 NA 3.30 000 

50398 ......... ............ A Change kidney tube ..................................... 1.46 16.30 0.52 0.09 17.85 2.07 000 

50400 ......... ............ A Revision of kidney/ureter ............................. 19.47 NA 7.86 1.49 NA 28.82 090 

50405 ......... ............ A Revision of kidney/ureter ............................. 23.89 NA 9.01 1.79 NA 34.69 090 

50500 ......... ............ A Repair of kidney wound ............................... 19.54 NA 8.39 1.96 NA 29.89 090 

50520 ......... ............ A Close kidney-skin fistula .............................. 17.20 NA 7.41 1.55 NA 26.16 090 

50525 ......... ............ A Repair renal-abdomen fistula ...................... 22.24 NA 8.99 2.30 NA 33.53 090 

50526 ......... ............ A Repair renal-abdomen fistula ...................... 23.98 NA 9.84 4.17 NA 37.99 090 

50540 ......... ............ A Revision of horseshoe kidney ..................... 19.90 NA 8.32 1.76 NA 29.98 090 

50541 ......... ............ A Laparo ablate renal cyst .............................. 15.98 NA 6.47 1.22 NA 23.67 090 

50542 ......... ............ A Laparo ablate renal mass ............................ 19.97 NA 8.11 1.66 NA 29.74 090 

50543 ......... ............ A Laparo partial nephrectomy ......................... 25.46 NA 10.17 1.66 NA 37.29 090 

50544 ......... ............ A Laparoscopy, pyeloplasty ............................ 22.37 NA 8.51 1.69 NA 32.57 090 

50545 ......... ............ A Laparo radical nephrectomy ........................ 23.96 NA 9.17 1.82 NA 34.95 090 

50546 ......... ............ A Laparoscopic nephrectomy .......................... 20.45 NA 8.35 1.60 NA 30.40 090 

50547 ......... ............ A Laparo removal donor kidney ...................... 25.46 NA 11.10 2.80 NA 39.36 090 

50548 ......... ............ A Laparo remove w/ ureter ............................. 24.36 NA 9.15 1.84 NA 35.35 090 

50551 ......... ............ A Kidney endoscopy ....................................... 5.59 4.14 1.96 0.40 10.13 7.95 000 

50553 ......... ............ A Kidney endoscopy ....................................... 5.98 4.35 2.16 0.39 10.72 8.53 000 

50555 ......... ............ A Kidney endoscopy & biopsy ........................ 6.52 4.82 2.33 0.49 11.83 9.34 000 

50557 ......... ............ A Kidney endoscopy & treatment ................... 6.61 4.57 2.29 0.48 11.66 9.38 000 

50559 ......... ............ A Renal endoscopy/radiotracer ....................... 6.77 5.30 2.78 0.41 12.48 9.96 000 

50561 ......... ............ A Kidney endoscopy & treatment ................... 7.58 5.08 2.64 0.55 13.21 10.77 000 

50562 ......... ............ A Renal scope w/tumor resect ........................ 10.90 NA 4.27 0.48 NA 15.65 090 

50570 ......... ............ A Kidney endoscopy ....................................... 9.53 NA 3.20 0.66 NA 13.39 000 

50572 ......... ............ A Kidney endoscopy ....................................... 10.33 NA 3.49 0.87 NA 14.69 000 

50574 ......... ............ A Kidney endoscopy & biopsy ........................ 11.00 NA 3.74 0.74 NA 15.48 000 

50575 ......... ............ A Kidney endoscopy ....................................... 13.96 NA 4.62 1.00 NA 19.58 000 

50576 ......... ............ A Kidney endoscopy & treatment ................... 10.97 NA 3.65 0.76 NA 15.38 000 

50578 ......... ............ A Renal endoscopy/radiotracer ....................... 11.33 NA 3.79 0.81 NA 15.93 000 

50580 ......... ............ A Kidney endoscopy & treatment ................... 11.84 NA 3.95 0.84 NA 16.63 000 

50590 ......... ............ A Fragmenting of kidney stone ....................... 9.08 12.49 4.11 0.66 22.23 13.85 090 

50600 ......... ............ A Exploration of ureter .................................... 15.82 NA 6.66 1.34 NA 23.82 090 

50605 ......... ............ A Insert ureteral support ................................. 15.44 NA 6.73 1.44 NA 23.61 090 

50610 ......... ............ A Removal of ureter stone .............................. 15.90 NA 6.96 1.28 NA 24.14 090 

50620 ......... ............ A Removal of ureter stone .............................. 15.14 NA 6.32 1.12 NA 22.58 090 

50630 ......... ............ A Removal of ureter stone .............................. 14.92 NA 6.27 1.14 NA 22.33 090 

50650 ......... ............ A Removal of ureter ........................................ 17.38 NA 7.21 1.26 NA 25.85 090 

50660 ......... ............ A Removal of ureter ........................................ 19.52 NA 7.94 1.55 NA 29.01 090 

50684 ......... ............ A Injection for ureter x-ray .............................. 0.76 5.00 0.47 0.05 5.81 1.28 000 

50686 ......... ............ A Measure ureter pressure ............................. 1.51 3.43 0.82 0.11 5.05 2.44 000 

50688 ......... ............ A Change of ureter tube ................................. 1.17 NA 1.06 0.07 NA 2.30 010 

50690 ......... ............ A Injection for ureter x-ray .............................. 1.16 1.80 0.72 0.08 3.04 1.96 000 

50700 ......... ............ A Revision of ureter ........................................ 15.19 NA 7.10 1.25 NA 23.54 090 

50715 ......... ............ A Release of ureter ......................................... 18.87 NA 8.73 2.06 NA 29.66 090 

50722 ......... ............ A Release of ureter ......................................... 16.33 NA 7.80 1.88 NA 26.01 090 

50725 ......... ............ A Release/revise ureter ................................... 18.46 NA 8.04 1.58 NA 28.08 090 

50727 ......... ............ A Revise ureter ............................................... 8.17 NA 4.27 0.65 NA 13.09 090 

50728 ......... ............ A Revise ureter ............................................... 12.00 NA 5.55 1.05 NA 18.60 090 

50740 ......... ............ A Fusion of ureter & kidney ............................ 18.39 NA 7.73 1.88 NA 28.00 090 

50750 ......... ............ A Fusion of ureter & kidney ............................ 19.48 NA 7.97 1.54 NA 28.99 090 

50760 ......... ............ A Fusion of ureters .......................................... 18.39 NA 7.67 1.53 NA 27.59 090 

50770 ......... ............ A Splicing of ureters ........................................ 19.48 NA 7.96 1.61 NA 29.05 090 

50780 ......... ............ A Reimplant ureter in bladder ......................... 18.33 NA 7.58 1.59 NA 27.50 090 

50782 ......... ............ A Reimplant ureter in bladder ......................... 19.51 NA 8.80 1.61 NA 29.92 090 

50783 ......... ............ A Reimplant ureter in bladder ......................... 20.52 NA 8.20 1.64 NA 30.36 090 

50785 ......... ............ A Reimplant ureter in bladder ......................... 20.49 NA 8.28 1.63 NA 30.40 090 

50800 ......... ............ A Implant ureter in bowel ................................ 14.50 NA 6.46 1.23 NA 22.19 090 

50810 ......... ............ A Fusion of ureter & bowel ............................. 20.02 NA 9.08 2.16 NA 31.26 090 

50815 ......... ............ A Urine shunt to intestine ................................ 19.90 NA 8.43 1.62 NA 29.95 090 

50820 ......... ............ A Construct bowel bladder .............................. 21.86 NA 8.62 1.83 NA 32.31 090 

47630

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

50825 ......... ............ A Construct bowel bladder .............................. 28.14 NA 11.10 2.14 NA 41.38 090 

50830 ......... ............ A Revise urine flow ......................................... 31.23 NA 12.15 2.58 NA 45.96 090 

50840 ......... ............ A Replace ureter by bowel .............................. 19.97 NA 8.42 1.56 NA 29.95 090 

50845 ......... ............ A Appendico-vesicostomy ............................... 20.86 NA 8.89 1.53 NA 31.28 090 

50860 ......... ............ A Transplant ureter to skin .............................. 15.34 NA 6.61 1.21 NA 23.16 090 

50900 ......... ............ A Repair of ureter ............................................ 13.60 NA 6.13 1.26 NA 20.99 090 

50920 ......... ............ A Closure ureter/skin fistula ............................ 14.31 NA 6.56 1.13 NA 22.00 090 

50930 ......... ............ A Closure ureter/bowel fistula ......................... 18.69 NA 7.96 1.28 NA 27.93 090 

50940 ......... ............ A Release of ureter ......................................... 14.49 NA 6.39 1.40 NA 22.28 090 

50945 ......... ............ A Laparoscopy ureterolithotomy ..................... 16.97 NA 7.02 1.18 NA 25.17 090 

50947 ......... ............ A Laparo new ureter/bladder .......................... 24.46 NA 9.66 1.97 NA 36.09 090 

50948 ......... ............ A Laparo new ureter/bladder .......................... 22.47 NA 8.67 1.60 NA 32.74 090 

50951 ......... ............ A Endoscopy of ureter .................................... 5.83 4.28 2.05 0.42 10.53 8.30 000 

50953 ......... ............ A Endoscopy of ureter .................................... 6.23 4.40 2.36 0.44 11.07 9.03 000 

50955 ......... ............ A Ureter endoscopy & biopsy ......................... 6.74 6.66 2.68 0.46 13.86 9.88 000 

50957 ......... ............ A Ureter endoscopy & treatment .................... 6.78 4.56 2.37 0.48 11.82 9.63 000 

50959 ......... ............ A Ureter endoscopy & tracer .......................... 4.39 NA 1.88 0.25 NA 6.52 000 

50961 ......... ............ A Ureter endoscopy & treatment .................... 6.04 4.36 2.18 0.42 10.82 8.64 000 

50970 ......... ............ A Ureter endoscopy ........................................ 7.13 NA 2.45 0.50 NA 10.08 000 

50972 ......... ............ A Ureter endoscopy & catheter ....................... 6.88 NA 2.46 0.50 NA 9.84 000 

50974 ......... ............ A Ureter endoscopy & biopsy ......................... 9.16 NA 3.10 0.63 NA 12.89 000 

50976 ......... ............ A Ureter endoscopy & treatment .................... 9.03 NA 3.06 0.64 NA 12.73 000 

50978 ......... ............ A Ureter endoscopy & tracer .......................... 5.09 NA 1.83 0.36 NA 7.28 000 

50980 ......... ............ A Ureter endoscopy & treatment .................... 6.84 NA 2.36 0.51 NA 9.71 000 

51000 ......... ............ A Drainage of bladder ..................................... 0.78 1.97 0.24 0.06 2.81 1.08 000 

51005 ......... ............ A Drainage of bladder ..................................... 1.02 4.75 0.34 0.09 5.86 1.45 000 

51010 ......... ............ A Drainage of bladder ..................................... 3.52 5.59 1.87 0.28 9.39 5.67 010 

51020 ......... ............ A Incise & treat bladder .................................. 6.70 NA 3.91 0.53 NA 11.14 090 

51030 ......... ............ A Incise & treat bladder .................................. 6.76 NA 4.04 0.56 NA 11.36 090 

51040 ......... ............ A Incise & drain bladder .................................. 4.39 NA 2.82 0.33 NA 7.54 090 

51045 ......... ............ A Incise bladder/drain ureter ........................... 6.76 NA 4.00 0.58 NA 11.34 090 

51050 ......... ............ A Removal of bladder stone ........................... 6.91 NA 3.69 0.50 NA 11.10 090 

51060 ......... ............ A Removal of ureter stone .............................. 8.84 NA 4.56 0.68 NA 14.08 090 

51065 ......... ............ A Remove ureter calculus ............................... 8.84 NA 4.40 0.67 NA 13.91 090 

51080 ......... ............ A Drainage of bladder abscess ....................... 5.95 NA 3.61 0.47 NA 10.03 090 

51500 ......... ............ A Removal of bladder cyst .............................. 10.12 NA 5.03 1.10 NA 16.25 090 

51520 ......... ............ A Removal of bladder lesion ........................... 9.28 NA 4.72 0.72 NA 14.72 090 

51525 ......... ............ A Removal of bladder lesion ........................... 13.95 NA 6.17 1.05 NA 21.17 090 

51530 ......... ............ A Removal of bladder lesion ........................... 12.36 NA 5.80 1.12 NA 19.28 090 

51535 ......... ............ A Repair of ureter lesion ................................. 12.55 NA 6.16 1.20 NA 19.91 090 

51550 ......... ............ A Partial removal of bladder ........................... 15.64 NA 6.78 1.37 NA 23.79 090 

51555 ......... ............ A Partial removal of bladder ........................... 21.20 NA 8.71 1.80 NA 31.71 090 

51565 ......... ............ A Revise bladder & ureter(s) .......................... 21.59 NA 9.01 1.69 NA 32.29 090 

51570 ......... ............ A Removal of bladder ..................................... 24.20 NA 9.81 1.89 NA 35.90 090 

51575 ......... ............ A Removal of bladder & nodes ....................... 30.40 NA 12.10 2.27 NA 44.77 090 

51580 ......... ............ A Remove bladder/revise tract ........................ 31.03 NA 12.58 2.29 NA 45.90 090 

51585 ......... ............ A Removal of bladder & nodes ....................... 35.18 NA 13.77 2.80 NA 51.75 090 

51590 ......... ............ A Remove bladder/revise tract ........................ 32.61 NA 12.69 2.43 NA 47.73 090 

51595 ......... ............ A Remove bladder/revise tract ........................ 37.08 NA 14.19 2.74 NA 54.01 090 

51596 ......... ............ A Remove bladder/create pouch .................... 39.46 NA 15.30 2.88 NA 57.64 090 

51597 ......... ............ A Removal of pelvic structures ....................... 38.29 NA 14.91 2.97 NA 56.17 090 

51600 ......... ............ A Injection for bladder x-ray ............................ 0.88 5.08 0.29 0.06 6.02 1.23 000 

51605 ......... ............ A Preparation for bladder xray ........................ 0.64 6.03 0.35 0.04 6.71 1.03 000 

51610 ......... ............ A Injection for bladder x-ray ............................ 1.05 2.33 0.60 0.07 3.45 1.72 000 

51700 ......... ............ A Irrigation of bladder ...................................... 0.88 1.60 0.28 0.06 2.54 1.22 000 

51701 ......... ............ A Insert bladder catheter ................................. 0.50 1.57 0.19 0.04 2.11 0.73 000 

51702 ......... ............ A Insert temp bladder cath .............................. 0.50 2.08 0.24 0.04 2.62 0.78 000 

51703 ......... ............ A Insert bladder cath, complex ....................... 1.47 2.72 0.56 0.08 4.27 2.11 000 

51705 ......... ............ A Change of bladder tube ............................... 1.02 2.27 0.62 0.07 3.36 1.71 010 

51710 ......... ............ A Change of bladder tube ............................... 1.49 3.32 0.77 0.11 4.92 2.37 010 

51715 ......... ............ A Endoscopic injection/implant ....................... 3.73 3.88 1.35 0.29 7.90 5.37 000 

51720 ......... ............ A Treatment of bladder lesion ......................... 1.96 1.74 0.69 0.14 3.84 2.79 000 

51725 ......... ............ A Simple cystometrogram ............................... 1.51 5.58 NA 0.16 7.25 NA 000 

51725 ......... 26 ....... A Simple cystometrogram ............................... 1.51 0.49 0.49 0.12 2.12 2.12 000 

51725 ......... TC ...... A Simple cystometrogram ............................... 0.00 5.09 NA 0.04 5.13 NA 000 

51726 ......... ............ A Complex cystometrogram ............................ 1.71 7.48 NA 0.18 9.37 NA 000 

51726 ......... 26 ....... A Complex cystometrogram ............................ 1.71 0.56 0.56 0.13 2.40 2.40 000 

51726 ......... TC ...... A Complex cystometrogram ............................ 0.00 6.92 NA 0.05 6.97 NA 000 

51736 ......... ............ A Urine flow measurement .............................. 0.61 0.58 NA 0.06 1.25 NA 000 

51736 ......... 26 ....... A Urine flow measurement .............................. 0.61 0.20 0.20 0.05 0.86 0.86 000 

51736 ......... TC ...... A Urine flow measurement .............................. 0.00 0.38 NA 0.01 0.39 NA 000 

51741 ......... ............ A Electro-uroflowmetry, first ............................ 1.14 0.80 NA 0.11 2.05 NA 000 

51741 ......... 26 ....... A Electro-uroflowmetry, first ............................ 1.14 0.37 0.37 0.09 1.60 1.60 000 

51741 ......... TC ...... A Electro-uroflowmetry, first ............................ 0.00 0.43 NA 0.02 0.45 NA 000 

51772 ......... ............ A Urethra pressure profile ............................... 1.61 5.58 NA 0.19 7.38 NA 000 

47631

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

51772 ......... 26 ....... A Urethra pressure profile ............................... 1.61 0.55 0.55 0.14 2.30 2.30 000 

51772 ......... TC ...... A Urethra pressure profile ............................... 0.00 5.03 NA 0.05 5.08 NA 000 

51784 ......... ............ A Anal/urinary muscle study ........................... 1.53 3.99 NA 0.16 5.68 NA 000 

51784 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.12 2.15 2.15 000 

51784 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.48 NA 0.04 3.52 NA 000 

51785 ......... ............ A Anal/urinary muscle study ........................... 1.53 4.44 NA 0.15 6.12 NA 000 

51785 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.11 2.14 2.14 000 

51785 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.94 NA 0.04 3.98 NA 000 

51792 ......... ............ A Urinary reflex study ...................................... 1.10 5.99 NA 0.20 7.29 NA 000 

51792 ......... 26 ....... A Urinary reflex study ...................................... 1.10 0.41 0.41 0.07 1.58 1.58 000 

51792 ......... TC ...... A Urinary reflex study ...................................... 0.00 5.57 NA 0.13 5.70 NA 000 

51795 ......... ............ A Urine voiding pressure study ....................... 1.53 7.28 NA 0.22 9.03 NA 000 

51795 ......... 26 ....... A Urine voiding pressure study ....................... 1.53 0.50 0.50 0.12 2.15 2.15 000 

51795 ......... TC ...... A Urine voiding pressure study ....................... 0.00 6.78 NA 0.10 6.88 NA 000 

51797 ......... ............ A Intraabdominal pressure test ....................... 1.60 5.76 NA 0.17 7.53 NA 000 

51797 ......... 26 ....... A Intraabdominal pressure test ....................... 1.60 0.52 0.52 0.12 2.24 2.24 000 

51797 ......... TC ...... A Intraabdominal pressure test ....................... 0.00 5.23 NA 0.05 5.28 NA 000 

51798 ......... ............ A Us urine capacity measure .......................... 0.00 0.34 NA 0.08 0.42 NA XXX 

51800 ......... ............ A Revision of bladder/urethra ......................... 17.39 NA 7.60 1.38 NA 26.37 090 

51820 ......... ............ A Revision of urinary tract ............................... 17.86 NA 8.38 1.90 NA 28.14 090 

51840 ......... ............ A Attach bladder/urethra ................................. 10.69 NA 5.56 1.10 NA 17.35 090 

51841 ......... ............ A Attach bladder/urethra ................................. 13.01 NA 6.37 1.30 NA 20.68 090 

51845 ......... ............ A Repair bladder neck .................................... 9.72 NA 4.80 0.81 NA 15.33 090 

51860 ......... ............ A Repair of bladder wound ............................. 12.00 NA 5.83 1.20 NA 19.03 090 

51865 ......... ............ A Repair of bladder wound ............................. 15.02 NA 6.74 1.33 NA 23.09 090 

51880 ......... ............ A Repair of bladder opening ........................... 7.65 NA 4.02 0.70 NA 12.37 090 

51900 ......... ............ A Repair bladder/vagina lesion ....................... 12.95 NA 6.13 1.15 NA 20.23 090 

51920 ......... ............ A Close bladder-uterus fistula ......................... 11.79 NA 5.68 0.90 NA 18.37 090 

51925 ......... ............ A Hysterectomy/bladder repair ........................ 15.56 NA 8.75 1.38 NA 25.69 090 

51940 ......... ............ A Correction of bladder defect ........................ 28.39 NA 12.23 2.39 NA 43.01 090 

51960 ......... ............ A Revision of bladder & bowel ........................ 22.98 NA 9.74 1.73 NA 34.45 090 

51980 ......... ............ A Construct bladder opening .......................... 11.34 NA 5.42 0.88 NA 17.64 090 

51990 ......... ............ A Laparo urethral suspension ......................... 12.48 NA 6.13 1.41 NA 20.02 090 

51992 ......... ............ A Laparo sling operation ................................. 13.99 NA 6.19 1.36 NA 21.54 090 

52000 ......... ............ A Cystoscopy .................................................. 2.01 3.29 0.76 0.15 5.45 2.92 000 

52001 ......... ............ A Cystoscopy, removal of clots ....................... 5.44 5.06 1.86 0.17 10.67 7.47 000 

52005 ......... ............ A Cystoscopy & ureter catheter ...................... 2.37 5.54 0.89 0.17 8.08 3.43 000 

52007 ......... ............ A Cystoscopy and biopsy ................................ 3.02 16.43 1.15 0.22 19.67 4.39 000 

52010 ......... ............ A Cystoscopy & duct catheter ......................... 3.02 10.81 1.15 0.22 14.05 4.39 000 

52204 ......... ............ A Cystoscopy .................................................. 2.37 14.45 0.90 0.17 16.99 3.44 000 

52214 ......... ............ A Cystoscopy and treatment ........................... 3.70 37.93 1.33 0.27 41.90 5.30 000 

52224 ......... ............ A Cystoscopy and treatment ........................... 3.14 36.30 1.15 0.22 39.66 4.51 000 

52234 ......... ............ A Cystoscopy and treatment ........................... 4.62 NA 1.65 0.33 NA 6.60 000 

52235 ......... ............ A Cystoscopy and treatment ........................... 5.44 NA 1.93 0.39 NA 7.76 000 

52240 ......... ............ A Cystoscopy and treatment ........................... 9.71 NA 3.29 0.69 NA 13.69 000 

52250 ......... ............ A Cystoscopy and radiotracer ......................... 4.49 NA 1.65 0.33 NA 6.47 000 

52260 ......... ............ A Cystoscopy and treatment ........................... 3.91 NA 1.42 0.29 NA 5.62 000 

52265 ......... ............ A Cystoscopy and treatment ........................... 2.94 13.28 1.11 0.22 16.44 4.27 000 

52270 ......... ............ A Cystoscopy & revise urethra ....................... 3.36 10.99 1.24 0.24 14.59 4.84 000 

52275 ......... ............ A Cystoscopy & revise urethra ....................... 4.69 15.48 1.66 0.34 20.51 6.69 000 

52276 ......... ............ A Cystoscopy and treatment ........................... 4.99 NA 1.78 0.36 NA 7.13 000 

52277 ......... ............ A Cystoscopy and treatment ........................... 6.16 NA 2.22 0.45 NA 8.83 000 

52281 ......... ............ A Cystoscopy and treatment ........................... 2.80 7.07 1.08 0.20 10.07 4.08 000 

52282 ......... ............ A Cystoscopy, implant stent ............................ 6.39 NA 2.23 0.46 NA 9.08 000 

52283 ......... ............ A Cystoscopy and treatment ........................... 3.73 3.94 1.38 0.27 7.94 5.38 000 

52285 ......... ............ A Cystoscopy and treatment ........................... 3.60 4.00 1.33 0.27 7.87 5.20 000 

52290 ......... ............ A Cystoscopy and treatment ........................... 4.58 NA 1.65 0.33 NA 6.56 000 

52300 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.90 0.38 NA 7.58 000 

52301 ......... ............ A Cystoscopy and treatment ........................... 5.50 NA 1.99 0.48 NA 7.97 000 

52305 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.85 0.39 NA 7.54 000 

52310 ......... ............ A Cystoscopy and treatment ........................... 2.81 4.68 1.03 0.20 7.69 4.04 000 

52315 ......... ............ A Cystoscopy and treatment ........................... 5.20 8.68 1.83 0.37 14.25 7.40 000 

52317 ......... ............ A Remove bladder stone ................................ 6.71 28.82 2.27 0.48 36.01 9.46 000 

52318 ......... ............ A Remove bladder stone ................................ 9.18 NA 3.09 0.66 NA 12.93 000 

52320 ......... ............ A Cystoscopy and treatment ........................... 4.69 NA 1.63 0.34 NA 6.66 000 

52325 ......... ............ A Cystoscopy, stone removal ......................... 6.15 NA 2.10 0.44 NA 8.69 000 

52327 ......... ............ A Cystoscopy, inject material .......................... 5.18 31.67 1.81 0.39 37.24 7.38 000 

52330 ......... ............ A Cystoscopy and treatment ........................... 5.03 38.66 1.74 0.36 44.05 7.13 000 

52332 ......... ............ A Cystoscopy and treatment ........................... 2.83 5.73 1.05 0.21 8.77 4.09 000 

52334 ......... ............ A Create passage to kidney ............................ 4.82 NA 1.73 0.34 NA 6.89 000 

52341 ......... ............ A Cysto w/ureter stricture tx ............................ 5.99 NA 2.21 0.43 NA 8.63 000 

52342 ......... ............ A Cysto w/up stricture tx ................................. 6.49 NA 2.34 0.47 NA 9.30 000 

52343 ......... ............ A Cysto w/renal stricture tx ............................. 7.19 NA 2.57 0.51 NA 10.27 000 

52344 ......... ............ A Cysto/uretero, stone remove ....................... 7.69 NA 2.79 0.56 NA 11.04 000 

52345 ......... ............ A Cysto/uretero w/up stricture ......................... 8.19 NA 2.95 0.58 NA 11.72 000 

47632

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

52346 ......... ............ A Cystouretero w/renal strict ........................... 9.22 NA 3.27 0.67 NA 13.16 000 

52347 ......... ............ A Cystoscopy, resect ducts ............................. 5.27 NA 1.70 0.38 NA 7.35 000 

52351 ......... ............ A Cystouretero & or pyeloscope ..................... 5.85 NA 2.14 0.42 NA 8.41 000 

52352 ......... ............ A Cystouretero w/stone remove ...................... 6.87 NA 2.50 0.49 NA 9.86 000 

52353 ......... ............ A Cystouretero w/lithotripsy ............................ 7.96 NA 2.85 0.57 NA 11.38 000 

52354 ......... ............ A Cystouretero w/biopsy ................................. 7.33 NA 2.66 0.53 NA 10.52 000 

52355 ......... ............ A Cystouretero w/excise tumor ....................... 8.81 NA 3.13 0.63 NA 12.57 000 

52400 ......... ............ A Cystouretero w/congen repr ........................ 9.67 NA 3.75 0.69 NA 14.11 090 

52450 ......... ............ A Incision of prostate ...................................... 7.63 NA 3.68 0.55 NA 11.86 090 

52500 ......... ............ A Revision of bladder neck ............................. 8.46 NA 3.92 0.60 NA 12.98 090 

52510 ......... ............ A Dilation prostatic urethra .............................. 6.71 NA 3.12 0.49 NA 10.32 090 

52601 ......... ............ A Prostatectomy (TURP) ................................. 12.35 NA 5.11 0.88 NA 18.34 090 

52606 ......... ............ A Control postop bleeding ............................... 8.12 NA 3.55 0.58 NA 12.25 090 

52612 ......... ............ A Prostatectomy, first stage ............................ 7.97 NA 3.74 0.57 NA 12.28 090 

52614 ......... ............ A Prostatectomy, second stage ...................... 6.83 NA 3.35 0.49 NA 10.67 090 

52620 ......... ............ A Remove residual prostate ............................ 6.60 NA 2.98 0.47 NA 10.05 090 

52630 ......... ............ A Remove prostate regrowth .......................... 7.25 NA 3.19 0.52 NA 10.96 090 

52640 ......... ............ A Relieve bladder contracture ......................... 6.61 NA 2.96 0.47 NA 10.04 090 

52647 ......... ............ A Laser surgery of prostate ............................ 10.34 73.74 4.53 0.74 84.82 15.61 090 

52648 ......... ............ A Laser surgery of prostate ............................ 11.19 NA 4.79 0.80 NA 16.78 090 

52700 ......... ............ A Drainage of prostate abscess ...................... 6.79 NA 3.18 0.49 NA 10.46 090 

53000 ......... ............ A Incision of urethra ........................................ 2.28 NA 1.55 0.16 NA 3.99 010 

53010 ......... ............ A Incision of urethra ........................................ 3.63 NA 2.97 0.26 NA 6.86 090 

53020 ......... ............ A Incision of urethra ........................................ 1.77 2.99 0.67 0.13 4.89 2.57 000 

53025 ......... ............ A Incision of urethra ........................................ 1.13 3.71 0.51 0.09 4.93 1.73 000 

53040 ......... ............ A Drainage of urethra abscess ....................... 6.39 NA 3.43 0.47 NA 10.29 090 

53060 ......... ............ A Drainage of urethra abscess ....................... 2.63 2.09 1.37 0.27 4.99 4.27 010 

53080 ......... ............ A Drainage of urinary leakage ........................ 6.28 NA 6.06 0.55 NA 12.89 090 

53085 ......... ............ A Drainage of urinary leakage ........................ 10.25 NA 7.45 0.92 NA 18.62 090 

53200 ......... ............ A Biopsy of urethra ......................................... 2.59 1.32 0.98 0.20 4.11 3.77 000 

53210 ......... ............ A Removal of urethra ...................................... 12.55 NA 5.91 1.00 NA 19.46 090 

53215 ......... ............ A Removal of urethra ...................................... 15.56 NA 6.69 1.13 NA 23.38 090 

53220 ......... ............ A Treatment of urethra lesion ......................... 6.99 NA 3.79 0.54 NA 11.32 090 

53230 ......... ............ A Removal of urethra lesion ........................... 9.57 NA 4.76 0.72 NA 15.05 090 

53235 ......... ............ A Removal of urethra lesion ........................... 10.12 NA 4.96 0.79 NA 15.87 090 

53240 ......... ............ A Surgery for urethra pouch ........................... 6.44 NA 3.59 0.54 NA 10.57 090 

53250 ......... ............ A Removal of urethra gland ............................ 5.88 NA 3.35 0.50 NA 9.73 090 

53260 ......... ............ A Treatment of urethra lesion ......................... 2.98 2.25 1.42 0.26 5.49 4.66 010 

53265 ......... ............ A Treatment of urethra lesion ......................... 3.12 2.71 1.42 0.24 6.07 4.78 010 

53270 ......... ............ A Removal of urethra gland ............................ 3.09 2.20 1.54 0.32 5.61 4.95 010 

53275 ......... ............ A Repair of urethra defect ............................... 4.52 NA 2.24 0.33 NA 7.09 010 

53400 ......... ............ A Revise urethra, stage 1 ............................... 12.75 NA 6.02 1.04 NA 19.81 090 

53405 ......... ............ A Revise urethra, stage 2 ............................... 14.46 NA 6.37 1.22 NA 22.05 090 

53410 ......... ............ A Reconstruction of urethra ............................ 16.42 NA 7.12 1.21 NA 24.75 090 

53415 ......... ............ A Reconstruction of urethra ............................ 19.38 NA 7.40 1.46 NA 28.24 090 

53420 ......... ............ A Reconstruct urethra, stage 1 ....................... 14.06 NA 6.43 0.98 NA 21.47 090 

53425 ......... ............ A Reconstruct urethra, stage 2 ....................... 15.96 NA 6.96 1.16 NA 24.08 090 

53430 ......... ............ A Reconstruction of urethra ............................ 16.32 NA 7.05 1.27 NA 24.64 090 

53431 ......... ............ A Reconstruct urethra/bladder ........................ 19.86 NA 8.09 1.44 NA 29.39 090 

53440 ......... ............ A Male sling procedure ................................... 13.60 NA 5.97 0.89 NA 20.46 090 

53442 ......... ............ A Remove/revise male sling ........................... 11.55 NA 5.45 0.61 NA 17.61 090 

53444 ......... ............ A Insert tandem cuff ........................................ 13.38 NA 5.87 0.99 NA 20.24 090 

53445 ......... ............ A Insert uro/ves nck sphincter ........................ 14.04 NA 7.14 1.03 NA 22.21 090 

53446 ......... ............ A Remove uro sphincter ................................. 10.21 NA 5.21 0.74 NA 16.16 090 

53447 ......... ............ A Remove/replace ur sphincter ....................... 13.47 NA 6.41 0.98 NA 20.86 090 

53448 ......... ............ A Remov/replc ur sphinctr comp ..................... 21.12 NA 9.03 1.51 NA 31.66 090 

53449 ......... ............ A Repair uro sphincter .................................... 9.69 NA 4.77 0.65 NA 15.11 090 

53450 ......... ............ A Revision of urethra ...................................... 6.13 NA 3.35 0.44 NA 9.92 090 

53460 ......... ............ A Revision of urethra ...................................... 7.11 NA 3.75 0.53 NA 11.39 090 

53500 ......... ............ A Urethrlys, transvag w/ scope ....................... 12.19 NA 6.19 0.91 NA 19.29 090 

53502 ......... ............ A Repair of urethra injury ................................ 7.62 NA 4.06 0.63 NA 12.31 090 

53505 ......... ............ A Repair of urethra injury ................................ 7.62 NA 3.92 0.55 NA 12.09 090 

53510 ......... ............ A Repair of urethra injury ................................ 10.09 NA 5.23 0.74 NA 16.06 090 

53515 ......... ............ A Repair of urethra injury ................................ 13.29 NA 5.98 0.95 NA 20.22 090 

53520 ......... ............ A Repair of urethra defect ............................... 8.67 NA 4.53 0.64 NA 13.84 090 

53600 ......... ............ A Dilate urethra stricture ................................. 1.21 1.14 0.42 0.09 2.44 1.72 000 

53601 ......... ............ A Dilate urethra stricture ................................. 0.98 1.26 0.37 0.07 2.31 1.42 000 

53605 ......... ............ A Dilate urethra stricture ................................. 1.28 NA 0.41 0.09 NA 1.78 000 

53620 ......... ............ A Dilate urethra stricture ................................. 1.62 1.99 0.59 0.12 3.73 2.33 000 

53621 ......... ............ A Dilate urethra stricture ................................. 1.35 2.06 0.49 0.10 3.51 1.94 000 

53660 ......... ............ A Dilation of urethra ........................................ 0.71 1.31 0.31 0.05 2.07 1.07 000 

53661 ......... ............ A Dilation of urethra ........................................ 0.72 1.30 0.29 0.05 2.07 1.06 000 

53665 ......... ............ A Dilation of urethra ........................................ 0.76 NA 0.25 0.06 NA 1.07 000 

53850 ......... ............ A Prostatic microwave thermotx ..................... 9.44 94.10 3.94 0.67 104.21 14.05 090 

53852 ......... ............ A Prostatic rf thermotx .................................... 9.87 88.49 4.37 0.70 99.06 14.94 090 

47633

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

53853 ......... ............ A Prostatic water thermother .......................... 5.23 55.09 2.85 0.29 60.61 8.37 090 

54000 ......... ............ A Slitting of prepuce ........................................ 1.54 2.91 0.93 0.11 4.56 2.58 010 

54001 ......... ............ A Slitting of prepuce ........................................ 2.19 3.18 1.11 0.16 5.53 3.46 010 

54015 ......... ............ A Drain penis lesion ........................................ 5.31 NA 2.55 0.40 NA 8.26 010 

54050 ......... ............ A Destruction, penis lesion(s) ......................... 1.24 1.67 1.04 0.10 3.01 2.38 010 

54055 ......... ............ A Destruction, penis lesion(s) ......................... 1.22 1.57 0.80 0.09 2.88 2.11 010 

54056 ......... ............ A Cryosurgery, penis lesion(s) ........................ 1.24 1.70 1.14 0.10 3.04 2.48 010 

54057 ......... ............ A Laser surg, penis lesion(s) .......................... 1.24 2.22 0.83 0.09 3.55 2.16 010 

54060 ......... ............ A Excision of penis lesion(s) ........................... 1.93 3.09 1.06 0.15 5.17 3.14 010 

54065 ......... ............ A Destruction, penis lesion(s) ......................... 2.42 2.63 1.23 0.19 5.24 3.84 010 

54100 ......... ............ A Biopsy of penis ............................................ 1.90 2.82 0.82 0.15 4.87 2.87 000 

54105 ......... ............ A Biopsy of penis ............................................ 3.49 4.28 1.93 0.25 8.02 5.67 010 

54110 ......... ............ A Treatment of penis lesion ............................ 10.11 NA 4.75 0.74 NA 15.60 090 

54111 ......... ............ A Treat penis lesion, graft ............................... 13.55 NA 5.75 0.96 NA 20.26 090 

54112 ......... ............ A Treat penis lesion, graft ............................... 15.84 NA 6.78 1.13 NA 23.75 090 

54115 ......... ............ A Treatment of penis lesion ............................ 6.14 4.37 3.45 0.44 10.95 10.03 090 

54120 ......... ............ A Partial removal of penis ............................... 9.96 NA 4.67 0.72 NA 15.35 090 

54125 ......... ............ A Removal of penis ......................................... 13.51 NA 5.82 0.99 NA 20.32 090 

54130 ......... ............ A Remove penis & nodes ............................... 20.11 NA 8.16 1.43 NA 29.70 090 

54135 ......... ............ A Remove penis & nodes ............................... 26.32 NA 10.15 1.87 NA 38.34 090 

54150 ......... ............ A Circumcision ................................................ 1.81 4.53 0.97 0.19 6.53 2.97 010 

54152 ......... ............ A Circumcision ................................................ 2.31 NA 1.20 0.19 NA 3.70 010 

54160 ......... ............ A Circumcision ................................................ 2.48 4.13 1.09 0.19 6.80 3.76 010 

54161 ......... ............ A Circumcision ................................................ 3.27 NA 1.56 0.24 NA 5.07 010 

54162 ......... ............ A Lysis penil circumic lesion ........................... 3.00 4.63 1.44 0.22 7.85 4.66 010 

54163 ......... ............ A Repair of circumcision ................................. 3.00 NA 2.00 0.22 NA 5.22 010 

54164 ......... ............ A Frenulotomy of penis ................................... 2.50 NA 1.83 0.18 NA 4.51 010 

54200 ......... ............ A Treatment of penis lesion ............................ 1.06 1.79 0.98 0.08 2.93 2.12 010 

54205 ......... ............ A Treatment of penis lesion ............................ 7.92 NA 4.73 0.56 NA 13.21 090 

54220 ......... ............ A Treatment of penis lesion ............................ 2.42 3.83 0.95 0.18 6.43 3.55 000 

54230 ......... ............ A Prepare penis study ..................................... 1.34 1.08 0.63 0.10 2.52 2.07 000 

54231 ......... ............ A Dynamic cavernosometry ............................ 2.04 1.38 0.87 0.15 3.57 3.06 000 

54235 ......... ............ A Penile injection ............................................. 1.19 0.96 0.58 0.09 2.24 1.86 000 

54240 ......... ............ A Penis study .................................................. 1.31 1.01 NA 0.17 2.49 NA 000 

54240 ......... 26 ....... A Penis study .................................................. 1.31 0.43 0.43 0.11 1.85 1.85 000 

54240 ......... TC ...... A Penis study .................................................. 0.00 0.59 NA 0.06 0.65 NA 000 

54250 ......... ............ A Penis study .................................................. 2.22 0.92 NA 0.19 3.33 NA 000 

54250 ......... 26 ....... A Penis study .................................................. 2.22 0.71 0.71 0.17 3.10 3.10 000 

54250 ......... TC ...... A Penis study .................................................. 0.00 0.21 NA 0.02 0.23 NA 000 

54300 ......... ............ A Revision of penis ......................................... 10.39 NA 5.65 0.74 NA 16.78 090 

54304 ......... ............ A Revision of penis ......................................... 12.47 NA 6.43 0.92 NA 19.82 090 

54308 ......... ............ A Reconstruction of urethra ............................ 11.81 NA 6.05 0.84 NA 18.70 090 

54312 ......... ............ A Reconstruction of urethra ............................ 13.55 NA 7.07 0.96 NA 21.58 090 

54316 ......... ............ A Reconstruction of urethra ............................ 16.79 NA 8.05 1.21 NA 26.05 090 

54318 ......... ............ A Reconstruction of urethra ............................ 11.23 NA 5.88 0.80 NA 17.91 090 

54322 ......... ............ A Reconstruction of urethra ............................ 12.99 NA 6.53 0.99 NA 20.51 090 

54324 ......... ............ A Reconstruction of urethra ............................ 16.29 NA 8.10 1.48 NA 25.87 090 

54326 ......... ............ A Reconstruction of urethra ............................ 15.70 NA 7.89 1.12 NA 24.71 090 

54328 ......... ............ A Revise penis/urethra .................................... 15.63 NA 7.33 1.11 NA 24.07 090 

54332 ......... ............ A Revise penis/urethra .................................... 17.05 NA 7.82 1.21 NA 26.08 090 

54336 ......... ............ A Revise penis/urethra .................................... 20.01 NA 10.59 1.42 NA 32.02 090 

54340 ......... ............ A Secondary urethral surgery ......................... 8.90 NA 5.16 0.59 NA 14.65 090 

54344 ......... ............ A Secondary urethral surgery ......................... 15.92 NA 7.86 1.13 NA 24.91 090 

54348 ......... ............ A Secondary urethral surgery ......................... 17.12 NA 8.48 1.18 NA 26.78 090 

54352 ......... ............ A Reconstruct urethra/penis ............................ 24.70 NA 11.36 1.81 NA 37.87 090 

54360 ......... ............ A Penis plastic surgery ................................... 11.91 NA 6.08 0.86 NA 18.85 090 

54380 ......... ............ A Repair penis ................................................. 13.16 NA 6.78 1.00 NA 20.94 090 

54385 ......... ............ A Repair penis ................................................. 15.37 NA 8.57 1.20 NA 25.14 090 

54390 ......... ............ A Repair penis and bladder ............................ 21.58 NA 9.47 1.28 NA 32.33 090 

54400 ......... ............ A Insert semi-rigid prosthesis .......................... 8.98 NA 4.40 0.65 NA 14.03 090 

54401 ......... ............ A Insert self-contd prosthesis .......................... 10.26 NA 5.75 0.73 NA 16.74 090 

54405 ......... ............ A Insert multi-comp penis pros ....................... 13.41 NA 5.98 0.99 NA 20.38 090 

54406 ......... ............ A Remove muti-comp penis pros .................... 12.08 NA 5.41 0.88 NA 18.37 090 

54408 ......... ............ A Repair multi-comp penis pros ...................... 12.73 NA 5.72 0.92 NA 19.37 090 

54410 ......... ............ A Remove/replace penis prosth ...................... 15.48 NA 6.61 1.13 NA 23.22 090 

54411 ......... ............ A Remov/replc penis pros, comp .................... 15.98 NA 7.02 1.17 NA 24.17 090 

54415 ......... ............ A Remove self-contd penis pros ..................... 8.19 NA 4.18 0.59 NA 12.96 090 

54416 ......... ............ A Remv/repl penis contain pros ...................... 10.85 NA 5.36 0.79 NA 17.00 090 

54417 ......... ............ A Remv/replc penis pros, compl ..................... 14.17 NA 6.15 1.01 NA 21.33 090 

54420 ......... ............ A Revision of penis ......................................... 11.40 NA 5.63 0.91 NA 17.94 090 

54430 ......... ............ A Revision of penis ......................................... 10.13 NA 5.16 0.73 NA 16.02 090 

54435 ......... ............ A Revision of penis ......................................... 6.11 NA 3.66 0.47 NA 10.24 090 

54450 ......... ............ A Preputial stretching ...................................... 1.12 0.95 0.44 0.08 2.15 1.64 000 

54500 ......... ............ A Biopsy of testis ............................................ 1.31 0.60 0.56 0.11 2.02 1.98 000 

54505 ......... ............ A Biopsy of testis ............................................ 3.45 NA 1.91 0.28 NA 5.64 010 

47634

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

54512 ......... ............ A Excise lesion testis ...................................... 8.57 NA 4.12 0.65 NA 13.34 090 

54520 ......... ............ A Removal of testis ......................................... 5.22 NA 2.81 0.50 NA 8.53 090 

54522 ......... ............ A Orchiectomy, partial ..................................... 9.49 NA 4.85 0.91 NA 15.25 090 

54530 ......... ............ A Removal of testis ......................................... 8.57 NA 4.26 0.68 NA 13.51 090 

54535 ......... ............ A Extensive testis surgery ............................... 12.14 NA 5.59 1.09 NA 18.82 090 

54550 ......... ............ A Exploration for testis .................................... 7.77 NA 3.84 0.63 NA 12.24 090 

54560 ......... ............ A Exploration for testis .................................... 11.11 NA 5.20 0.96 NA 17.27 090 

54600 ......... ............ A Reduce testis torsion ................................... 7.00 NA 3.57 0.53 NA 11.10 090 

54620 ......... ............ A Suspension of testis .................................... 4.89 NA 2.43 0.42 NA 7.74 010 

54640 ......... ............ A Suspension of testis .................................... 6.89 NA 3.76 0.63 NA 11.28 090 

54650 ......... ............ A Orchiopexy (Fowler-Stephens) .................... 11.43 NA 5.45 1.41 NA 18.29 090 

54660 ......... ............ A Revision of testis ......................................... 5.10 NA 3.01 0.40 NA 8.51 090 

54670 ......... ............ A Repair testis injury ....................................... 6.40 NA 3.56 0.50 NA 10.46 090 

54680 ......... ............ A Relocation of testis(es) ................................ 12.63 NA 6.22 1.23 NA 20.08 090 

54690 ......... ............ A Laparoscopy, orchiectomy ........................... 10.94 NA 4.99 1.23 NA 17.16 090 

54692 ......... ............ A Laparoscopy, orchiopexy ............................. 12.86 NA 5.40 1.05 NA 19.31 090 

54700 ......... ............ A Drainage of scrotum .................................... 3.42 NA 1.93 0.28 NA 5.63 010 

54800 ......... ............ A Biopsy of epididymis .................................... 2.33 0.94 0.89 0.22 3.49 3.44 000 

54820 ......... ............ A Exploration of epididymis ............................. 5.13 NA 2.96 0.39 NA 8.48 090 

54830 ......... ............ A Remove epididymis lesion ........................... 5.37 NA 3.04 0.42 NA 8.83 090 

54840 ......... ............ A Remove epididymis lesion ........................... 5.19 NA 2.80 0.37 NA 8.36 090 

54860 ......... ............ A Removal of epididymis ................................ 6.31 NA 3.33 0.46 NA 10.10 090 

54861 ......... ............ A Removal of epididymis ................................ 8.89 NA 4.33 0.64 NA 13.86 090 

54900 ......... ............ A Fusion of spermatic ducts ........................... 13.18 NA 5.80 1.62 NA 20.60 090 

54901 ......... ............ A Fusion of spermatic ducts ........................... 17.91 NA 7.55 1.28 NA 26.74 090 

55000 ......... ............ A Drainage of hydrocele ................................. 1.43 2.06 0.65 0.12 3.61 2.20 000 

55040 ......... ............ A Removal of hydrocele .................................. 5.35 NA 2.92 0.44 NA 8.71 090 

55041 ......... ............ A Removal of hydroceles ................................ 7.73 NA 3.98 0.60 NA 12.31 090 

55060 ......... ............ A Repair of hydrocele ..................................... 5.51 NA 3.09 0.46 NA 9.06 090 

55100 ......... ............ A Drainage of scrotum abscess ...................... 2.13 3.67 1.56 0.17 5.97 3.86 010 

55110 ......... ............ A Explore scrotum ........................................... 5.69 NA 3.12 0.45 NA 9.26 090 

55120 ......... ............ A Removal of scrotum lesion .......................... 5.08 NA 2.94 0.39 NA 8.41 090 

55150 ......... ............ A Removal of scrotum ..................................... 7.21 NA 3.83 0.58 NA 11.62 090 

55175 ......... ............ A Revision of scrotum ..................................... 5.23 NA 3.00 0.40 NA 8.63 090 

55180 ......... ............ A Revision of scrotum ..................................... 10.70 NA 5.34 0.85 NA 16.89 090 

55200 ......... ............ A Incision of sperm duct ................................. 4.23 12.26 2.37 0.30 16.79 6.90 090 

55250 ......... ............ A Removal of sperm duct(s) ........................... 3.29 11.44 2.21 0.26 14.99 5.76 090 

55300 ......... ............ A Prepare, sperm duct x-ray ........................... 3.50 NA 1.31 0.26 NA 5.07 000 

55400 ......... ............ A Repair of sperm duct ................................... 8.48 NA 4.05 0.74 NA 13.27 090 

55450 ......... ............ A Ligation of sperm duct ................................. 4.11 6.96 1.86 0.29 11.36 6.26 010 

55500 ......... ............ A Removal of hydrocele .................................. 5.58 NA 3.11 0.55 NA 9.24 090 

55520 ......... ............ A Removal of sperm cord lesion ..................... 6.02 NA 3.28 0.73 NA 10.03 090 

55530 ......... ............ A Revise spermatic cord veins ....................... 5.65 NA 3.03 0.46 NA 9.14 090 

55535 ......... ............ A Revise spermatic cord veins ....................... 6.55 NA 3.41 0.53 NA 10.49 090 

55540 ......... ............ A Revise hernia & sperm veins ...................... 7.66 NA 3.83 0.94 NA 12.43 090 

55550 ......... ............ A Laparo ligate spermatic vein ....................... 6.56 NA 3.29 0.66 NA 10.51 090 

55600 ......... ............ A Incise sperm duct pouch ............................. 6.37 NA 3.35 0.59 NA 10.31 090 

55605 ......... ............ A Incise sperm duct pouch ............................. 7.95 NA 4.32 0.97 NA 13.24 090 

55650 ......... ............ A Remove sperm duct pouch ......................... 11.78 NA 5.29 0.95 NA 18.02 090 

55680 ......... ............ A Remove sperm pouch lesion ....................... 5.18 NA 2.98 0.47 NA 8.63 090 

55700 ......... ............ A Biopsy of prostate ........................................ 1.57 4.18 0.64 0.11 5.86 2.32 000 

55705 ......... ............ A Biopsy of prostate ........................................ 4.56 NA 2.29 0.33 NA 7.18 010 

55720 ......... ............ A Drainage of prostate abscess ...................... 7.63 NA 3.88 0.55 NA 12.06 090 

55725 ......... ............ A Drainage of prostate abscess ...................... 8.67 NA 4.55 0.74 NA 13.96 090 

55801 ......... ............ A Removal of prostate .................................... 17.77 NA 7.65 1.37 NA 26.79 090 

55810 ......... ............ A Extensive prostate surgery .......................... 22.55 NA 8.99 1.66 NA 33.20 090 

55812 ......... ............ A Extensive prostate surgery .......................... 27.47 NA 11.03 2.22 NA 40.72 090 

55815 ......... ............ A Extensive prostate surgery .......................... 30.41 NA 11.94 2.39 NA 44.74 090 

55821 ......... ............ A Removal of prostate .................................... 14.23 NA 6.24 1.05 NA 21.52 090 

55831 ......... ............ A Removal of prostate .................................... 15.60 NA 6.69 1.16 NA 23.45 090 

55840 ......... ............ A Extensive prostate surgery .......................... 22.66 NA 9.33 1.68 NA 33.67 090 

55842 ......... ............ A Extensive prostate surgery .......................... 24.34 NA 9.89 1.82 NA 36.05 090 

55845 ......... ............ A Extensive prostate surgery .......................... 28.51 NA 10.99 2.13 NA 41.63 090 

55859 ......... ............ A Percut/needle insert, pros ............................ 12.50 NA 5.87 0.88 NA 19.25 090 

55860 ......... ............ A Surgical exposure, prostate ......................... 14.43 NA 6.45 0.99 NA 21.87 090 

55862 ......... ............ A Extensive prostate surgery .......................... 18.36 NA 7.88 1.31 NA 27.55 090 

55865 ......... ............ A Extensive prostate surgery .......................... 22.84 NA 9.29 1.73 NA 33.86 090 

55866 ......... ............ A Laparo radical prostatectomy ...................... 30.69 NA 11.68 1.68 NA 44.05 090 

55870 ......... ............ A Electroejaculation ......................................... 2.58 1.53 1.08 0.17 4.28 3.83 000 

55873 ......... ............ A Cryoablate prostate ..................................... 19.44 NA 8.92 1.39 NA 29.75 090 

56405 ......... ............ A I & D of vulva/perineum ............................... 1.44 1.33 1.14 0.17 2.94 2.75 010 

56420 ......... ............ A Drainage of gland abscess .......................... 1.39 2.28 1.05 0.15 3.82 2.59 010 

56440 ......... ............ A Surgery for vulva lesion ............................... 2.84 NA 1.71 0.34 NA 4.89 010 

56441 ......... ............ A Lysis of labial lesion(s) ................................ 1.97 1.81 1.42 0.19 3.97 3.58 010 

56501 ......... ............ A Destroy, vulva lesions, sim .......................... 1.53 1.78 1.25 0.18 3.49 2.96 010 

47635

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

56515 ......... ............ A Destroy vulva lesion/s compl ....................... 2.76 2.55 1.81 0.32 5.63 4.89 010 

56605 ......... ............ A Biopsy of vulva/perineum ............................ 1.10 1.08 0.46 0.13 2.31 1.69 000 

56606 ......... ............ A Biopsy of vulva/perineum ............................ 0.55 0.49 0.22 0.07 1.11 0.84 ZZZ 

56620 ......... ............ A Partial removal of vulva ............................... 7.46 NA 4.83 0.89 NA 13.18 090 

56625 ......... ............ A Complete removal of vulva .......................... 8.39 NA 5.39 1.00 NA 14.78 090 

56630 ......... ............ A Extensive vulva surgery ............................... 12.34 NA 6.96 1.45 NA 20.75 090 

56631 ......... ............ A Extensive vulva surgery ............................... 16.18 NA 8.98 1.92 NA 27.08 090 

56632 ......... ............ A Extensive vulva surgery ............................... 20.26 NA 9.64 2.35 NA 32.25 090 

56633 ......... ............ A Extensive vulva surgery ............................... 16.45 NA 8.71 1.93 NA 27.09 090 

56634 ......... ............ A Extensive vulva surgery ............................... 17.85 NA 9.60 2.09 NA 29.54 090 

56637 ......... ............ A Extensive vulva surgery ............................... 21.94 NA 11.24 2.56 NA 35.74 090 

56640 ......... ............ A Extensive vulva surgery ............................... 22.14 NA 10.78 2.61 NA 35.53 090 

56700 ......... ............ A Partial removal of hymen ............................. 2.52 NA 1.83 0.29 NA 4.64 010 

56720 ......... ............ A Incision of hymen ......................................... 0.68 NA 0.51 0.08 NA 1.27 000 

56740 ......... ............ A Remove vagina gland lesion ....................... 4.56 NA 2.56 0.55 NA 7.67 010 

56800 ......... ............ A Repair of vagina .......................................... 3.88 NA 2.18 0.44 NA 6.50 010 

56805 ......... ............ A Repair clitoris ............................................... 18.83 NA 9.38 2.08 NA 30.29 090 

56810 ......... ............ A Repair of perineum ...................................... 4.12 NA 2.29 0.48 NA 6.89 010 

56820 ......... ............ A Exam of vulva w/scope ................................ 1.50 1.32 0.65 0.11 2.93 2.26 000 

56821 ......... ............ A Exam/biopsy of vulva w/scope .................... 2.05 1.76 0.91 0.15 3.96 3.11 000 

57000 ......... ............ A Exploration of vagina ................................... 2.97 NA 1.72 0.30 NA 4.99 010 

57010 ......... ............ A Drainage of pelvic abscess ......................... 6.02 NA 3.83 0.69 NA 10.54 090 

57020 ......... ............ A Drainage of pelvic fluid ................................ 1.50 0.95 0.59 0.18 2.63 2.27 000 

57022 ......... ............ A I & d vaginal hematoma, pp ........................ 2.56 NA 1.50 0.27 NA 4.33 010 

57023 ......... ............ A I & d vag hematoma, non-ob ....................... 4.74 NA 2.57 0.55 NA 7.86 010 

57061 ......... ............ A Destroy vag lesions, simple ......................... 1.25 1.66 1.12 0.15 3.06 2.52 010 

57065 ......... ............ A Destroy vag lesions, complex ...................... 2.61 2.30 1.68 0.31 5.22 4.60 010 

57100 ......... ............ A Biopsy of vagina .......................................... 1.20 1.09 0.48 0.14 2.43 1.82 000 

57105 ......... ............ A Biopsy of vagina .......................................... 1.69 1.79 1.43 0.20 3.68 3.32 010 

57106 ......... ............ A Remove vagina wall, partial ........................ 6.35 NA 4.19 0.73 NA 11.27 090 

57107 ......... ............ A Remove vagina tissue, part ......................... 22.97 NA 10.45 2.67 NA 36.09 090 

57109 ......... ............ A Vaginectomy partial w/nodes ....................... 26.96 NA 11.28 3.10 NA 41.34 090 

57110 ......... ............ A Remove vagina wall, complete .................... 14.27 NA 7.28 1.67 NA 23.22 090 

57111 ......... ............ A Remove vagina tissue, compl ..................... 26.96 NA 12.58 2.95 NA 42.49 090 

57112 ......... ............ A Vaginectomy w/nodes, compl ...................... 28.96 NA 12.12 2.61 NA 43.69 090 

57120 ......... ............ A Closure of vagina ......................................... 7.40 NA 4.62 0.87 NA 12.89 090 

57130 ......... ............ A Remove vagina lesion ................................. 2.43 2.16 1.54 0.27 4.86 4.24 010 

57135 ......... ............ A Remove vagina lesion ................................. 2.67 2.27 1.65 0.31 5.25 4.63 010 

57150 ......... ............ A Treat vagina infection .................................. 0.55 1.10 0.21 0.07 1.72 0.83 000 

57155 ......... ............ A Insert uteri tandems/ovoids ......................... 6.26 NA 4.61 0.45 NA 11.32 090 

57160 ......... ............ A Insert pessary/other device ......................... 0.89 1.01 0.34 0.10 2.00 1.33 000 

57170 ......... ............ A Fitting of diaphragm/cap .............................. 0.91 1.49 0.33 0.11 2.51 1.35 000 

57180 ......... ............ A Treat vaginal bleeding ................................. 1.58 2.17 1.27 0.18 3.93 3.03 010 

57200 ......... ............ A Repair of vagina .......................................... 3.93 NA 2.89 0.45 NA 7.27 090 

57210 ......... ............ A Repair vagina/perineum ............................... 5.16 NA 3.43 0.61 NA 9.20 090 

57220 ......... ............ A Revision of urethra ...................................... 4.30 NA 3.10 0.50 NA 7.90 090 

57230 ......... ............ A Repair of urethral lesion .............................. 5.63 NA 3.40 0.57 NA 9.60 090 

57240 ......... ............ A Repair bladder & vagina .............................. 6.06 NA 3.81 0.62 NA 10.49 090 

57250 ......... ............ A Repair rectum & vagina ............................... 5.52 NA 3.57 0.64 NA 9.73 090 

57260 ......... ............ A Repair of vagina .......................................... 8.26 NA 4.83 0.96 NA 14.05 090 

57265 ......... ............ A Extensive repair of vagina ........................... 11.32 NA 6.03 1.32 NA 18.67 090 

57268 ......... ............ A Repair of bowel bulge .................................. 6.75 NA 4.19 0.78 NA 11.72 090 

57270 ......... ............ A Repair of bowel pouch ................................. 12.09 NA 6.24 1.39 NA 19.72 090 

57280 ......... ............ A Suspension of vagina .................................. 15.02 NA 7.35 1.65 NA 24.02 090 

57282 ......... ............ A Repair of vaginal prolapse ........................... 8.85 NA 5.29 1.02 NA 15.16 090 

57284 ......... ............ A Repair paravaginal defect ............................ 12.68 NA 7.13 1.44 NA 21.25 090 

57287 ......... ............ A Revise/remove sling repair .......................... 10.69 NA 5.46 0.91 NA 17.06 090 

57288 ......... ............ A Repair bladder defect .................................. 13.00 NA 5.90 1.14 NA 20.04 090 

57289 ......... ............ A Repair bladder & vagina .............................. 11.56 NA 6.03 1.17 NA 18.76 090 

57291 ......... ............ A Construction of vagina ................................. 7.94 NA 4.92 0.94 NA 13.80 090 

57292 ......... ............ A Construct vagina with graft .......................... 13.07 NA 6.93 1.57 NA 21.57 090 

57300 ......... ............ A Repair rectum-vagina fistula ........................ 7.60 NA 4.29 0.88 NA 12.77 090 

57305 ......... ............ A Repair rectum-vagina fistula ........................ 13.75 NA 6.26 1.67 NA 21.68 090 

57307 ......... ............ A Fistula repair & colostomy ........................... 15.91 NA 7.02 1.96 NA 24.89 090 

57308 ......... ............ A Fistula repair, transperine ............................ 9.93 NA 5.13 1.12 NA 16.18 090 

57310 ......... ............ A Repair urethrovaginal lesion ........................ 6.77 NA 3.86 0.57 NA 11.20 090 

57311 ......... ............ A Repair urethrovaginal lesion ........................ 7.97 NA 4.14 0.68 NA 12.79 090 

57320 ......... ............ A Repair bladder-vagina lesion ....................... 8.00 NA 4.39 0.65 NA 13.04 090 

57330 ......... ............ A Repair bladder-vagina lesion ....................... 12.33 NA 5.73 1.07 NA 19.13 090 

57335 ......... ............ A Repair vagina ............................................... 18.70 NA 9.03 1.84 NA 29.57 090 

57400 ......... ............ A Dilation of vagina ......................................... 2.27 NA 1.11 0.26 NA 3.64 000 

57410 ......... ............ A Pelvic examination ....................................... 1.75 2.02 0.89 0.17 3.94 2.81 000 

57415 ......... ............ A Remove vaginal foreign body ...................... 2.17 NA 1.43 0.23 NA 3.83 010 

57420 ......... ............ A Exam of vagina w/scope ............................. 1.60 1.36 0.67 0.11 3.07 2.38 000 

57421 ......... ............ A Exam/biopsy of vag w/scope ....................... 2.20 1.85 0.96 0.15 4.20 3.31 000 

47636 

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued 

CPT 1/ 

HCPCS2 MOD Status Description 

Physician 

work 

RVUs 3

Nonfacility 

PE RVUs 

Facility 

PE RVUs 

Malpractice 

RVUs 

Nonfacility 

Total 

Facility 

total Global 

57425 ......... ............ A Laparoscopy, surg, colpopexy ..................... 15.73 NA 6.63 1.74 NA 24.10 090 

57452 ......... ............ A Exam of cervix w/scope ............................... 1.50 1.29 0.77 0.11 2.90 2.38 000 

57454 ......... ............ A Bx/curett of cervix w/scope .......................... 2.33 1.64 1.15 0.15 4.12 3.63 000 

57455 ......... ............ A Biopsy of cervix w/scope ............................. 1.99 1.72 0.87 0.15 3.86 3.01 000 

57456 ......... ............ A Endocerv curettage w/scope ....................... 1.85 1.65 0.82 0.15 3.65 2.82 000 

57460 ......... ............ A Bx of cervix w/scope, leep ........................... 2.83 5.85 1.37 0.33 9.01 4.53 000 

57461 ......... ............ A Conz of cervix w/scope, leep ...................... 3.43 6.11 1.47 0.33 9.87 5.23 000 

57500 ......... ............ A Biopsy of cervix ........................................... 0.97 2.55 0.63 0.11 3.63 1.71 000 

57505 ......... ............ A Endocervical curettage ................................ 1.14 1.47 1.10 0.13 2.74 2.37 010 

57510 ......... ............ A Cauterization of cervix ................................. 1.90 1.57 1.04 0.22 3.69 3.16 010 

57511 ......... ............ A Cryocautery of cervix ................................... 1.90 1.83 1.38 0.22 3.95 3.50 010 

57513 ......... ............ A Laser surgery of cervix ................................ 1.90 1.73 1.41 0.23 3.86 3.54 010 

57520 ......... ............ A Conization of cervix ..................................... 4.03 3.93 2.88 0.48 8.44 7.39 090 

57522 ......... ............ A Conization of cervix ..................................... 3.35 3.15 2.46 0.40 6.90 6.21 090 

57530 ......... ............ A Removal of cervix ........................................ 4.78 NA 3.42 0.56 NA 8.76 090 

57531 ......... ............ A Removal of cervix, radical ........................... 27.96 NA 13.18 3.29 NA 44.43 090 

57540 ......... ............ A Removal of residual cervix .......................... 12.20 NA 6.24 1.39 NA 19.83 090 

57545 ......... ............ A Remove cervix/repair pelvis ........................ 13.01 NA 6.67 1.57 NA 21.25 090 

57550 ......... ............ A Removal of residual cervix .......................... 5.52 NA 3.85 0.67 NA 10.04 090 

57555 ......... ............ A Remove cervix/repair vagina ....................... 8.94 NA 5.11 1.08 NA 15.13 090 

57556 ......... ............ A Remove cervix, repair bowel ....................... 8.36 NA 4.87 0.95 NA 14.18 090 

57700 ......... ............ A Revision of cervix ........................................ 3.54 NA 3.08 0.40 NA 7.02 090 

57720 ......... ............ A Revision of cervix ........................................ 4.12 NA 3.14 0.49 NA 7.75 090 

57800 ......... ............ A Dilation of cervical canal .............................. 0.77 0.76 0.47 0.09 1.62 1.33 000 

57820 ......... ............ A D & c of residual cervix ............................... 1.67 1.48 1.14 0.20 3.35 3.01 010 

58100 ......... ............ A Biopsy of uterus lining ................................. 1.53 1.32 0.72 0.18 3.03 2.43 000 

58120 ......... ............ A Dilation and curettage .................................. 3.27 2.30 1.87 0.39 5.96 5.53 010 

58140 ......... ............ A Myomectomy abdom method ...................... 14.58 NA 7.10 1.77 NA 23.45 090 

58145 ......... ............ A Myomectomy vag method ........................... 8.03 NA 4.82 0.96 NA 13.81 090 

58146 ......... ............ A Myomectomy abdom complex ..................... 18.97 NA 8.90 1.77 NA 29.64 090 

58150 ......... ............ A Total hysterectomy ...................................... 15.22 NA 7.48 1.81 NA 24.51 090 

58152 ......... ............ A Total hysterectomy ...................................... 20.57 NA 9.83 2.39 NA 32.79 090 

58180 ......... ............ A Partial hysterectomy .................................... 15.27 NA 7.44 1.83 NA 24.54 090 

58200 ......... ............ A Extensive hysterectomy ............................... 21.56 NA 10.00 2.52 NA 34.08 090 

58210 ......... ............ A Extensive hysterectomy ............................... 28.81 NA 13.20 3.31 NA 45.32 090 

58240 ......... ............ A Removal of pelvis contents ......................... 38.33 NA 17.63 4.33 NA 60.29 090 

58260 ......... ............ A Vaginal hysterectomy .................................. 12.96 NA 6.68 1.54 NA 21.18 090 

58262 ......... ............ A Vag hyst including t/o .................................. 14.75 NA 7.36 1.75 NA 23.86 090 

58263 ......... ............ A Vag hyst w/t/o & vag repair ......................... 16.04 NA 7.86 1.90 NA 25.80 090 

58267 ......... ............ A Vag hyst w/urinary repair ............................. 17.01 NA 8.36 2.01 NA 27.38 090 

58270 ......... ............ A Vag hyst w/enterocele repair ....................... 14.24 NA 7.05 1.69 NA 22.98 090 

58275 ......... ............ A Hysterectomy/revise vagina ......................... 15.74 NA 7.75 1.86 NA 25.35 090 

58280 ......... ............ A Hysterectomy/revise vagina ......................... 16.98 NA 8.23 1.99 NA 27.20 090 

58285 ......... ............ A Extensive hysterectomy ............................... 22.23 NA 9.97 2.65 NA 34.85 090 

58290 ......... ............ A Vag hyst complex ........................................ 18.97 NA 9.10 1.48 NA 29.55 090 

58291 ......... ............ A Vag hyst incl t/o, complex ........................... 20.76 NA 9.86 1.75 NA 32.37 090 

58292 ......... ............ A Vag hyst t/o & repair, compl ........................ 22.05 NA 10.34 1.90 NA 34.29 090 

58293 ......... ............ A Vag hyst w/uro repair, compl ....................... 23.03 NA 10.66 2.01 NA 35.70 090 

58294 ......... ............ A Vag hyst w/enterocele, compl ..................... 20.25 NA 9.54 1.69 NA 31.48 090 

58301 ......... ............ A Remove intrauterine device ......................... 1.27 1.32 0.48 0.14 2.73 1.89 000 

58321 ......... ............ A Artificial insemination ................................... 0.92 1.15 0.37 0.11 2.18 1.40 000 

58322 ......... ............ A Artificial insemination ................................... 1.10 1.21 0.42 0.13 2.44 1.65 000 

58323 ......... ............ A Sperm washing ............................................ 0.23 0.53 0.09 0.03 0.79 0.35 000 

58340 ......... ............ A Catheter for hysterography .......................... 0.88 3.16 0.65 0.09 4.13 1.62 000 

58345 ......... ............ A Reopen fallopian tube .................................. 4.65 NA 2.43 0.33 NA 7.41 010 

58346 ......... ............ A Insert heyman uteri capsule ........................ 6.74 NA 3.93 0.79 NA 11.46 090 

58350 ......... ............ A Reopen fallopian tube .................................. 1.01 1.49 0.93 0.12 2.62 2.06 010 

58353 ......... ............ A Endometr ablate, thermal ............................ 3.55 35.73 2.04 0.42 39.70 6.01 010 

58400 ......... ............ A Suspension of uterus ................................... 6.35 NA 3.96 0.75 NA 11.06 090 

58410 ......... ............ A Suspension of uterus ................................... 12.71 NA 6.46 1.37 NA 20.54 090 

58520 ......... ............ A Repair of ruptured uterus ............................ 11.90 NA 6.04 1.32 NA 19.26 090 

58540 ......... ............ A Revision of uterus ........................................ 14.62 NA 6.95 1.76 NA 23.33 090 

58545 ......... ............ A Laparoscopic myomectomy ......................... 14.58 NA 7.21 1.71 NA 23.50 090 

58546 ......... ............ A Laparo-myomectomy, complex .................... 18.97 NA 9.05 1.71 NA 29.73 090 

58550 ......... ............ A Laparo-asst vag hysterectomy .................... 14.17 NA 7.28 1.70 NA 23.15 090 

58552 ......... ............ A Laparo-vag hyst incl t/o ............................... 15.98 NA 8.00 1.70 NA 25.68 090 

58553 ......... ............ A Laparo-vag hyst, complex ........................... 18.97 NA 8.93 1.54 NA 29.44 090 

58554 ......... ............ A Laparo-vag hyst w/t/o, compl ...................... 21.97 NA 10.41 1.54 NA 33.92 090 

58555 ......... ............ A Hysteroscopy, dx, sep proc ......................... 3.33 2.19 1.55 0.40 5.92 5.28 000 

58558 ......... ............ A Hysteroscopy, biopsy ................................... 4.74 NA 2.17 0.57 NA 7.48 000 

58559 ......... ............ A Hysteroscopy, lysis ...................................... 6.16 NA 2.72 0.73 NA 9.61 000 

58560 ......... ............ A Hysteroscopy, resect septum ...................... 6.99 NA 3.07 0.84 NA 10.90 000 

58561 ......... ............ A Hysteroscopy, remove myoma .................... 9.99 NA 4.27 1.18 NA 15.44 000 

58562 ......... ............ A Hysteroscopy, remove fb ............................. 5.20 NA 2.34 0.62 NA 8.16 000 

47637

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

58563 ......... ............ A Hysteroscopy, ablation ................................ 6.16 56.02 2.74 0.74 62.92 9.64 000 

58600 ......... ............ A Division of fallopian tube ............................. 5.59 NA 3.35 0.67 NA 9.61 090 

58605 ......... ............ A Division of fallopian tube ............................. 4.99 NA 3.14 0.59 NA 8.72 090 

58611 ......... ............ A Ligate oviduct(s) add-on .............................. 1.45 NA 0.57 0.17 NA 2.19 ZZZ 

58615 ......... ............ A Occlude fallopian tube(s) ............................. 3.89 NA 2.71 0.48 NA 7.08 010 

58660 ......... ............ A Laparoscopy, lysis ....................................... 11.27 NA 5.25 1.38 NA 17.90 090 

58661 ......... ............ A Laparoscopy, remove adnexa ..................... 11.03 NA 5.11 1.31 NA 17.45 010 

58662 ......... ............ A Laparoscopy, excise lesions ........................ 11.77 NA 5.78 1.42 NA 18.97 090 

58670 ......... ............ A Laparoscopy, tubal cautery ......................... 5.59 NA 3.27 0.66 NA 9.52 090 

58671 ......... ............ A Laparoscopy, tubal block ............................. 5.59 NA 3.28 0.67 NA 9.54 090 

58672 ......... ............ A Laparoscopy, fimbrioplasty .......................... 12.86 NA 6.21 1.49 NA 20.56 090 

58673 ......... ............ A Laparoscopy, salpingostomy ....................... 13.72 NA 6.59 1.68 NA 21.99 090 

58700 ......... ............ A Removal of fallopian tube ............................ 12.03 NA 5.99 1.47 NA 19.49 090 

58720 ......... ............ A Removal of ovary/tube(s) ............................ 11.34 NA 5.79 1.36 NA 18.49 090 

58740 ......... ............ A Revise fallopian tube(s) ............................... 13.98 NA 7.13 1.68 NA 22.79 090 

58750 ......... ............ A Repair oviduct .............................................. 14.82 NA 7.37 1.72 NA 23.91 090 

58752 ......... ............ A Revise ovarian tube(s) ................................. 14.82 NA 6.96 1.82 NA 23.60 090 

58760 ......... ............ A Remove tubal obstruction ............................ 13.11 NA 6.71 1.53 NA 21.35 090 

58770 ......... ............ A Create new tubal opening ........................... 13.95 NA 6.91 1.52 NA 22.38 090 

58800 ......... ............ A Drainage of ovarian cyst(s) ......................... 4.13 3.64 2.90 0.47 8.24 7.50 090 

58805 ......... ............ A Drainage of ovarian cyst(s) ......................... 5.87 NA 3.53 0.66 NA 10.06 090 

58820 ......... ............ A Drain ovary abscess, open .......................... 4.21 NA 3.32 0.41 NA 7.94 090 

58822 ......... ............ A Drain ovary abscess, percut ........................ 10.11 NA 5.22 1.23 NA 16.56 090 

58823 ......... ............ A Drain pelvic abscess, percut ....................... 3.37 21.77 1.12 0.25 25.39 4.74 000 

58825 ......... ............ A Transposition, ovary(s) ................................ 10.96 NA 5.80 1.33 NA 18.09 090 

58900 ......... ............ A Biopsy of ovary(s) ........................................ 5.98 NA 3.59 0.70 NA 10.27 090 

58920 ......... ............ A Partial removal of ovary(s) .......................... 11.34 NA 5.60 1.37 NA 18.31 090 

58925 ......... ............ A Removal of ovarian cyst(s) .......................... 11.34 NA 5.69 1.39 NA 18.42 090 

58940 ......... ............ A Removal of ovary(s) .................................... 7.28 NA 4.12 0.88 NA 12.28 090 

58943 ......... ............ A Removal of ovary(s) .................................... 18.40 NA 8.73 2.19 NA 29.32 090 

58950 ......... ............ A Resect ovarian malignancy ......................... 16.90 NA 8.48 2.01 NA 27.39 090 

58951 ......... ............ A Resect ovarian malignancy ......................... 22.35 NA 10.52 2.62 NA 35.49 090 

58952 ......... ............ A Resect ovarian malignancy ......................... 24.97 NA 11.83 2.96 NA 39.76 090 

58953 ......... ............ A Tah, rad dissect for debulk .......................... 31.95 NA 14.54 3.77 NA 50.26 090 

58954 ......... ............ A Tah rad debulk/lymph remove ..................... 34.95 NA 15.68 4.14 NA 54.77 090 

58960 ......... ............ A Exploration of abdomen ............................... 14.63 NA 7.44 1.74 NA 23.81 090 

58970 ......... ............ A Retrieval of oocyte ....................................... 3.52 2.31 1.49 0.29 6.12 5.30 000 

58976 ......... ............ A Transfer of embryo ...................................... 3.82 2.65 1.82 0.47 6.94 6.11 000 

59000 ......... ............ A Amniocentesis, diagnostic ........................... 1.30 2.08 0.67 0.31 3.69 2.28 000 

59001 ......... ............ A Amniocentesis, therapeutic .......................... 3.00 NA 1.40 0.71 NA 5.11 000 

59012 ......... ............ A Fetal cord puncture,prenatal ........................ 3.44 NA 1.53 0.82 NA 5.79 000 

59015 ......... ............ A Chorion biopsy ............................................. 2.20 1.56 1.04 0.52 4.28 3.76 000 

59020 ......... ............ A Fetal contract stress test ............................. 0.66 0.78 NA 0.26 1.70 NA 000 

59020 ......... 26 ....... A Fetal contract stress test ............................. 0.66 0.26 0.26 0.16 1.08 1.08 000 

59020 ......... TC ...... A Fetal contract stress test ............................. 0.00 0.52 NA 0.10 0.62 NA 000 

59025 ......... ............ A Fetal non-stress test .................................... 0.53 0.44 NA 0.15 1.12 NA 000 

59025 ......... 26 ....... A Fetal non-stress test .................................... 0.53 0.21 0.21 0.13 0.87 0.87 000 

59025 ......... TC ...... A Fetal non-stress test .................................... 0.00 0.23 NA 0.02 0.25 NA 000 

59030 ......... ............ A Fetal scalp blood sample ............................. 1.99 NA 0.77 0.47 NA 3.23 000 

59050 ......... ............ A Fetal monitor w/report .................................. 0.89 NA 0.35 0.21 NA 1.45 XXX 

59051 ......... ............ A Fetal monitor/interpret only .......................... 0.74 NA 0.29 0.18 NA 1.21 XXX 

59070 ......... ............ A Transabdom amnioinfus w/ us .................... 5.24 5.06 2.29 0.28 10.58 7.81 000 

59072 ......... ............ A Umbilical cord occlud w/ us ......................... 8.99 NA 3.11 0.16 NA 12.26 000 

59074 ......... ............ A Fetal fluid drainage w/ us ............................ 5.24 4.47 2.29 0.28 9.99 7.81 000 

59076 ......... ............ A Fetal shunt placement, w/ us ...................... 8.99 NA 3.11 0.16 NA 12.26 000 

59100 ......... ............ A Remove uterus lesion .................................. 12.33 NA 6.46 2.93 NA 21.72 090 

59120 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.24 2.73 NA 20.44 090 

59121 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.32 2.77 NA 20.74 090 

59130 ......... ............ A Treat ectopic pregnancy .............................. 14.20 NA 4.86 1.96 NA 21.02 090 

59135 ......... ............ A Treat ectopic pregnancy .............................. 13.86 NA 7.22 3.00 NA 24.08 090 

59136 ......... ............ A Treat ectopic pregnancy .............................. 13.16 NA 6.61 2.85 NA 22.62 090 

59140 ......... ............ A Treat ectopic pregnancy .............................. 5.45 2.20 2.20 1.30 8.95 8.95 090 

59150 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.02 2.77 NA 20.44 090 

59151 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.06 2.73 NA 20.26 090 

59160 ......... ............ A D & c after delivery ...................................... 2.71 3.29 2.13 0.64 6.64 5.48 010 

59200 ......... ............ A Insert cervical dilator .................................... 0.79 1.19 0.30 0.19 2.17 1.28 000 

59300 ......... ............ A Episiotomy or vaginal repair ........................ 2.41 2.20 0.95 0.57 5.18 3.93 000 

59320 ......... ............ A Revision of cervix ........................................ 2.48 NA 1.24 0.59 NA 4.31 000 

59325 ......... ............ A Revision of cervix ........................................ 4.06 NA 1.89 0.88 NA 6.83 000 

59350 ......... ............ A Repair of uterus ........................................... 4.94 NA 1.86 1.18 NA 7.98 000 

59400 ......... ............ A Obstetrical care ............................................ 23.03 NA 15.35 5.48 NA 43.86 MMM 

59409 ......... ............ A Obstetrical care ............................................ 13.48 NA 5.29 3.21 NA 21.98 MMM 

59410 ......... ............ A Obstetrical care ............................................ 14.76 NA 6.29 3.51 NA 24.56 MMM 

59412 ......... ............ A Antepartum manipulation ............................. 1.71 NA 0.81 0.41 NA 2.93 MMM 

59414 ......... ............ A Deliver placenta ........................................... 1.61 NA 0.64 0.38 NA 2.63 MMM 

47638

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

59425 ......... ............ A Antepartum care only .................................. 4.80 4.22 1.85 1.14 10.16 7.79 MMM 

59426 ......... ............ A Antepartum care only .................................. 8.27 7.58 3.21 1.97 17.82 13.45 MMM 

59430 ......... ............ A Care after delivery ....................................... 2.13 1.23 0.93 0.51 3.87 3.57 MMM 

59510 ......... ............ A Cesarean delivery ........................................ 26.18 NA 17.26 6.23 NA 49.67 MMM 

59514 ......... ............ A Cesarean delivery only ................................ 15.95 NA 6.19 3.79 NA 25.93 MMM 

59515 ......... ............ A Cesarean delivery ........................................ 17.34 NA 7.81 4.13 NA 29.28 MMM 

59525 ......... ............ A Remove uterus after cesarean .................... 8.53 NA 3.29 2.03 NA 13.85 ZZZ 

59610 ......... ............ A Vbac delivery ............................................... 24.58 NA 15.89 5.85 NA 46.32 MMM 

59612 ......... ............ A Vbac delivery only ....................................... 15.04 NA 6.03 3.58 NA 24.65 MMM 

59614 ......... ............ A Vbac care after delivery ............................... 16.32 NA 6.91 3.88 NA 27.11 MMM 

59618 ......... ............ A Attempted vbac delivery .............................. 27.74 NA 18.29 6.60 NA 52.63 MMM 

59620 ......... ............ A Attempted vbac delivery only ...................... 17.50 NA 6.74 4.17 NA 28.41 MMM 

59622 ......... ............ A Attempted vbac after care ........................... 18.90 NA 8.61 4.50 NA 32.01 MMM 

59812 ......... ............ A Treatment of miscarriage ............................. 4.00 NA 2.54 0.95 NA 7.49 090 

59820 ......... ............ A Care of miscarriage ..................................... 4.00 4.43 3.56 0.95 9.38 8.51 090 

59821 ......... ............ A Treatment of miscarriage ............................. 4.46 4.26 3.40 1.06 9.78 8.92 090 

59830 ......... ............ A Treat uterus infection ................................... 6.10 NA 3.99 1.45 NA 11.54 090 

59840 ......... ............ R Abortion ........................................................ 3.01 NA 2.12 0.72 NA 5.85 010 

59841 ......... ............ R Abortion ........................................................ 5.23 2.56 2.56 1.25 9.04 9.04 010 

59850 ......... ............ R Abortion ........................................................ 5.90 NA 3.25 1.28 NA 10.43 090 

59851 ......... ............ R Abortion ........................................................ 5.92 NA 3.73 1.41 NA 11.06 090 

59852 ......... ............ R Abortion ........................................................ 8.23 NA 5.05 1.79 NA 15.07 090 

59855 ......... ............ R Abortion ........................................................ 6.11 NA 3.55 1.45 NA 11.11 090 

59856 ......... ............ R Abortion ........................................................ 7.47 NA 4.05 1.62 NA 13.14 090 

59857 ......... ............ R Abortion ........................................................ 9.28 NA 4.59 2.00 NA 15.87 090 

59866 ......... ............ R Abortion (mpr) .............................................. 3.99 NA 1.82 0.87 NA 6.68 000 

59870 ......... ............ A Evacuate mole of uterus .............................. 6.00 NA 4.42 1.43 NA 11.85 090 

59871 ......... ............ A Remove cerclage suture .............................. 2.13 1.74 1.13 0.51 4.38 3.77 000 

60000 ......... ............ A Drain thyroid/tongue cyst ............................. 1.76 1.94 1.73 0.14 3.84 3.63 010 

60001 ......... ............ A Aspirate/inject thyriod cyst ........................... 0.97 1.43 0.33 0.08 2.48 1.38 000 

60100 ......... ............ A Biopsy of thyroid .......................................... 1.56 1.40 0.53 0.10 3.06 2.19 000 

60200 ......... ............ A Remove thyroid lesion ................................. 9.54 NA 6.08 1.01 NA 16.63 090 

60210 ......... ............ A Partial thyroid excision ................................. 10.86 NA 5.72 1.24 NA 17.82 090 

60212 ......... ............ A Partial thyroid excision ................................. 16.01 NA 7.75 1.59 NA 25.35 090 

60220 ......... ............ A Partial removal of thyroid ............................. 11.88 NA 6.24 1.34 NA 19.46 090 

60225 ......... ............ A Partial removal of thyroid ............................. 14.17 NA 7.48 1.65 NA 23.30 090 

60240 ......... ............ A Removal of thyroid ....................................... 16.04 NA 7.68 1.84 NA 25.56 090 

60252 ......... ............ A Removal of thyroid ....................................... 20.54 NA 10.20 2.28 NA 33.02 090 

60254 ......... ............ A Extensive thyroid surgery ............................ 26.95 NA 14.28 2.75 NA 43.98 090 

60260 ......... ............ A Repeat thyroid surgery ................................ 17.44 NA 8.77 1.94 NA 28.15 090 

60270 ......... ............ A Removal of thyroid ....................................... 20.24 NA 10.56 2.27 NA 33.07 090 

60271 ......... ............ A Removal of thyroid ....................................... 16.80 NA 8.70 1.83 NA 27.33 090 

60280 ......... ............ A Remove thyroid duct lesion ......................... 5.86 NA 4.78 0.53 NA 11.17 090 

60281 ......... ............ A Remove thyroid duct lesion ......................... 8.52 NA 5.94 0.80 NA 15.26 090 

60500 ......... ............ A Explore parathyroid glands .......................... 16.21 NA 7.47 1.98 NA 25.66 090 

60502 ......... ............ A Re-explore parathyroids .............................. 20.32 NA 9.41 2.50 NA 32.23 090 

60505 ......... ............ A Explore parathyroid glands .......................... 21.46 NA 11.03 2.65 NA 35.14 090 

60512 ......... ............ A Autotransplant parathyroid ........................... 4.44 NA 1.62 0.54 NA 6.60 ZZZ 

60520 ......... ............ A Removal of thymus gland ............................ 16.78 NA 8.31 2.16 NA 27.25 090 

60521 ......... ............ A Removal of thymus gland ............................ 18.84 NA 9.57 1.92 NA 30.33 090 

60522 ......... ............ A Removal of thymus gland ............................ 23.06 NA 11.28 3.13 NA 37.47 090 

60540 ......... ............ A Explore adrenal gland .................................. 17.00 NA 7.58 1.75 NA 26.33 090 

60545 ......... ............ A Explore adrenal gland .................................. 19.85 NA 8.54 2.05 NA 30.44 090 

60600 ......... ............ A Remove carotid body lesion ........................ 17.90 NA 10.76 2.15 NA 30.81 090 

60605 ......... ............ A Remove carotid body lesion ........................ 20.21 NA 12.59 2.45 NA 35.25 090 

60650 ......... ............ A Laparoscopy adrenalectomy ........................ 19.97 NA 7.95 2.32 NA 30.24 090 

61000 ......... ............ A Remove cranial cavity fluid .......................... 1.58 NA 0.96 0.17 NA 2.71 000 

61001 ......... ............ A Remove cranial cavity fluid .......................... 1.49 NA 1.07 0.18 NA 2.74 000 

61020 ......... ............ A Remove brain cavity fluid ............................ 1.51 NA 1.35 0.30 NA 3.16 000 

61026 ......... ............ A Injection into brain canal .............................. 1.69 NA 1.40 0.25 NA 3.34 000 

61050 ......... ............ A Remove brain canal fluid ............................. 1.51 NA 1.27 0.12 NA 2.90 000 

61055 ......... ............ A Injection into brain canal .............................. 2.10 NA 1.43 0.16 NA 3.69 000 

61070 ......... ............ A Brain canal shunt procedure ....................... 0.89 NA 1.03 0.14 NA 2.06 000 

61105 ......... ............ A Twist drill hole .............................................. 5.13 NA 3.93 1.26 NA 10.32 090 

61107 ......... ............ A Drill skull for implantation ............................ 4.99 NA 2.52 1.24 NA 8.75 000 

61108 ......... ............ A Drill skull for drainage .................................. 10.17 NA 7.13 2.53 NA 19.83 090 

61120 ......... ............ A Burr hole for puncture .................................. 8.75 NA 5.99 2.04 NA 16.78 090 

61140 ......... ............ A Pierce skull for biopsy ................................. 15.88 NA 9.87 3.63 NA 29.38 090 

61150 ......... ............ A Pierce skull for drainage .............................. 17.54 NA 10.36 3.95 NA 31.85 090 

61151 ......... ............ A Pierce skull for drainage .............................. 12.40 NA 7.81 2.97 NA 23.18 090 

61154 ......... ............ A Pierce skull & remove clot ........................... 14.97 NA 9.47 3.76 NA 28.20 090 

61156 ......... ............ A Pierce skull for drainage .............................. 16.30 NA 9.82 4.03 NA 30.15 090 

61210 ......... ............ A Pierce skull, implant device ......................... 5.83 NA 2.91 1.45 NA 10.19 000 

61215 ......... ............ A Insert brain-fluid device ............................... 4.88 NA 4.00 1.21 NA 10.09 090 

61250 ......... ............ A Pierce skull & explore .................................. 10.40 NA 6.84 2.15 NA 19.39 090 

47639

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

61253 ......... ............ A Pierce skull & explore .................................. 12.34 NA 7.72 2.01 NA 22.07 090 

61304 ......... ............ A Open skull for exploration ............................ 21.93 NA 12.83 4.96 NA 39.72 090 

61305 ......... ............ A Open skull for exploration ............................ 26.57 NA 15.30 6.08 NA 47.95 090 

61312 ......... ............ A Open skull for drainage ............................... 24.53 NA 15.03 5.60 NA 45.16 090 

61313 ......... ............ A Open skull for drainage ............................... 24.89 NA 14.79 5.79 NA 45.47 090 

61314 ......... ............ A Open skull for drainage ............................... 24.19 NA 13.03 5.53 NA 42.75 090 

61315 ......... ............ A Open skull for drainage ............................... 27.64 NA 16.00 6.33 NA 49.97 090 

61316 ......... ............ A Implt cran bone flap to abdo ....................... 1.39 NA 0.60 0.52 NA 2.51 ZZZ 

61320 ......... ............ A Open skull for drainage ............................... 25.58 NA 14.74 5.81 NA 46.13 090 

61321 ......... ............ A Open skull for drainage ............................... 28.46 NA 16.11 6.55 NA 51.12 090 

61322 ......... ............ A Decompressive craniotomy ......................... 29.46 NA 15.68 6.02 NA 51.16 090 

61323 ......... ............ A Decompressive lobectomy ........................... 30.95 NA 16.13 6.02 NA 53.10 090 

61330 ......... ............ A Decompress eye socket .............................. 23.29 NA 13.70 3.67 NA 40.66 090 

61332 ......... ............ A Explore/biopsy eye socket ........................... 27.24 NA 15.57 4.76 NA 47.57 090 

61333 ......... ............ A Explore orbit/remove lesion ......................... 27.91 NA 15.55 3.55 NA 47.01 090 

61334 ......... ............ A Explore orbit/remove object ......................... 18.24 NA 10.62 3.15 NA 32.01 090 

61340 ......... ............ A Subtemporal decompression ....................... 18.63 NA 11.12 4.26 NA 34.01 090 

61343 ......... ............ A Incise skull (press relief) .............................. 29.73 NA 16.81 6.70 NA 53.24 090 

61345 ......... ............ A Relieve cranial pressure .............................. 27.16 NA 15.40 5.70 NA 48.26 090 

61440 ......... ............ A Incise skull for surgery ................................. 26.59 NA 14.21 6.88 NA 47.68 090 

61450 ......... ............ A Incise skull for surgery ................................. 25.91 NA 14.28 5.43 NA 45.62 090 

61458 ......... ............ A Incise skull for brain wound ......................... 27.25 NA 15.50 6.24 NA 48.99 090 

61460 ......... ............ A Incise skull for surgery ................................. 28.35 NA 16.40 5.35 NA 50.10 090 

61470 ......... ............ A Incise skull for surgery ................................. 26.02 NA 13.85 6.74 NA 46.61 090 

61480 ......... ............ A Incise skull for surgery ................................. 26.45 NA 15.27 6.10 NA 47.82 090 

61490 ......... ............ A Incise skull for surgery ................................. 25.62 NA 14.32 6.26 NA 46.20 090 

61500 ......... ............ A Removal of skull lesion ................................ 17.89 NA 10.80 3.71 NA 32.40 090 

61501 ......... ............ A Remove infected skull bone ........................ 14.82 NA 9.21 3.00 NA 27.03 090 

61510 ......... ............ A Removal of brain lesion ............................... 28.41 NA 16.68 6.49 NA 51.58 090 

61512 ......... ............ A Remove brain lining lesion .......................... 35.04 NA 19.66 8.06 NA 62.76 090 

61514 ......... ............ A Removal of brain abscess ........................... 25.22 NA 14.42 6.01 NA 45.65 090 

61516 ......... ............ A Removal of brain lesion ............................... 24.57 NA 14.27 5.43 NA 44.27 090 

61517 ......... ............ A Implt brain chemotx add-on ......................... 1.38 NA 0.64 0.10 NA 2.12 ZZZ 

61518 ......... ............ A Removal of brain lesion ............................... 37.26 NA 21.09 8.46 NA 66.81 090 

61519 ......... ............ A Remove brain lining lesion .......................... 41.33 NA 22.64 9.61 NA 73.58 090 

61520 ......... ............ A Removal of brain lesion ............................... 54.76 NA 30.31 10.02 NA 95.09 090 

61521 ......... ............ A Removal of brain lesion ............................... 44.41 NA 24.21 9.76 NA 78.38 090 

61522 ......... ............ A Removal of brain abscess ........................... 29.41 NA 16.42 6.78 NA 52.61 090 

61524 ......... ............ A Removal of brain lesion ............................... 27.82 NA 15.67 6.02 NA 49.51 090 

61526 ......... ............ A Removal of brain lesion ............................... 52.09 NA 29.46 7.10 NA 88.65 090 

61530 ......... ............ A Removal of brain lesion ............................... 43.79 NA 25.06 5.67 NA 74.52 090 

61531 ......... ............ A Implant brain electrodes .............................. 14.61 NA 9.13 3.60 NA 27.34 090 

61533 ......... ............ A Implant brain electrodes .............................. 19.68 NA 11.54 4.43 NA 35.65 090 

61534 ......... ............ A Removal of brain lesion ............................... 20.94 NA 12.10 5.32 NA 38.36 090 

61535 ......... ............ A Remove brain electrodes ............................. 11.61 NA 7.43 2.81 NA 21.85 090 

61536 ......... ............ A Removal of brain lesion ............................... 35.47 NA 19.78 7.56 NA 62.81 090 

61537 ......... ............ A Removal of brain tissue ............................... 24.96 NA 14.72 6.05 NA 45.73 090 

61538 ......... ............ A Removal of brain tissue ............................... 26.77 NA 15.31 6.05 NA 48.13 090 

61539 ......... ............ A Removal of brain tissue ............................... 32.03 NA 17.77 7.41 NA 57.21 090 

61540 ......... ............ A Removal of brain tissue ............................... 29.96 NA 17.23 7.41 NA 54.60 090 

61541 ......... ............ A Incision of brain tissue ................................. 28.81 NA 16.20 6.10 NA 51.11 090 

61542 ......... ............ A Removal of brain tissue ............................... 30.97 NA 17.82 7.83 NA 56.62 090 

61543 ......... ............ A Removal of brain tissue ............................... 29.18 NA 16.39 6.58 NA 52.15 090 

61544 ......... ............ A Remove & treat brain lesion ........................ 25.46 NA 13.84 5.73 NA 45.03 090 

61545 ......... ............ A Excision of brain tumor ................................ 43.73 NA 24.21 10.03 NA 77.97 090 

61546 ......... ............ A Removal of pituitary gland ........................... 31.25 NA 17.49 7.15 NA 55.89 090 

61548 ......... ............ A Removal of pituitary gland ........................... 21.50 NA 12.79 3.31 NA 37.60 090 

61550 ......... ............ A Release of skull seams ............................... 14.63 NA 6.98 1.37 NA 22.98 090 

61552 ......... ............ A Release of skull seams ............................... 19.53 NA 9.14 5.06 NA 33.73 090 

61556 ......... ............ A Incise skull/sutures ...................................... 22.23 NA 11.37 5.12 NA 38.72 090 

61557 ......... ............ A Incise skull/sutures ...................................... 22.35 NA 13.62 5.79 NA 41.76 090 

61558 ......... ............ A Excision of skull/sutures .............................. 25.54 NA 14.18 3.15 NA 42.87 090 

61559 ......... ............ A Excision of skull/sutures .............................. 32.74 NA 19.30 2.01 NA 54.05 090 

61563 ......... ............ A Excision of skull tumor ................................. 26.79 NA 15.25 5.75 NA 47.79 090 

61564 ......... ............ A Excision of skull tumor ................................. 33.78 NA 18.27 8.28 NA 60.33 090 

61566 ......... ............ A Removal of brain tissue ............................... 30.95 NA 17.75 6.05 NA 54.75 090 

61567 ......... ............ A Incision of brain tissue ................................. 35.45 NA 20.66 6.49 NA 62.60 090 

61570 ......... ............ A Remove foreign body, brain ........................ 24.56 NA 13.90 5.07 NA 43.53 090 

61571 ......... ............ A Incise skull for brain wound ......................... 26.35 NA 15.13 5.77 NA 47.25 090 

61575 ......... ............ A Skull base/brainstem surgery ...................... 34.31 NA 19.64 5.42 NA 59.37 090 

61576 ......... ............ A Skull base/brainstem surgery ...................... 52.35 NA 34.69 5.80 NA 92.84 090 

61580 ......... ............ A Craniofacial approach, skull ........................ 30.30 NA 25.50 3.37 NA 59.17 090 

61581 ......... ............ A Craniofacial approach, skull ........................ 34.55 NA 23.42 3.30 NA 61.27 090 

61582 ......... ............ A Craniofacial approach, skull ........................ 31.61 NA 27.28 6.96 NA 65.85 090 

61583 ......... ............ A Craniofacial approach, skull ........................ 36.16 NA 25.08 8.12 NA 69.36 090 

47640

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

61584 ......... ............ A Orbitocranial approach/skull ........................ 34.60 NA 24.48 7.51 NA 66.59 090 

61585 ......... ............ A Orbitocranial approach/skull ........................ 38.55 NA 26.44 7.50 NA 72.49 090 

61586 ......... ............ A Resect nasopharynx, skull ........................... 25.06 NA 22.52 4.95 NA 52.53 090 

61590 ......... ............ A Infratemporal approach/skull ....................... 41.72 NA 28.54 5.11 NA 75.37 090 

61591 ......... ............ A Infratemporal approach/skull ....................... 43.61 NA 29.45 5.64 NA 78.70 090 

61592 ......... ............ A Orbitocranial approach/skull ........................ 39.58 NA 26.46 8.93 NA 74.97 090 

61595 ......... ............ A Transtemporal approach/skull ..................... 29.53 NA 22.27 3.81 NA 55.61 090 

61596 ......... ............ A Transcochlear approach/skull ...................... 35.58 NA 24.37 4.83 NA 64.78 090 

61597 ......... ............ A Transcondylar approach/skull ...................... 37.90 NA 22.96 8.56 NA 69.42 090 

61598 ......... ............ A Transpetrosal approach/skull ....................... 33.36 NA 23.18 5.50 NA 62.04 090 

61600 ......... ............ A Resect/excise cranial lesion ........................ 25.81 NA 19.72 3.60 NA 49.13 090 

61601 ......... ............ A Resect/excise cranial lesion ........................ 27.85 NA 20.46 6.16 NA 54.47 090 

61605 ......... ............ A Resect/excise cranial lesion ........................ 29.29 NA 21.89 2.90 NA 54.08 090 

61606 ......... ............ A Resect/excise cranial lesion ........................ 38.77 NA 25.10 8.22 NA 72.09 090 

61607 ......... ............ A Resect/excise cranial lesion ........................ 36.22 NA 23.74 6.58 NA 66.54 090 

61608 ......... ............ A Resect/excise cranial lesion ........................ 42.04 NA 26.54 9.67 NA 78.25 090 

61609 ......... ............ A Transect artery, sinus .................................. 9.88 NA 4.85 1.57 NA 16.30 ZZZ 

61610 ......... ............ A Transect artery, sinus .................................. 29.63 NA 13.11 4.25 NA 46.99 ZZZ 

61611 ......... ............ A Transect artery, sinus .................................. 7.41 NA 3.81 1.87 NA 13.09 ZZZ 

61612 ......... ............ A Transect artery, sinus .................................. 27.84 NA 13.29 2.08 NA 43.21 ZZZ 

61613 ......... ............ A Remove aneurysm, sinus ............................ 40.80 NA 26.22 8.76 NA 75.78 090 

61615 ......... ............ A Resect/excise lesion, skull ........................... 32.02 NA 22.66 5.07 NA 59.75 090 

61616 ......... ............ A Resect/excise lesion, skull ........................... 43.27 NA 28.59 8.13 NA 79.99 090 

61618 ......... ............ A Repair dura .................................................. 16.96 NA 10.46 3.42 NA 30.84 090 

61619 ......... ............ A Repair dura .................................................. 20.68 NA 12.25 3.41 NA 36.34 090 

61623 ......... ............ A Endovasc tempory vessel occl .................... 9.95 NA 4.07 0.60 NA 14.62 000 

61624 ......... ............ A Transcath occlusion, cns ............................. 20.12 NA 6.88 1.84 NA 28.84 000 

61626 ......... ............ A Transcath occlusion, non-cns ...................... 16.60 NA 5.50 1.17 NA 23.27 000 

61680 ......... ............ A Intracranial vessel surgery ........................... 30.66 NA 17.44 7.03 NA 55.13 090 

61682 ......... ............ A Intracranial vessel surgery ........................... 61.48 NA 32.20 14.22 NA 107.90 090 

61684 ......... ............ A Intracranial vessel surgery ........................... 39.75 NA 21.99 9.24 NA 70.98 090 

61686 ......... ............ A Intracranial vessel surgery ........................... 64.39 NA 34.70 14.04 NA 113.13 090 

61690 ......... ............ A Intracranial vessel surgery ........................... 29.27 NA 16.72 7.58 NA 53.57 090 

61692 ......... ............ A Intracranial vessel surgery ........................... 51.79 NA 27.47 11.64 NA 90.90 090 

61697 ......... ............ A Brain aneurysm repr, complx ...................... 50.44 NA 27.98 12.05 NA 90.47 090 

61698 ......... ............ A Brain aneurysm repr, complx ...................... 48.34 NA 26.67 11.01 NA 86.02 090 

61700 ......... ............ A Brain aneurysm repr, simple ....................... 50.44 NA 27.78 11.94 NA 90.16 090 

61702 ......... ............ A Inner skull vessel surgery ............................ 48.34 NA 26.02 11.56 NA 85.92 090 

61703 ......... ............ A Clamp neck artery ....................................... 17.44 NA 10.48 3.72 NA 31.64 090 

61705 ......... ............ A Revise circulation to head ........................... 36.15 NA 19.24 8.11 NA 63.50 090 

61708 ......... ............ A Revise circulation to head ........................... 35.25 NA 15.14 2.67 NA 53.06 090 

61710 ......... ............ A Revise circulation to head ........................... 29.63 NA 13.63 3.78 NA 47.04 090 

61711 ......... ............ A Fusion of skull arteries ................................ 36.28 NA 19.80 8.36 NA 64.44 090 

61720 ......... ............ A Incise skull/brain surgery ............................. 16.74 NA 9.98 3.55 NA 30.27 090 

61735 ......... ............ A Incise skull/brain surgery ............................. 20.40 NA 12.16 3.83 NA 36.39 090 

61750 ......... ............ A Incise skull/brain biopsy ............................... 18.17 NA 10.61 4.48 NA 33.26 090 

61751 ......... ............ A Brain biopsy w/ct/mr guide .......................... 17.59 NA 10.82 4.34 NA 32.75 090 

61760 ......... ............ A Implant brain electrodes .............................. 22.24 NA 8.73 5.49 NA 36.46 090 

61770 ......... ............ A Incise skull for treatment ............................. 21.41 NA 12.26 4.44 NA 38.11 090 

61790 ......... ............ A Treat trigeminal nerve .................................. 10.84 NA 5.92 2.66 NA 19.42 090 

61791 ......... ............ A Treat trigeminal tract .................................... 14.59 NA 8.92 3.51 NA 27.02 090 

61793 ......... ............ A Focus radiation beam .................................. 17.21 NA 10.13 4.22 NA 31.56 090 

61795 ......... ............ A Brain surgery using computer ..................... 4.03 NA 2.03 0.80 NA 6.86 ZZZ 

61850 ......... ............ A Implant neuroelectrodes .............................. 12.37 NA 7.68 1.98 NA 22.03 090 

61860 ......... ............ A Implant neuroelectrodes .............................. 20.84 NA 12.07 4.87 NA 37.78 090 

61863 ......... ............ A Implant neuroelectrode ................................ 18.97 NA 11.76 4.66 NA 35.39 090 

61864 ......... ............ A Implant neuroelectrde, add-l ........................ 4.49 NA 2.27 4.66 NA 11.42 ZZZ 

61867 ......... ............ A Implant neuroelectrode ................................ 31.29 NA 18.00 4.66 NA 53.95 090 

61868 ......... ............ A Implant neuroelectrde, add-l ........................ 7.91 NA 4.01 4.66 NA 16.58 ZZZ 

61870 ......... ............ A Implant neuroelectrodes .............................. 14.92 NA 9.73 2.05 NA 26.70 090 

61875 ......... ............ A Implant neuroelectrodes .............................. 15.04 NA 8.57 2.39 NA 26.00 090 

61880 ......... ............ A Revise/remove neuroelectrode .................... 6.28 NA 4.59 1.50 NA 12.37 090 

61885 ......... ............ A Implant neurostim one array ........................ 5.84 NA 5.31 1.35 NA 12.50 090 

61886 ......... ............ A Implant neurostim arrays ............................. 7.99 NA 6.36 1.78 NA 16.13 090 

61888 ......... ............ A Revise/remove neuroreceiver ...................... 5.06 NA 3.67 1.22 NA 9.95 010 

62000 ......... ............ A Treat skull fracture ....................................... 12.51 NA 5.50 1.28 NA 19.29 090 

62005 ......... ............ A Treat skull fracture ....................................... 16.15 NA 8.79 3.26 NA 28.20 090 

62010 ......... ............ A Treatment of head injury ............................. 19.78 NA 11.70 4.64 NA 36.12 090 

62100 ......... ............ A Repair brain fluid leakage ............................ 22.00 NA 12.80 4.71 NA 39.51 090 

62115 ......... ............ A Reduction of skull defect ............................. 21.63 NA 11.64 5.46 NA 38.73 090 

62116 ......... ............ A Reduction of skull defect ............................. 23.55 NA 13.36 1.92 NA 38.83 090 

62117 ......... ............ A Reduction of skull defect ............................. 26.56 NA 15.37 6.88 NA 48.81 090 

62120 ......... ............ A Repair skull cavity lesion ............................. 23.31 NA 18.61 2.64 NA 44.56 090 

62121 ......... ............ A Incise skull repair ......................................... 21.55 NA 15.41 3.49 NA 40.45 090 

62140 ......... ............ A Repair of skull defect ................................... 13.49 NA 8.33 3.02 NA 24.84 090 

47641

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

62141 ......... ............ A Repair of skull defect ................................... 14.89 NA 9.06 3.26 NA 27.21 090 

62142 ......... ............ A Remove skull plate/flap ............................... 10.77 NA 7.00 2.41 NA 20.18 090 

62143 ......... ............ A Replace skull plate/flap ................................ 13.03 NA 8.05 3.02 NA 24.10 090 

62145 ......... ............ A Repair of skull & brain ................................. 18.79 NA 10.90 3.77 NA 33.46 090 

62146 ......... ............ A Repair of skull with graft .............................. 16.10 NA 9.64 3.20 NA 28.94 090 

62147 ......... ............ A Repair of skull with graft .............................. 19.31 NA 11.32 4.35 NA 34.98 090 

62148 ......... ............ A Retr bone flap to fix skull ............................. 2.00 NA 0.86 0.52 NA 3.38 ZZZ 

62160 ......... ............ A Neuroendoscopy add-on ............................. 3.00 NA 1.53 0.63 NA 5.16 ZZZ 

62161 ......... ............ A Dissect brain w/scope .................................. 19.97 NA 12.08 4.46 NA 36.51 090 

62162 ......... ............ A Remove colloid cyst w/scope ...................... 25.21 NA 15.07 6.96 NA 47.24 090 

62163 ......... ............ A Neuroendoscopy w/fb removal .................... 15.48 NA 9.91 4.46 NA 29.85 090 

62164 ......... ............ A Remove brain tumor w/scope ...................... 27.46 NA 14.95 6.96 NA 49.37 090 

62165 ......... ............ A Remove pituit tumor w/scope ...................... 21.97 NA 13.34 4.38 NA 39.69 090 

62180 ......... ............ A Establish brain cavity shunt ......................... 21.03 NA 12.29 4.55 NA 37.87 090 

62190 ......... ............ A Establish brain cavity shunt ......................... 11.05 NA 7.09 2.67 NA 20.81 090 

62192 ......... ............ A Establish brain cavity shunt ......................... 12.23 NA 7.63 2.79 NA 22.65 090 

62194 ......... ............ A Replace/irrigate catheter .............................. 5.02 NA 2.44 0.62 NA 8.08 010 

62200 ......... ............ A Establish brain cavity shunt ......................... 18.29 NA 10.85 4.45 NA 33.59 090 

62201 ......... ............ A Brain cavity shunt w/scope .......................... 14.84 NA 9.45 2.88 NA 27.17 090 

62220 ......... ............ A Establish brain cavity shunt ......................... 12.98 NA 8.00 2.85 NA 23.83 090 

62223 ......... ............ A Establish brain cavity shunt ......................... 12.85 NA 8.25 2.83 NA 23.93 090 

62225 ......... ............ A Replace/irrigate catheter .............................. 5.40 NA 4.10 1.32 NA 10.82 090 

62230 ......... ............ A Replace/revise brain shunt .......................... 10.52 NA 6.49 2.40 NA 19.41 090 

62252 ......... ............ A Csf shunt reprogram .................................... 0.74 1.47 NA 0.20 2.41 NA XXX 

62252 ......... 26 ....... A Csf shunt reprogram .................................... 0.74 0.37 0.37 0.18 1.29 1.29 XXX 

62252 ......... TC ...... A Csf shunt reprogram .................................... 0.00 1.10 NA 0.02 1.12 NA XXX 

62256 ......... ............ A Remove brain cavity shunt .......................... 6.59 NA 4.71 1.57 NA 12.87 090 

62258 ......... ............ A Replace brain cavity shunt .......................... 14.52 NA 8.71 3.27 NA 26.50 090 

62263 ......... ............ A Epidural lysis mult sessions ........................ 6.13 12.79 3.22 0.40 19.32 9.75 010 

62264 ......... ............ A Epidural lysis on single day ......................... 4.42 7.75 1.42 0.40 12.57 6.24 010 

62268 ......... ............ A Drain spinal cord cyst .................................. 4.73 11.63 2.14 0.31 16.67 7.18 000 

62269 ......... ............ A Needle biopsy, spinal cord .......................... 5.01 15.11 1.97 0.39 20.51 7.37 000 

62270 ......... ............ A Spinal fluid tap, diagnostic ........................... 1.13 2.98 0.56 0.08 4.19 1.77 000 

62272 ......... ............ A Drain cerebro spinal fluid ............................. 1.35 3.60 0.71 0.17 5.12 2.23 000 

62273 ......... ............ A Treat epidural spine lesion .......................... 2.15 2.73 0.72 0.14 5.02 3.01 000 

62280 ......... ............ A Treat spinal cord lesion ............................... 2.63 6.99 1.01 0.23 9.85 3.87 010 

62281 ......... ............ A Treat spinal cord lesion ............................... 2.66 5.70 0.90 0.18 8.54 3.74 010 

62282 ......... ............ A Treat spinal canal lesion .............................. 2.33 8.43 0.92 0.17 10.93 3.42 010 

62284 ......... ............ A Injection for myelogram ............................... 1.54 5.02 0.68 0.13 6.69 2.35 000 

62287 ......... ............ A Percutaneous diskectomy ............................ 8.07 NA 5.55 0.69 NA 14.31 090 

62290 ......... ............ A Inject for spine disk x-ray ............................ 3.00 7.19 1.38 0.26 10.45 4.64 000 

62291 ......... ............ A Inject for spine disk x-ray ............................ 2.91 5.99 1.23 0.28 9.18 4.42 000 

62292 ......... ............ A Injection into disk lesion .............................. 7.85 NA 4.49 0.84 NA 13.18 090 

62294 ......... ............ A Injection into spinal artery ............................ 11.81 NA 5.59 1.38 NA 18.78 090 

62310 ......... ............ A Inject spine c/t .............................................. 1.91 4.85 0.65 0.12 6.88 2.68 000 

62311 ......... ............ A Inject spine l/s (cd) ...................................... 1.54 4.94 0.60 0.10 6.58 2.24 000 

62318 ......... ............ A Inject spine w/cath, c/t ................................. 2.04 5.76 0.65 0.13 7.93 2.82 000 

62319 ......... ............ A Inject spine w/cath l/s (cd) ........................... 1.87 5.03 0.61 0.12 7.02 2.60 000 

62350 ......... ............ A Implant spinal canal cath ............................. 6.86 NA 3.97 0.86 NA 11.69 090 

62351 ......... ............ A Implant spinal canal cath ............................. 9.99 NA 7.12 1.88 NA 18.99 090 

62355 ......... ............ A Remove spinal canal catheter ..................... 5.44 NA 3.18 0.69 NA 9.31 090 

62360 ......... ............ A Insert spine infusion device ......................... 2.62 NA 2.71 0.33 NA 5.66 090 

62361 ......... ............ A Implant spine infusion pump ........................ 5.41 NA 3.94 0.69 NA 10.04 090 

62362 ......... ............ A Implant spine infusion pump ........................ 7.03 NA 4.37 1.08 NA 12.48 090 

62365 ......... ............ A Remove spine infusion device ..................... 5.41 NA 3.59 0.77 NA 9.77 090 

62367 ......... 26 ....... A Analyze spine infusion pump ....................... 0.48 0.13 0.13 0.03 0.64 0.64 XXX 

62368 ......... 26 ....... A Analyze spine infusion pump ....................... 0.75 0.19 0.19 0.06 1.00 1.00 XXX 

63001 ......... ............ A Removal of spinal lamina ............................ 15.80 NA 9.50 3.30 NA 28.60 090 

63003 ......... ............ A Removal of spinal lamina ............................ 15.93 NA 9.85 3.41 NA 29.19 090 

63005 ......... ............ A Removal of spinal lamina ............................ 14.90 NA 9.96 2.77 NA 27.63 090 

63011 ......... ............ A Removal of spinal lamina ............................ 14.50 NA 8.27 3.17 NA 25.94 090 

63012 ......... ............ A Removal of spinal lamina ............................ 15.38 NA 10.11 3.04 NA 28.53 090 

63015 ......... ............ A Removal of spinal lamina ............................ 19.32 NA 11.86 4.14 NA 35.32 090 

63016 ......... ............ A Removal of spinal lamina ............................ 19.17 NA 11.77 4.03 NA 34.97 090 

63017 ......... ............ A Removal of spinal lamina ............................ 15.92 NA 10.38 3.20 NA 29.50 090 

63020 ......... ............ A Neck spine disk surgery .............................. 14.79 NA 9.66 3.29 NA 27.74 090 

63030 ......... ............ A Low back disk surgery ................................. 11.98 NA 8.41 2.43 NA 22.82 090 

63035 ......... ............ A Spinal disk surgery add-on .......................... 3.15 NA 1.59 0.67 NA 5.41 ZZZ 

63040 ......... ............ A Laminotomy, single cervical ........................ 18.78 NA 11.49 4.07 NA 34.34 090 

63042 ......... ............ A Laminotomy, single lumbar .......................... 17.44 NA 11.32 3.58 NA 32.34 090 

63045 ......... ............ A Removal of spinal lamina ............................ 16.48 NA 10.34 3.47 NA 30.29 090 

63046 ......... ............ A Removal of spinal lamina ............................ 15.78 NA 10.17 3.17 NA 29.12 090 

63047 ......... ............ A Removal of spinal lamina ............................ 14.59 NA 9.88 2.77 NA 27.24 090 

63048 ......... ............ A Remove spinal lamina add-on ..................... 3.26 NA 1.66 0.63 NA 5.55 ZZZ 

63055 ......... ............ A Decompress spinal cord .............................. 21.96 NA 13.12 4.73 NA 39.81 090 

47642

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

63056 ......... ............ A Decompress spinal cord .............................. 20.33 NA 12.54 4.07 NA 36.94 090 

63057 ......... ............ A Decompress spine cord add-on .................. 5.25 NA 2.63 1.11 NA 8.99 ZZZ 

63064 ......... ............ A Decompress spinal cord .............................. 24.57 NA 14.41 5.05 NA 44.03 090 

63066 ......... ............ A Decompress spine cord add-on .................. 3.26 NA 1.66 0.66 NA 5.58 ZZZ 

63075 ......... ............ A Neck spine disk surgery .............................. 19.38 NA 12.07 3.95 NA 35.40 090 

63076 ......... ............ A Neck spine disk surgery .............................. 4.04 NA 2.05 0.82 NA 6.91 ZZZ 

63077 ......... ............ A Spine disk surgery, thorax ........................... 21.41 NA 12.77 3.41 NA 37.59 090 

63078 ......... ............ A Spine disk surgery, thorax ........................... 3.28 NA 1.63 0.53 NA 5.44 ZZZ 

63081 ......... ............ A Removal of vertebral body .......................... 23.69 NA 14.30 4.86 NA 42.85 090 

63082 ......... ............ A Remove vertebral body add-on ................... 4.36 NA 2.22 0.91 NA 7.49 ZZZ 

63085 ......... ............ A Removal of vertebral body .......................... 26.88 NA 15.45 4.23 NA 46.56 090 

63086 ......... ............ A Remove vertebral body add-on ................... 3.19 NA 1.59 0.57 NA 5.35 ZZZ 

63087 ......... ............ A Removal of vertebral body .......................... 35.52 NA 19.43 5.70 NA 60.65 090 

63088 ......... ............ A Remove vertebral body add-on ................... 4.32 NA 2.17 0.72 NA 7.21 ZZZ 

63090 ......... ............ A Removal of vertebral body .......................... 28.12 NA 16.01 4.09 NA 48.22 090 

63091 ......... ............ A Remove vertebral body add-on ................... 3.03 NA 1.45 0.47 NA 4.95 ZZZ 

63101 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.28 5.05 NA 56.28 090 

63102 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.28 5.05 NA 56.28 090 

63103 ......... ............ A Remove vertebral body add-on ................... 3.89 NA 2.03 0.66 NA 6.58 ZZZ 

63170 ......... ............ A Incise spinal cord tract(s) ............................ 19.80 NA 12.08 4.48 NA 36.36 090 

63172 ......... ............ A Drainage of spinal cyst ................................ 17.63 NA 10.90 4.06 NA 32.59 090 

63173 ......... ............ A Drainage of spinal cyst ................................ 21.96 NA 13.06 4.95 NA 39.97 090 

63180 ......... ............ A Revise spinal cord ligaments ....................... 18.24 NA 11.24 2.46 NA 31.94 090 

63182 ......... ............ A Revise spinal cord ligaments ....................... 20.47 NA 11.18 3.47 NA 35.12 090 

63185 ......... ............ A Incise spinal column/nerves ........................ 15.02 NA 8.29 2.22 NA 25.53 090 

63190 ......... ............ A Incise spinal column/nerves ........................ 17.42 NA 10.34 3.35 NA 31.11 090 

63191 ......... ............ A Incise spinal column/nerves ........................ 17.51 NA 10.71 4.53 NA 32.75 090 

63194 ......... ............ A Incise spinal column & cord ........................ 19.16 NA 11.93 3.82 NA 34.91 090 

63195 ......... ............ A Incise spinal column & cord ........................ 18.81 NA 11.26 4.37 NA 34.44 090 

63196 ......... ............ A Incise spinal column & cord ........................ 22.27 NA 13.60 5.62 NA 41.49 090 

63197 ......... ............ A Incise spinal column & cord ........................ 21.08 NA 12.41 4.20 NA 37.69 090 

63198 ......... ............ A Incise spinal column & cord ........................ 25.34 NA 8.58 6.40 NA 40.32 090 

63199 ......... ............ A Incise spinal column & cord ........................ 26.85 NA 15.23 6.78 NA 48.86 090 

63200 ......... ............ A Release of spinal cord ................................. 19.15 NA 11.50 4.31 NA 34.96 090 

63250 ......... ............ A Revise spinal cord vessels .......................... 40.70 NA 19.92 8.81 NA 69.43 090 

63251 ......... ............ A Revise spinal cord vessels .......................... 41.14 NA 22.57 9.46 NA 73.17 090 

63252 ......... ............ A Revise spinal cord vessels .......................... 41.13 NA 22.22 9.52 NA 72.87 090 

63265 ......... ............ A Excise intraspinal lesion .............................. 21.53 NA 12.76 4.85 NA 39.14 090 

63266 ......... ............ A Excise intraspinal lesion .............................. 22.27 NA 13.18 4.89 NA 40.34 090 

63267 ......... ............ A Excise intraspinal lesion .............................. 17.92 NA 11.07 3.79 NA 32.78 090 

63268 ......... ............ A Excise intraspinal lesion .............................. 18.49 NA 10.38 3.01 NA 31.88 090 

63270 ......... ............ A Excise intraspinal lesion .............................. 26.76 NA 15.46 5.94 NA 48.16 090 

63271 ......... ............ A Excise intraspinal lesion .............................. 26.88 NA 15.56 6.38 NA 48.82 090 

63272 ......... ............ A Excise intraspinal lesion .............................. 25.28 NA 14.68 5.41 NA 45.37 090 

63273 ......... ............ A Excise intraspinal lesion .............................. 24.25 NA 14.33 6.05 NA 44.63 090 

63275 ......... ............ A Biopsy/excise spinal tumor .......................... 23.64 NA 13.77 5.20 NA 42.61 090 

63276 ......... ............ A Biopsy/excise spinal tumor .......................... 23.41 NA 13.67 5.16 NA 42.24 090 

63277 ......... ............ A Biopsy/excise spinal tumor .......................... 20.80 NA 12.51 4.32 NA 37.63 090 

63278 ......... ............ A Biopsy/excise spinal tumor .......................... 20.53 NA 12.38 4.07 NA 36.98 090 

63280 ......... ............ A Biopsy/excise spinal tumor .......................... 28.31 NA 16.30 6.47 NA 51.08 090 

63281 ......... ............ A Biopsy/excise spinal tumor .......................... 28.01 NA 16.16 6.41 NA 50.58 090 

63282 ......... ............ A Biopsy/excise spinal tumor .......................... 26.35 NA 15.32 6.03 NA 47.70 090 

63283 ......... ............ A Biopsy/excise spinal tumor .......................... 24.96 NA 14.65 5.64 NA 45.25 090 

63285 ......... ............ A Biopsy/excise spinal tumor .......................... 35.95 NA 19.92 9.19 NA 65.06 090 

63286 ......... ............ A Biopsy/excise spinal tumor .......................... 35.58 NA 19.88 8.10 NA 63.56 090 

63287 ......... ............ A Biopsy/excise spinal tumor .......................... 36.64 NA 20.41 8.00 NA 65.05 090 

63290 ......... ............ A Biopsy/excise spinal tumor .......................... 37.32 NA 20.57 9.00 NA 66.89 090 

63300 ......... ............ A Removal of vertebral body .......................... 24.39 NA 14.29 4.92 NA 43.60 090 

63301 ......... ............ A Removal of vertebral body .......................... 27.56 NA 15.54 5.21 NA 48.31 090 

63302 ......... ............ A Removal of vertebral body .......................... 27.77 NA 15.83 5.11 NA 48.71 090 

63303 ......... ............ A Removal of vertebral body .......................... 30.45 NA 16.89 4.99 NA 52.33 090 

63304 ......... ............ A Removal of vertebral body .......................... 30.28 NA 17.26 6.03 NA 53.57 090 

63305 ......... ............ A Removal of vertebral body .......................... 31.98 NA 18.03 5.92 NA 55.93 090 

63306 ......... ............ A Removal of vertebral body .......................... 32.17 NA 17.78 6.13 NA 56.08 090 

63307 ......... ............ A Removal of vertebral body .......................... 31.58 NA 16.79 4.80 NA 53.17 090 

63308 ......... ............ A Remove vertebral body add-on ................... 5.24 NA 2.60 1.15 NA 8.99 ZZZ 

63600 ......... ............ A Remove spinal cord lesion .......................... 14.00 NA 5.41 1.29 NA 20.70 090 

63610 ......... ............ A Stimulation of spinal cord ............................ 8.72 59.95 2.25 0.55 69.22 11.52 000 

63615 ......... ............ A Remove lesion of spinal cord ...................... 16.26 NA 9.30 1.89 NA 27.45 090 

63650 ......... ............ A Implant neuroelectrodes .............................. 6.73 NA 3.19 0.54 NA 10.46 090 

63655 ......... ............ A Implant neuroelectrodes .............................. 10.27 NA 6.90 2.07 NA 19.24 090 

63660 ......... ............ A Revise/remove neuroelectrode .................... 6.15 NA 3.63 0.80 NA 10.58 090 

63685 ......... ............ A Implant neuroreceiver .................................. 7.03 NA 4.16 0.99 NA 12.18 090 

63688 ......... ............ A Revise/remove neuroreceiver ...................... 5.38 NA 3.57 0.85 NA 9.80 090 

63700 ......... ............ A Repair of spinal herniation ........................... 16.51 NA 10.29 3.14 NA 29.94 090 

47643

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

63702 ......... ............ A Repair of spinal herniation ........................... 18.45 NA 11.05 3.43 NA 32.93 090 

63704 ......... ............ A Repair of spinal herniation ........................... 21.15 NA 12.90 4.54 NA 38.59 090 

63706 ......... ............ A Repair of spinal herniation ........................... 24.07 NA 13.58 5.45 NA 43.10 090 

63707 ......... ............ A Repair spinal fluid leakage .......................... 11.24 NA 7.70 2.18 NA 21.12 090 

63709 ......... ............ A Repair spinal fluid leakage .......................... 14.30 NA 9.39 2.77 NA 26.46 090 

63710 ......... ............ A Graft repair of spine defect .......................... 14.05 NA 9.04 3.02 NA 26.11 090 

63740 ......... ............ A Install spinal shunt ....................................... 11.34 NA 7.35 2.44 NA 21.13 090 

63741 ......... ............ A Install spinal shunt ....................................... 8.24 NA 4.76 1.69 NA 14.69 090 

63744 ......... ............ A Revision of spinal shunt .............................. 8.09 NA 5.26 1.54 NA 14.89 090 

63746 ......... ............ A Removal of spinal shunt .............................. 6.42 NA 3.79 1.60 NA 11.81 090 

64400 ......... ............ A N block inj, trigeminal .................................. 1.11 1.89 0.43 0.09 3.09 1.63 000 

64402 ......... ............ A N block inj, facial ......................................... 1.25 1.62 0.60 0.08 2.95 1.93 000 

64405 ......... ............ A N block inj, occipital ..................................... 1.32 1.46 0.46 0.09 2.87 1.87 000 

64408 ......... ............ A N block inj, vagus ........................................ 1.41 1.58 0.85 0.09 3.08 2.35 000 

64410 ......... ............ A N block inj, phrenic ...................................... 1.43 2.52 0.47 0.09 4.04 1.99 000 

64412 ......... ............ A N block inj, spinal accessor ......................... 1.18 2.66 0.43 0.08 3.92 1.69 000 

64413 ......... ............ A N block inj, cervical plexus .......................... 1.40 1.85 0.50 0.10 3.35 2.00 000 

64415 ......... ............ A N block inj, brachial plexus .......................... 1.48 2.81 0.46 0.10 4.39 2.04 000 

64416 ......... ............ A N block cont infuse, b plex .......................... 3.49 NA 0.79 0.10 NA 4.38 010 

64417 ......... ............ A N block inj, axillary ....................................... 1.44 3.04 0.49 0.12 4.60 2.05 000 

64418 ......... ............ A N block inj, suprascapular ........................... 1.32 2.63 0.44 0.08 4.03 1.84 000 

64420 ......... ............ A N block inj, intercost, sng ............................ 1.18 3.98 0.42 0.08 5.24 1.68 000 

64421 ......... ............ A N block inj, intercost, mlt ............................. 1.68 6.19 0.52 0.12 7.99 2.32 000 

64425 ......... ............ A N block inj ilio-ing/hypogi ............................. 1.75 1.65 0.54 0.14 3.54 2.43 000 

64430 ......... ............ A N block inj, pudendal ................................... 1.46 2.51 0.55 0.11 4.08 2.12 000 

64435 ......... ............ A N block inj, paracervical .............................. 1.45 2.52 0.69 0.17 4.14 2.31 000 

64445 ......... ............ A N block inj, sciatic, sng ................................ 1.48 2.68 0.50 0.10 4.26 2.08 000 

64446 ......... ............ A N blk inj, sciatic, cont inf .............................. 3.25 NA 1.01 0.10 NA 4.36 010 

64447 ......... ............ A N block inj fem, single ................................. 1.50 NA 0.43 0.10 NA 2.03 000 

64448 ......... ............ A N block inj fem, cont inf ............................... 3.00 NA 0.81 0.10 NA 3.91 010 

64449 ......... ............ A N block inj, lumbar plexus ........................... 3.00 NA 0.96 0.10 NA 4.06 010 

64450 ......... ............ A N block, other peripheral ............................. 1.27 1.24 0.48 0.10 2.61 1.85 000 

64470 ......... ............ A Inj paravertebral c/t ...................................... 1.85 7.29 0.72 0.14 9.28 2.71 000 

64472 ......... ............ A Inj paravertebral c/t add-on ......................... 1.29 2.35 0.34 0.09 3.73 1.72 ZZZ 

64475 ......... ............ A Inj paravertebral l/s ...................................... 1.41 6.93 0.63 0.11 8.45 2.15 000 

64476 ......... ............ A Inj paravertebral l/s add-on .......................... 0.98 2.14 0.24 0.08 3.20 1.30 ZZZ 

64479 ......... ............ A Inj foramen epidural c/t ................................ 2.20 7.56 0.89 0.16 9.92 3.25 000 

64480 ......... ............ A Inj foramen epidural add-on ........................ 1.54 2.87 0.47 0.12 4.53 2.13 ZZZ 

64483 ......... ............ A Inj foramen epidural l/s ................................ 1.90 7.95 0.83 0.12 9.97 2.85 000 

64484 ......... ............ A Inj foramen epidural add-on ........................ 1.33 3.31 0.37 0.09 4.73 1.79 ZZZ 

64505 ......... ............ A N block, spenopalatine gangl ...................... 1.36 1.25 0.66 0.09 2.70 2.11 000 

64508 ......... ............ A N block, carotid sinus s/p ............................ 1.12 3.39 0.74 0.09 4.60 1.95 000 

64510 ......... ............ A N block, stellate ganglion ............................ 1.22 3.51 0.51 0.08 4.81 1.81 000 

64517 ......... ............ A N block inj, hypogas plxs ............................. 2.20 2.73 0.87 0.11 5.04 3.18 000 

64520 ......... ............ A N block, lumbar/thoracic .............................. 1.35 5.21 0.55 0.09 6.65 1.99 000 

64530 ......... ............ A N block inj, celiac pelus ............................... 1.58 4.49 0.66 0.10 6.17 2.34 000 

64550 ......... ............ A Apply neurostimulator .................................. 0.18 0.28 0.05 0.01 0.47 0.24 000 

64553 ......... ............ A Implant neuroelectrodes .............................. 2.31 2.83 1.85 0.23 5.37 4.39 010 

64555 ......... ............ A Implant neuroelectrodes .............................. 2.27 3.11 1.20 0.23 5.61 3.70 010 

64560 ......... ............ A Implant neuroelectrodes .............................. 2.36 2.66 1.30 0.24 5.26 3.90 010 

64561 ......... ............ A Implant neuroelectrodes .............................. 6.73 30.03 2.82 0.51 37.27 10.06 010 

64565 ......... ............ A Implant neuroelectrodes .............................. 1.76 3.30 1.26 0.10 5.16 3.12 010 

64573 ......... ............ A Implant neuroelectrodes .............................. 7.49 NA 5.25 1.48 NA 14.22 090 

64575 ......... ............ A Implant neuroelectrodes .............................. 4.34 NA 2.69 0.45 NA 7.48 090 

64577 ......... ............ A Implant neuroelectrodes .............................. 4.61 NA 3.30 0.61 NA 8.52 090 

64580 ......... ............ A Implant neuroelectrodes .............................. 4.11 NA 3.57 0.23 NA 7.91 090 

64581 ......... ............ A Implant neuroelectrodes .............................. 13.48 NA 5.36 1.05 NA 19.89 090 

64585 ......... ............ A Revise/remove neuroelectrode .................... 2.06 11.26 2.14 0.22 13.54 4.42 010 

64590 ......... ............ A Implant neuroreceiver .................................. 2.40 7.15 2.28 0.23 9.78 4.91 010 

64595 ......... ............ A Revise/remove neuroreceiver ...................... 1.73 10.42 1.93 0.22 12.37 3.88 010 

64600 ......... ............ A Injection treatment of nerve ......................... 3.44 9.36 1.66 0.33 13.13 5.43 010 

64605 ......... ............ A Injection treatment of nerve ......................... 5.60 9.58 2.19 0.92 16.10 8.71 010 

64610 ......... ............ A Injection treatment of nerve ......................... 7.15 8.92 3.71 1.35 17.42 12.21 010 

64612 ......... ............ A Destroy nerve, face muscle ......................... 1.96 2.48 1.32 0.12 4.56 3.40 010 

64613 ......... ............ A Destroy nerve, spine muscle ....................... 1.96 2.90 1.22 0.12 4.98 3.30 010 

64614 ......... ............ A Destroy nerve, extrem musc ....................... 2.20 3.21 1.31 0.12 5.53 3.63 010 

64620 ......... ............ A Injection treatment of nerve ......................... 2.84 5.13 1.34 0.20 8.17 4.38 010 

64622 ......... ............ A Destr paravertebrl nerve l/s ......................... 3.00 7.82 1.38 0.21 11.03 4.59 010 

64623 ......... ............ A Destr paravertebral n add-on ...................... 0.99 2.98 0.22 0.07 4.04 1.28 ZZZ 

64626 ......... ............ A Destr paravertebrl nerve c/t ......................... 3.28 7.84 1.98 0.22 11.34 5.48 010 

64627 ......... ............ A Destr paravertebral n add-on ...................... 1.16 4.58 0.27 0.08 5.82 1.51 ZZZ 

64630 ......... ............ A Injection treatment of nerve ......................... 3.00 2.73 1.42 0.23 5.96 4.65 010 

64640 ......... ............ A Injection treatment of nerve ......................... 2.76 4.19 1.85 0.19 7.14 4.80 010 

64680 ......... ............ A Injection treatment of nerve ......................... 2.62 6.75 1.44 0.18 9.55 4.24 010 

64681 ......... ............ A Injection treatment of nerve ......................... 3.54 9.36 2.06 0.19 13.09 5.79 010 

47644

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

64702 ......... ............ A Revise finger/toe nerve ................................ 4.22 NA 3.86 0.60 NA 8.68 090 

64704 ......... ............ A Revise hand/foot nerve ................................ 4.56 NA 3.31 0.47 NA 8.34 090 

64708 ......... ............ A Revise arm/leg nerve ................................... 6.11 NA 4.87 0.92 NA 11.90 090 

64712 ......... ............ A Revision of sciatic nerve .............................. 7.74 NA 4.98 0.98 NA 13.70 090 

64713 ......... ............ A Revision of arm nerve(s) ............................. 10.98 NA 5.88 1.68 NA 18.54 090 

64714 ......... ............ A Revise low back nerve(s) ............................ 10.31 NA 4.23 1.04 NA 15.58 090 

64716 ......... ............ A Revision of cranial nerve ............................. 6.30 NA 5.96 0.64 NA 12.90 090 

64718 ......... ............ A Revise ulnar nerve at elbow ........................ 5.98 NA 5.98 1.03 NA 12.99 090 

64719 ......... ............ A Revise ulnar nerve at wrist .......................... 4.84 NA 4.53 0.78 NA 10.15 090 

64721 ......... ............ A Carpal tunnel surgery .................................. 4.28 NA 5.35 0.72 NA 10.35 090 

64722 ......... ............ A Relieve pressure on nerve(s) ...................... 4.69 NA 3.06 0.45 NA 8.20 090 

64726 ......... ............ A Release foot/toe nerve ................................ 4.17 NA 2.80 0.40 NA 7.37 090 

64727 ......... ............ A Internal nerve revision ................................. 3.10 NA 1.50 0.49 NA 5.09 ZZZ 

64732 ......... ............ A Incision of brow nerve ................................. 4.40 NA 3.52 0.81 NA 8.73 090 

64734 ......... ............ A Incision of cheek nerve ................................ 4.91 NA 4.05 0.95 NA 9.91 090 

64736 ......... ............ A Incision of chin nerve ................................... 4.59 NA 4.03 0.64 NA 9.26 090 

64738 ......... ............ A Incision of jaw nerve .................................... 5.72 NA 4.61 1.24 NA 11.57 090 

64740 ......... ............ A Incision of tongue nerve .............................. 5.58 NA 5.11 0.57 NA 11.26 090 

64742 ......... ............ A Incision of facial nerve ................................. 6.21 NA 4.70 0.57 NA 11.48 090 

64744 ......... ............ A Incise nerve, back of head .......................... 5.23 NA 3.78 1.03 NA 10.04 090 

64746 ......... ............ A Incise diaphragm nerve ............................... 5.92 NA 4.51 0.82 NA 11.25 090 

64752 ......... ............ A Incision of vagus nerve ................................ 7.05 NA 4.30 0.89 NA 12.24 090 

64755 ......... ............ A Incision of stomach nerves .......................... 13.50 NA 5.65 1.63 NA 20.78 090 

64760 ......... ............ A Incision of vagus nerve ................................ 6.95 NA 3.48 0.79 NA 11.22 090 

64761 ......... ............ A Incision of pelvis nerve ................................ 6.40 NA 3.54 0.45 NA 10.39 090 

64763 ......... ............ A Incise hip/thigh nerve ................................... 6.92 NA 5.23 0.98 NA 13.13 090 

64766 ......... ............ A Incise hip/thigh nerve ................................... 8.66 NA 5.26 1.11 NA 15.03 090 

64771 ......... ............ A Sever cranial nerve ...................................... 7.34 NA 5.56 1.04 NA 13.94 090 

64772 ......... ............ A Incision of spinal nerve ................................ 7.20 NA 4.93 1.25 NA 13.38 090 

64774 ......... ............ A Remove skin nerve lesion ........................... 5.16 NA 3.83 0.63 NA 9.62 090 

64776 ......... ............ A Remove digit nerve lesion ........................... 5.11 NA 3.70 0.66 NA 9.47 090 

64778 ......... ............ A Digit nerve surgery add-on .......................... 3.11 NA 1.50 0.46 NA 5.07 ZZZ 

64782 ......... ............ A Remove limb nerve lesion ........................... 6.22 NA 3.77 0.71 NA 10.70 090 

64783 ......... ............ A Limb nerve surgery add-on ......................... 3.71 NA 1.83 0.52 NA 6.06 ZZZ 

64784 ......... ............ A Remove nerve lesion ................................... 9.81 NA 6.60 1.39 NA 17.80 090 

64786 ......... ............ A Remove sciatic nerve lesion ........................ 15.44 NA 9.84 2.52 NA 27.80 090 

64787 ......... ............ A Implant nerve end ........................................ 4.29 NA 2.11 0.56 NA 6.96 ZZZ 

64788 ......... ............ A Remove skin nerve lesion ........................... 4.60 NA 3.48 0.64 NA 8.72 090 

64790 ......... ............ A Removal of nerve lesion .............................. 11.29 NA 7.20 1.76 NA 20.25 090 

64792 ......... ............ A Removal of nerve lesion .............................. 14.90 NA 8.82 2.29 NA 26.01 090 

64795 ......... ............ A Biopsy of nerve ............................................ 3.01 NA 1.58 0.50 NA 5.09 000 

64802 ......... ............ A Remove sympathetic nerves ....................... 9.14 NA 5.15 1.17 NA 15.46 090 

64804 ......... ............ A Remove sympathetic nerves ....................... 14.62 NA 7.17 1.99 NA 23.78 090 

64809 ......... ............ A Remove sympathetic nerves ....................... 13.65 NA 5.77 1.79 NA 21.21 090 

64818 ......... ............ A Remove sympathetic nerves ....................... 10.28 NA 5.29 1.32 NA 16.89 090 

64820 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 7.14 1.54 NA 19.03 090 

64821 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.33 1.38 NA 17.45 090 

64822 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.22 1.33 NA 17.29 090 

64823 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 8.13 1.58 NA 20.06 090 

64831 ......... ............ A Repair of digit nerve .................................... 9.43 NA 7.08 1.40 NA 17.91 090 

64832 ......... ............ A Repair nerve add-on .................................... 5.65 NA 2.93 0.83 NA 9.41 ZZZ 

64834 ......... ............ A Repair of hand or foot nerve ....................... 10.17 NA 7.09 1.57 NA 18.83 090 

64835 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.70 1.61 NA 20.23 090 

64836 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.67 1.63 NA 20.22 090 

64837 ......... ............ A Repair nerve add-on .................................... 6.25 NA 3.22 0.95 NA 10.42 ZZZ 

64840 ......... ............ A Repair of leg nerve ...................................... 13.00 NA 8.25 1.44 NA 22.69 090 

64856 ......... ............ A Repair/transpose nerve ............................... 13.78 NA 9.18 2.06 NA 25.02 090 

64857 ......... ............ A Repair arm/leg nerve ................................... 14.47 NA 9.63 2.22 NA 26.32 090 

64858 ......... ............ A Repair sciatic nerve ..................................... 16.47 NA 10.77 2.98 NA 30.22 090 

64859 ......... ............ A Nerve surgery .............................................. 4.25 NA 2.19 0.59 NA 7.03 ZZZ 

64861 ......... ............ A Repair of arm nerves ................................... 19.21 NA 11.78 4.24 NA 35.23 090 

64862 ......... ............ A Repair of low back nerves ........................... 19.41 NA 11.93 2.98 NA 34.32 090 

64864 ......... ............ A Repair of facial nerve .................................. 12.53 NA 8.75 1.35 NA 22.63 090 

64865 ......... ............ A Repair of facial nerve .................................. 15.22 NA 13.44 1.82 NA 30.48 090 

64866 ......... ............ A Fusion of facial/other nerve ......................... 15.72 NA 13.10 1.63 NA 30.45 090 

64868 ......... ............ A Fusion of facial/other nerve ......................... 14.02 NA 11.39 1.64 NA 27.05 090 

64870 ......... ............ A Fusion of facial/other nerve ......................... 15.97 NA 8.72 0.80 NA 25.49 090 

64872 ......... ............ A Subsequent repair of nerve ......................... 1.99 NA 1.08 0.28 NA 3.35 ZZZ 

64874 ......... ............ A Repair & revise nerve add-on ..................... 2.98 NA 1.53 0.41 NA 4.92 ZZZ 

64876 ......... ............ A Repair nerve/shorten bone .......................... 3.37 NA 1.27 0.47 NA 5.11 ZZZ 

64885 ......... ............ A Nerve graft, head or neck ............................ 17.50 NA 11.59 1.69 NA 30.78 090 

64886 ......... ............ A Nerve graft, head or neck ............................ 20.72 NA 13.52 2.06 NA 36.30 090 

64890 ......... ............ A Nerve graft, hand or foot ............................. 15.13 NA 9.99 2.24 NA 27.36 090 

64891 ......... ............ A Nerve graft, hand or foot ............................. 16.12 NA 7.60 1.38 NA 25.10 090 

64892 ......... ............ A Nerve graft, arm or leg ................................ 14.63 NA 8.87 1.97 NA 25.47 090 

47645

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

64893 ......... ............ A Nerve graft, arm or leg ................................ 15.58 NA 9.87 2.28 NA 27.73 090 

64895 ......... ............ A Nerve graft, hand or foot ............................. 19.22 NA 9.65 2.43 NA 31.30 090 

64896 ......... ............ A Nerve graft, hand or foot ............................. 20.46 NA 11.00 1.97 NA 33.43 090 

64897 ......... ............ A Nerve graft, arm or leg ................................ 18.21 NA 10.69 2.61 NA 31.51 090 

64898 ......... ............ A Nerve graft, arm or leg ................................ 19.47 NA 11.79 2.14 NA 33.40 090 

64901 ......... ............ A Nerve graft add-on ....................................... 10.20 NA 5.25 1.22 NA 16.67 ZZZ 

64902 ......... ............ A Nerve graft add-on ....................................... 11.81 NA 5.95 1.43 NA 19.19 ZZZ 

64905 ......... ............ A Nerve pedicle transfer ................................. 14.00 NA 8.50 1.53 NA 24.03 090 

64907 ......... ............ A Nerve pedicle transfer ................................. 18.80 NA 12.50 2.16 NA 33.46 090 

65091 ......... ............ A Revise eye ................................................... 6.45 NA 8.37 0.34 NA 15.16 090 

65093 ......... ............ A Revise eye with implant ............................... 6.86 NA 8.73 0.36 NA 15.95 090 

65101 ......... ............ A Removal of eye ............................................ 7.02 NA 9.55 0.37 NA 16.94 090 

65103 ......... ............ A Remove eye/insert implant .......................... 7.56 NA 9.75 0.39 NA 17.70 090 

65105 ......... ............ A Remove eye/attach implant ......................... 8.48 NA 10.48 0.44 NA 19.40 090 

65110 ......... ............ A Removal of eye ............................................ 13.93 NA 13.66 0.86 NA 28.45 090 

65112 ......... ............ A Remove eye/revise socket .......................... 16.36 NA 16.08 0.98 NA 33.42 090 

65114 ......... ............ A Remove eye/revise socket .......................... 17.50 NA 16.31 1.07 NA 34.88 090 

65125 ......... ............ A Revise ocular implant .................................. 3.12 8.84 3.59 0.18 12.14 6.89 090 

65130 ......... ............ A Insert ocular implant .................................... 7.14 NA 9.18 0.38 NA 16.70 090 

65135 ......... ............ A Insert ocular implant .................................... 7.32 NA 9.32 0.38 NA 17.02 090 

65140 ......... ............ A Attach ocular implant ................................... 8.01 NA 9.88 0.43 NA 18.32 090 

65150 ......... ............ A Revise ocular implant .................................. 6.25 NA 7.99 0.35 NA 14.59 090 

65155 ......... ............ A Reinsert ocular implant ................................ 8.65 NA 10.48 0.50 NA 19.63 090 

65175 ......... ............ A Removal of ocular implant ........................... 6.27 NA 8.49 0.34 NA 15.10 090 

65205 ......... ............ A Remove foreign body from eye ................... 0.71 0.64 0.30 0.04 1.39 1.05 000 

65210 ......... ............ A Remove foreign body from eye ................... 0.84 0.81 0.38 0.04 1.69 1.26 000 

65220 ......... ............ A Remove foreign body from eye ................... 0.71 0.65 0.29 0.05 1.41 1.05 000 

65222 ......... ............ A Remove foreign body from eye ................... 0.93 0.89 0.38 0.05 1.87 1.36 000 

65235 ......... ............ A Remove foreign body from eye ................... 7.56 NA 6.74 0.38 NA 14.68 090 

65260 ......... ............ A Remove foreign body from eye ................... 10.94 NA 9.65 0.56 NA 21.15 090 

65265 ......... ............ A Remove foreign body from eye ................... 12.57 NA 10.63 0.66 NA 23.86 090 

65270 ......... ............ A Repair of eye wound ................................... 1.90 5.24 1.39 0.10 7.24 3.39 010 

65272 ......... ............ A Repair of eye wound ................................... 3.81 7.73 3.29 0.20 11.74 7.30 090 

65273 ......... ............ A Repair of eye wound ................................... 4.35 NA 3.57 0.25 NA 8.17 090 

65275 ......... ............ A Repair of eye wound ................................... 5.33 6.33 3.95 0.30 11.96 9.58 090 

65280 ......... ............ A Repair of eye wound ................................... 7.65 NA 6.23 0.39 NA 14.27 090 

65285 ......... ............ A Repair of eye wound ................................... 12.88 NA 9.20 0.65 NA 22.73 090 

65286 ......... ............ A Repair of eye wound ................................... 5.50 11.17 4.62 0.28 16.95 10.40 090 

65290 ......... ............ A Repair of eye socket wound ........................ 5.40 NA 4.73 0.36 NA 10.49 090 

65400 ......... ............ A Removal of eye lesion ................................. 6.05 8.33 6.12 0.30 14.68 12.47 090 

65410 ......... ............ A Biopsy of cornea .......................................... 1.47 2.11 0.97 0.07 3.65 2.51 000 

65420 ......... ............ A Removal of eye lesion ................................. 4.16 8.86 4.44 0.21 13.23 8.81 090 

65426 ......... ............ A Removal of eye lesion ................................. 5.24 10.19 4.92 0.26 15.69 10.42 090 

65430 ......... ............ A Corneal smear ............................................. 1.47 1.29 0.98 0.07 2.83 2.52 000 

65435 ......... ............ A Curette/treat cornea ..................................... 0.92 1.00 0.71 0.05 1.97 1.68 000 

65436 ......... ............ A Curette/treat cornea ..................................... 4.18 4.10 3.67 0.21 8.49 8.06 090 

65450 ......... ............ A Treatment of corneal lesion ......................... 3.27 4.03 3.86 0.17 7.47 7.30 090 

65600 ......... ............ A Revision of cornea ....................................... 3.39 5.49 3.03 0.17 9.05 6.59 090 

65710 ......... ............ A Corneal transplant ....................................... 12.33 NA 11.43 0.62 NA 24.38 090 

65730 ......... ............ A Corneal transplant ....................................... 14.23 NA 11.83 0.71 NA 26.77 090 

65750 ......... ............ A Corneal transplant ....................................... 14.98 NA 12.29 0.75 NA 28.02 090 

65755 ......... ............ A Corneal transplant ....................................... 14.87 NA 12.22 0.74 NA 27.83 090 

65770 ......... ............ A Revise cornea with implant ......................... 17.53 NA 13.20 0.87 NA 31.60 090 

65772 ......... ............ A Correction of astigmatism ............................ 4.28 5.53 4.13 0.21 10.02 8.62 090 

65775 ......... ............ A Correction of astigmatism ............................ 5.78 NA 6.25 0.29 NA 12.32 090 

65780 ......... ............ A Ocular reconst, transplant ........................... 10.23 NA 10.30 0.45 NA 20.98 090 

65781 ......... ............ A Ocular reconst, transplant ........................... 17.64 NA 13.67 0.45 NA 31.76 090 

65782 ......... ............ A Ocular reconst, transplant ........................... 14.98 NA 11.99 0.45 NA 27.42 090 

65800 ......... ............ A Drainage of eye ........................................... 1.91 1.79 1.18 0.10 3.80 3.19 000 

65805 ......... ............ A Drainage of eye ........................................... 1.91 2.17 1.18 0.10 4.18 3.19 000 

65810 ......... ............ A Drainage of eye ........................................... 4.86 NA 4.70 0.25 NA 9.81 090 

65815 ......... ............ A Drainage of eye ........................................... 5.04 10.02 4.81 0.26 15.32 10.11 090 

65820 ......... ............ A Relieve inner eye pressure .......................... 8.12 NA 9.06 0.42 NA 17.60 090 

65850 ......... ............ A Incision of eye .............................................. 10.50 NA 8.44 0.52 NA 19.46 090 

65855 ......... ............ A Laser surgery of eye .................................... 3.84 4.32 3.10 0.19 8.35 7.13 010 

65860 ......... ............ A Incise inner eye adhesions .......................... 3.54 4.05 2.50 0.18 7.77 6.22 090 

65865 ......... ............ A Incise inner eye adhesions .......................... 5.59 NA 5.63 0.28 NA 11.50 090 

65870 ......... ............ A Incise inner eye adhesions .......................... 6.26 NA 6.41 0.31 NA 12.98 090 

65875 ......... ............ A Incise inner eye adhesions .......................... 6.53 NA 6.80 0.33 NA 13.66 090 

65880 ......... ............ A Incise inner eye adhesions .......................... 7.08 NA 7.04 0.35 NA 14.47 090 

65900 ......... ............ A Remove eye lesion ...................................... 10.91 NA 10.42 0.56 NA 21.89 090 

65920 ......... ............ A Remove implant of eye ................................ 8.39 NA 8.17 0.42 NA 16.98 090 

65930 ......... ............ A Remove blood clot from eye ....................... 7.43 NA 6.84 0.37 NA 14.64 090 

66020 ......... ............ A Injection treatment of eye ............................ 1.59 3.13 1.43 0.08 4.80 3.10 010 

66030 ......... ............ A Injection treatment of eye ............................ 1.25 2.97 1.28 0.06 4.28 2.59 010 

47646

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

66130 ......... ............ A Remove eye lesion ...................................... 7.68 9.64 5.60 0.39 17.71 13.67 090 

66150 ......... ............ A Glaucoma surgery ....................................... 8.29 NA 9.41 0.44 NA 18.14 090 

66155 ......... ............ A Glaucoma surgery ....................................... 8.28 NA 9.37 0.43 NA 18.08 090 

66160 ......... ............ A Glaucoma surgery ....................................... 10.15 NA 10.20 0.52 NA 20.87 090 

66165 ......... ............ A Glaucoma surgery ....................................... 8.00 NA 9.24 0.42 NA 17.66 090 

66170 ......... ............ A Glaucoma surgery ....................................... 12.14 NA 12.23 0.61 NA 24.98 090 

66172 ......... ............ A Incision of eye .............................................. 15.02 NA 15.21 0.75 NA 30.98 090 

66180 ......... ............ A Implant eye shunt ........................................ 14.53 NA 10.76 0.73 NA 26.02 090 

66185 ......... ............ A Revise eye shunt ......................................... 8.13 NA 7.38 0.41 NA 15.92 090 

66220 ......... ............ A Repair eye lesion ......................................... 7.76 NA 7.11 0.41 NA 15.28 090 

66225 ......... ............ A Repair/graft eye lesion ................................. 11.03 NA 8.73 0.55 NA 20.31 090 

66250 ......... ............ A Follow-up surgery of eye ............................. 5.97 11.71 5.48 0.30 17.98 11.75 090 

66500 ......... ............ A Incision of iris ............................................... 3.70 NA 4.65 0.19 NA 8.54 090 

66505 ......... ............ A Incision of iris ............................................... 4.07 NA 4.99 0.20 NA 9.26 090 

66600 ......... ............ A Remove iris and lesion ................................ 8.67 NA 8.23 0.44 NA 17.34 090 

66605 ......... ............ A Removal of iris ............................................. 12.77 NA 10.02 0.79 NA 23.58 090 

66625 ......... ............ A Removal of iris ............................................. 5.12 NA 4.73 0.27 NA 10.12 090 

66630 ......... ............ A Removal of iris ............................................. 6.15 NA 5.70 0.31 NA 12.16 090 

66635 ......... ............ A Removal of iris ............................................. 6.24 NA 5.74 0.32 NA 12.30 090 

66680 ......... ............ A Repair iris & ciliary body .............................. 5.43 NA 5.27 0.27 NA 10.97 090 

66682 ......... ............ A Repair iris & ciliary body .............................. 6.20 NA 6.61 0.31 NA 13.12 090 

66700 ......... ............ A Destruction, ciliary body .............................. 4.77 5.25 3.93 0.25 10.27 8.95 090 

66710 ......... ............ A Destruction, ciliary body .............................. 4.77 5.17 3.84 0.24 10.18 8.85 090 

66720 ......... ............ A Destruction, ciliary body .............................. 4.77 5.82 4.71 0.26 10.85 9.74 090 

66740 ......... ............ A Destruction, ciliary body .............................. 4.77 5.09 3.97 0.24 10.10 8.98 090 

66761 ......... ............ A Revision of iris ............................................. 4.06 5.59 4.31 0.21 9.86 8.58 090 

66762 ......... ............ A Revision of iris ............................................. 4.57 5.66 4.28 0.23 10.46 9.08 090 

66770 ......... ............ A Removal of inner eye lesion ........................ 5.17 6.09 4.80 0.26 11.52 10.23 090 

66820 ......... ............ A Incision, secondary cataract ........................ 3.88 NA 5.83 0.19 NA 9.90 090 

66821 ......... ............ A After cataract laser surgery ......................... 2.35 3.81 3.63 0.11 6.27 6.09 090 

66825 ......... ............ A Reposition intraocular lens .......................... 8.22 NA 9.07 0.40 NA 17.69 090 

66830 ......... ............ A Removal of lens lesion ................................ 8.19 NA 6.95 0.40 NA 15.54 090 

66840 ......... ............ A Removal of lens material ............................. 7.90 NA 6.86 0.39 NA 15.15 090 

66850 ......... ............ A Removal of lens material ............................. 9.10 NA 7.64 0.45 NA 17.19 090 

66852 ......... ............ A Removal of lens material ............................. 9.96 NA 8.10 0.50 NA 18.56 090 

66920 ......... ............ A Extraction of lens ......................................... 8.85 NA 7.30 0.44 NA 16.59 090 

66930 ......... ............ A Extraction of lens ......................................... 10.16 NA 8.14 0.51 NA 18.81 090 

66940 ......... ............ A Extraction of lens ......................................... 8.92 NA 7.67 0.44 NA 17.03 090 

66982 ......... ............ A Cataract surgery, complex ........................... 13.48 NA 9.86 0.63 NA 23.97 090 

66983 ......... ............ A Cataract surg w/iol, 1 stage ......................... 8.98 NA 6.11 0.21 NA 15.30 090 

66984 ......... ............ A Cataract surg w/iol, 1 stage ......................... 10.21 NA 7.41 0.42 NA 18.04 090 

66985 ......... ............ A Insert lens prosthesis ................................... 8.38 NA 7.45 0.39 NA 16.22 090 

66986 ......... ............ A Exchange lens prosthesis ............................ 12.26 NA 9.17 0.60 NA 22.03 090 

66990 ......... ............ A Ophthalmic endoscope add-on .................... 1.51 NA 0.69 0.07 NA 2.27 ZZZ 

67005 ......... ............ A Partial removal of eye fluid .......................... 5.69 NA 4.37 0.29 NA 10.35 090 

67010 ......... ............ A Partial removal of eye fluid .......................... 6.86 NA 4.91 0.34 NA 12.11 090 

67015 ......... ............ A Release of eye fluid ..................................... 6.91 NA 6.46 0.35 NA 13.72 090 

67025 ......... ............ A Replace eye fluid ......................................... 6.83 9.24 6.22 0.34 16.41 13.39 090 

67027 ......... ............ A Implant eye drug system ............................. 10.83 NA 8.00 0.55 NA 19.38 090 

67028 ......... ............ A Injection eye drug ........................................ 2.52 2.70 1.45 0.13 5.35 4.10 000 

67030 ......... ............ A Incise inner eye strands .............................. 4.83 NA 5.85 0.25 NA 10.93 090 

67031 ......... ............ A Laser surgery, eye strands .......................... 3.66 4.61 3.64 0.18 8.45 7.48 090 

67036 ......... ............ A Removal of inner eye fluid ........................... 11.87 NA 9.12 0.60 NA 21.59 090 

67038 ......... ............ A Strip retinal membrane ................................ 21.21 NA 15.49 1.07 NA 37.77 090 

67039 ......... ............ A Laser treatment of retina ............................. 14.50 NA 12.18 0.73 NA 27.41 090 

67040 ......... ............ A Laser treatment of retina ............................. 17.20 NA 13.68 0.87 NA 31.75 090 

67101 ......... ............ A Repair detached retina ................................ 7.52 9.13 6.53 0.38 17.03 14.43 090 

67105 ......... ............ A Repair detached retina ................................ 7.40 8.09 6.15 0.37 15.86 13.92 090 

67107 ......... ............ A Repair detached retina ................................ 14.82 NA 11.30 0.74 NA 26.86 090 

67108 ......... ............ A Repair detached retina ................................ 20.79 NA 14.41 1.05 NA 36.25 090 

67110 ......... ............ A Repair detached retina ................................ 8.80 10.24 7.39 0.44 19.48 16.63 090 

67112 ......... ............ A Rerepair detached retina ............................. 16.83 NA 11.81 0.85 NA 29.49 090 

67115 ......... ............ A Release encircling material ......................... 4.98 NA 5.08 0.25 NA 10.31 090 

67120 ......... ............ A Remove eye implant material ...................... 5.97 8.59 5.52 0.30 14.86 11.79 090 

67121 ......... ............ A Remove eye implant material ...................... 10.65 NA 8.53 0.53 NA 19.71 090 

67141 ......... ............ A Treatment of retina ...................................... 5.19 5.85 4.86 0.26 11.30 10.31 090 

67145 ......... ............ A Treatment of retina ...................................... 5.36 5.72 4.93 0.27 11.35 10.56 090 

67208 ......... ............ A Treatment of retinal lesion ........................... 6.69 6.12 5.51 0.34 13.15 12.54 090 

67210 ......... ............ A Treatment of retinal lesion ........................... 8.81 6.58 5.87 0.44 15.83 15.12 090 

67218 ......... ............ A Treatment of retinal lesion ........................... 18.50 NA 12.15 0.93 NA 31.58 090 

67220 ......... ............ A Treatment of choroid lesion ......................... 13.11 10.43 9.01 0.66 24.20 22.78 090 

67221 ......... ............ R Ocular photodynamic ther ........................... 4.00 4.34 1.80 0.20 8.54 6.00 000 

67225 ......... ............ A Eye photodynamic ther add-on ................... 0.47 0.25 0.21 0.02 0.74 0.70 ZZZ 

67227 ......... ............ A Treatment of retinal lesion ........................... 6.57 6.58 5.52 0.33 13.48 12.42 090 

67228 ......... ............ A Treatment of retinal lesion ........................... 12.72 11.49 8.54 0.64 24.85 21.90 090 

47647

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

67250 ......... ............ A Reinforce eye wall ....................................... 8.65 NA 9.18 0.43 NA 18.26 090 

67255 ......... ............ A Reinforce/graft eye wall ............................... 8.89 NA 9.91 0.45 NA 19.25 090 

67311 ......... ............ A Revise eye muscle ...................................... 6.64 NA 6.02 0.37 NA 13.03 090 

67312 ......... ............ A Revise two eye muscles .............................. 8.53 NA 6.75 0.44 NA 15.72 090 

67314 ......... ............ A Revise eye muscle ...................................... 7.51 NA 6.55 0.40 NA 14.46 090 

67316 ......... ............ A Revise two eye muscles .............................. 9.65 NA 7.50 0.51 NA 17.66 090 

67318 ......... ............ A Revise eye muscle(s) .................................. 7.84 NA 6.93 0.41 NA 15.18 090 

67320 ......... ............ A Revise eye muscle(s) add-on ...................... 4.32 NA 1.95 0.23 NA 6.50 ZZZ 

67331 ......... ............ A Eye surgery follow-up add-on ...................... 4.05 NA 1.82 0.21 NA 6.08 ZZZ 

67332 ......... ............ A Rerevise eye muscles add-on ..................... 4.48 NA 2.02 0.24 NA 6.74 ZZZ 

67334 ......... ............ A Revise eye muscle w/suture ........................ 3.97 NA 1.79 0.20 NA 5.96 ZZZ 

67335 ......... ............ A Eye suture during surgery ........................... 2.49 NA 1.12 0.13 NA 3.74 ZZZ 

67340 ......... ............ A Revise eye muscle add-on .......................... 4.92 NA 2.20 0.26 NA 7.38 ZZZ 

67343 ......... ............ A Release eye tissue ...................................... 7.34 NA 6.50 0.42 NA 14.26 090 

67345 ......... ............ A Destroy nerve of eye muscle ....................... 2.96 2.58 2.01 0.18 5.72 5.15 010 

67350 ......... ............ A Biopsy eye muscle ....................................... 2.87 NA 1.86 0.15 NA 4.88 000 

67400 ......... ............ A Explore/biopsy eye socket ........................... 9.75 NA 11.27 0.58 NA 21.60 090 

67405 ......... ............ A Explore/drain eye socket ............................. 7.92 NA 9.78 0.49 NA 18.19 090 

67412 ......... ............ A Explore/treat eye socket .............................. 9.49 NA 10.95 0.53 NA 20.97 090 

67413 ......... ............ A Explore/treat eye socket .............................. 9.99 NA 10.78 0.56 NA 21.33 090 

67414 ......... ............ A Explr/decompress eye socket ...................... 11.11 NA 12.06 0.66 NA 23.83 090 

67415 ......... ............ A Aspiration, orbital contents .......................... 1.76 NA 0.76 0.09 NA 2.61 000 

67420 ......... ............ A Explore/treat eye socket .............................. 20.03 NA 17.39 1.21 NA 38.63 090 

67430 ......... ............ A Explore/treat eye socket .............................. 13.37 NA 15.08 0.84 NA 29.29 090 

67440 ......... ............ A Explore/drain eye socket ............................. 13.07 NA 14.27 0.76 NA 28.10 090 

67445 ......... ............ A Explr/decompress eye socket ...................... 14.40 NA 13.93 0.92 NA 29.25 090 

67450 ......... ............ A Explore/biopsy eye socket ........................... 13.49 NA 14.71 0.75 NA 28.95 090 

67500 ......... ............ A Inject/treat eye socket .................................. 0.79 0.67 0.29 0.05 1.51 1.13 000 

67505 ......... ............ A Inject/treat eye socket .................................. 0.82 0.69 0.31 0.05 1.56 1.18 000 

67515 ......... ............ A Inject/treat eye socket .................................. 0.61 0.59 0.38 0.03 1.23 1.02 000 

67550 ......... ............ A Insert eye socket implant ............................. 10.17 NA 11.29 0.66 NA 22.12 090 

67560 ......... ............ A Revise eye socket implant ........................... 10.58 NA 11.37 0.70 NA 22.65 090 

67570 ......... ............ A Decompress optic nerve .............................. 13.56 NA 13.60 0.82 NA 27.98 090 

67700 ......... ............ A Drainage of eyelid abscess ......................... 1.35 6.05 1.27 0.07 7.47 2.69 010 

67710 ......... ............ A Incision of eyelid .......................................... 1.02 5.40 1.20 0.05 6.47 2.27 010 

67715 ......... ............ A Incision of eyelid fold ................................... 1.22 5.39 1.29 0.06 6.67 2.57 010 

67800 ......... ............ A Remove eyelid lesion .................................. 1.38 1.62 1.03 0.07 3.07 2.48 010 

67801 ......... ............ A Remove eyelid lesions ................................. 1.88 1.96 1.26 0.10 3.94 3.24 010 

67805 ......... ............ A Remove eyelid lesions ................................. 2.22 2.52 1.64 0.12 4.86 3.98 010 

67808 ......... ............ A Remove eyelid lesion(s) .............................. 3.79 NA 3.77 0.21 NA 7.77 090 

67810 ......... ............ A Biopsy of eyelid ........................................... 1.48 3.34 0.67 0.11 4.93 2.26 000 

67820 ......... ............ A Revise eyelashes ......................................... 0.89 0.60 0.56 0.04 1.53 1.49 000 

67825 ......... ............ A Revise eyelashes ......................................... 1.38 1.73 1.41 0.07 3.18 2.86 010 

67830 ......... ............ A Revise eyelashes ......................................... 1.70 5.55 1.50 0.09 7.34 3.29 010 

67835 ......... ............ A Revise eyelashes ......................................... 5.55 NA 4.61 0.29 NA 10.45 090 

67840 ......... ............ A Remove eyelid lesion .................................. 2.04 5.49 1.65 0.11 7.64 3.80 010 

67850 ......... ............ A Treat eyelid lesion ....................................... 1.69 3.37 1.46 0.11 5.17 3.26 010 

67875 ......... ............ A Closure of eyelid by suture .......................... 1.35 3.31 0.94 0.08 4.74 2.37 000 

67880 ......... ............ A Revision of eyelid ........................................ 3.79 6.63 3.79 0.20 10.62 7.78 090 

67882 ......... ............ A Revision of eyelid ........................................ 5.06 7.65 4.80 0.27 12.98 10.13 090 

67900 ......... ............ A Repair brow defect ...................................... 6.13 9.05 5.23 0.39 15.57 11.75 090 

67901 ......... ............ A Repair eyelid defect ..................................... 6.96 NA 5.38 0.53 NA 12.87 090 

67902 ......... ............ A Repair eyelid defect ..................................... 7.02 NA 5.44 0.46 NA 12.92 090 

67903 ......... ............ A Repair eyelid defect ..................................... 6.36 9.58 5.47 0.44 16.38 12.27 090 

67904 ......... ............ A Repair eyelid defect ..................................... 6.25 9.69 5.22 0.41 16.35 11.88 090 

67906 ......... ............ A Repair eyelid defect ..................................... 6.78 5.39 5.02 0.44 12.61 12.24 090 

67908 ......... ............ A Repair eyelid defect ..................................... 5.12 7.04 5.24 0.30 12.46 10.66 090 

67909 ......... ............ A Revise eyelid defect .................................... 5.39 8.03 4.93 0.32 13.74 10.64 090 

67911 ......... ............ A Revise eyelid defect .................................... 5.26 NA 4.77 0.31 NA 10.34 090 

67912 ......... ............ A Correction eyelid w/ implant ........................ 5.67 18.69 5.46 0.28 24.64 11.41 090 

67914 ......... ............ A Repair eyelid defect ..................................... 3.67 6.35 3.04 0.21 10.23 6.92 090 

67915 ......... ............ A Repair eyelid defect ..................................... 3.18 6.00 2.80 0.17 9.35 6.15 090 

67916 ......... ............ A Repair eyelid defect ..................................... 5.30 8.06 4.76 0.30 13.66 10.36 090 

67917 ......... ............ A Repair eyelid defect ..................................... 6.01 8.47 5.07 0.37 14.85 11.45 090 

67921 ......... ............ A Repair eyelid defect ..................................... 3.39 6.21 2.89 0.18 9.78 6.46 090 

67922 ......... ............ A Repair eyelid defect ..................................... 3.06 5.93 2.75 0.16 9.15 5.97 090 

67923 ......... ............ A Repair eyelid defect ..................................... 5.87 8.14 4.97 0.32 14.33 11.16 090 

67924 ......... ............ A Repair eyelid defect ..................................... 5.78 8.94 4.68 0.32 15.04 10.78 090 

67930 ......... ............ A Repair eyelid wound .................................... 3.60 5.74 2.17 0.20 9.54 5.97 010 

67935 ......... ............ A Repair eyelid wound .................................... 6.21 8.53 4.40 0.39 15.13 11.00 090 

67938 ......... ............ A Remove eyelid foreign body ........................ 1.33 5.40 1.27 0.07 6.80 2.67 010 

67950 ......... ............ A Revision of eyelid ........................................ 5.81 8.63 5.19 0.36 14.80 11.36 090 

67961 ......... ............ A Revision of eyelid ........................................ 5.68 8.68 5.01 0.33 14.69 11.02 090 

67966 ......... ............ A Revision of eyelid ........................................ 6.56 9.13 5.53 0.39 16.08 12.48 090 

67971 ......... ............ A Reconstruction of eyelid .............................. 9.78 NA 7.27 0.54 NA 17.59 090 

47648

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

67973 ......... ............ A Reconstruction of eyelid .............................. 12.85 NA 9.29 0.73 NA 22.87 090 

67974 ......... ............ A Reconstruction of eyelid .............................. 12.82 NA 9.21 0.70 NA 22.73 090 

67975 ......... ............ A Reconstruction of eyelid .............................. 9.12 NA 6.94 0.49 NA 16.55 090 

68020 ......... ............ A Incise/drain eyelid lining .............................. 1.37 1.41 1.21 0.07 2.85 2.65 010 

68040 ......... ............ A Treatment of eyelid lesions ......................... 0.85 0.71 0.43 0.04 1.60 1.32 000 

68100 ......... ............ A Biopsy of eyelid lining .................................. 1.35 3.25 0.95 0.07 4.67 2.37 000 

68110 ......... ............ A Remove eyelid lining lesion ......................... 1.77 4.10 1.64 0.09 5.96 3.50 010 

68115 ......... ............ A Remove eyelid lining lesion ......................... 2.36 5.97 1.91 0.12 8.45 4.39 010 

68130 ......... ............ A Remove eyelid lining lesion ......................... 4.92 8.72 4.59 0.25 13.89 9.76 090 

68135 ......... ............ A Remove eyelid lining lesion ......................... 1.84 1.81 1.65 0.09 3.74 3.58 010 

68200 ......... ............ A Treat eyelid by injection ............................... 0.49 0.54 0.33 0.02 1.05 0.84 000 

68320 ......... ............ A Revise/graft eyelid lining .............................. 5.36 11.29 5.52 0.29 16.94 11.17 090 

68325 ......... ............ A Revise/graft eyelid lining .............................. 7.35 NA 6.53 0.41 NA 14.29 090 

68326 ......... ............ A Revise/graft eyelid lining .............................. 7.14 NA 6.40 0.38 NA 13.92 090 

68328 ......... ............ A Revise/graft eyelid lining .............................. 8.17 NA 7.26 0.55 NA 15.98 090 

68330 ......... ............ A Revise eyelid lining ...................................... 4.82 9.41 4.71 0.25 14.48 9.78 090 

68335 ......... ............ A Revise/graft eyelid lining .............................. 7.18 NA 6.37 0.36 NA 13.91 090 

68340 ......... ............ A Separate eyelid adhesions .......................... 4.16 8.89 4.10 0.21 13.26 8.47 090 

68360 ......... ............ A Revise eyelid lining ...................................... 4.36 8.05 4.18 0.22 12.63 8.76 090 

68362 ......... ............ A Revise eyelid lining ...................................... 7.33 NA 6.40 0.37 NA 14.10 090 

68371 ......... ............ A Harvest eye tissue, alograft ......................... 4.89 NA 4.73 0.45 NA 10.07 010 

68400 ......... ............ A Incise/drain tear gland ................................. 1.69 5.92 1.83 0.09 7.70 3.61 010 

68420 ......... ............ A Incise/drain tear sac .................................... 2.30 6.22 2.11 0.12 8.64 4.53 010 

68440 ......... ............ A Incise tear duct opening .............................. 0.94 2.09 1.27 0.05 3.08 2.26 010 

68500 ......... ............ A Removal of tear gland ................................. 11.00 NA 9.73 0.63 NA 21.36 090 

68505 ......... ............ A Partial removal, tear gland .......................... 10.92 NA 10.59 0.61 NA 22.12 090 

68510 ......... ............ A Biopsy of tear gland ..................................... 4.60 7.35 2.09 0.24 12.19 6.93 000 

68520 ......... ............ A Removal of tear sac .................................... 7.50 NA 7.41 0.39 NA 15.30 090 

68525 ......... ............ A Biopsy of tear sac ........................................ 4.42 NA 2.01 0.24 NA 6.67 000 

68530 ......... ............ A Clearance of tear duct ................................. 3.65 8.19 2.64 0.20 12.04 6.49 010 

68540 ......... ............ A Remove tear gland lesion ............................ 10.58 NA 9.38 0.53 NA 20.49 090 

68550 ......... ............ A Remove tear gland lesion ............................ 13.24 NA 11.33 0.66 NA 25.23 090 

68700 ......... ............ A Repair tear ducts ......................................... 6.59 NA 5.97 0.35 NA 12.91 090 

68705 ......... ............ A Revise tear duct opening ............................. 2.06 4.19 1.78 0.10 6.35 3.94 010 

68720 ......... ............ A Create tear sac drain ................................... 8.95 NA 7.86 0.50 NA 17.31 090 

68745 ......... ............ A Create tear duct drain .................................. 8.62 NA 7.86 0.43 NA 16.91 090 

68750 ......... ............ A Create tear duct drain .................................. 8.65 NA 8.27 0.46 NA 17.38 090 

68760 ......... ............ A Close tear duct opening .............................. 1.73 3.55 1.63 0.09 5.37 3.45 010 

68761 ......... ............ A Close tear duct opening .............................. 1.36 2.27 1.32 0.07 3.70 2.75 010 

68770 ......... ............ A Close tear system fistula ............................. 7.01 3.17 3.17 0.36 10.54 10.54 090 

68801 ......... ............ A Dilate tear duct opening .............................. 0.94 1.95 1.48 0.05 2.94 2.47 010 

68810 ......... ............ A Probe nasolacrimal duct .............................. 1.90 3.66 2.67 0.11 5.67 4.68 010 

68811 ......... ............ A Probe nasolacrimal duct .............................. 2.35 NA 2.40 0.14 NA 4.89 010 

68815 ......... ............ A Probe nasolacrimal duct .............................. 3.20 8.27 2.81 0.18 11.65 6.19 010 

68840 ......... ............ A Explore/irrigate tear ducts ............................ 1.25 1.61 1.12 0.06 2.92 2.43 010 

68850 ......... ............ A Injection for tear sac x-ray ........................... 0.80 0.88 0.67 0.04 1.72 1.51 000 

69000 ......... ............ A Drain external ear lesion ............................. 1.45 2.89 1.38 0.12 4.46 2.95 010 

69005 ......... ............ A Drain external ear lesion ............................. 2.11 2.93 1.83 0.18 5.22 4.12 010 

69020 ......... ............ A Drain outer ear canal lesion ........................ 1.48 3.97 2.07 0.12 5.57 3.67 010 

69100 ......... ............ A Biopsy of external ear .................................. 0.81 1.71 0.39 0.07 2.59 1.27 000 

69105 ......... ............ A Biopsy of external ear canal ........................ 0.85 2.32 0.77 0.07 3.24 1.69 000 

69110 ......... ............ A Remove external ear, partial ....................... 3.43 6.73 4.46 0.34 10.50 8.23 090 

69120 ......... ............ A Removal of external ear .............................. 4.04 NA 6.16 0.39 NA 10.59 090 

69140 ......... ............ A Remove ear canal lesion(s) ......................... 7.96 NA 13.21 0.67 NA 21.84 090 

69145 ......... ............ A Remove ear canal lesion(s) ......................... 2.62 5.73 3.28 0.22 8.57 6.12 090 

69150 ......... ............ A Extensive ear canal surgery ........................ 13.41 NA 13.32 1.27 NA 28.00 090 

69155 ......... ............ A Extensive ear/neck surgery ......................... 20.77 NA 19.43 1.84 NA 42.04 090 

69200 ......... ............ A Clear outer ear canal ................................... 0.77 2.38 0.56 0.06 3.21 1.39 000 

69205 ......... ............ A Clear outer ear canal ................................... 1.20 NA 1.35 0.10 NA 2.65 010 

69210 ......... ............ A Remove impacted ear wax .......................... 0.61 0.63 0.23 0.05 1.29 0.89 000 

69220 ......... ............ A Clean out mastoid cavity ............................. 0.83 2.35 0.74 0.07 3.25 1.64 000 

69222 ......... ............ A Clean out mastoid cavity ............................. 1.40 3.82 2.05 0.12 5.34 3.57 010 

69300 ......... ............ R Revise external ear ...................................... 6.35 NA 4.21 0.75 NA 11.31 YYY 

69310 ......... ............ A Rebuild outer ear canal ............................... 10.77 NA 16.18 0.89 NA 27.84 090 

69320 ......... ............ A Rebuild outer ear canal ............................... 16.93 NA 21.71 1.45 NA 40.09 090 

69400 ......... ............ A Inflate middle ear canal ............................... 0.83 2.16 0.67 0.07 3.06 1.57 000 

69401 ......... ............ A Inflate middle ear canal ............................... 0.63 1.24 0.65 0.05 1.92 1.33 000 

69405 ......... ............ A Catheterize middle ear canal ....................... 2.63 3.46 2.29 0.21 6.30 5.13 010 

69410 ......... ............ A Inset middle ear (baffle) ............................... 0.33 2.12 0.48 0.03 2.48 0.84 000 

69420 ......... ............ A Incision of eardrum ...................................... 1.33 3.12 1.58 0.11 4.56 3.02 010 

69421 ......... ............ A Incision of eardrum ...................................... 1.73 NA 2.15 0.16 NA 4.04 010 

69424 ......... ............ A Remove ventilating tube .............................. 0.85 2.17 0.68 0.07 3.09 1.60 000 

69433 ......... ............ A Create eardrum opening .............................. 1.52 3.09 1.64 0.13 4.74 3.29 010 

69436 ......... ............ A Create eardrum opening .............................. 1.96 NA 2.27 0.19 NA 4.42 010 

69440 ......... ............ A Exploration of middle ear ............................. 7.56 NA 8.71 0.62 NA 16.89 090 

47649

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

69450 ......... ............ A Eardrum revision .......................................... 5.56 NA 6.99 0.45 NA 13.00 090 

69501 ......... ............ A Mastoidectomy ............................................. 9.06 NA 8.96 0.76 NA 18.78 090 

69502 ......... ............ A Mastoidectomy ............................................. 12.36 NA 11.54 1.03 NA 24.93 090 

69505 ......... ............ A Remove mastoid structures ......................... 12.97 NA 17.11 1.08 NA 31.16 090 

69511 ......... ............ A Extensive mastoid surgery .......................... 13.50 NA 17.39 1.09 NA 31.98 090 

69530 ......... ............ A Extensive mastoid surgery .......................... 19.16 NA 21.52 1.44 NA 42.12 090 

69535 ......... ............ A Remove part of temporal bone .................... 36.09 NA 31.85 2.98 NA 70.92 090 

69540 ......... ............ A Remove ear lesion ....................................... 1.20 3.71 1.95 0.10 5.01 3.25 010 

69550 ......... ............ A Remove ear lesion ....................................... 10.97 NA 14.79 0.90 NA 26.66 090 

69552 ......... ............ A Remove ear lesion ....................................... 19.43 NA 20.60 1.55 NA 41.58 090 

69554 ......... ............ A Remove ear lesion ....................................... 33.11 NA 30.18 2.94 NA 66.23 090 

69601 ......... ............ A Mastoid surgery revision .............................. 13.22 NA 12.60 1.07 NA 26.89 090 

69602 ......... ............ A Mastoid surgery revision .............................. 13.56 NA 13.16 1.05 NA 27.77 090 

69603 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 18.26 1.14 NA 33.40 090 

69604 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 13.63 0.92 NA 28.55 090 

69605 ......... ............ A Mastoid surgery revision .............................. 18.46 NA 20.85 1.51 NA 40.82 090 

69610 ......... ............ A Repair of eardrum ........................................ 4.42 5.50 3.26 0.36 10.28 8.04 010 

69620 ......... ............ A Repair of eardrum ........................................ 5.88 11.03 6.25 0.48 17.39 12.61 090 

69631 ......... ............ A Repair eardrum structures ........................... 9.85 NA 11.13 0.81 NA 21.79 090 

69632 ......... ............ A Rebuild eardrum structures ......................... 12.73 NA 13.39 1.04 NA 27.16 090 

69633 ......... ............ A Rebuild eardrum structures ......................... 12.08 NA 12.97 0.99 NA 26.04 090 

69635 ......... ............ A Repair eardrum structures ........................... 13.31 NA 16.66 1.08 NA 31.05 090 

69636 ......... ............ A Rebuild eardrum structures ......................... 15.20 NA 19.18 1.23 NA 35.61 090 

69637 ......... ............ A Rebuild eardrum structures ......................... 15.09 NA 19.11 1.25 NA 35.45 090 

69641 ......... ............ A Revise middle ear & mastoid ...................... 12.69 NA 12.70 1.04 NA 26.43 090 

69642 ......... ............ A Revise middle ear & mastoid ...................... 16.81 NA 16.19 1.37 NA 34.37 090 

69643 ......... ............ A Revise middle ear & mastoid ...................... 15.30 NA 14.73 1.26 NA 31.29 090 

69644 ......... ............ A Revise middle ear & mastoid ...................... 16.94 NA 20.30 1.38 NA 38.62 090 

69645 ......... ............ A Revise middle ear & mastoid ...................... 16.36 NA 19.92 1.35 NA 37.63 090 

69646 ......... ............ A Revise middle ear & mastoid ...................... 17.96 NA 20.65 1.48 NA 40.09 090 

69650 ......... ............ A Release middle ear bone ............................ 9.65 NA 9.85 0.78 NA 20.28 090 

69660 ......... ............ A Revise middle ear bone ............................... 11.88 NA 11.13 0.95 NA 23.96 090 

69661 ......... ............ A Revise middle ear bone ............................... 15.72 NA 14.62 1.29 NA 31.63 090 

69662 ......... ............ A Revise middle ear bone ............................... 15.42 NA 13.68 1.26 NA 30.36 090 

69666 ......... ............ A Repair middle ear structures ....................... 9.74 NA 9.91 0.79 NA 20.44 090 

69667 ......... ............ A Repair middle ear structures ....................... 9.75 NA 9.92 0.79 NA 20.46 090 

69670 ......... ............ A Remove mastoid air cells ............................ 11.49 NA 11.65 0.96 NA 24.10 090 

69676 ......... ............ A Remove middle ear nerve ........................... 9.51 NA 10.67 0.84 NA 21.02 090 

69700 ......... ............ A Close mastoid fistula ................................... 8.22 NA 9.20 0.66 NA 18.08 090 

69711 ......... ............ A Remove/repair hearing aid .......................... 10.42 NA 10.74 0.85 NA 22.01 090 

69714 ......... ............ A Implant temple bone w/stimul ...................... 13.98 NA 12.61 1.21 NA 27.80 090 

69715 ......... ............ A Temple bne implnt w/stimulat ...................... 18.22 NA 14.96 1.49 NA 34.67 090 

69717 ......... ............ A Temple bone implant revision ..................... 14.96 NA 14.46 1.35 NA 30.77 090 

69718 ......... ............ A Revise temple bone implant ........................ 18.47 NA 15.26 1.62 NA 35.35 090 

69720 ......... ............ A Release facial nerve .................................... 14.36 NA 14.43 1.24 NA 30.03 090 

69725 ......... ............ A Release facial nerve .................................... 25.34 NA 20.02 2.29 NA 47.65 090 

69740 ......... ............ A Repair facial nerve ....................................... 15.94 NA 13.37 1.58 NA 30.89 090 

69745 ......... ............ A Repair facial nerve ....................................... 16.66 NA 14.91 1.36 NA 32.93 090 

69801 ......... ............ A Incise inner ear ............................................ 8.55 NA 9.41 0.70 NA 18.66 090 

69802 ......... ............ A Incise inner ear ............................................ 13.08 NA 12.25 1.07 NA 26.40 090 

69805 ......... ............ A Explore inner ear ......................................... 13.80 NA 11.82 1.16 NA 26.78 090 

69806 ......... ............ A Explore inner ear ......................................... 12.33 NA 10.99 1.04 NA 24.36 090 

69820 ......... ............ A Establish inner ear window .......................... 10.32 NA 11.19 0.82 NA 22.33 090 

69840 ......... ............ A Revise inner ear window ............................. 10.24 NA 13.15 0.74 NA 24.13 090 

69905 ......... ............ A Remove inner ear ........................................ 11.08 NA 11.29 0.90 NA 23.27 090 

69910 ......... ............ A Remove inner ear & mastoid ....................... 13.61 NA 11.88 1.10 NA 26.59 090 

69915 ......... ............ A Incise inner ear nerve .................................. 21.20 NA 16.39 1.70 NA 39.29 090 

69930 ......... ............ A Implant cochlear device ............................... 16.78 NA 14.68 1.38 NA 32.84 090 

69950 ......... ............ A Incise inner ear nerve .................................. 25.60 NA 18.82 3.07 NA 47.49 090 

69955 ......... ............ A Release facial nerve .................................... 27.00 NA 21.29 2.77 NA 51.06 090 

69960 ......... ............ A Release inner ear canal .............................. 27.00 NA 19.98 2.69 NA 49.67 090 

69970 ......... ............ A Remove inner ear lesion ............................. 29.99 NA 23.17 2.73 NA 55.89 090 

69990 ......... ............ R Microsurgery add-on .................................... 3.46 NA 1.78 0.81 NA 6.05 ZZZ 

70010 ......... ............ A Contrast x-ray of brain ................................. 1.19 4.72 NA 0.28 6.19 NA XXX 

70010 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 

70010 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 4.32 NA 0.22 4.54 NA XXX 

70015 ......... ............ A Contrast x-ray of brain ................................. 1.19 1.74 NA 0.14 3.07 NA XXX 

70015 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 

70015 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 1.35 NA 0.08 1.43 NA XXX 

70030 ......... ............ A X-ray eye for foreign body ........................... 0.17 0.47 NA 0.03 0.67 NA XXX 

70030 ......... 26 ....... A X-ray eye for foreign body ........................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70030 ......... TC ...... A X-ray eye for foreign body ........................... 0.00 0.42 NA 0.02 0.44 NA XXX 

70100 ......... ............ A X-ray exam of jaw ........................................ 0.18 0.58 NA 0.03 0.79 NA XXX 

70100 ......... 26 ....... A X-ray exam of jaw ........................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70100 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX 

47650

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

70110 ......... ............ A X-ray exam of jaw ........................................ 0.25 0.70 NA 0.05 1.00 NA XXX 

70110 ......... 26 ....... A X-ray exam of jaw ........................................ 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

70110 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.62 NA 0.04 0.66 NA XXX 

70120 ......... ............ A X-ray exam of mastoids ............................... 0.18 0.68 NA 0.05 0.91 NA XXX 

70120 ......... 26 ....... A X-ray exam of mastoids ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70120 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70130 ......... ............ A X-ray exam of mastoids ............................... 0.34 0.89 NA 0.07 1.30 NA XXX 

70130 ......... 26 ....... A X-ray exam of mastoids ............................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 

70130 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.78 NA 0.05 0.83 NA XXX 

70134 ......... ............ A X-ray exam of middle ear ............................ 0.34 0.85 NA 0.07 1.26 NA XXX 

70134 ......... 26 ....... A X-ray exam of middle ear ............................ 0.34 0.11 0.11 0.02 0.47 0.47 XXX 

70134 ......... TC ...... A X-ray exam of middle ear ............................ 0.00 0.73 NA 0.05 0.78 NA XXX 

70140 ......... ............ A X-ray exam of facial bones .......................... 0.19 0.68 NA 0.05 0.92 NA XXX 

70140 ......... 26 ....... A X-ray exam of facial bones .......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70140 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70150 ......... ............ A X-ray exam of facial bones .......................... 0.26 0.87 NA 0.06 1.19 NA XXX 

70150 ......... 26 ....... A X-ray exam of facial bones .......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

70150 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.78 NA 0.05 0.83 NA XXX 

70160 ......... ............ A X-ray exam of nasal bones ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 

70160 ......... 26 ....... A X-ray exam of nasal bones ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70160 ......... TC ...... A X-ray exam of nasal bones ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

70170 ......... ............ A X-ray exam of tear duct ............................... 0.30 1.04 NA 0.07 1.41 NA XXX 

70170 ......... 26 ....... A X-ray exam of tear duct ............................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 

70170 ......... TC ...... A X-ray exam of tear duct ............................... 0.00 0.95 NA 0.06 1.01 NA XXX 

70190 ......... ............ A X-ray exam of eye sockets .......................... 0.21 0.69 NA 0.05 0.95 NA XXX 

70190 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

70190 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70200 ......... ............ A X-ray exam of eye sockets .......................... 0.28 0.87 NA 0.06 1.21 NA XXX 

70200 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.28 0.09 0.09 0.01 0.38 0.38 XXX 

70200 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.78 NA 0.05 0.83 NA XXX 

70210 ......... ............ A X-ray exam of sinuses ................................. 0.17 0.67 NA 0.05 0.89 NA XXX 

70210 ......... 26 ....... A X-ray exam of sinuses ................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70210 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.62 NA 0.04 0.66 NA XXX 

70220 ......... ............ A X-ray exam of sinuses ................................. 0.25 0.86 NA 0.06 1.17 NA XXX 

70220 ......... 26 ....... A X-ray exam of sinuses ................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

70220 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.78 NA 0.05 0.83 NA XXX 

70240 ......... ............ A X-ray exam, pituitary saddle ........................ 0.19 0.48 NA 0.03 0.70 NA XXX 

70240 ......... 26 ....... A X-ray exam, pituitary saddle ........................ 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70240 ......... TC ...... A X-ray exam, pituitary saddle ........................ 0.00 0.42 NA 0.02 0.44 NA XXX 

70250 ......... ............ A X-ray exam of skull ...................................... 0.24 0.70 NA 0.05 0.99 NA XXX 

70250 ......... 26 ....... A X-ray exam of skull ...................................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70250 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70260 ......... ............ A X-ray exam of skull ...................................... 0.34 1.00 NA 0.08 1.42 NA XXX 

70260 ......... 26 ....... A X-ray exam of skull ...................................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 

70260 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.89 NA 0.06 0.95 NA XXX 

70300 ......... ............ A X-ray exam of teeth ..................................... 0.10 0.31 NA 0.03 0.44 NA XXX 

70300 ......... 26 ....... A X-ray exam of teeth ..................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX 

70300 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.26 NA 0.02 0.28 NA XXX 

70310 ......... ............ A X-ray exam of teeth ..................................... 0.16 0.49 NA 0.03 0.68 NA XXX 

70310 ......... 26 ....... A X-ray exam of teeth ..................................... 0.16 0.08 0.08 0.01 0.25 0.25 XXX 

70310 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.42 NA 0.02 0.44 NA XXX 

70320 ......... ............ A Full mouth x-ray of teeth ............................. 0.22 0.86 NA 0.06 1.14 NA XXX 

70320 ......... 26 ....... A Full mouth x-ray of teeth ............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

70320 ......... TC ...... A Full mouth x-ray of teeth ............................. 0.00 0.78 NA 0.05 0.83 NA XXX 

70328 ......... ............ A X-ray exam of jaw joint ................................ 0.18 0.55 NA 0.03 0.76 NA XXX 

70328 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70328 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 0.49 NA 0.02 0.51 NA XXX 

70330 ......... ............ A X-ray exam of jaw joints .............................. 0.24 0.92 NA 0.06 1.22 NA XXX 

70330 ......... 26 ....... A X-ray exam of jaw joints .............................. 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70330 ......... TC ...... A X-ray exam of jaw joints .............................. 0.00 0.84 NA 0.05 0.89 NA XXX 

70332 ......... ............ A X-ray exam of jaw joint ................................ 0.54 2.29 NA 0.15 2.98 NA XXX 

70332 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.54 0.20 0.20 0.03 0.77 0.77 XXX 

70332 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 2.09 NA 0.12 2.21 NA XXX 

70336 ......... ............ A Magnetic image, jaw joint ............................ 1.48 11.67 NA 0.66 13.81 NA XXX 

70336 ......... 26 ....... A Magnetic image, jaw joint ............................ 1.48 0.49 0.49 0.07 2.04 2.04 XXX 

70336 ......... TC ...... A Magnetic image, jaw joint ............................ 0.00 11.19 NA 0.59 11.78 NA XXX 

70350 ......... ............ A X-ray head for orthodontia ........................... 0.17 0.45 NA 0.03 0.65 NA XXX 

70350 ......... 26 ....... A X-ray head for orthodontia ........................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

70350 ......... TC ...... A X-ray head for orthodontia ........................... 0.00 0.38 NA 0.02 0.40 NA XXX 

70355 ......... ............ A Panoramic x-ray of jaws .............................. 0.20 0.64 NA 0.05 0.89 NA XXX 

70355 ......... 26 ....... A Panoramic x-ray of jaws .............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

70355 ......... TC ...... A Panoramic x-ray of jaws .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 

70360 ......... ............ A X-ray exam of neck ..................................... 0.17 0.47 NA 0.03 0.67 NA XXX 

70360 ......... 26 ....... A X-ray exam of neck ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70360 ......... TC ...... A X-ray exam of neck ..................................... 0.00 0.42 NA 0.02 0.44 NA XXX 

47651

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

70370 ......... ............ A Throat x-ray & fluoroscopy .......................... 0.32 1.41 NA 0.08 1.81 NA XXX 

70370 ......... 26 ....... A Throat x-ray & fluoroscopy .......................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 

70370 ......... TC ...... A Throat x-ray & fluoroscopy .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

70371 ......... ............ A Speech evaluation, complex ........................ 0.84 2.37 NA 0.16 3.37 NA XXX 

70371 ......... 26 ....... A Speech evaluation, complex ........................ 0.84 0.27 0.27 0.04 1.15 1.15 XXX 

70371 ......... TC ...... A Speech evaluation, complex ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 

70373 ......... ............ A Contrast x-ray of larynx ............................... 0.44 1.92 NA 0.13 2.49 NA XXX 

70373 ......... 26 ....... A Contrast x-ray of larynx ............................... 0.44 0.14 0.14 0.02 0.60 0.60 XXX 

70373 ......... TC ...... A Contrast x-ray of larynx ............................... 0.00 1.78 NA 0.11 1.89 NA XXX 

70380 ......... ............ A X-ray exam of salivary gland ....................... 0.17 0.72 NA 0.05 0.94 NA XXX 

70380 ......... 26 ....... A X-ray exam of salivary gland ....................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70380 ......... TC ...... A X-ray exam of salivary gland ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 

70390 ......... ............ A X-ray exam of salivary duct ......................... 0.38 1.90 NA 0.13 2.41 NA XXX 

70390 ......... 26 ....... A X-ray exam of salivary duct ......................... 0.38 0.12 0.12 0.02 0.52 0.52 XXX 

70390 ......... TC ...... A X-ray exam of salivary duct ......................... 0.00 1.78 NA 0.11 1.89 NA XXX 

70450 ......... ............ A Ct head/brain w/o dye ................................. 0.85 4.99 NA 0.29 6.13 NA XXX 

70450 ......... 26 ....... A Ct head/brain w/o dye ................................. 0.85 0.28 0.28 0.04 1.17 1.17 XXX 

70450 ......... TC ...... A Ct head/brain w/o dye ................................. 0.00 4.71 NA 0.25 4.96 NA XXX 

70460 ......... ............ A Ct head/brain w/dye ..................................... 1.13 6.02 NA 0.35 7.50 NA XXX 

70460 ......... 26 ....... A Ct head/brain w/dye ..................................... 1.13 0.37 0.37 0.05 1.55 1.55 XXX 

70460 ......... TC ...... A Ct head/brain w/dye ..................................... 0.00 5.65 NA 0.30 5.95 NA XXX 

70470 ......... ............ A Ct head/brain w/o & w/ dye ......................... 1.27 7.47 NA 0.43 9.17 NA XXX 

70470 ......... 26 ....... A Ct head/brain w/o & w/ dye ......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

70470 ......... TC ...... A Ct head/brain w/o & w/ dye ......................... 0.00 7.06 NA 0.37 7.43 NA XXX 

70480 ......... ............ A Ct orbit/ear/fossa w/o dye ............................ 1.28 5.13 NA 0.31 6.72 NA XXX 

70480 ......... 26 ....... A Ct orbit/ear/fossa w/o dye ............................ 1.28 0.42 0.42 0.06 1.76 1.76 XXX 

70480 ......... TC ...... A Ct orbit/ear/fossa w/o dye ............................ 0.00 4.71 NA 0.25 4.96 NA XXX 

70481 ......... ............ A Ct orbit/ear/fossa w/dye ............................... 1.38 6.10 NA 0.36 7.84 NA XXX 

70481 ......... 26 ....... A Ct orbit/ear/fossa w/dye ............................... 1.38 0.45 0.45 0.06 1.89 1.89 XXX 

70481 ......... TC ...... A Ct orbit/ear/fossa w/dye ............................... 0.00 5.65 NA 0.30 5.95 NA XXX 

70482 ......... ............ A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 7.53 NA 0.44 9.42 NA XXX 

70482 ......... 26 ....... A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 

70482 ......... TC ...... A Ct orbit/ear/fossa w/o&w dye ....................... 0.00 7.06 NA 0.37 7.43 NA XXX 

70486 ......... ............ A Ct maxillofacial w/o dye ............................... 1.14 5.08 NA 0.30 6.52 NA XXX 

70486 ......... 26 ....... A Ct maxillofacial w/o dye ............................... 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

70486 ......... TC ...... A Ct maxillofacial w/o dye ............................... 0.00 4.71 NA 0.25 4.96 NA XXX 

70487 ......... ............ A Ct maxillofacial w/dye .................................. 1.30 6.07 NA 0.36 7.73 NA XXX 

70487 ......... 26 ....... A Ct maxillofacial w/dye .................................. 1.30 0.43 0.43 0.06 1.79 1.79 XXX 

70487 ......... TC ...... A Ct maxillofacial w/dye .................................. 0.00 5.65 NA 0.30 5.95 NA XXX 

70488 ......... ............ A Ct maxillofacial w/o & w dye ....................... 1.42 7.52 NA 0.43 9.37 NA XXX 

70488 ......... 26 ....... A Ct maxillofacial w/o & w dye ....................... 1.42 0.46 0.46 0.06 1.94 1.94 XXX 

70488 ......... TC ...... A Ct maxillofacial w/o & w dye ....................... 0.00 7.06 NA 0.37 7.43 NA XXX 

70490 ......... ............ A Ct soft tissue neck w/o dye ......................... 1.28 5.13 NA 0.31 6.72 NA XXX 

70490 ......... 26 ....... A Ct soft tissue neck w/o dye ......................... 1.28 0.42 0.42 0.06 1.76 1.76 XXX 

70490 ......... TC ...... A Ct soft tissue neck w/o dye ......................... 0.00 4.71 NA 0.25 4.96 NA XXX 

70491 ......... ............ A Ct soft tissue neck w/dye ............................ 1.38 6.10 NA 0.36 7.84 NA XXX 

70491 ......... 26 ....... A Ct soft tissue neck w/dye ............................ 1.38 0.45 0.45 0.06 1.89 1.89 XXX 

70491 ......... TC ...... A Ct soft tissue neck w/dye ............................ 0.00 5.65 NA 0.30 5.95 NA XXX 

70492 ......... ............ A Ct sft tsue nck w/o & w/dye ......................... 1.45 7.53 NA 0.44 9.42 NA XXX 

70492 ......... 26 ....... A Ct sft tsue nck w/o & w/dye ......................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 

70492 ......... TC ...... A Ct sft tsue nck w/o & w/dye ......................... 0.00 7.06 NA 0.37 7.43 NA XXX 

70496 ......... ............ A Ct angiography, head .................................. 1.75 11.16 NA 0.66 13.57 NA XXX 

70496 ......... 26 ....... A Ct angiography, head .................................. 1.75 0.57 0.57 0.08 2.40 2.40 XXX 

70496 ......... TC ...... A Ct angiography, head .................................. 0.00 10.59 NA 0.58 11.17 NA XXX 

70498 ......... ............ A Ct angiography, neck ................................... 1.75 11.16 NA 0.66 13.57 NA XXX 

70498 ......... 26 ....... A Ct angiography, neck ................................... 1.75 0.57 0.57 0.08 2.40 2.40 XXX 

70498 ......... TC ...... A Ct angiography, neck ................................... 0.00 10.59 NA 0.58 11.17 NA XXX 

70540 ......... ............ A Mri orbit/face/neck w/o dye .......................... 1.35 11.63 NA 0.45 13.43 NA XXX 

70540 ......... 26 ....... A Mri orbit/face/neck w/o dye .......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 

70540 ......... TC ...... A Mri orbit/face/neck w/o dye .......................... 0.00 11.19 NA 0.39 11.58 NA XXX 

70542 ......... ............ A Mri orbit/face/neck w/dye ............................. 1.62 13.95 NA 0.54 16.11 NA XXX 

70542 ......... 26 ....... A Mri orbit/face/neck w/dye ............................. 1.62 0.53 0.53 0.07 2.22 2.22 XXX 

70542 ......... TC ...... A Mri orbit/face/neck w/dye ............................. 0.00 13.42 NA 0.47 13.89 NA XXX 

70543 ......... ............ A Mri orbt/fac/nck w/o & w dye ....................... 2.15 25.55 NA 0.94 28.64 NA XXX 

70543 ......... 26 ....... A Mri orbt/fac/nck w/o & w dye ....................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

70543 ......... TC ...... A Mri orbt/fac/nck w/o & w dye ....................... 0.00 24.84 NA 0.84 25.68 NA XXX 

70544 ......... ............ A Mr angiography head w/o dye ..................... 1.20 11.58 NA 0.64 13.42 NA XXX 

70544 ......... 26 ....... A Mr angiography head w/o dye ..................... 1.20 0.39 0.39 0.05 1.64 1.64 XXX 

70544 ......... TC ...... A Mr angiography head w/o dye ..................... 0.00 11.19 NA 0.59 11.78 NA XXX 

70545 ......... ............ A Mr angiography head w/dye ........................ 1.20 11.58 NA 0.65 13.43 NA XXX 

70545 ......... 26 ....... A Mr angiography head w/dye ........................ 1.20 0.39 0.39 0.06 1.65 1.65 XXX 

70545 ......... TC ...... A Mr angiography head w/dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 

70546 ......... ............ A Mr angiograph head w/o&w dye .................. 1.80 22.96 NA 0.67 25.43 NA XXX 

70546 ......... 26 ....... A Mr angiograph head w/o&w dye .................. 1.80 0.59 0.59 0.08 2.47 2.47 XXX 

70546 ......... TC ...... A Mr angiograph head w/o&w dye .................. 0.00 22.37 NA 0.59 22.96 NA XXX 

47652

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

70547 ......... ............ A Mr angiography neck w/o dye ..................... 1.20 11.58 NA 0.64 13.42 NA XXX 

70547 ......... 26 ....... A Mr angiography neck w/o dye ..................... 1.20 0.39 0.39 0.05 1.64 1.64 XXX 

70547 ......... TC ...... A Mr angiography neck w/o dye ..................... 0.00 11.19 NA 0.59 11.78 NA XXX 

70548 ......... ............ A Mr angiography neck w/dye ........................ 1.20 11.58 NA 0.64 13.42 NA XXX 

70548 ......... 26 ....... A Mr angiography neck w/dye ........................ 1.20 0.39 0.39 0.05 1.64 1.64 XXX 

70548 ......... TC ...... A Mr angiography neck w/dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 

70549 ......... ............ A Mr angiograph neck w/o&w dye .................. 1.80 22.97 NA 0.67 25.44 NA XXX 

70549 ......... 26 ....... A Mr angiograph neck w/o&w dye .................. 1.80 0.59 0.59 0.08 2.47 2.47 XXX 

70549 ......... TC ...... A Mr angiograph neck w/o&w dye .................. 0.00 22.37 NA 0.59 22.96 NA XXX 

70551 ......... ............ A Mri brain w/o dye ......................................... 1.48 11.67 NA 0.66 13.81 NA XXX 

70551 ......... 26 ....... A Mri brain w/o dye ......................................... 1.48 0.49 0.49 0.07 2.04 2.04 XXX 

70551 ......... TC ...... A Mri brain w/o dye ......................................... 0.00 11.19 NA 0.59 11.78 NA XXX 

70552 ......... ............ A Mri brain w/ dye ........................................... 1.78 14.01 NA 0.79 16.58 NA XXX 

70552 ......... 26 ....... A Mri brain w/ dye ........................................... 1.78 0.59 0.59 0.09 2.46 2.46 XXX 

70552 ......... TC ...... A Mri brain w/ dye ........................................... 0.00 13.42 NA 0.70 14.12 NA XXX 

70553 ......... ............ A Mri brain w/o & w/ dye ................................. 2.36 25.62 NA 1.42 29.40 NA XXX 

70553 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 2.36 0.77 0.77 0.11 3.24 3.24 XXX 

70553 ......... TC ...... A Mri brain w/o & w/ dye ................................. 0.00 24.84 NA 1.31 26.15 NA XXX 

70557 ......... 26 ....... A Mri brain w/o dye ......................................... 2.90 1.12 1.12 0.08 4.10 4.10 XXX 

70558 ......... 26 ....... A Mri brain w/ dye ........................................... 3.20 1.23 1.23 0.10 4.53 4.53 XXX 

70559 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 3.20 1.23 1.23 0.12 4.55 4.55 XXX 

71010 ......... ............ A Chest x-ray .................................................. 0.18 0.53 NA 0.03 0.74 NA XXX 

71010 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71010 ......... TC ...... A Chest x-ray .................................................. 0.00 0.47 NA 0.02 0.49 NA XXX 

71015 ......... ............ A Chest x-ray .................................................. 0.21 0.59 NA 0.03 0.83 NA XXX 

71015 ......... 26 ....... A Chest x-ray .................................................. 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

71015 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

71020 ......... ............ A Chest x-ray .................................................. 0.22 0.69 NA 0.05 0.96 NA XXX 

71020 ......... 26 ....... A Chest x-ray .................................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71020 ......... TC ...... A Chest x-ray .................................................. 0.00 0.62 NA 0.04 0.66 NA XXX 

71021 ......... ............ A Chest x-ray .................................................. 0.27 0.82 NA 0.06 1.15 NA XXX 

71021 ......... 26 ....... A Chest x-ray .................................................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71021 ......... TC ...... A Chest x-ray .................................................. 0.00 0.73 NA 0.05 0.78 NA XXX 

71022 ......... ............ A Chest x-ray .................................................. 0.31 0.83 NA 0.06 1.20 NA XXX 

71022 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

71022 ......... TC ...... A Chest x-ray .................................................. 0.00 0.73 NA 0.05 0.78 NA XXX 

71023 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.38 0.91 NA 0.07 1.36 NA XXX 

71023 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

71023 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 0.78 NA 0.05 0.83 NA XXX 

71030 ......... ............ A Chest x-ray .................................................. 0.31 0.88 NA 0.06 1.25 NA XXX 

71030 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

71030 ......... TC ...... A Chest x-ray .................................................. 0.00 0.78 NA 0.05 0.83 NA XXX 

71034 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.46 1.60 NA 0.10 2.16 NA XXX 

71034 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.46 0.16 0.16 0.02 0.64 0.64 XXX 

71034 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 1.44 NA 0.08 1.52 NA XXX 

71035 ......... ............ A Chest x-ray .................................................. 0.18 0.58 NA 0.03 0.79 NA XXX 

71035 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71035 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

71040 ......... ............ A Contrast x-ray of bronchi ............................. 0.58 1.65 NA 0.11 2.34 NA XXX 

71040 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

71040 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

71060 ......... ............ A Contrast x-ray of bronchi ............................. 0.74 2.44 NA 0.17 3.35 NA XXX 

71060 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.74 0.24 0.24 0.04 1.02 1.02 XXX 

71060 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 2.20 NA 0.13 2.33 NA XXX 

71090 ......... ............ A X-ray & pacemaker insertion ....................... 0.54 1.89 NA 0.13 2.56 NA XXX 

71090 ......... 26 ....... A X-ray & pacemaker insertion ....................... 0.54 0.21 0.21 0.02 0.77 0.77 XXX 

71090 ......... TC ...... A X-ray & pacemaker insertion ....................... 0.00 1.68 NA 0.11 1.79 NA XXX 

71100 ......... ............ A X-ray exam of ribs ....................................... 0.22 0.64 NA 0.05 0.91 NA XXX 

71100 ......... 26 ....... A X-ray exam of ribs ....................................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71100 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

71101 ......... ............ A X-ray exam of ribs/chest .............................. 0.27 0.75 NA 0.05 1.07 NA XXX 

71101 ......... 26 ....... A X-ray exam of ribs/chest .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71101 ......... TC ...... A X-ray exam of ribs/chest .............................. 0.00 0.67 NA 0.04 0.71 NA XXX 

71110 ......... ............ A X-ray exam of ribs ....................................... 0.27 0.87 NA 0.06 1.20 NA XXX 

71110 ......... 26 ....... A X-ray exam of ribs ....................................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71110 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.78 NA 0.05 0.83 NA XXX 

71111 ......... ............ A X-ray exam of ribs/ chest ............................ 0.32 0.99 NA 0.07 1.38 NA XXX 

71111 ......... 26 ....... A X-ray exam of ribs/ chest ............................ 0.32 0.10 0.10 0.01 0.43 0.43 XXX 

71111 ......... TC ...... A X-ray exam of ribs/ chest ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 

71120 ......... ............ A X-ray exam of breastbone ........................... 0.20 0.71 NA 0.05 0.96 NA XXX 

71120 ......... 26 ....... A X-ray exam of breastbone ........................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

71120 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.65 NA 0.04 0.69 NA XXX 

71130 ......... ............ A X-ray exam of breastbone ........................... 0.22 0.78 NA 0.05 1.05 NA XXX 

71130 ......... 26 ....... A X-ray exam of breastbone ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71130 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.70 NA 0.04 0.74 NA XXX 

47653

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

71250 ......... ............ A Ct thorax w/o dye ........................................ 1.16 6.28 NA 0.36 7.80 NA XXX 

71250 ......... 26 ....... A Ct thorax w/o dye ........................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

71250 ......... TC ...... A Ct thorax w/o dye ........................................ 0.00 5.90 NA 0.31 6.21 NA XXX 

71260 ......... ............ A Ct thorax w/dye ............................................ 1.24 7.46 NA 0.43 9.13 NA XXX 

71260 ......... 26 ....... A Ct thorax w/dye ............................................ 1.24 0.40 0.40 0.06 1.70 1.70 XXX 

71260 ......... TC ...... A Ct thorax w/dye ............................................ 0.00 7.06 NA 0.37 7.43 NA XXX 

71270 ......... ............ A Ct thorax w/o & w/ dye ................................ 1.38 9.28 NA 0.52 11.18 NA XXX 

71270 ......... 26 ....... A Ct thorax w/o & w/ dye ................................ 1.38 0.45 0.45 0.06 1.89 1.89 XXX 

71270 ......... TC ...... A Ct thorax w/o & w/ dye ................................ 0.00 8.83 NA 0.46 9.29 NA XXX 

71275 ......... ............ A Ct angiography, chest .................................. 1.92 12.99 NA 0.48 15.39 NA XXX 

71275 ......... 26 ....... A Ct angiography, chest .................................. 1.92 0.63 0.63 0.09 2.64 2.64 XXX 

71275 ......... TC ...... A Ct angiography, chest .................................. 0.00 12.36 NA 0.39 12.75 NA XXX 

71550 ......... ............ A Mri chest w/o dye ........................................ 1.46 11.66 NA 0.52 13.64 NA XXX 

71550 ......... 26 ....... A Mri chest w/o dye ........................................ 1.46 0.48 0.48 0.07 2.01 2.01 XXX 

71550 ......... TC ...... A Mri chest w/o dye ........................................ 0.00 11.19 NA 0.45 11.64 NA XXX 

71551 ......... ............ A Mri chest w/dye ............................................ 1.73 13.98 NA 0.60 16.31 NA XXX 

71551 ......... 26 ....... A Mri chest w/dye ............................................ 1.73 0.56 0.56 0.08 2.37 2.37 XXX 

71551 ......... TC ...... A Mri chest w/dye ............................................ 0.00 13.42 NA 0.52 13.94 NA XXX 

71552 ......... ............ A Mri chest w/o & w/dye ................................. 2.26 25.58 NA 0.78 28.62 NA XXX 

71552 ......... 26 ....... A Mri chest w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

71552 ......... TC ...... A Mri chest w/o & w/dye ................................. 0.00 24.84 NA 0.68 25.52 NA XXX 

71555 ......... ............ R Mri angio chest w or w/o dye ...................... 1.81 11.78 NA 0.67 14.26 NA XXX 

71555 ......... 26 ....... R Mri angio chest w or w/o dye ...................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 

71555 ......... TC ...... R Mri angio chest w or w/o dye ...................... 0.00 11.19 NA 0.59 11.78 NA XXX 

72010 ......... ............ A X-ray exam of spine .................................... 0.45 1.17 NA 0.08 1.70 NA XXX 

72010 ......... 26 ....... A X-ray exam of spine .................................... 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

72010 ......... TC ...... A X-ray exam of spine .................................... 0.00 1.02 NA 0.06 1.08 NA XXX 

72020 ......... ............ A X-ray exam of spine .................................... 0.15 0.46 NA 0.03 0.64 NA XXX 

72020 ......... 26 ....... A X-ray exam of spine .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

72020 ......... TC ...... A X-ray exam of spine .................................... 0.00 0.42 NA 0.02 0.44 NA XXX 

72040 ......... ............ A X-ray exam of neck spine ............................ 0.22 0.67 NA 0.05 0.94 NA XXX 

72040 ......... 26 ....... A X-ray exam of neck spine ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72040 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.60 NA 0.04 0.64 NA XXX 

72050 ......... ............ A X-ray exam of neck spine ............................ 0.31 0.99 NA 0.07 1.37 NA XXX 

72050 ......... 26 ....... A X-ray exam of neck spine ............................ 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

72050 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 

72052 ......... ............ A X-ray exam of neck spine ............................ 0.36 1.25 NA 0.08 1.69 NA XXX 

72052 ......... 26 ....... A X-ray exam of neck spine ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

72052 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 1.13 NA 0.06 1.19 NA XXX 

72069 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.57 NA 0.03 0.82 NA XXX 

72069 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

72069 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.49 NA 0.02 0.51 NA XXX 

72070 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.72 NA 0.05 0.99 NA XXX 

72070 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72070 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.65 NA 0.04 0.69 NA XXX 

72072 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.81 NA 0.06 1.09 NA XXX 

72072 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72072 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.73 NA 0.05 0.78 NA XXX 

72074 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.98 NA 0.07 1.27 NA XXX 

72074 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72074 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.91 NA 0.06 0.97 NA XXX 

72080 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.74 NA 0.05 1.01 NA XXX 

72080 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72080 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72090 ......... ............ A X-ray exam of trunk spine ........................... 0.28 0.76 NA 0.05 1.09 NA XXX 

72090 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.28 0.09 0.09 0.01 0.38 0.38 XXX 

72090 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72100 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.74 NA 0.05 1.01 NA XXX 

72100 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72100 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72110 ......... ............ A X-ray exam of lower spine ........................... 0.31 1.01 NA 0.07 1.39 NA XXX 

72110 ......... 26 ....... A X-ray exam of lower spine ........................... 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

72110 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.91 NA 0.06 0.97 NA XXX 

72114 ......... ............ A X-ray exam of lower spine ........................... 0.36 1.31 NA 0.08 1.75 NA XXX 

72114 ......... 26 ....... A X-ray exam of lower spine ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

72114 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 1.19 NA 0.06 1.25 NA XXX 

72120 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.96 NA 0.07 1.25 NA XXX 

72120 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72120 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.89 NA 0.06 0.95 NA XXX 

72125 ......... ............ A Ct neck spine w/o dye ................................. 1.16 6.28 NA 0.36 7.80 NA XXX 

72125 ......... 26 ....... A Ct neck spine w/o dye ................................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

72125 ......... TC ...... A Ct neck spine w/o dye ................................. 0.00 5.90 NA 0.31 6.21 NA XXX 

72126 ......... ............ A Ct neck spine w/dye .................................... 1.22 7.45 NA 0.43 9.10 NA XXX 

72126 ......... 26 ....... A Ct neck spine w/dye .................................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

72126 ......... TC ...... A Ct neck spine w/dye .................................... 0.00 7.06 NA 0.37 7.43 NA XXX 

47654

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

72127 ......... ............ A Ct neck spine w/o & w/dye .......................... 1.27 9.25 NA 0.52 11.04 NA XXX 

72127 ......... 26 ....... A Ct neck spine w/o & w/dye .......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

72127 ......... TC ...... A Ct neck spine w/o & w/dye .......................... 0.00 8.83 NA 0.46 9.29 NA XXX 

72128 ......... ............ A Ct chest spine w/o dye ................................ 1.16 6.28 NA 0.36 7.80 NA XXX 

72128 ......... 26 ....... A Ct chest spine w/o dye ................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

72128 ......... TC ...... A Ct chest spine w/o dye ................................ 0.00 5.90 NA 0.31 6.21 NA XXX 

72129 ......... ............ A Ct chest spine w/dye ................................... 1.22 7.45 NA 0.43 9.10 NA XXX 

72129 ......... 26 ....... A Ct chest spine w/dye ................................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

72129 ......... TC ...... A Ct chest spine w/dye ................................... 0.00 7.06 NA 0.37 7.43 NA XXX 

72130 ......... ............ A Ct chest spine w/o & w/dye ......................... 1.27 9.25 NA 0.52 11.04 NA XXX 

72130 ......... 26 ....... A Ct chest spine w/o & w/dye ......................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

72130 ......... TC ...... A Ct chest spine w/o & w/dye ......................... 0.00 8.83 NA 0.46 9.29 NA XXX 

72131 ......... ............ A Ct lumbar spine w/o dye .............................. 1.16 6.28 NA 0.36 7.80 NA XXX 

72131 ......... 26 ....... A Ct lumbar spine w/o dye .............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

72131 ......... TC ...... A Ct lumbar spine w/o dye .............................. 0.00 5.90 NA 0.31 6.21 NA XXX 

72132 ......... ............ A Ct lumbar spine w/dye ................................. 1.22 7.45 NA 0.43 9.10 NA XXX 

72132 ......... 26 ....... A Ct lumbar spine w/dye ................................. 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

72132 ......... TC ...... A Ct lumbar spine w/dye ................................. 0.00 7.06 NA 0.37 7.43 NA XXX 

72133 ......... ............ A Ct lumbar spine w/o & w/dye ...................... 1.27 9.25 NA 0.52 11.04 NA XXX 

72133 ......... 26 ....... A Ct lumbar spine w/o & w/dye ...................... 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

72133 ......... TC ...... A Ct lumbar spine w/o & w/dye ...................... 0.00 8.83 NA 0.46 9.29 NA XXX 

72141 ......... ............ A Mri neck spine w/o dye ................................ 1.60 11.71 NA 0.66 13.97 NA XXX 

72141 ......... 26 ....... A Mri neck spine w/o dye ................................ 1.60 0.53 0.53 0.07 2.20 2.20 XXX 

72141 ......... TC ...... A Mri neck spine w/o dye ................................ 0.00 11.19 NA 0.59 11.78 NA XXX 

72142 ......... ............ A Mri neck spine w/dye ................................... 1.92 14.06 NA 0.79 16.77 NA XXX 

72142 ......... 26 ....... A Mri neck spine w/dye ................................... 1.92 0.64 0.64 0.09 2.65 2.65 XXX 

72142 ......... TC ...... A Mri neck spine w/dye ................................... 0.00 13.42 NA 0.70 14.12 NA XXX 

72146 ......... ............ A Mri chest spine w/o dye ............................... 1.60 12.95 NA 0.71 15.26 NA XXX 

72146 ......... 26 ....... A Mri chest spine w/o dye ............................... 1.60 0.52 0.52 0.07 2.19 2.19 XXX 

72146 ......... TC ...... A Mri chest spine w/o dye ............................... 0.00 12.42 NA 0.64 13.06 NA XXX 

72147 ......... ............ A Mri chest spine w/dye .................................. 1.92 14.05 NA 0.79 16.76 NA XXX 

72147 ......... 26 ....... A Mri chest spine w/dye .................................. 1.92 0.63 0.63 0.09 2.64 2.64 XXX 

72147 ......... TC ...... A Mri chest spine w/dye .................................. 0.00 13.42 NA 0.70 14.12 NA XXX 

72148 ......... ............ A Mri lumbar spine w/o dye ............................ 1.48 12.91 NA 0.71 15.10 NA XXX 

72148 ......... 26 ....... A Mri lumbar spine w/o dye ............................ 1.48 0.49 0.49 0.07 2.04 2.04 XXX 

72148 ......... TC ...... A Mri lumbar spine w/o dye ............................ 0.00 12.42 NA 0.64 13.06 NA XXX 

72149 ......... ............ A Mri lumbar spine w/dye ............................... 1.78 14.01 NA 0.79 16.58 NA XXX 

72149 ......... 26 ....... A Mri lumbar spine w/dye ............................... 1.78 0.59 0.59 0.09 2.46 2.46 XXX 

72149 ......... TC ...... A Mri lumbar spine w/dye ............................... 0.00 13.42 NA 0.70 14.12 NA XXX 

72156 ......... ............ A Mri neck spine w/o & w/dye ........................ 2.57 25.69 NA 1.43 29.69 NA XXX 

72156 ......... 26 ....... A Mri neck spine w/o & w/dye ........................ 2.57 0.85 0.85 0.12 3.54 3.54 XXX 

72156 ......... TC ...... A Mri neck spine w/o & w/dye ........................ 0.00 24.84 NA 1.31 26.15 NA XXX 

72157 ......... ............ A Mri chest spine w/o & w/dye ....................... 2.57 25.68 NA 1.43 29.68 NA XXX 

72157 ......... 26 ....... A Mri chest spine w/o & w/dye ....................... 2.57 0.84 0.84 0.12 3.53 3.53 XXX 

72157 ......... TC ...... A Mri chest spine w/o & w/dye ....................... 0.00 24.84 NA 1.31 26.15 NA XXX 

72158 ......... ............ A Mri lumbar spine w/o & w/dye ..................... 2.36 25.62 NA 1.42 29.40 NA XXX 

72158 ......... 26 ....... A Mri lumbar spine w/o & w/dye ..................... 2.36 0.77 0.77 0.11 3.24 3.24 XXX 

72158 ......... TC ...... A Mri lumbar spine w/o & w/dye ..................... 0.00 24.84 NA 1.31 26.15 NA XXX 

72170 ......... ............ A X-ray exam of pelvis .................................... 0.17 0.58 NA 0.03 0.78 NA XXX 

72170 ......... 26 ....... A X-ray exam of pelvis .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72170 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

72190 ......... ............ A X-ray exam of pelvis .................................... 0.21 0.74 NA 0.05 1.00 NA XXX 

72190 ......... 26 ....... A X-ray exam of pelvis .................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

72190 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72191 ......... ............ A Ct angiograph pelv w/o&w/dye .................... 1.81 12.60 NA 0.47 14.88 NA XXX 

72191 ......... 26 ....... A Ct angiograph pelv w/o&w/dye .................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 

72191 ......... TC ...... A Ct angiograph pelv w/o&w/dye .................... 0.00 12.01 NA 0.39 12.40 NA XXX 

72192 ......... ............ A Ct pelvis w/o dye ......................................... 1.09 6.25 NA 0.36 7.70 NA XXX 

72192 ......... 26 ....... A Ct pelvis w/o dye ......................................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 

72192 ......... TC ...... A Ct pelvis w/o dye ......................................... 0.00 5.90 NA 0.31 6.21 NA XXX 

72193 ......... ............ A Ct pelvis w/dye ............................................ 1.16 7.21 NA 0.41 8.78 NA XXX 

72193 ......... 26 ....... A Ct pelvis w/dye ............................................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

72193 ......... TC ...... A Ct pelvis w/dye ............................................ 0.00 6.83 NA 0.36 7.19 NA XXX 

72194 ......... ............ A Ct pelvis w/o & w/dye .................................. 1.22 8.87 NA 0.48 10.57 NA XXX 

72194 ......... 26 ....... A Ct pelvis w/o & w/dye .................................. 1.22 0.40 0.40 0.05 1.67 1.67 XXX 

72194 ......... TC ...... A Ct pelvis w/o & w/dye .................................. 0.00 8.47 NA 0.43 8.90 NA XXX 

72195 ......... ............ A Mri pelvis w/o dye ........................................ 1.46 11.66 NA 0.52 13.64 NA XXX 

72195 ......... 26 ....... A Mri pelvis w/o dye ........................................ 1.46 0.48 0.48 0.07 2.01 2.01 XXX 

72195 ......... TC ...... A Mri pelvis w/o dye ........................................ 0.00 11.19 NA 0.45 11.64 NA XXX 

72196 ......... ............ A Mri pelvis w/dye ........................................... 1.73 13.98 NA 0.60 16.31 NA XXX 

72196 ......... 26 ....... A Mri pelvis w/dye ........................................... 1.73 0.56 0.56 0.08 2.37 2.37 XXX 

72196 ......... TC ...... A Mri pelvis w/dye ........................................... 0.00 13.42 NA 0.52 13.94 NA XXX 

72197 ......... ............ A Mri pelvis w/o & w/dye ................................. 2.26 25.58 NA 1.02 28.86 NA XXX 

72197 ......... 26 ....... A Mri pelvis w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

72197 ......... TC ...... A Mri pelvis w/o & w/dye ................................. 0.00 24.84 NA 0.92 25.76 NA XXX 

47655

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

72198 ......... ............ A Mr angio pelvis w/o & w/dye ....................... 1.80 11.77 NA 0.69 14.26 NA XXX 

72198 ......... 26 ....... A Mr angio pelvis w/o & w/dye ....................... 1.80 0.59 0.59 0.10 2.49 2.49 XXX 

72198 ......... TC ...... A Mr angio pelvis w/o & w/dye ....................... 0.00 11.19 NA 0.59 11.78 NA XXX 

72200 ......... ............ A X-ray exam sacroiliac joints ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 

72200 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72200 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

72202 ......... ............ A X-ray exam sacroiliac joints ......................... 0.19 0.68 NA 0.05 0.92 NA XXX 

72202 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

72202 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

72220 ......... ............ A X-ray exam of tailbone ................................ 0.17 0.63 NA 0.05 0.85 NA XXX 

72220 ......... 26 ....... A X-ray exam of tailbone ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72220 ......... TC ...... A X-ray exam of tailbone ................................ 0.00 0.57 NA 0.04 0.61 NA XXX 

72240 ......... ............ A Contrast x-ray of neck spine ....................... 0.91 5.03 NA 0.29 6.23 NA XXX 

72240 ......... 26 ....... A Contrast x-ray of neck spine ....................... 0.91 0.29 0.29 0.04 1.24 1.24 XXX 

72240 ......... TC ...... A Contrast x-ray of neck spine ....................... 0.00 4.74 NA 0.25 4.99 NA XXX 

72255 ......... ............ A Contrast x-ray, thorax spine ........................ 0.91 4.59 NA 0.26 5.76 NA XXX 

72255 ......... 26 ....... A Contrast x-ray, thorax spine ........................ 0.91 0.27 0.27 0.04 1.22 1.22 XXX 

72255 ......... TC ...... A Contrast x-ray, thorax spine ........................ 0.00 4.32 NA 0.22 4.54 NA XXX 

72265 ......... ............ A Contrast x-ray, lower spine .......................... 0.83 4.32 NA 0.26 5.41 NA XXX 

72265 ......... 26 ....... A Contrast x-ray, lower spine .......................... 0.83 0.25 0.25 0.04 1.12 1.12 XXX 

72265 ......... TC ...... A Contrast x-ray, lower spine .......................... 0.00 4.06 NA 0.22 4.28 NA XXX 

72270 ......... ............ A Contrast x-ray, spine ................................... 1.33 6.51 NA 0.40 8.24 NA XXX 

72270 ......... 26 ....... A Contrast x-ray, spine ................................... 1.33 0.42 0.42 0.07 1.82 1.82 XXX 

72270 ......... TC ...... A Contrast x-ray, spine ................................... 0.00 6.09 NA 0.33 6.42 NA XXX 

72275 ......... ............ A Epidurography .............................................. 0.76 2.29 NA 0.27 3.32 NA XXX 

72275 ......... 26 ....... A Epidurography .............................................. 0.76 0.20 0.20 0.05 1.01 1.01 XXX 

72275 ......... TC ...... A Epidurography .............................................. 0.00 2.09 NA 0.22 2.31 NA XXX 

72285 ......... ............ A X-ray c/t spine disk ...................................... 1.16 8.72 NA 0.50 10.38 NA XXX 

72285 ......... 26 ....... A X-ray c/t spine disk ...................................... 1.16 0.35 0.35 0.07 1.58 1.58 XXX 

72285 ......... TC ...... A X-ray c/t spine disk ...................................... 0.00 8.37 NA 0.43 8.80 NA XXX 

72295 ......... ............ A X-ray of lower spine disk ............................. 0.83 8.11 NA 0.46 9.40 NA XXX 

72295 ......... 26 ....... A X-ray of lower spine disk ............................. 0.83 0.27 0.27 0.06 1.16 1.16 XXX 

72295 ......... TC ...... A X-ray of lower spine disk ............................. 0.00 7.85 NA 0.40 8.25 NA XXX 

73000 ......... ............ A X-ray exam of collar bone ........................... 0.16 0.57 NA 0.03 0.76 NA XXX 

73000 ......... 26 ....... A X-ray exam of collar bone ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73000 ......... TC ...... A X-ray exam of collar bone ........................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73010 ......... ............ A X-ray exam of shoulder blade ..................... 0.17 0.58 NA 0.03 0.78 NA XXX 

73010 ......... 26 ....... A X-ray exam of shoulder blade ..................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73010 ......... TC ...... A X-ray exam of shoulder blade ..................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73020 ......... ............ A X-ray exam of shoulder ............................... 0.15 0.52 NA 0.03 0.70 NA XXX 

73020 ......... 26 ....... A X-ray exam of shoulder ............................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73020 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73030 ......... ............ A X-ray exam of shoulder ............................... 0.18 0.63 NA 0.05 0.86 NA XXX 

73030 ......... 26 ....... A X-ray exam of shoulder ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

73030 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73040 ......... ............ A Contrast x-ray of shoulder ........................... 0.54 2.27 NA 0.14 2.95 NA XXX 

73040 ......... 26 ....... A Contrast x-ray of shoulder ........................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

73040 ......... TC ...... A Contrast x-ray of shoulder ........................... 0.00 2.09 NA 0.12 2.21 NA XXX 

73050 ......... ............ A X-ray exam of shoulders ............................. 0.20 0.73 NA 0.05 0.98 NA XXX 

73050 ......... 26 ....... A X-ray exam of shoulders ............................. 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

73050 ......... TC ...... A X-ray exam of shoulders ............................. 0.00 0.67 NA 0.04 0.71 NA XXX 

73060 ......... ............ A X-ray exam of humerus ............................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73060 ......... 26 ....... A X-ray exam of humerus ............................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73060 ......... TC ...... A X-ray exam of humerus ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73070 ......... ............ A X-ray exam of elbow .................................... 0.15 0.57 NA 0.03 0.75 NA XXX 

73070 ......... 26 ....... A X-ray exam of elbow .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73070 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73080 ......... ............ A X-ray exam of elbow .................................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73080 ......... 26 ....... A X-ray exam of elbow .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73080 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73085 ......... ............ A Contrast x-ray of elbow ............................... 0.54 2.28 NA 0.15 2.97 NA XXX 

73085 ......... 26 ....... A Contrast x-ray of elbow ............................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

73085 ......... TC ...... A Contrast x-ray of elbow ............................... 0.00 2.09 NA 0.12 2.21 NA XXX 

73090 ......... ............ A X-ray exam of forearm ................................. 0.16 0.57 NA 0.03 0.76 NA XXX 

73090 ......... 26 ....... A X-ray exam of forearm ................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73090 ......... TC ...... A X-ray exam of forearm ................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

73092 ......... ............ A X-ray exam of arm, infant ............................ 0.16 0.54 NA 0.03 0.73 NA XXX 

73092 ......... 26 ....... A X-ray exam of arm, infant ............................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73092 ......... TC ...... A X-ray exam of arm, infant ............................ 0.00 0.49 NA 0.02 0.51 NA XXX 

73100 ......... ............ A X-ray exam of wrist ...................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73100 ......... 26 ....... A X-ray exam of wrist ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73100 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73110 ......... ............ A X-ray exam of wrist ...................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73110 ......... 26 ....... A X-ray exam of wrist ...................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73110 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

47656

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

73115 ......... ............ A Contrast x-ray of wrist ................................. 0.54 1.76 NA 0.13 2.43 NA XXX 

73115 ......... 26 ....... A Contrast x-ray of wrist ................................. 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

73115 ......... TC ...... A Contrast x-ray of wrist ................................. 0.00 1.57 NA 0.10 1.67 NA XXX 

73120 ......... ............ A X-ray exam of hand ..................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73120 ......... 26 ....... A X-ray exam of hand ..................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73120 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73130 ......... ............ A X-ray exam of hand ..................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73130 ......... 26 ....... A X-ray exam of hand ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73130 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73140 ......... ............ A X-ray exam of finger(s) ................................ 0.13 0.46 NA 0.03 0.62 NA XXX 

73140 ......... 26 ....... A X-ray exam of finger(s) ................................ 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73140 ......... TC ...... A X-ray exam of finger(s) ................................ 0.00 0.42 NA 0.02 0.44 NA XXX 

73200 ......... ............ A Ct upper extremity w/o dye ......................... 1.09 5.31 NA 0.30 6.70 NA XXX 

73200 ......... 26 ....... A Ct upper extremity w/o dye ......................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 

73200 ......... TC ...... A Ct upper extremity w/o dye ......................... 0.00 4.95 NA 0.25 5.20 NA XXX 

73201 ......... ............ A Ct upper extremity w/dye ............................. 1.16 6.28 NA 0.36 7.80 NA XXX 

73201 ......... 26 ....... A Ct upper extremity w/dye ............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

73201 ......... TC ...... A Ct upper extremity w/dye ............................. 0.00 5.90 NA 0.31 6.21 NA XXX 

73202 ......... ............ A Ct uppr extremity w/o&w/dye ....................... 1.22 7.81 NA 0.44 9.47 NA XXX 

73202 ......... 26 ....... A Ct uppr extremity w/o&w/dye ....................... 1.22 0.40 0.40 0.05 1.67 1.67 XXX 

73202 ......... TC ...... A Ct uppr extremity w/o&w/dye ....................... 0.00 7.41 NA 0.39 7.80 NA XXX 

73206 ......... ............ A Ct angio upr extrm w/o&w/dye .................... 1.81 11.54 NA 0.47 13.82 NA XXX 

73206 ......... 26 ....... A Ct angio upr extrm w/o&w/dye .................... 1.81 0.59 0.59 0.08 2.48 2.48 XXX 

73206 ......... TC ...... A Ct angio upr extrm w/o&w/dye .................... 0.00 10.94 NA 0.39 11.33 NA XXX 

73218 ......... ............ A Mri upper extremity w/o dye ........................ 1.35 11.63 NA 0.45 13.43 NA XXX 

73218 ......... 26 ....... A Mri upper extremity w/o dye ........................ 1.35 0.44 0.44 0.06 1.85 1.85 XXX 

73218 ......... TC ...... A Mri upper extremity w/o dye ........................ 0.00 11.19 NA 0.39 11.58 NA XXX 

73219 ......... ............ A Mri upper extremity w/dye ........................... 1.62 13.95 NA 0.54 16.11 NA XXX 

73219 ......... 26 ....... A Mri upper extremity w/dye ........................... 1.62 0.53 0.53 0.07 2.22 2.22 XXX 

73219 ......... TC ...... A Mri upper extremity w/dye ........................... 0.00 13.42 NA 0.47 13.89 NA XXX 

73220 ......... ............ A Mri uppr extremity w/o&w/dye ..................... 2.15 25.55 NA 0.94 28.64 NA XXX 

73220 ......... 26 ....... A Mri uppr extremity w/o&w/dye ..................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

73220 ......... TC ...... A Mri uppr extremity w/o&w/dye ..................... 0.00 24.84 NA 0.84 25.68 NA XXX 

73221 ......... ............ A Mri joint upr extrem w/o dye ........................ 1.35 11.63 NA 0.45 13.43 NA XXX 

73221 ......... 26 ....... A Mri joint upr extrem w/o dye ........................ 1.35 0.44 0.44 0.06 1.85 1.85 XXX 

73221 ......... TC ...... A Mri joint upr extrem w/o dye ........................ 0.00 11.19 NA 0.39 11.58 NA XXX 

73222 ......... ............ A Mri joint upr extrem w/dye ........................... 1.62 13.95 NA 0.54 16.11 NA XXX 

73222 ......... 26 ....... A Mri joint upr extrem w/dye ........................... 1.62 0.53 0.53 0.07 2.22 2.22 XXX 

73222 ......... TC ...... A Mri joint upr extrem w/dye ........................... 0.00 13.42 NA 0.47 13.89 NA XXX 

73223 ......... ............ A Mri joint upr extr w/o&w/dye ........................ 2.15 25.55 NA 0.94 28.64 NA XXX 

73223 ......... 26 ....... A Mri joint upr extr w/o&w/dye ........................ 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

73223 ......... TC ...... A Mri joint upr extr w/o&w/dye ........................ 0.00 24.84 NA 0.84 25.68 NA XXX 

73500 ......... ............ A X-ray exam of hip ........................................ 0.17 0.53 NA 0.03 0.73 NA XXX 

73500 ......... 26 ....... A X-ray exam of hip ........................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73500 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.47 NA 0.02 0.49 NA XXX 

73510 ......... ............ A X-ray exam of hip ........................................ 0.21 0.64 NA 0.05 0.90 NA XXX 

73510 ......... 26 ....... A X-ray exam of hip ........................................ 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

73510 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.57 NA 0.04 0.61 NA XXX 

73520 ......... ............ A X-ray exam of hips ...................................... 0.26 0.75 NA 0.05 1.06 NA XXX 

73520 ......... 26 ....... A X-ray exam of hips ...................................... 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

73520 ......... TC ...... A X-ray exam of hips ...................................... 0.00 0.67 NA 0.04 0.71 NA XXX 

73525 ......... ............ A Contrast x-ray of hip .................................... 0.54 2.27 NA 0.15 2.96 NA XXX 

73525 ......... 26 ....... A Contrast x-ray of hip .................................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

73525 ......... TC ...... A Contrast x-ray of hip .................................... 0.00 2.09 NA 0.12 2.21 NA XXX 

73530 ......... ............ A X-ray exam of hip ........................................ 0.29 0.62 NA 0.03 0.94 NA XXX 

73530 ......... 26 ....... A X-ray exam of hip ........................................ 0.29 0.10 0.10 0.01 0.40 0.40 XXX 

73530 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX 

73540 ......... ............ A X-ray exam of pelvis & hips ........................ 0.20 0.64 NA 0.05 0.89 NA XXX 

73540 ......... 26 ....... A X-ray exam of pelvis & hips ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

73540 ......... TC ...... A X-ray exam of pelvis & hips ........................ 0.00 0.57 NA 0.04 0.61 NA XXX 

73542 ......... ............ A X-ray exam, sacroiliac joint ......................... 0.59 2.25 NA 0.15 2.99 NA XXX 

73542 ......... 26 ....... A X-ray exam, sacroiliac joint ......................... 0.59 0.16 0.16 0.03 0.78 0.78 XXX 

73542 ......... TC ...... A X-ray exam, sacroiliac joint ......................... 0.00 2.09 NA 0.12 2.21 NA XXX 

73550 ......... ............ A X-ray exam of thigh ..................................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73550 ......... 26 ....... A X-ray exam of thigh ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73550 ......... TC ...... A X-ray exam of thigh ..................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73560 ......... ............ A X-ray exam of knee, 1 or 2 ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 

73560 ......... 26 ....... A X-ray exam of knee, 1 or 2 ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73560 ......... TC ...... A X-ray exam of knee, 1 or 2 ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73562 ......... ............ A X-ray exam of knee, 3 ................................. 0.18 0.63 NA 0.05 0.86 NA XXX 

73562 ......... 26 ....... A X-ray exam of knee, 3 ................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

73562 ......... TC ...... A X-ray exam of knee, 3 ................................. 0.00 0.57 NA 0.04 0.61 NA XXX 

73564 ......... ............ A X-ray exam, knee, 4 or more ...................... 0.22 0.69 NA 0.05 0.96 NA XXX 

73564 ......... 26 ....... A X-ray exam, knee, 4 or more ...................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

73564 ......... TC ...... A X-ray exam, knee, 4 or more ...................... 0.00 0.62 NA 0.04 0.66 NA XXX 

47657

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

73565 ......... ............ A X-ray exam of knees ................................... 0.17 0.55 NA 0.03 0.75 NA XXX 

73565 ......... 26 ....... A X-ray exam of knees ................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73565 ......... TC ...... A X-ray exam of knees ................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73580 ......... ............ A Contrast x-ray of knee joint ......................... 0.54 2.79 NA 0.17 3.50 NA XXX 

73580 ......... 26 ....... A Contrast x-ray of knee joint ......................... 0.54 0.17 0.17 0.03 0.74 0.74 XXX 

73580 ......... TC ...... A Contrast x-ray of knee joint ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

73590 ......... ............ A X-ray exam of lower leg .............................. 0.17 0.58 NA 0.03 0.78 NA XXX 

73590 ......... 26 ....... A X-ray exam of lower leg .............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73590 ......... TC ...... A X-ray exam of lower leg .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 

73592 ......... ............ A X-ray exam of leg, infant ............................. 0.16 0.55 NA 0.03 0.74 NA XXX 

73592 ......... 26 ....... A X-ray exam of leg, infant ............................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73592 ......... TC ...... A X-ray exam of leg, infant ............................. 0.00 0.49 NA 0.02 0.51 NA XXX 

73600 ......... ............ A X-ray exam of ankle .................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73600 ......... 26 ....... A X-ray exam of ankle .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73600 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73610 ......... ............ A X-ray exam of ankle .................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73610 ......... 26 ....... A X-ray exam of ankle .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73610 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73615 ......... ............ A Contrast x-ray of ankle ................................ 0.54 2.28 NA 0.15 2.97 NA XXX 

73615 ......... 26 ....... A Contrast x-ray of ankle ................................ 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

73615 ......... TC ...... A Contrast x-ray of ankle ................................ 0.00 2.09 NA 0.12 2.21 NA XXX 

73620 ......... ............ A X-ray exam of foot ....................................... 0.16 0.55 NA 0.03 0.74 NA XXX 

73620 ......... 26 ....... A X-ray exam of foot ....................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73620 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73630 ......... ............ A X-ray exam of foot ....................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73630 ......... 26 ....... A X-ray exam of foot ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73630 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73650 ......... ............ A X-ray exam of heel ...................................... 0.16 0.53 NA 0.03 0.72 NA XXX 

73650 ......... 26 ....... A X-ray exam of heel ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73650 ......... TC ...... A X-ray exam of heel ...................................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73660 ......... ............ A X-ray exam of toe(s) .................................... 0.13 0.46 NA 0.03 0.62 NA XXX 

73660 ......... 26 ....... A X-ray exam of toe(s) .................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73660 ......... TC ...... A X-ray exam of toe(s) .................................... 0.00 0.42 NA 0.02 0.44 NA XXX 

73700 ......... ............ A Ct lower extremity w/o dye .......................... 1.09 5.31 NA 0.30 6.70 NA XXX 

73700 ......... 26 ....... A Ct lower extremity w/o dye .......................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 

73700 ......... TC ...... A Ct lower extremity w/o dye .......................... 0.00 4.95 NA 0.25 5.20 NA XXX 

73701 ......... ............ A Ct lower extremity w/dye ............................. 1.16 6.28 NA 0.36 7.80 NA XXX 

73701 ......... 26 ....... A Ct lower extremity w/dye ............................. 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

73701 ......... TC ...... A Ct lower extremity w/dye ............................. 0.00 5.90 NA 0.31 6.21 NA XXX 

73702 ......... ............ A Ct lwr extremity w/o&w/dye ......................... 1.22 7.81 NA 0.45 9.48 NA XXX 

73702 ......... 26 ....... A Ct lwr extremity w/o&w/dye ......................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

73702 ......... TC ...... A Ct lwr extremity w/o&w/dye ......................... 0.00 7.41 NA 0.39 7.80 NA XXX 

73706 ......... ............ A Ct angio lwr extr w/o&w/dye ........................ 1.90 11.57 NA 0.48 13.95 NA XXX 

73706 ......... 26 ....... A Ct angio lwr extr w/o&w/dye ........................ 1.90 0.62 0.62 0.09 2.61 2.61 XXX 

73706 ......... TC ...... A Ct angio lwr extr w/o&w/dye ........................ 0.00 10.94 NA 0.39 11.33 NA XXX 

73718 ......... ............ A Mri lower extremity w/o dye ......................... 1.35 11.63 NA 0.45 13.43 NA XXX 

73718 ......... 26 ....... A Mri lower extremity w/o dye ......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 

73718 ......... TC ...... A Mri lower extremity w/o dye ......................... 0.00 11.19 NA 0.39 11.58 NA XXX 

73719 ......... ............ A Mri lower extremity w/dye ............................ 1.62 13.95 NA 0.54 16.11 NA XXX 

73719 ......... 26 ....... A Mri lower extremity w/dye ............................ 1.62 0.53 0.53 0.07 2.22 2.22 XXX 

73719 ......... TC ...... A Mri lower extremity w/dye ............................ 0.00 13.42 NA 0.47 13.89 NA XXX 

73720 ......... ............ A Mri lwr extremity w/o&w/dye ........................ 2.15 25.55 NA 0.94 28.64 NA XXX 

73720 ......... 26 ....... A Mri lwr extremity w/o&w/dye ........................ 2.15 0.70 0.70 0.10 2.95 2.95 XXX 

73720 ......... TC ...... A Mri lwr extremity w/o&w/dye ........................ 0.00 24.84 NA 0.84 25.68 NA XXX 

73721 ......... ............ A Mri jnt of lwr extre w/o dye .......................... 1.35 11.63 NA 0.45 13.43 NA XXX 

73721 ......... 26 ....... A Mri jnt of lwr extre w/o dye .......................... 1.35 0.44 0.44 0.06 1.85 1.85 XXX 

73721 ......... TC ...... A Mri jnt of lwr extre w/o dye .......................... 0.00 11.19 NA 0.39 11.58 NA XXX 

73722 ......... ............ A Mri joint of lwr extr w/dye ............................ 1.62 13.95 NA 0.55 16.12 NA XXX 

73722 ......... 26 ....... A Mri joint of lwr extr w/dye ............................ 1.62 0.53 0.53 0.08 2.23 2.23 XXX 

73722 ......... TC ...... A Mri joint of lwr extr w/dye ............................ 0.00 13.42 NA 0.47 13.89 NA XXX 

73723 ......... ............ A Mri joint lwr extr w/o&w/dye ......................... 2.15 25.55 NA 0.94 28.64 NA XXX 

73723 ......... 26 ....... A Mri joint lwr extr w/o&w/dye ......................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

73723 ......... TC ...... A Mri joint lwr extr w/o&w/dye ......................... 0.00 24.84 NA 0.84 25.68 NA XXX 

73725 ......... ............ R Mr ang lwr ext w or w/o dye ........................ 1.82 11.78 NA 0.67 14.27 NA XXX 

73725 ......... 26 ....... R Mr ang lwr ext w or w/o dye ........................ 1.82 0.60 0.60 0.08 2.50 2.50 XXX 

73725 ......... TC ...... R Mr ang lwr ext w or w/o dye ........................ 0.00 11.19 NA 0.59 11.78 NA XXX 

74000 ......... ............ A X-ray exam of abdomen .............................. 0.18 0.58 NA 0.03 0.79 NA XXX 

74000 ......... 26 ....... A X-ray exam of abdomen .............................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

74000 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 

74010 ......... ............ A X-ray exam of abdomen .............................. 0.23 0.64 NA 0.05 0.92 NA XXX 

74010 ......... 26 ....... A X-ray exam of abdomen .............................. 0.23 0.07 0.07 0.01 0.31 0.31 XXX 

74010 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 

74020 ......... ............ A X-ray exam of abdomen .............................. 0.27 0.71 NA 0.05 1.03 NA XXX 

74020 ......... 26 ....... A X-ray exam of abdomen .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

74020 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.62 NA 0.04 0.66 NA XXX 

47658

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

74022 ......... ............ A X-ray exam series, abdomen ...................... 0.32 0.84 NA 0.06 1.22 NA XXX 

74022 ......... 26 ....... A X-ray exam series, abdomen ...................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 

74022 ......... TC ...... A X-ray exam series, abdomen ...................... 0.00 0.73 NA 0.05 0.78 NA XXX 

74150 ......... ............ A Ct abdomen w/o dye ................................... 1.19 6.03 NA 0.35 7.57 NA XXX 

74150 ......... 26 ....... A Ct abdomen w/o dye ................................... 1.19 0.39 0.39 0.05 1.63 1.63 XXX 

74150 ......... TC ...... A Ct abdomen w/o dye ................................... 0.00 5.65 NA 0.30 5.95 NA XXX 

74160 ......... ............ A Ct abdomen w/dye ....................................... 1.27 7.25 NA 0.42 8.94 NA XXX 

74160 ......... 26 ....... A Ct abdomen w/dye ....................................... 1.27 0.41 0.41 0.06 1.74 1.74 XXX 

74160 ......... TC ...... A Ct abdomen w/dye ....................................... 0.00 6.83 NA 0.36 7.19 NA XXX 

74170 ......... ............ A Ct abdomen w/o &w /dye ............................ 1.40 8.93 NA 0.49 10.82 NA XXX 

74170 ......... 26 ....... A Ct abdomen w/o &w /dye ............................ 1.40 0.46 0.46 0.06 1.92 1.92 XXX 

74170 ......... TC ...... A Ct abdomen w/o &w /dye ............................ 0.00 8.47 NA 0.43 8.90 NA XXX 

74175 ......... ............ A Ct angio abdom w/o & w/dye ...................... 1.90 12.63 NA 0.48 15.01 NA XXX 

74175 ......... 26 ....... A Ct angio abdom w/o & w/dye ...................... 1.90 0.62 0.62 0.09 2.61 2.61 XXX 

74175 ......... TC ...... A Ct angio abdom w/o & w/dye ...................... 0.00 12.01 NA 0.39 12.40 NA XXX 

74181 ......... ............ A Mri abdomen w/o dye .................................. 1.46 11.66 NA 0.52 13.64 NA XXX 

74181 ......... 26 ....... A Mri abdomen w/o dye .................................. 1.46 0.48 0.48 0.07 2.01 2.01 XXX 

74181 ......... TC ...... A Mri abdomen w/o dye .................................. 0.00 11.19 NA 0.45 11.64 NA XXX 

74182 ......... ............ A Mri abdomen w/dye ..................................... 1.73 13.98 NA 0.60 16.31 NA XXX 

74182 ......... 26 ....... A Mri abdomen w/dye ..................................... 1.73 0.56 0.56 0.08 2.37 2.37 XXX 

74182 ......... TC ...... A Mri abdomen w/dye ..................................... 0.00 13.42 NA 0.52 13.94 NA XXX 

74183 ......... ............ A Mri abdomen w/o & w/dye ........................... 2.26 25.58 NA 1.02 28.86 NA XXX 

74183 ......... 26 ....... A Mri abdomen w/o & w/dye ........................... 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

74183 ......... TC ...... A Mri abdomen w/o & w/dye ........................... 0.00 24.84 NA 0.92 25.76 NA XXX 

74185 ......... ............ R Mri angio, abdom w orw/o dye .................... 1.80 11.78 NA 0.67 14.25 NA XXX 

74185 ......... 26 ....... R Mri angio, abdom w orw/o dye .................... 1.80 0.59 0.59 0.08 2.47 2.47 XXX 

74185 ......... TC ...... R Mri angio, abdom w orw/o dye .................... 0.00 11.19 NA 0.59 11.78 NA XXX 

74190 ......... ............ A X-ray exam of peritoneum ........................... 0.48 1.46 NA 0.09 2.03 NA XXX 

74190 ......... 26 ....... A X-ray exam of peritoneum ........................... 0.48 0.16 0.16 0.02 0.66 0.66 XXX 

74190 ......... TC ...... A X-ray exam of peritoneum ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74210 ......... ............ A Contrst x-ray exam of throat ........................ 0.36 1.30 NA 0.08 1.74 NA XXX 

74210 ......... 26 ....... A Contrst x-ray exam of throat ........................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74210 ......... TC ...... A Contrst x-ray exam of throat ........................ 0.00 1.19 NA 0.06 1.25 NA XXX 

74220 ......... ............ A Contrast x-ray, esophagus .......................... 0.46 1.34 NA 0.08 1.88 NA XXX 

74220 ......... 26 ....... A Contrast x-ray, esophagus .......................... 0.46 0.15 0.15 0.02 0.63 0.63 XXX 

74220 ......... TC ...... A Contrast x-ray, esophagus .......................... 0.00 1.19 NA 0.06 1.25 NA XXX 

74230 ......... ............ A Cine/vid x-ray, throat/esoph ......................... 0.53 1.48 NA 0.09 2.10 NA XXX 

74230 ......... 26 ....... A Cine/vid x-ray, throat/esoph ......................... 0.53 0.17 0.17 0.02 0.72 0.72 XXX 

74230 ......... TC ...... A Cine/vid x-ray, throat/esoph ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74235 ......... ............ A Remove esophagus obstruction .................. 1.19 3.01 NA 0.19 4.39 NA XXX 

74235 ......... 26 ....... A Remove esophagus obstruction .................. 1.19 0.39 0.39 0.05 1.63 1.63 XXX 

74235 ......... TC ...... A Remove esophagus obstruction .................. 0.00 2.62 NA 0.14 2.76 NA XXX 

74240 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.68 NA 0.11 2.48 NA XXX 

74240 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 

74240 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.46 NA 0.08 1.54 NA XXX 

74241 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.71 NA 0.11 2.51 NA XXX 

74241 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 

74241 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.49 NA 0.08 1.57 NA XXX 

74245 ......... ............ A X-ray exam, upper gi tract ........................... 0.91 2.67 NA 0.17 3.75 NA XXX 

74245 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.91 0.30 0.30 0.04 1.25 1.25 XXX 

74245 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 2.37 NA 0.13 2.50 NA XXX 

74246 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.87 NA 0.13 2.69 NA XXX 

74246 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.03 0.95 0.95 XXX 

74246 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.64 NA 0.10 1.74 NA XXX 

74247 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.90 NA 0.14 2.73 NA XXX 

74247 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.03 0.95 0.95 XXX 

74247 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.68 NA 0.11 1.79 NA XXX 

74249 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.91 2.86 NA 0.18 3.95 NA XXX 

74249 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.91 0.30 0.30 0.04 1.25 1.25 XXX 

74249 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 2.57 NA 0.14 2.71 NA XXX 

74250 ......... ............ A X-ray exam of small bowel .......................... 0.47 1.46 NA 0.09 2.02 NA XXX 

74250 ......... 26 ....... A X-ray exam of small bowel .......................... 0.47 0.15 0.15 0.02 0.64 0.64 XXX 

74250 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74251 ......... ............ A X-ray exam of small bowel .......................... 0.69 1.53 NA 0.10 2.32 NA XXX 

74251 ......... 26 ....... A X-ray exam of small bowel .......................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 

74251 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74260 ......... ............ A X-ray exam of small bowel .......................... 0.50 1.65 NA 0.10 2.25 NA XXX 

74260 ......... 26 ....... A X-ray exam of small bowel .......................... 0.50 0.16 0.16 0.02 0.68 0.68 XXX 

74260 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.49 NA 0.08 1.57 NA XXX 

74270 ......... ............ A Contrast x-ray exam of colon ...................... 0.69 1.92 NA 0.14 2.75 NA XXX 

74270 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.69 0.22 0.22 0.03 0.94 0.94 XXX 

74270 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 1.70 NA 0.11 1.81 NA XXX 

74280 ......... ............ A Contrast x-ray exam of colon ...................... 0.99 2.55 NA 0.17 3.71 NA XXX 

74280 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX 

74280 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.23 NA 0.13 2.36 NA XXX 

47659

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

74283 ......... ............ A Contrast x-ray exam of colon ...................... 2.02 3.22 NA 0.23 5.47 NA XXX 

74283 ......... 26 ....... A Contrast x-ray exam of colon ...................... 2.02 0.66 0.66 0.09 2.77 2.77 XXX 

74283 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.56 NA 0.14 2.70 NA XXX 

74290 ......... ............ A Contrast x-ray, gallbladder .......................... 0.32 0.84 NA 0.06 1.22 NA XXX 

74290 ......... 26 ....... A Contrast x-ray, gallbladder .......................... 0.32 0.10 0.10 0.01 0.43 0.43 XXX 

74290 ......... TC ...... A Contrast x-ray, gallbladder .......................... 0.00 0.73 NA 0.05 0.78 NA XXX 

74291 ......... ............ A Contrast x-rays, gallbladder ......................... 0.20 0.48 NA 0.03 0.71 NA XXX 

74291 ......... 26 ....... A Contrast x-rays, gallbladder ......................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

74291 ......... TC ...... A Contrast x-rays, gallbladder ......................... 0.00 0.42 NA 0.02 0.44 NA XXX 

74300 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74301 ......... 26 ....... A X-rays at surgery add-on ............................. 0.21 0.07 0.07 0.01 0.29 0.29 ZZZ 

74305 ......... ............ A X-ray bile ducts/pancreas ............................ 0.42 0.92 NA 0.07 1.41 NA XXX 

74305 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.42 0.14 0.14 0.02 0.58 0.58 XXX 

74305 ......... TC ...... A X-ray bile ducts/pancreas ............................ 0.00 0.78 NA 0.05 0.83 NA XXX 

74320 ......... ............ A Contrast x-ray of bile ducts ......................... 0.54 3.32 NA 0.19 4.05 NA XXX 

74320 ......... 26 ....... A Contrast x-ray of bile ducts ......................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74320 ......... TC ...... A Contrast x-ray of bile ducts ......................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74327 ......... ............ A X-ray bile stone removal .............................. 0.70 1.98 NA 0.14 2.82 NA XXX 

74327 ......... 26 ....... A X-ray bile stone removal .............................. 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

74327 ......... TC ...... A X-ray bile stone removal .............................. 0.00 1.76 NA 0.11 1.87 NA XXX 

74328 ......... ............ A X-ray bile duct endoscopy ........................... 0.70 3.38 NA 0.20 4.28 NA XXX 

74328 ......... 26 ....... A X-ray bile duct endoscopy ........................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

74328 ......... TC ...... A X-ray bile duct endoscopy ........................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74329 ......... ............ A X-ray for pancreas endoscopy .................... 0.70 3.38 NA 0.20 4.28 NA XXX 

74329 ......... 26 ....... A X-ray for pancreas endoscopy .................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

74329 ......... TC ...... A X-ray for pancreas endoscopy .................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74330 ......... ............ A X-ray bile/panc endoscopy .......................... 0.90 3.44 NA 0.21 4.55 NA XXX 

74330 ......... 26 ....... A X-ray bile/panc endoscopy .......................... 0.90 0.29 0.29 0.04 1.23 1.23 XXX 

74330 ......... TC ...... A X-ray bile/panc endoscopy .......................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74340 ......... ............ A X-ray guide for GI tube ................................ 0.54 2.79 NA 0.16 3.49 NA XXX 

74340 ......... 26 ....... A X-ray guide for GI tube ................................ 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74340 ......... TC ...... A X-ray guide for GI tube ................................ 0.00 2.62 NA 0.14 2.76 NA XXX 

74350 ......... ............ A X-ray guide, stomach tube .......................... 0.76 3.39 NA 0.20 4.35 NA XXX 

74350 ......... 26 ....... A X-ray guide, stomach tube .......................... 0.76 0.25 0.25 0.03 1.04 1.04 XXX 

74350 ......... TC ...... A X-ray guide, stomach tube .......................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74355 ......... ............ A X-ray guide, intestinal tube .......................... 0.76 2.86 NA 0.17 3.79 NA XXX 

74355 ......... 26 ....... A X-ray guide, intestinal tube .......................... 0.76 0.25 0.25 0.03 1.04 1.04 XXX 

74355 ......... TC ...... A X-ray guide, intestinal tube .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

74360 ......... ............ A X-ray guide, GI dilation ................................ 0.54 3.33 NA 0.19 4.06 NA XXX 

74360 ......... 26 ....... A X-ray guide, GI dilation ................................ 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74360 ......... TC ...... A X-ray guide, GI dilation ................................ 0.00 3.15 NA 0.17 3.32 NA XXX 

74363 ......... ............ A X-ray, bile duct dilation ................................ 0.88 6.38 NA 0.37 7.63 NA XXX 

74363 ......... 26 ....... A X-ray, bile duct dilation ................................ 0.88 0.29 0.29 0.04 1.21 1.21 XXX 

74363 ......... TC ...... A X-ray, bile duct dilation ................................ 0.00 6.09 NA 0.33 6.42 NA XXX 

74400 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 1.84 NA 0.13 2.46 NA XXX 

74400 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74400 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.68 NA 0.11 1.79 NA XXX 

74410 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.11 NA 0.13 2.73 NA XXX 

74410 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74410 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.95 NA 0.11 2.06 NA XXX 

74415 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.27 NA 0.14 2.90 NA XXX 

74415 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74415 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.11 NA 0.12 2.23 NA XXX 

74420 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 2.73 NA 0.16 3.25 NA XXX 

74420 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74420 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.62 NA 0.14 2.76 NA XXX 

74425 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 1.42 NA 0.09 1.87 NA XXX 

74425 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74425 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74430 ......... ............ A Contrast x-ray, bladder ................................ 0.32 1.16 NA 0.08 1.56 NA XXX 

74430 ......... 26 ....... A Contrast x-ray, bladder ................................ 0.32 0.10 0.10 0.02 0.44 0.44 XXX 

74430 ......... TC ...... A Contrast x-ray, bladder ................................ 0.00 1.05 NA 0.06 1.11 NA XXX 

74440 ......... ............ A X-ray, male genital tract .............................. 0.38 1.25 NA 0.08 1.71 NA XXX 

74440 ......... 26 ....... A X-ray, male genital tract .............................. 0.38 0.12 0.12 0.02 0.52 0.52 XXX 

74440 ......... TC ...... A X-ray, male genital tract .............................. 0.00 1.13 NA 0.06 1.19 NA XXX 

74445 ......... ............ A X-ray exam of penis .................................... 1.14 1.50 NA 0.12 2.76 NA XXX 

74445 ......... 26 ....... A X-ray exam of penis .................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

74445 ......... TC ...... A X-ray exam of penis .................................... 0.00 1.13 NA 0.06 1.19 NA XXX 

74450 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.56 NA 0.10 1.99 NA XXX 

74450 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 

74450 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.46 NA 0.08 1.54 NA XXX 

74455 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.68 NA 0.12 2.13 NA XXX 

74455 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 

74455 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.57 NA 0.10 1.67 NA XXX 

74470 ......... ............ A X-ray exam of kidney lesion ........................ 0.54 1.42 NA 0.10 2.06 NA XXX 

47660

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

74470 ......... 26 ....... A X-ray exam of kidney lesion ........................ 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

74470 ......... TC ...... A X-ray exam of kidney lesion ........................ 0.00 1.25 NA 0.07 1.32 NA XXX 

74475 ......... ............ A X-ray control, cath insert ............................. 0.54 4.24 NA 0.24 5.02 NA XXX 

74475 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74475 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.06 NA 0.22 4.28 NA XXX 

74480 ......... ............ A X-ray control, cath insert ............................. 0.54 4.24 NA 0.24 5.02 NA XXX 

74480 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74480 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.06 NA 0.22 4.28 NA XXX 

74485 ......... ............ A X-ray guide, GU dilation .............................. 0.54 3.32 NA 0.20 4.06 NA XXX 

74485 ......... 26 ....... A X-ray guide, GU dilation .............................. 0.54 0.17 0.17 0.03 0.74 0.74 XXX 

74485 ......... TC ...... A X-ray guide, GU dilation .............................. 0.00 3.15 NA 0.17 3.32 NA XXX 

74710 ......... ............ A X-ray measurement of pelvis ....................... 0.34 1.16 NA 0.08 1.58 NA XXX 

74710 ......... 26 ....... A X-ray measurement of pelvis ....................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 

74710 ......... TC ...... A X-ray measurement of pelvis ....................... 0.00 1.05 NA 0.06 1.11 NA XXX 

74740 ......... ............ A X-ray, female genital tract ........................... 0.38 1.43 NA 0.09 1.90 NA XXX 

74740 ......... 26 ....... A X-ray, female genital tract ........................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

74740 ......... TC ...... A X-ray, female genital tract ........................... 0.00 1.30 NA 0.07 1.37 NA XXX 

74742 ......... ............ A X-ray, fallopian tube ..................................... 0.61 3.35 NA 0.20 4.16 NA XXX 

74742 ......... 26 ....... A X-ray, fallopian tube ..................................... 0.61 0.20 0.20 0.03 0.84 0.84 XXX 

74742 ......... TC ...... A X-ray, fallopian tube ..................................... 0.00 3.15 NA 0.17 3.32 NA XXX 

74775 ......... ............ A X-ray exam of perineum .............................. 0.62 1.66 NA 0.11 2.39 NA XXX 

74775 ......... 26 ....... A X-ray exam of perineum .............................. 0.62 0.21 0.21 0.03 0.86 0.86 XXX 

74775 ......... TC ...... A X-ray exam of perineum .............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

75552 ......... ............ A Heart mri for morph w/o dye ....................... 1.60 11.71 NA 0.66 13.97 NA XXX 

75552 ......... 26 ....... A Heart mri for morph w/o dye ....................... 1.60 0.53 0.53 0.07 2.20 2.20 XXX 

75552 ......... TC ...... A Heart mri for morph w/o dye ....................... 0.00 11.19 NA 0.59 11.78 NA XXX 

75553 ......... ............ A Heart mri for morph w/dye ........................... 2.00 11.84 NA 0.68 14.52 NA XXX 

75553 ......... 26 ....... A Heart mri for morph w/dye ........................... 2.00 0.65 0.65 0.09 2.74 2.74 XXX 

75553 ......... TC ...... A Heart mri for morph w/dye ........................... 0.00 11.19 NA 0.59 11.78 NA XXX 

75554 ......... ............ A Cardiac MRI/function ................................... 1.83 11.83 NA 0.66 14.32 NA XXX 

75554 ......... 26 ....... A Cardiac MRI/function ................................... 1.83 0.64 0.64 0.07 2.54 2.54 XXX 

75554 ......... TC ...... A Cardiac MRI/function ................................... 0.00 11.19 NA 0.59 11.78 NA XXX 

75555 ......... ............ A Cardiac MRI/limited study ............................ 1.74 11.82 NA 0.66 14.22 NA XXX 

75555 ......... 26 ....... A Cardiac MRI/limited study ............................ 1.74 0.64 0.64 0.07 2.45 2.45 XXX 

75555 ......... TC ...... A Cardiac MRI/limited study ............................ 0.00 11.19 NA 0.59 11.78 NA XXX 

75600 ......... ............ A Contrast x-ray exam of aorta ....................... 0.49 12.76 NA 0.67 13.92 NA XXX 

75600 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 0.49 0.19 0.19 0.02 0.70 0.70 XXX 

75600 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75605 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 12.97 NA 0.70 14.81 NA XXX 

75605 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.40 0.40 0.05 1.59 1.59 XXX 

75605 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75625 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 12.95 NA 0.71 14.80 NA XXX 

75625 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.38 0.38 0.06 1.58 1.58 XXX 

75625 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75630 ......... ............ A X-ray aorta, leg arteries ............................... 1.79 13.72 NA 0.79 16.30 NA XXX 

75630 ......... 26 ....... A X-ray aorta, leg arteries ............................... 1.79 0.61 0.61 0.10 2.50 2.50 XXX 

75630 ......... TC ...... A X-ray aorta, leg arteries ............................... 0.00 13.11 NA 0.69 13.80 NA XXX 

75635 ......... ............ A Ct angio abdominal arteries ........................ 2.40 16.68 NA 0.50 19.58 NA XXX 

75635 ......... 26 ....... A Ct angio abdominal arteries ........................ 2.40 0.79 0.79 0.11 3.30 3.30 XXX 

75635 ......... TC ...... A Ct angio abdominal arteries ........................ 0.00 15.89 NA 0.39 16.28 NA XXX 

75650 ......... ............ A Artery x-rays, head & neck .......................... 1.49 13.07 NA 0.72 15.28 NA XXX 

75650 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.49 0.49 0.49 0.07 2.05 2.05 XXX 

75650 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75658 ......... ............ A Artery x-rays, arm ........................................ 1.31 13.05 NA 0.72 15.08 NA XXX 

75658 ......... 26 ....... A Artery x-rays, arm ........................................ 1.31 0.47 0.47 0.07 1.85 1.85 XXX 

75658 ......... TC ...... A Artery x-rays, arm ........................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75660 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.02 NA 0.72 15.05 NA XXX 

75660 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.44 0.44 0.07 1.82 1.82 XXX 

75660 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75662 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.17 NA 0.73 15.56 NA XXX 

75662 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.59 0.59 0.08 2.33 2.33 XXX 

75662 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75665 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.01 NA 0.74 15.06 NA XXX 

75665 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.44 0.44 0.09 1.84 1.84 XXX 

75665 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75671 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.12 NA 0.73 15.51 NA XXX 

75671 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.55 0.55 0.08 2.29 2.29 XXX 

75671 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75676 ......... ............ A Artery x-rays, neck ....................................... 1.31 13.01 NA 0.73 15.05 NA XXX 

75676 ......... 26 ....... A Artery x-rays, neck ....................................... 1.31 0.44 0.44 0.08 1.83 1.83 XXX 

75676 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75680 ......... ............ A Artery x-rays, neck ....................................... 1.66 13.12 NA 0.73 15.51 NA XXX 

75680 ......... 26 ....... A Artery x-rays, neck ....................................... 1.66 0.55 0.55 0.08 2.29 2.29 XXX 

75680 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75685 ......... ............ A Artery x-rays, spine ...................................... 1.31 13.01 NA 0.72 15.04 NA XXX 

47661

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

75685 ......... 26 ....... A Artery x-rays, spine ...................................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75685 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75705 ......... ............ A Artery x-rays, spine ...................................... 2.18 13.31 NA 0.78 16.27 NA XXX 

75705 ......... 26 ....... A Artery x-rays, spine ...................................... 2.18 0.73 0.73 0.13 3.04 3.04 XXX 

75705 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75710 ......... ............ A Artery x-rays, arm/leg .................................. 1.14 12.96 NA 0.71 14.81 NA XXX 

75710 ......... 26 ....... A Artery x-rays, arm/leg .................................. 1.14 0.39 0.39 0.06 1.59 1.59 XXX 

75710 ......... TC ...... A Artery x-rays, arm/leg .................................. 0.00 12.58 NA 0.65 13.23 NA XXX 

75716 ......... ............ A Artery x-rays, arms/legs ............................... 1.31 13.01 NA 0.72 15.04 NA XXX 

75716 ......... 26 ....... A Artery x-rays, arms/legs ............................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75716 ......... TC ...... A Artery x-rays, arms/legs ............................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75722 ......... ............ A Artery x-rays, kidney .................................... 1.14 12.97 NA 0.71 14.82 NA XXX 

75722 ......... 26 ....... A Artery x-rays, kidney .................................... 1.14 0.40 0.40 0.06 1.60 1.60 XXX 

75722 ......... TC ...... A Artery x-rays, kidney .................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75724 ......... ............ A Artery x-rays, kidneys .................................. 1.49 13.13 NA 0.71 15.33 NA XXX 

75724 ......... 26 ....... A Artery x-rays, kidneys .................................. 1.49 0.56 0.56 0.06 2.11 2.11 XXX 

75724 ......... TC ...... A Artery x-rays, kidneys .................................. 0.00 12.58 NA 0.65 13.23 NA XXX 

75726 ......... ............ A Artery x-rays, abdomen ............................... 1.14 12.95 NA 0.70 14.79 NA XXX 

75726 ......... 26 ....... A Artery x-rays, abdomen ............................... 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

75726 ......... TC ...... A Artery x-rays, abdomen ............................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75731 ......... ............ A Artery x-rays, adrenal gland ........................ 1.14 12.95 NA 0.70 14.79 NA XXX 

75731 ......... 26 ....... A Artery x-rays, adrenal gland ........................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

75731 ......... TC ...... A Artery x-rays, adrenal gland ........................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75733 ......... ............ A Artery x-rays, adrenals ................................ 1.31 13.01 NA 0.70 15.02 NA XXX 

75733 ......... 26 ....... A Artery x-rays, adrenals ................................ 1.31 0.43 0.43 0.05 1.79 1.79 XXX 

75733 ......... TC ...... A Artery x-rays, adrenals ................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75736 ......... ............ A Artery x-rays, pelvis ..................................... 1.14 12.95 NA 0.71 14.80 NA XXX 

75736 ......... 26 ....... A Artery x-rays, pelvis ..................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75736 ......... TC ...... A Artery x-rays, pelvis ..................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75741 ......... ............ A Artery x-rays, lung ....................................... 1.31 13.01 NA 0.71 15.03 NA XXX 

75741 ......... 26 ....... A Artery x-rays, lung ....................................... 1.31 0.43 0.43 0.06 1.80 1.80 XXX 

75741 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75743 ......... ............ A Artery x-rays, lungs ...................................... 1.66 13.12 NA 0.73 15.51 NA XXX 

75743 ......... 26 ....... A Artery x-rays, lungs ...................................... 1.66 0.54 0.54 0.08 2.28 2.28 XXX 

75743 ......... TC ...... A Artery x-rays, lungs ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75746 ......... ............ A Artery x-rays, lung ....................................... 1.14 12.95 NA 0.70 14.79 NA XXX 

75746 ......... 26 ....... A Artery x-rays, lung ....................................... 1.14 0.38 0.38 0.05 1.57 1.57 XXX 

75746 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75756 ......... ............ A Artery x-rays, chest ...................................... 1.14 13.02 NA 0.69 14.85 NA XXX 

75756 ......... 26 ....... A Artery x-rays, chest ...................................... 1.14 0.45 0.45 0.04 1.63 1.63 XXX 

75756 ......... TC ...... A Artery x-rays, chest ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75774 ......... ............ A Artery x-ray, each vessel ............................. 0.36 12.70 NA 0.67 13.73 NA ZZZ 

75774 ......... 26 ....... A Artery x-ray, each vessel ............................. 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 

75774 ......... TC ...... A Artery x-ray, each vessel ............................. 0.00 12.58 NA 0.65 13.23 NA ZZZ 

75790 ......... ............ A Visualize A-V shunt ..................................... 1.84 1.95 NA 0.18 3.97 NA XXX 

75790 ......... 26 ....... A Visualize A-V shunt ..................................... 1.84 0.60 0.60 0.10 2.54 2.54 XXX 

75790 ......... TC ...... A Visualize A-V shunt ..................................... 0.00 1.35 NA 0.08 1.43 NA XXX 

75801 ......... ............ A Lymph vessel x-ray, arm/leg ....................... 0.81 5.67 NA 0.37 6.85 NA XXX 

75801 ......... 26 ....... A Lymph vessel x-ray, arm/leg ....................... 0.81 0.27 0.27 0.08 1.16 1.16 XXX 

75801 ......... TC ...... A Lymph vessel x-ray, arm/leg ....................... 0.00 5.40 NA 0.29 5.69 NA XXX 

75803 ......... ............ A Lymph vessel x-ray,arms/legs ..................... 1.17 5.79 NA 0.34 7.30 NA XXX 

75803 ......... 26 ....... A Lymph vessel x-ray,arms/legs ..................... 1.17 0.38 0.38 0.05 1.60 1.60 XXX 

75803 ......... TC ...... A Lymph vessel x-ray,arms/legs ..................... 0.00 5.40 NA 0.29 5.69 NA XXX 

75805 ......... ............ A Lymph vessel x-ray, trunk ........................... 0.81 6.36 NA 0.38 7.55 NA XXX 

75805 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 0.81 0.27 0.27 0.05 1.13 1.13 XXX 

75805 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.09 NA 0.33 6.42 NA XXX 

75807 ......... ............ A Lymph vessel x-ray, trunk ........................... 1.17 6.47 NA 0.39 8.03 NA XXX 

75807 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 1.17 0.38 0.38 0.06 1.61 1.61 XXX 

75807 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.09 NA 0.33 6.42 NA XXX 

75809 ......... ............ A Nonvascular shunt, x-ray ............................. 0.47 0.94 NA 0.07 1.48 NA XXX 

75809 ......... 26 ....... A Nonvascular shunt, x-ray ............................. 0.47 0.15 0.15 0.02 0.64 0.64 XXX 

75809 ......... TC ...... A Nonvascular shunt, x-ray ............................. 0.00 0.78 NA 0.05 0.83 NA XXX 

75810 ......... ............ A Vein x-ray, spleen/liver ................................ 1.14 12.95 NA 0.70 14.79 NA XXX 

75810 ......... 26 ....... A Vein x-ray, spleen/liver ................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

75810 ......... TC ...... A Vein x-ray, spleen/liver ................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75820 ......... ............ A Vein x-ray, arm/leg ...................................... 0.70 1.17 NA 0.10 1.97 NA XXX 

75820 ......... 26 ....... A Vein x-ray, arm/leg ...................................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

75820 ......... TC ...... A Vein x-ray, arm/leg ...................................... 0.00 0.95 NA 0.06 1.01 NA XXX 

75822 ......... ............ A Vein x-ray, arms/legs ................................... 1.06 1.82 NA 0.13 3.01 NA XXX 

75822 ......... 26 ....... A Vein x-ray, arms/legs ................................... 1.06 0.35 0.35 0.05 1.46 1.46 XXX 

75822 ......... TC ...... A Vein x-ray, arms/legs ................................... 0.00 1.48 NA 0.08 1.56 NA XXX 

75825 ......... ............ A Vein x-ray, trunk .......................................... 1.14 12.95 NA 0.72 14.81 NA XXX 

75825 ......... 26 ....... A Vein x-ray, trunk .......................................... 1.14 0.37 0.37 0.07 1.58 1.58 XXX 

75825 ......... TC ...... A Vein x-ray, trunk .......................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75827 ......... ............ A Vein x-ray, chest .......................................... 1.14 12.95 NA 0.71 14.80 NA XXX 

47662

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

75827 ......... 26 ....... A Vein x-ray, chest .......................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75827 ......... TC ...... A Vein x-ray, chest .......................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75831 ......... ............ A Vein x-ray, kidney ........................................ 1.14 12.94 NA 0.70 14.78 NA XXX 

75831 ......... 26 ....... A Vein x-ray, kidney ........................................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75831 ......... TC ...... A Vein x-ray, kidney ........................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75833 ......... ............ A Vein x-ray, kidneys ...................................... 1.49 13.06 NA 0.73 15.28 NA XXX 

75833 ......... 26 ....... A Vein x-ray, kidneys ...................................... 1.49 0.49 0.49 0.08 2.06 2.06 XXX 

75833 ......... TC ...... A Vein x-ray, kidneys ...................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75840 ......... ............ A Vein x-ray, adrenal gland ............................ 1.14 12.95 NA 0.70 14.79 NA XXX 

75840 ......... 26 ....... A Vein x-ray, adrenal gland ............................ 1.14 0.38 0.38 0.05 1.57 1.57 XXX 

75840 ......... TC ...... A Vein x-ray, adrenal gland ............................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75842 ......... ............ A Vein x-ray, adrenal glands ........................... 1.49 13.06 NA 0.73 15.28 NA XXX 

75842 ......... 26 ....... A Vein x-ray, adrenal glands ........................... 1.49 0.48 0.48 0.08 2.05 2.05 XXX 

75842 ......... TC ...... A Vein x-ray, adrenal glands ........................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75860 ......... ............ A Vein x-ray, neck ........................................... 1.14 12.97 NA 0.70 14.81 NA XXX 

75860 ......... 26 ....... A Vein x-ray, neck ........................................... 1.14 0.39 0.39 0.05 1.58 1.58 XXX 

75860 ......... TC ...... A Vein x-ray, neck ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75870 ......... ............ A Vein x-ray, skull ........................................... 1.14 12.96 NA 0.71 14.81 NA XXX 

75870 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.39 0.39 0.06 1.59 1.59 XXX 

75870 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75872 ......... ............ A Vein x-ray, skull ........................................... 1.14 12.95 NA 0.76 14.85 NA XXX 

75872 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.37 0.37 0.11 1.62 1.62 XXX 

75872 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75880 ......... ............ A Vein x-ray, eye socket ................................. 0.70 1.18 NA 0.10 1.98 NA XXX 

75880 ......... 26 ....... A Vein x-ray, eye socket ................................. 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

75880 ......... TC ...... A Vein x-ray, eye socket ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 

75885 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.04 NA 0.72 15.20 NA XXX 

75885 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75885 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75887 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.04 NA 0.72 15.20 NA XXX 

75887 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75887 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75889 ......... ............ A Vein x-ray, liver ............................................ 1.14 12.95 NA 0.70 14.79 NA XXX 

75889 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

75889 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75891 ......... ............ A Vein x-ray, liver ............................................ 1.14 12.95 NA 0.70 14.79 NA XXX 

75891 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.05 1.56 1.56 XXX 

75891 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.58 NA 0.65 13.23 NA XXX 

75893 ......... ............ A Venous sampling by catheter ...................... 0.54 12.75 NA 0.68 13.97 NA XXX 

75893 ......... 26 ....... A Venous sampling by catheter ...................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

75893 ......... TC ...... A Venous sampling by catheter ...................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75894 ......... ............ A X-rays, transcath therapy ............................ 1.31 24.52 NA 1.35 27.18 NA XXX 

75894 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.43 0.43 0.08 1.82 1.82 XXX 

75894 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 24.09 NA 1.27 25.36 NA XXX 

75896 ......... ............ A X-rays, transcath therapy ............................ 1.31 21.40 NA 1.16 23.87 NA XXX 

75896 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.45 0.45 0.06 1.82 1.82 XXX 

75896 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 20.95 NA 1.10 22.05 NA XXX 

75898 ......... ............ A Follow-up angiography ................................ 1.65 1.60 NA 0.14 3.39 NA XXX 

75898 ......... 26 ....... A Follow-up angiography ................................ 1.65 0.55 0.55 0.08 2.28 2.28 XXX 

75898 ......... TC ...... A Follow-up angiography ................................ 0.00 1.05 NA 0.06 1.11 NA XXX 

75900 ......... ............ A Arterial catheter exchange ........................... 0.49 21.09 NA 1.14 22.72 NA XXX 

75900 ......... 26 ....... A Arterial catheter exchange ........................... 0.49 0.16 0.16 0.03 0.68 0.68 XXX 

75900 ......... TC ...... A Arterial catheter exchange ........................... 0.00 20.93 NA 1.11 22.04 NA XXX 

75901 ......... ............ A Remove cva device obstruct ....................... 0.49 1.46 NA 1.04 2.99 NA XXX 

75901 ......... 26 ....... A Remove cva device obstruct ....................... 0.49 0.16 0.16 0.21 0.86 0.86 XXX 

75901 ......... TC ...... A Remove cva device obstruct ....................... 0.00 1.30 NA 0.83 2.13 NA XXX 

75902 ......... ............ A Remove cva lumen obstruct ........................ 0.39 1.43 NA 0.86 2.68 NA XXX 

75902 ......... 26 ....... A Remove cva lumen obstruct ........................ 0.39 0.13 0.13 0.03 0.55 0.55 XXX 

75902 ......... TC ...... A Remove cva lumen obstruct ........................ 0.00 1.30 NA 0.83 2.13 NA XXX 

75940 ......... ............ A X-ray placement, vein filter .......................... 0.54 12.75 NA 0.68 13.97 NA XXX 

75940 ......... 26 ....... A X-ray placement, vein filter .......................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

75940 ......... TC ...... A X-ray placement, vein filter .......................... 0.00 12.58 NA 0.65 13.23 NA XXX 

75945 ......... ............ A Intravascular us ........................................... 0.40 4.70 NA 0.27 5.37 NA XXX 

75945 ......... 26 ....... A Intravascular us ........................................... 0.40 0.14 0.14 0.03 0.57 0.57 XXX 

75945 ......... TC ...... A Intravascular us ........................................... 0.00 4.56 NA 0.24 4.80 NA XXX 

75946 ......... ............ A Intravascular us add-on ............................... 0.40 2.42 NA 0.18 3.00 NA ZZZ 

75946 ......... 26 ....... A Intravascular us add-on ............................... 0.40 0.14 0.14 0.05 0.59 0.59 ZZZ 

75946 ......... TC ...... A Intravascular us add-on ............................... 0.00 2.29 NA 0.13 2.42 NA ZZZ 

75952 ......... 26 ....... A Endovasc repair abdom aorta ..................... 4.49 1.49 1.49 0.43 6.41 6.41 XXX 

75953 ......... 26 ....... A Abdom aneurysm endovas rpr .................... 1.36 0.45 0.45 0.13 1.94 1.94 XXX 

75954 ......... 26 ....... A Iliac aneurysm endovas rpr ......................... 2.25 0.77 0.77 0.05 3.07 3.07 XXX 

75960 ......... ............ A Transcatheter intro, stent ............................. 0.82 15.16 NA 0.82 16.80 NA XXX 

75960 ......... 26 ....... A Transcatheter intro, stent ............................. 0.82 0.28 0.28 0.05 1.15 1.15 XXX 

75960 ......... TC ...... A Transcatheter intro, stent ............................. 0.00 14.87 NA 0.77 15.64 NA XXX 

75961 ......... ............ A Retrieval, broken catheter ........................... 4.24 11.87 NA 0.76 16.87 NA XXX 

47663

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

75961 ......... 26 ....... A Retrieval, broken catheter ........................... 4.24 1.39 1.39 0.21 5.84 5.84 XXX 

75961 ......... TC ...... A Retrieval, broken catheter ........................... 0.00 10.48 NA 0.55 11.03 NA XXX 

75962 ......... ............ A Repair arterial blockage ............................... 0.54 15.90 NA 0.86 17.30 NA XXX 

75962 ......... 26 ....... A Repair arterial blockage ............................... 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

75962 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.71 NA 0.83 16.54 NA XXX 

75964 ......... ............ A Repair artery blockage, each ...................... 0.36 8.50 NA 0.45 9.31 NA ZZZ 

75964 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 

75964 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.38 NA 0.43 8.81 NA ZZZ 

75966 ......... ............ A Repair arterial blockage ............................... 1.31 16.18 NA 0.89 18.38 NA XXX 

75966 ......... 26 ....... A Repair arterial blockage ............................... 1.31 0.46 0.46 0.06 1.83 1.83 XXX 

75966 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.71 NA 0.83 16.54 NA XXX 

75968 ......... ............ A Repair artery blockage, each ...................... 0.36 8.51 NA 0.45 9.32 NA ZZZ 

75968 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 

75968 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.38 NA 0.43 8.81 NA ZZZ 

75970 ......... ............ A Vascular biopsy ........................................... 0.83 11.80 NA 0.64 13.27 NA XXX 

75970 ......... 26 ....... A Vascular biopsy ........................................... 0.83 0.28 0.28 0.04 1.15 1.15 XXX 

75970 ......... TC ...... A Vascular biopsy ........................................... 0.00 11.52 NA 0.60 12.12 NA XXX 

75978 ......... ............ A Repair venous blockage .............................. 0.54 15.89 NA 0.86 17.29 NA XXX 

75978 ......... 26 ....... A Repair venous blockage .............................. 0.54 0.18 0.18 0.03 0.75 0.75 XXX 

75978 ......... TC ...... A Repair venous blockage .............................. 0.00 15.71 NA 0.83 16.54 NA XXX 

75980 ......... ............ A Contrast xray exam bile duct ....................... 1.44 5.87 NA 0.36 7.67 NA XXX 

75980 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75980 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 5.40 NA 0.29 5.69 NA XXX 

75982 ......... ............ A Contrast xray exam bile duct ....................... 1.44 6.56 NA 0.40 8.40 NA XXX 

75982 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75982 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 6.09 NA 0.33 6.42 NA XXX 

75984 ......... ............ A Xray control catheter change ...................... 0.72 2.18 NA 0.14 3.04 NA XXX 

75984 ......... 26 ....... A Xray control catheter change ...................... 0.72 0.23 0.23 0.03 0.98 0.98 XXX 

75984 ......... TC ...... A Xray control catheter change ...................... 0.00 1.95 NA 0.11 2.06 NA XXX 

75989 ......... ............ A Abscess drainage under x-ray ..................... 1.19 3.53 NA 0.22 4.94 NA XXX 

75989 ......... 26 ....... A Abscess drainage under x-ray ..................... 1.19 0.39 0.39 0.05 1.63 1.63 XXX 

75989 ......... TC ...... A Abscess drainage under x-ray ..................... 0.00 3.15 NA 0.17 3.32 NA XXX 

75992 ......... ............ A Atherectomy, x-ray exam ............................. 0.54 15.90 NA 0.86 17.30 NA XXX 

75992 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.54 0.19 0.19 0.03 0.76 0.76 XXX 

75992 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 

75993 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.51 NA 0.45 9.32 NA ZZZ 

75993 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 

75993 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.38 NA 0.43 8.81 NA ZZZ 

75994 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.18 NA 0.87 18.36 NA XXX 

75994 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.46 0.46 0.04 1.81 1.81 XXX 

75994 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 

75995 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.18 NA 0.91 18.40 NA XXX 

75995 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.47 0.47 0.08 1.86 1.86 XXX 

75995 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.71 NA 0.83 16.54 NA XXX 

75996 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.50 NA 0.44 9.30 NA ZZZ 

75996 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.12 0.12 0.01 0.49 0.49 ZZZ 

75996 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.38 NA 0.43 8.81 NA ZZZ 

75998 ......... ............ A Fluoroguide for vein device ......................... 0.38 1.43 NA 0.11 1.92 NA ZZZ 

75998 ......... 26 ....... A Fluoroguide for vein device ......................... 0.38 0.13 0.13 0.01 0.52 0.52 ZZZ 

75998 ......... TC ...... A Fluoroguide for vein device ......................... 0.00 1.30 NA 0.10 1.40 NA ZZZ 

76000 ......... ............ A Fluoroscope examination ............................. 0.17 1.36 NA 0.08 1.61 NA XXX 

76000 ......... 26 ....... A Fluoroscope examination ............................. 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

76000 ......... TC ...... A Fluoroscope examination ............................. 0.00 1.30 NA 0.07 1.37 NA XXX 

76001 ......... ............ A Fluoroscope exam, extensive ...................... 0.67 2.84 NA 0.18 3.69 NA XXX 

76001 ......... 26 ....... A Fluoroscope exam, extensive ...................... 0.67 0.22 0.22 0.04 0.93 0.93 XXX 

76001 ......... TC ...... A Fluoroscope exam, extensive ...................... 0.00 2.62 NA 0.14 2.76 NA XXX 

76003 ......... ............ A Needle localization by x-ray ........................ 0.54 1.47 NA 0.10 2.11 NA XXX 

76003 ......... 26 ....... A Needle localization by x-ray ........................ 0.54 0.17 0.17 0.03 0.74 0.74 XXX 

76003 ......... TC ...... A Needle localization by x-ray ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 

76005 ......... ............ A Fluoroguide for spine inject ......................... 0.60 1.46 NA 0.11 2.17 NA XXX 

76005 ......... 26 ....... A Fluoroguide for spine inject ......................... 0.60 0.15 0.15 0.04 0.79 0.79 XXX 

76005 ......... TC ...... A Fluoroguide for spine inject ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

76006 ......... ............ A X-ray stress view ......................................... 0.41 0.18 0.18 0.06 0.65 0.65 XXX 

76010 ......... ............ A X-ray, nose to rectum .................................. 0.18 0.58 NA 0.03 0.79 NA XXX 

76010 ......... 26 ....... A X-ray, nose to rectum .................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

76010 ......... TC ...... A X-ray, nose to rectum .................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

76012 ......... 26 ....... A Percut vertebroplasty fluor ........................... 1.31 0.47 0.47 0.09 1.87 1.87 XXX 

76013 ......... 26 ....... A Percut vertebroplasty, ct .............................. 1.38 0.47 0.47 0.08 1.93 1.93 XXX 

76020 ......... ............ A X-rays for bone age ..................................... 0.19 0.58 NA 0.03 0.80 NA XXX 

76020 ......... 26 ....... A X-rays for bone age ..................................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

76020 ......... TC ...... A X-rays for bone age ..................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

76040 ......... ............ A X-rays, bone evaluation ............................... 0.27 0.87 NA 0.06 1.20 NA XXX 

76040 ......... 26 ....... A X-rays, bone evaluation ............................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

76040 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.78 NA 0.05 0.83 NA XXX 

76061 ......... ............ A X-rays, bone survey ..................................... 0.45 1.14 NA 0.08 1.67 NA XXX 

47664

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

76061 ......... 26 ....... A X-rays, bone survey ..................................... 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

76061 ......... TC ...... A X-rays, bone survey ..................................... 0.00 0.99 NA 0.06 1.05 NA XXX 

76062 ......... ............ A X-rays, bone survey ..................................... 0.54 1.61 NA 0.10 2.25 NA XXX 

76062 ......... 26 ....... A X-rays, bone survey ..................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76062 ......... TC ...... A X-rays, bone survey ..................................... 0.00 1.44 NA 0.08 1.52 NA XXX 

76065 ......... ............ A X-rays, bone evaluation ............................... 0.70 0.97 NA 0.08 1.75 NA XXX 

76065 ......... 26 ....... A X-rays, bone evaluation ............................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

76065 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.73 NA 0.05 0.78 NA XXX 

76066 ......... ............ A Joint survey, single view .............................. 0.31 1.21 NA 0.08 1.60 NA XXX 

76066 ......... 26 ....... A Joint survey, single view .............................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX 

76066 ......... TC ...... A Joint survey, single view .............................. 0.00 1.11 NA 0.06 1.17 NA XXX 

76070 ......... ............ A Ct bone density, axial .................................. 0.25 3.03 NA 0.17 3.45 NA XXX 

76070 ......... 26 ....... A Ct bone density, axial .................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

76070 ......... TC ...... A Ct bone density, axial .................................. 0.00 2.94 NA 0.16 3.10 NA XXX 

76071 ......... ............ A Ct bone density, peripheral ......................... 0.22 3.02 NA 0.06 3.30 NA XXX 

76071 ......... 26 ....... A Ct bone density, peripheral ......................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

76071 ......... TC ...... A Ct bone density, peripheral ......................... 0.00 2.94 NA 0.05 2.99 NA XXX 

76075 ......... ............ A Dexa, axial skeleton study ........................... 0.30 3.19 NA 0.18 3.67 NA XXX 

76075 ......... 26 ....... A Dexa, axial skeleton study ........................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 

76075 ......... TC ...... A Dexa, axial skeleton study ........................... 0.00 3.09 NA 0.17 3.26 NA XXX 

76076 ......... ............ A Dexa, peripheral study ................................. 0.22 0.83 NA 0.06 1.11 NA XXX 

76076 ......... 26 ....... A Dexa, peripheral study ................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

76076 ......... TC ...... A Dexa, peripheral study ................................. 0.00 0.75 NA 0.05 0.80 NA XXX 

76078 ......... ............ A Radiographic absorptiometry ....................... 0.20 0.82 NA 0.06 1.08 NA XXX 

76078 ......... 26 ....... A Radiographic absorptiometry ....................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

76078 ......... TC ...... A Radiographic absorptiometry ....................... 0.00 0.75 NA 0.05 0.80 NA XXX 

76080 ......... ............ A X-ray exam of fistula .................................... 0.54 1.23 NA 0.08 1.85 NA XXX 

76080 ......... 26 ....... A X-ray exam of fistula .................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76080 ......... TC ...... A X-ray exam of fistula .................................... 0.00 1.05 NA 0.06 1.11 NA XXX 

76082 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.01 0.50 NA ZZZ 

76082 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ 

76082 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.42 NA 0.01 0.43 NA ZZZ 

76083 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.01 0.50 NA ZZZ 

76083 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.00 0.08 0.08 ZZZ 

76083 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.42 NA 0.01 0.43 NA ZZZ 

76086 ......... ............ A X-ray of mammary duct ............................... 0.36 2.73 NA 0.16 3.25 NA XXX 

76086 ......... 26 ....... A X-ray of mammary duct ............................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

76086 ......... TC ...... A X-ray of mammary duct ............................... 0.00 2.62 NA 0.14 2.76 NA XXX 

76088 ......... ............ A X-ray of mammary ducts ............................. 0.45 3.80 NA 0.21 4.46 NA XXX 

76088 ......... 26 ....... A X-ray of mammary ducts ............................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

76088 ......... TC ...... A X-ray of mammary ducts ............................. 0.00 3.66 NA 0.19 3.85 NA XXX 

76090 ......... ............ A Mammogram, one breast ............................ 0.70 1.28 NA 0.09 2.07 NA XXX 

76090 ......... 26 ....... A Mammogram, one breast ............................ 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

76090 ......... TC ...... A Mammogram, one breast ............................ 0.00 1.05 NA 0.06 1.11 NA XXX 

76091 ......... ............ A Mammogram, both breasts .......................... 0.87 1.59 NA 0.11 2.57 NA XXX 

76091 ......... 26 ....... A Mammogram, both breasts .......................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX 

76091 ......... TC ...... A Mammogram, both breasts .......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

76092 ......... ............ A Mammogram, screening .............................. 0.70 1.45 NA 0.10 2.25 NA XXX 

76092 ......... 26 ....... A Mammogram, screening .............................. 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

76092 ......... TC ...... A Mammogram, screening .............................. 0.00 1.23 NA 0.07 1.30 NA XXX 

76093 ......... ............ A Magnetic image, breast ............................... 1.63 18.13 NA 0.99 20.75 NA XXX 

76093 ......... 26 ....... A Magnetic image, breast ............................... 1.63 0.53 0.53 0.07 2.23 2.23 XXX 

76093 ......... TC ...... A Magnetic image, breast ............................... 0.00 17.59 NA 0.92 18.51 NA XXX 

76094 ......... ............ A Magnetic image, both breasts ..................... 1.63 24.40 NA 1.31 27.34 NA XXX 

76094 ......... 26 ....... A Magnetic image, both breasts ..................... 1.63 0.53 0.53 0.07 2.23 2.23 XXX 

76094 ......... TC ...... A Magnetic image, both breasts ..................... 0.00 23.87 NA 1.24 25.11 NA XXX 

76095 ......... ............ A Stereotactic breast biopsy ........................... 1.59 7.67 NA 0.47 9.73 NA XXX 

76095 ......... 26 ....... A Stereotactic breast biopsy ........................... 1.59 0.52 0.52 0.10 2.21 2.21 XXX 

76095 ......... TC ...... A Stereotactic breast biopsy ........................... 0.00 7.15 NA 0.37 7.52 NA XXX 

76096 ......... ............ A X-ray of needle wire, breast ........................ 0.56 1.49 NA 0.10 2.15 NA XXX 

76096 ......... 26 ....... A X-ray of needle wire, breast ........................ 0.56 0.18 0.18 0.03 0.77 0.77 XXX 

76096 ......... TC ...... A X-ray of needle wire, breast ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 

76098 ......... ............ A X-ray exam, breast specimen ...................... 0.16 0.47 NA 0.03 0.66 NA XXX 

76098 ......... 26 ....... A X-ray exam, breast specimen ...................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76098 ......... TC ...... A X-ray exam, breast specimen ...................... 0.00 0.42 NA 0.02 0.44 NA XXX 

76100 ......... ............ A X-ray exam of body section ......................... 0.58 1.43 NA 0.10 2.11 NA XXX 

76100 ......... 26 ....... A X-ray exam of body section ......................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

76100 ......... TC ...... A X-ray exam of body section ......................... 0.00 1.25 NA 0.07 1.32 NA XXX 

76101 ......... ............ A Complex body section x-ray ........................ 0.58 1.61 NA 0.11 2.30 NA XXX 

76101 ......... 26 ....... A Complex body section x-ray ........................ 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

76101 ......... TC ...... A Complex body section x-ray ........................ 0.00 1.42 NA 0.08 1.50 NA XXX 

76102 ......... ............ A Complex body section x-rays ...................... 0.58 1.92 NA 0.14 2.64 NA XXX 

76102 ......... 26 ....... A Complex body section x-rays ...................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

76102 ......... TC ...... A Complex body section x-rays ...................... 0.00 1.73 NA 0.11 1.84 NA XXX 

76120 ......... ............ A Cine/video x-rays ......................................... 0.38 1.18 NA 0.08 1.64 NA XXX 

47665

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

76120 ......... 26 ....... A Cine/video x-rays ......................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76120 ......... TC ...... A Cine/video x-rays ......................................... 0.00 1.05 NA 0.06 1.11 NA XXX 

76125 ......... ............ A Cine/video x-rays add-on ............................. 0.27 0.87 NA 0.06 1.20 NA ZZZ 

76125 ......... 26 ....... A Cine/video x-rays add-on ............................. 0.27 0.09 0.09 0.01 0.37 0.37 ZZZ 

76125 ......... TC ...... A Cine/video x-rays add-on ............................. 0.00 0.78 NA 0.05 0.83 NA ZZZ 

76150 ......... ............ A X-ray exam, dry process ............................. 0.00 0.42 NA 0.02 0.44 NA XXX 

76355 ......... ............ A Ct scan for localization ................................ 1.21 8.64 NA 0.48 10.33 NA XXX 

76355 ......... 26 ....... A Ct scan for localization ................................ 1.21 0.40 0.40 0.06 1.67 1.67 XXX 

76355 ......... TC ...... A Ct scan for localization ................................ 0.00 8.24 NA 0.42 8.66 NA XXX 

76360 ......... ............ A Ct scan for needle biopsy ............................ 1.16 8.62 NA 0.47 10.25 NA XXX 

76360 ......... 26 ....... A Ct scan for needle biopsy ............................ 1.16 0.38 0.38 0.05 1.59 1.59 XXX 

76360 ......... TC ...... A Ct scan for needle biopsy ............................ 0.00 8.24 NA 0.42 8.66 NA XXX 

76362 ......... ............ A Ct guide for tissue ablation .......................... 3.99 9.54 NA 1.64 15.17 NA XXX 

76362 ......... 26 ....... A Ct guide for tissue ablation .......................... 3.99 1.30 1.30 0.18 5.47 5.47 XXX 

76362 ......... TC ...... A Ct guide for tissue ablation .......................... 0.00 8.24 NA 1.46 9.70 NA XXX 

76370 ......... ............ A Ct scan for therapy guide ............................ 0.85 3.22 NA 0.20 4.27 NA XXX 

76370 ......... 26 ....... A Ct scan for therapy guide ............................ 0.85 0.28 0.28 0.04 1.17 1.17 XXX 

76370 ......... TC ...... A Ct scan for therapy guide ............................ 0.00 2.94 NA 0.16 3.10 NA XXX 

76375 ......... ............ A 3d/holograph reconstr add-on ..................... 0.16 3.58 NA 0.19 3.93 NA XXX 

76375 ......... 26 ....... A 3d/holograph reconstr add-on ..................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76375 ......... TC ...... A 3d/holograph reconstr add-on ..................... 0.00 3.53 NA 0.18 3.71 NA XXX 

76380 ......... ............ A CAT scan follow-up study ............................ 0.98 3.81 NA 0.22 5.01 NA XXX 

76380 ......... 26 ....... A CAT scan follow-up study ............................ 0.98 0.32 0.32 0.04 1.34 1.34 XXX 

76380 ......... TC ...... A CAT scan follow-up study ............................ 0.00 3.49 NA 0.18 3.67 NA XXX 

76393 ......... ............ A Mr guidance for needle place ...................... 1.50 11.68 NA 0.65 13.83 NA XXX 

76393 ......... 26 ....... A Mr guidance for needle place ...................... 1.50 0.50 0.50 0.10 2.10 2.10 XXX 

76393 ......... TC ...... A Mr guidance for needle place ...................... 0.00 11.19 NA 0.55 11.74 NA XXX 

76394 ......... ............ A Mri for tissue ablation .................................. 4.24 12.57 NA 1.80 18.61 NA XXX 

76394 ......... 26 ....... A Mri for tissue ablation .................................. 4.24 1.38 1.38 0.24 5.86 5.86 XXX 

76394 ......... TC ...... A Mri for tissue ablation .................................. 0.00 11.19 NA 1.56 12.75 NA XXX 

76400 ......... ............ A Magnetic image, bone marrow .................... 1.60 11.71 NA 0.66 13.97 NA XXX 

76400 ......... 26 ....... A Magnetic image, bone marrow .................... 1.60 0.52 0.52 0.07 2.19 2.19 XXX 

76400 ......... TC ...... A Magnetic image, bone marrow .................... 0.00 11.19 NA 0.59 11.78 NA XXX 

76506 ......... ............ A Echo exam of head ..................................... 0.63 1.66 NA 0.12 2.41 NA XXX 

76506 ......... 26 ....... A Echo exam of head ..................................... 0.63 0.24 0.24 0.04 0.91 0.91 XXX 

76506 ......... TC ...... A Echo exam of head ..................................... 0.00 1.42 NA 0.08 1.50 NA XXX 

76511 ......... ............ A Echo exam of eye ........................................ 0.94 1.85 NA 0.10 2.89 NA XXX 

76511 ......... 26 ....... A Echo exam of eye ........................................ 0.94 0.40 0.40 0.03 1.37 1.37 XXX 

76511 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.45 NA 0.07 1.52 NA XXX 

76512 ......... ............ A Echo exam of eye ........................................ 0.66 1.73 NA 0.12 2.51 NA XXX 

76512 ......... 26 ....... A Echo exam of eye ........................................ 0.66 0.29 0.29 0.02 0.97 0.97 XXX 

76512 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.44 NA 0.10 1.54 NA XXX 

76513 ......... ............ A Echo exam of eye, water bath .................... 0.66 1.82 NA 0.12 2.60 NA XXX 

76513 ......... 26 ....... A Echo exam of eye, water bath .................... 0.66 0.29 0.29 0.02 0.97 0.97 XXX 

76513 ......... TC ...... A Echo exam of eye, water bath .................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76514 ......... ............ A Echo exam of eye, thickness ...................... 0.17 0.13 NA 0.02 0.32 NA XXX 

76514 ......... 26 ....... A Echo exam of eye, thickness ...................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX 

76514 ......... TC ...... A Echo exam of eye, thickness ...................... 0.00 0.05 NA 0.01 0.06 NA XXX 

76516 ......... ............ A Echo exam of eye ........................................ 0.54 1.46 NA 0.08 2.08 NA XXX 

76516 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

76516 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.22 NA 0.07 1.29 NA XXX 

76519 ......... ............ A Echo exam of eye ........................................ 0.54 1.56 NA 0.08 2.18 NA XXX 

76519 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

76519 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.32 NA 0.07 1.39 NA XXX 

76529 ......... ............ A Echo exam of eye ........................................ 0.57 1.38 NA 0.10 2.05 NA XXX 

76529 ......... 26 ....... A Echo exam of eye ........................................ 0.57 0.24 0.24 0.02 0.83 0.83 XXX 

76529 ......... TC ...... A Echo exam of eye ........................................ 0.00 1.14 NA 0.08 1.22 NA XXX 

76536 ......... ............ A Us exam of head and neck ......................... 0.56 1.60 NA 0.11 2.27 NA XXX 

76536 ......... 26 ....... A Us exam of head and neck ......................... 0.56 0.18 0.18 0.03 0.77 0.77 XXX 

76536 ......... TC ...... A Us exam of head and neck ......................... 0.00 1.42 NA 0.08 1.50 NA XXX 

76604 ......... ............ A Us exam, chest, b-scan ............................... 0.55 1.48 NA 0.10 2.13 NA XXX 

76604 ......... 26 ....... A Us exam, chest, b-scan ............................... 0.55 0.18 0.18 0.03 0.76 0.76 XXX 

76604 ......... TC ...... A Us exam, chest, b-scan ............................... 0.00 1.30 NA 0.07 1.37 NA XXX 

76645 ......... ............ A Us exam, breast(s) ...................................... 0.54 1.23 NA 0.08 1.85 NA XXX 

76645 ......... 26 ....... A Us exam, breast(s) ...................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76645 ......... TC ...... A Us exam, breast(s) ...................................... 0.00 1.05 NA 0.06 1.11 NA XXX 

76700 ......... ............ A Us exam, abdom, complete ......................... 0.81 2.23 NA 0.15 3.19 NA XXX 

76700 ......... 26 ....... A Us exam, abdom, complete ......................... 0.81 0.26 0.26 0.04 1.11 1.11 XXX 

76700 ......... TC ...... A Us exam, abdom, complete ......................... 0.00 1.97 NA 0.11 2.08 NA XXX 

76705 ......... ............ A Echo exam of abdomen .............................. 0.59 1.61 NA 0.11 2.31 NA XXX 

76705 ......... 26 ....... A Echo exam of abdomen .............................. 0.59 0.19 0.19 0.03 0.81 0.81 XXX 

76705 ......... TC ...... A Echo exam of abdomen .............................. 0.00 1.42 NA 0.08 1.50 NA XXX 

76770 ......... ............ A Us exam abdo back wall, comp .................. 0.74 2.21 NA 0.14 3.09 NA XXX 

76770 ......... 26 ....... A Us exam abdo back wall, comp .................. 0.74 0.24 0.24 0.03 1.01 1.01 XXX 

76770 ......... TC ...... A Us exam abdo back wall, comp .................. 0.00 1.97 NA 0.11 2.08 NA XXX 

47666

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

76775 ......... ............ A Us exam abdo back wall, lim ...................... 0.58 1.61 NA 0.11 2.30 NA XXX 

76775 ......... 26 ....... A Us exam abdo back wall, lim ...................... 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

76775 ......... TC ...... A Us exam abdo back wall, lim ...................... 0.00 1.42 NA 0.08 1.50 NA XXX 

76778 ......... ............ A Us exam kidney transplant .......................... 0.74 2.21 NA 0.14 3.09 NA XXX 

76778 ......... 26 ....... A Us exam kidney transplant .......................... 0.74 0.24 0.24 0.03 1.01 1.01 XXX 

76778 ......... TC ...... A Us exam kidney transplant .......................... 0.00 1.97 NA 0.11 2.08 NA XXX 

76800 ......... ............ A Us exam, spinal canal ................................. 1.13 1.76 NA 0.14 3.03 NA XXX 

76800 ......... 26 ....... A Us exam, spinal canal ................................. 1.13 0.34 0.34 0.06 1.53 1.53 XXX 

76800 ......... TC ...... A Us exam, spinal canal ................................. 0.00 1.42 NA 0.08 1.50 NA XXX 

76801 ......... ............ A Ob us < 14 wks, single fetus ....................... 0.99 2.43 NA 0.17 3.59 NA XXX 

76801 ......... 26 ....... A Ob us < 14 wks, single fetus ....................... 0.99 0.34 0.34 0.05 1.38 1.38 XXX 

76801 ......... TC ...... A Ob us < 14 wks, single fetus ....................... 0.00 2.09 NA 0.12 2.21 NA XXX 

76802 ......... ............ A Ob us < 14 wks, add-l fetus ........................ 0.83 1.34 NA 0.17 2.34 NA ZZZ 

76802 ......... 26 ....... A Ob us < 14 wks, add-l fetus ........................ 0.83 0.29 0.29 0.05 1.17 1.17 ZZZ 

76802 ......... TC ...... A Ob us < 14 wks, add-l fetus ........................ 0.00 1.05 NA 0.12 1.17 NA ZZZ 

76805 ......... ............ A Ob us >/= 14 wks, sngl fetus ...................... 0.99 2.43 NA 0.17 3.59 NA XXX 

76805 ......... 26 ....... A Ob us >/= 14 wks, sngl fetus ...................... 0.99 0.34 0.34 0.05 1.38 1.38 XXX 

76805 ......... TC ...... A Ob us >/= 14 wks, sngl fetus ...................... 0.00 2.09 NA 0.12 2.21 NA XXX 

76810 ......... ............ A Ob us >/= 14 wks, addl fetus ...................... 0.98 1.39 NA 0.31 2.68 NA ZZZ 

76810 ......... 26 ....... A Ob us >/= 14 wks, addl fetus ...................... 0.98 0.34 0.34 0.09 1.41 1.41 ZZZ 

76810 ......... TC ...... A Ob us >/= 14 wks, addl fetus ...................... 0.00 1.05 NA 0.22 1.27 NA ZZZ 

76811 ......... ............ A Ob us, detailed, sngl fetus ........................... 1.90 4.23 NA 0.48 6.61 NA XXX 

76811 ......... 26 ....... A Ob us, detailed, sngl fetus ........................... 1.90 0.71 0.71 0.05 2.66 2.66 XXX 

76811 ......... TC ...... A Ob us, detailed, sngl fetus ........................... 0.00 3.52 NA 0.43 3.95 NA XXX 

76812 ......... ............ A Ob us, detailed, addl fetus .......................... 1.78 1.71 NA 0.50 3.99 NA ZZZ 

76812 ......... 26 ....... A Ob us, detailed, addl fetus .......................... 1.78 0.66 0.66 0.09 2.53 2.53 ZZZ 

76812 ......... TC ...... A Ob us, detailed, addl fetus .......................... 0.00 1.05 NA 0.41 1.46 NA ZZZ 

76815 ......... ............ A Ob us, limited, fetus(s) ................................ 0.65 1.65 NA 0.11 2.41 NA XXX 

76815 ......... 26 ....... A Ob us, limited, fetus(s) ................................ 0.65 0.23 0.23 0.03 0.91 0.91 XXX 

76815 ......... TC ...... A Ob us, limited, fetus(s) ................................ 0.00 1.42 NA 0.08 1.50 NA XXX 

76816 ......... ............ A Ob us, follow-up, per fetus .......................... 0.85 1.42 NA 0.09 2.36 NA XXX 

76816 ......... 26 ....... A Ob us, follow-up, per fetus .......................... 0.85 0.31 0.31 0.03 1.19 1.19 XXX 

76816 ......... TC ...... A Ob us, follow-up, per fetus .......................... 0.00 1.11 NA 0.06 1.17 NA XXX 

76817 ......... ............ A Transvaginal us, obstetric ............................ 0.75 1.78 NA 0.09 2.62 NA XXX 

76817 ......... 26 ....... A Transvaginal us, obstetric ............................ 0.75 0.26 0.26 0.03 1.04 1.04 XXX 

76817 ......... TC ...... A Transvaginal us, obstetric ............................ 0.00 1.52 NA 0.06 1.58 NA XXX 

76818 ......... ............ A Fetal biophys profile w/nst ........................... 1.05 2.00 NA 0.15 3.20 NA XXX 

76818 ......... 26 ....... A Fetal biophys profile w/nst ........................... 1.05 0.39 0.39 0.05 1.49 1.49 XXX 

76818 ......... TC ...... A Fetal biophys profile w/nst ........................... 0.00 1.61 NA 0.10 1.71 NA XXX 

76819 ......... ............ A Fetal biophys profil w/o nst .......................... 0.77 1.89 NA 0.14 2.80 NA XXX 

76819 ......... 26 ....... A Fetal biophys profil w/o nst .......................... 0.77 0.28 0.28 0.04 1.09 1.09 XXX 

76819 ......... TC ...... A Fetal biophys profil w/o nst .......................... 0.00 1.61 NA 0.10 1.71 NA XXX 

76825 ......... ............ A Echo exam of fetal heart ............................. 1.67 2.57 NA 0.18 4.42 NA XXX 

76825 ......... 26 ....... A Echo exam of fetal heart ............................. 1.67 0.60 0.60 0.07 2.34 2.34 XXX 

76825 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.97 NA 0.11 2.08 NA XXX 

76826 ......... ............ A Echo exam of fetal heart ............................. 0.83 0.99 NA 0.09 1.91 NA XXX 

76826 ......... 26 ....... A Echo exam of fetal heart ............................. 0.83 0.29 0.29 0.04 1.16 1.16 XXX 

76826 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 0.70 NA 0.05 0.75 NA XXX 

76827 ......... ............ A Echo exam of fetal heart ............................. 0.58 1.93 NA 0.15 2.66 NA XXX 

76827 ......... 26 ....... A Echo exam of fetal heart ............................. 0.58 0.21 0.21 0.03 0.82 0.82 XXX 

76827 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.72 NA 0.12 1.84 NA XXX 

76828 ......... ............ A Echo exam of fetal heart ............................. 0.56 1.32 NA 0.11 1.99 NA XXX 

76828 ......... 26 ....... A Echo exam of fetal heart ............................. 0.56 0.21 0.21 0.03 0.80 0.80 XXX 

76828 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.11 NA 0.08 1.19 NA XXX 

76830 ......... ............ A Transvaginal us, non-ob .............................. 0.69 1.74 NA 0.13 2.56 NA XXX 

76830 ......... 26 ....... A Transvaginal us, non-ob .............................. 0.69 0.23 0.23 0.03 0.95 0.95 XXX 

76830 ......... TC ...... A Transvaginal us, non-ob .............................. 0.00 1.52 NA 0.10 1.62 NA XXX 

76831 ......... ............ A Echo exam, uterus ....................................... 0.72 1.77 NA 0.13 2.62 NA XXX 

76831 ......... 26 ....... A Echo exam, uterus ....................................... 0.72 0.25 0.25 0.03 1.00 1.00 XXX 

76831 ......... TC ...... A Echo exam, uterus ....................................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76856 ......... ............ A Us exam, pelvic, complete .......................... 0.69 1.74 NA 0.13 2.56 NA XXX 

76856 ......... 26 ....... A Us exam, pelvic, complete .......................... 0.69 0.23 0.23 0.03 0.95 0.95 XXX 

76856 ......... TC ...... A Us exam, pelvic, complete .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76857 ......... ............ A Us exam, pelvic, limited ............................... 0.38 1.83 NA 0.08 2.29 NA XXX 

76857 ......... 26 ....... A Us exam, pelvic, limited ............................... 0.38 0.12 0.12 0.02 0.52 0.52 XXX 

76857 ......... TC ...... A Us exam, pelvic, limited ............................... 0.00 1.70 NA 0.06 1.76 NA XXX 

76870 ......... ............ A Us exam, scrotum ........................................ 0.64 1.72 NA 0.13 2.49 NA XXX 

76870 ......... 26 ....... A Us exam, scrotum ........................................ 0.64 0.21 0.21 0.03 0.88 0.88 XXX 

76870 ......... TC ...... A Us exam, scrotum ........................................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76872 ......... ............ A Us, transrectal .............................................. 0.69 2.25 NA 0.14 3.08 NA XXX 

76872 ......... 26 ....... A Us, transrectal .............................................. 0.69 0.22 0.22 0.04 0.95 0.95 XXX 

76872 ......... TC ...... A Us, transrectal .............................................. 0.00 2.02 NA 0.10 2.12 NA XXX 

76873 ......... ............ A Echograp trans r, pros study ....................... 1.55 2.59 NA 0.25 4.39 NA XXX 

76873 ......... 26 ....... A Echograp trans r, pros study ....................... 1.55 0.50 0.50 0.09 2.14 2.14 XXX 

76873 ......... TC ...... A Echograp trans r, pros study ....................... 0.00 2.09 NA 0.16 2.25 NA XXX 

47667

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

76880 ......... ............ A Us exam, extremity ...................................... 0.59 1.61 NA 0.11 2.31 NA XXX 

76880 ......... 26 ....... A Us exam, extremity ...................................... 0.59 0.19 0.19 0.03 0.81 0.81 XXX 

76880 ......... TC ...... A Us exam, extremity ...................................... 0.00 1.42 NA 0.08 1.50 NA XXX 

76885 ......... ............ A Us exam infant hips, dynamic ..................... 0.74 1.76 NA 0.13 2.63 NA XXX 

76885 ......... 26 ....... A Us exam infant hips, dynamic ..................... 0.74 0.24 0.24 0.03 1.01 1.01 XXX 

76885 ......... TC ...... A Us exam infant hips, dynamic ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76886 ......... ............ A Us exam infant hips, static .......................... 0.62 1.62 NA 0.11 2.35 NA XXX 

76886 ......... 26 ....... A Us exam infant hips, static .......................... 0.62 0.20 0.20 0.03 0.85 0.85 XXX 

76886 ......... TC ...... A Us exam infant hips, static .......................... 0.00 1.42 NA 0.08 1.50 NA XXX 

76930 ......... ............ A Echo guide, cardiocentesis .......................... 0.67 1.77 NA 0.12 2.56 NA XXX 

76930 ......... 26 ....... A Echo guide, cardiocentesis .......................... 0.67 0.25 0.25 0.02 0.94 0.94 XXX 

76930 ......... TC ...... A Echo guide, cardiocentesis .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76932 ......... ............ A Echo guide for heart biopsy ........................ 0.67 1.77 NA 0.12 2.56 NA XXX 

76932 ......... 26 ....... A Echo guide for heart biopsy ........................ 0.67 0.25 0.25 0.02 0.94 0.94 XXX 

76932 ......... TC ...... A Echo guide for heart biopsy ........................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76936 ......... ............ A Echo guide for artery repair ......................... 1.99 6.94 NA 0.47 9.40 NA XXX 

76936 ......... 26 ....... A Echo guide for artery repair ......................... 1.99 0.66 0.66 0.13 2.78 2.78 XXX 

76936 ......... TC ...... A Echo guide for artery repair ......................... 0.00 6.28 NA 0.34 6.62 NA XXX 

76937 ......... ............ A Us guide, vascular access ........................... 0.30 0.47 NA 0.13 0.90 NA ZZZ 

76937 ......... 26 ....... A Us guide, vascular access ........................... 0.30 0.10 0.10 0.03 0.43 0.43 ZZZ 

76937 ......... TC ...... A Us guide, vascular access ........................... 0.00 0.38 NA 0.10 0.48 NA ZZZ 

76940 ......... ............ A Us guide, tissue ablation ............................. 2.00 2.17 NA 0.48 4.65 NA XXX 

76940 ......... 26 ....... A Us guide, tissue ablation ............................. 2.00 0.65 0.65 0.19 2.84 2.84 XXX 

76940 ......... TC ...... A Us guide, tissue ablation ............................. 0.00 1.52 NA 0.29 1.81 NA XXX 

76941 ......... ............ A Echo guide for transfusion ........................... 1.34 2.00 NA 0.14 3.48 NA XXX 

76941 ......... 26 ....... A Echo guide for transfusion ........................... 1.34 0.47 0.47 0.06 1.87 1.87 XXX 

76941 ......... TC ...... A Echo guide for transfusion ........................... 0.00 1.52 NA 0.08 1.60 NA XXX 

76942 ......... ............ A Echo guide for biopsy .................................. 0.67 3.03 NA 0.13 3.83 NA XXX 

76942 ......... 26 ....... A Echo guide for biopsy .................................. 0.67 0.22 0.22 0.03 0.92 0.92 XXX 

76942 ......... TC ...... A Echo guide for biopsy .................................. 0.00 2.81 NA 0.10 2.91 NA XXX 

76945 ......... ............ A Echo guide, villus sampling ......................... 0.67 1.75 NA 0.11 2.53 NA XXX 

76945 ......... 26 ....... A Echo guide, villus sampling ......................... 0.67 0.22 0.22 0.03 0.92 0.92 XXX 

76945 ......... TC ...... A Echo guide, villus sampling ......................... 0.00 1.52 NA 0.08 1.60 NA XXX 

76946 ......... ............ A Echo guide for amniocentesis ..................... 0.38 1.66 NA 0.12 2.16 NA XXX 

76946 ......... 26 ....... A Echo guide for amniocentesis ..................... 0.38 0.14 0.14 0.02 0.54 0.54 XXX 

76946 ......... TC ...... A Echo guide for amniocentesis ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76948 ......... ............ A Echo guide, ova aspiration .......................... 0.38 1.64 NA 0.12 2.14 NA XXX 

76948 ......... 26 ....... A Echo guide, ova aspiration .......................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76948 ......... TC ...... A Echo guide, ova aspiration .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76950 ......... ............ A Echo guidance radiotherapy ........................ 0.58 1.49 NA 0.10 2.17 NA XXX 

76950 ......... 26 ....... A Echo guidance radiotherapy ........................ 0.58 0.19 0.19 0.03 0.80 0.80 XXX 

76950 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 1.30 NA 0.07 1.37 NA XXX 

76965 ......... ............ A Echo guidance radiotherapy ........................ 1.34 5.99 NA 0.38 7.71 NA XXX 

76965 ......... 26 ....... A Echo guidance radiotherapy ........................ 1.34 0.43 0.43 0.09 1.86 1.86 XXX 

76965 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 5.56 NA 0.29 5.85 NA XXX 

76970 ......... ............ A Ultrasound exam follow-up .......................... 0.40 1.18 NA 0.08 1.66 NA XXX 

76970 ......... 26 ....... A Ultrasound exam follow-up .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 

76970 ......... TC ...... A Ultrasound exam follow-up .......................... 0.00 1.05 NA 0.06 1.11 NA XXX 

76975 ......... ............ A GI endoscopic ultrasound ............................ 0.81 1.79 NA 0.14 2.74 NA XXX 

76975 ......... 26 ....... A GI endoscopic ultrasound ............................ 0.81 0.28 0.28 0.04 1.13 1.13 XXX 

76975 ......... TC ...... A GI endoscopic ultrasound ............................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76977 ......... ............ A Us bone density measure ............................ 0.05 0.84 NA 0.05 0.94 NA XXX 

76977 ......... 26 ....... A Us bone density measure ............................ 0.05 0.02 0.02 0.00 0.07 0.07 XXX 

76977 ......... TC ...... A Us bone density measure ............................ 0.00 0.82 NA 0.05 0.87 NA XXX 

76986 ......... ............ A Ultrasound guide intraoper .......................... 1.20 3.01 NA 0.24 4.45 NA XXX 

76986 ......... 26 ....... A Ultrasound guide intraoper .......................... 1.20 0.40 0.40 0.10 1.70 1.70 XXX 

76986 ......... TC ...... A Ultrasound guide intraoper .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

77261 ......... ............ A Radiation therapy planning .......................... 1.39 0.51 0.51 0.07 1.97 1.97 XXX 

77262 ......... ............ A Radiation therapy planning .......................... 2.11 0.76 0.76 0.11 2.98 2.98 XXX 

77263 ......... ............ A Radiation therapy planning .......................... 3.14 1.11 1.11 0.16 4.41 4.41 XXX 

77280 ......... ............ A Set radiation therapy field ............................ 0.70 3.69 NA 0.22 4.61 NA XXX 

77280 ......... 26 ....... A Set radiation therapy field ............................ 0.70 0.22 0.22 0.04 0.96 0.96 XXX 

77280 ......... TC ...... A Set radiation therapy field ............................ 0.00 3.46 NA 0.18 3.64 NA XXX 

77285 ......... ............ A Set radiation therapy field ............................ 1.05 5.89 NA 0.35 7.29 NA XXX 

77285 ......... 26 ....... A Set radiation therapy field ............................ 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77285 ......... TC ...... A Set radiation therapy field ............................ 0.00 5.56 NA 0.30 5.86 NA XXX 

77290 ......... ............ A Set radiation therapy field ............................ 1.56 6.99 NA 0.43 8.98 NA XXX 

77290 ......... 26 ....... A Set radiation therapy field ............................ 1.56 0.50 0.50 0.08 2.14 2.14 XXX 

77290 ......... TC ...... A Set radiation therapy field ............................ 0.00 6.50 NA 0.35 6.85 NA XXX 

77295 ......... ............ A Set radiation therapy field ............................ 4.56 29.34 NA 1.72 35.62 NA XXX 

77295 ......... 26 ....... A Set radiation therapy field ............................ 4.56 1.46 1.46 0.24 6.26 6.26 XXX 

77295 ......... TC ...... A Set radiation therapy field ............................ 0.00 27.88 NA 1.48 29.36 NA XXX 

77300 ......... ............ A Radiation therapy dose plan ........................ 0.62 1.54 NA 0.10 2.26 NA XXX 

77300 ......... 26 ....... A Radiation therapy dose plan ........................ 0.62 0.20 0.20 0.03 0.85 0.85 XXX 

77300 ......... TC ...... A Radiation therapy dose plan ........................ 0.00 1.34 NA 0.07 1.41 NA XXX 

47668

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

77301 ......... ............ A Radiotherapy dose plan, imrt ...................... 7.99 30.44 NA 1.88 40.31 NA XXX 

77301 ......... 26 ....... A Radiotherapy dose plan, imrt ...................... 7.99 2.55 2.55 0.40 10.94 10.94 XXX 

77301 ......... TC ...... A Radiotherapy dose plan, imrt ...................... 0.00 27.88 NA 1.48 29.36 NA XXX 

77305 ......... ............ A Teletx isodose plan simple .......................... 0.70 2.08 NA 0.15 2.93 NA XXX 

77305 ......... 26 ....... A Teletx isodose plan simple .......................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

77305 ......... TC ...... A Teletx isodose plan simple .......................... 0.00 1.85 NA 0.11 1.96 NA XXX 

77310 ......... ............ A Teletx isodose plan intermed ...................... 1.05 2.66 NA 0.18 3.89 NA XXX 

77310 ......... 26 ....... A Teletx isodose plan intermed ...................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77310 ......... TC ...... A Teletx isodose plan intermed ...................... 0.00 2.33 NA 0.13 2.46 NA XXX 

77315 ......... ............ A Teletx isodose plan complex ....................... 1.56 3.15 NA 0.22 4.93 NA XXX 

77315 ......... 26 ....... A Teletx isodose plan complex ....................... 1.56 0.50 0.50 0.08 2.14 2.14 XXX 

77315 ......... TC ...... A Teletx isodose plan complex ....................... 0.00 2.65 NA 0.14 2.79 NA XXX 

77321 ......... ............ A Special teletx port plan ................................ 0.95 4.34 NA 0.26 5.55 NA XXX 

77321 ......... 26 ....... A Special teletx port plan ................................ 0.95 0.30 0.30 0.05 1.30 1.30 XXX 

77321 ......... TC ...... A Special teletx port plan ................................ 0.00 4.03 NA 0.21 4.24 NA XXX 

77326 ......... ............ A Brachytx isodose calc simp ......................... 0.93 2.65 NA 0.18 3.76 NA XXX 

77326 ......... 26 ....... A Brachytx isodose calc simp ......................... 0.93 0.30 0.30 0.05 1.28 1.28 XXX 

77326 ......... TC ...... A Brachytx isodose calc simp ......................... 0.00 2.35 NA 0.13 2.48 NA XXX 

77327 ......... ............ A Brachytx isodose calc interm ....................... 1.39 3.91 NA 0.25 5.55 NA XXX 

77327 ......... 26 ....... A Brachytx isodose calc interm ....................... 1.39 0.44 0.44 0.07 1.90 1.90 XXX 

77327 ......... TC ...... A Brachytx isodose calc interm ....................... 0.00 3.46 NA 0.18 3.64 NA XXX 

77328 ......... ............ A Brachytx isodose plan compl ....................... 2.09 5.62 NA 0.36 8.07 NA XXX 

77328 ......... 26 ....... A Brachytx isodose plan compl ....................... 2.09 0.67 0.67 0.11 2.87 2.87 XXX 

77328 ......... TC ...... A Brachytx isodose plan compl ....................... 0.00 4.95 NA 0.25 5.20 NA XXX 

77331 ......... ............ A Special radiation dosimetry ......................... 0.87 0.78 NA 0.06 1.71 NA XXX 

77331 ......... 26 ....... A Special radiation dosimetry ......................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX 

77331 ......... TC ...... A Special radiation dosimetry ......................... 0.00 0.50 NA 0.02 0.52 NA XXX 

77332 ......... ............ A Radiation treatment aid(s) ........................... 0.54 1.51 NA 0.10 2.15 NA XXX 

77332 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.54 0.17 0.17 0.03 0.74 0.74 XXX 

77332 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.34 NA 0.07 1.41 NA XXX 

77333 ......... ............ A Radiation treatment aid(s) ........................... 0.84 2.16 NA 0.15 3.15 NA XXX 

77333 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.84 0.27 0.27 0.04 1.15 1.15 XXX 

77333 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.89 NA 0.11 2.00 NA XXX 

77334 ......... ............ A Radiation treatment aid(s) ........................... 1.24 3.64 NA 0.23 5.11 NA XXX 

77334 ......... 26 ....... A Radiation treatment aid(s) ........................... 1.24 0.40 0.40 0.06 1.70 1.70 XXX 

77334 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 3.24 NA 0.17 3.41 NA XXX 

77336 ......... ............ A Radiation physics consult ............................ 0.00 2.97 NA 0.16 3.13 NA XXX 

77370 ......... ............ A Radiation physics consult ............................ 0.00 3.48 NA 0.18 3.66 NA XXX 

77401 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 

77402 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 

77403 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 

77404 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 

77406 ......... ............ A Radiation treatment delivery ........................ 0.00 1.77 NA 0.11 1.88 NA XXX 

77407 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 

77408 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 

77409 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 

77411 ......... ............ A Radiation treatment delivery ........................ 0.00 2.08 NA 0.12 2.20 NA XXX 

77412 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 

77413 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 

77414 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 

77416 ......... ............ A Radiation treatment delivery ........................ 0.00 2.33 NA 0.13 2.46 NA XXX 

77417 ......... ............ A Radiology port film(s) ................................... 0.00 0.59 NA 0.04 0.63 NA XXX 

77418 ......... ............ A Radiation tx delivery, imrt ............................ 0.00 17.95 NA 0.13 18.08 NA XXX 

77427 ......... ............ A Radiation tx management, x5 ...................... 3.31 1.06 1.06 0.17 4.54 4.54 090 

77431 ......... ............ A Radiation therapy management .................. 1.81 0.68 0.68 0.09 2.58 2.58 XXX 

77432 ......... ............ A Stereotactic radiation trmt ............................ 7.92 2.91 2.91 0.42 11.25 11.25 XXX 

77470 ......... ............ A Special radiation treatment .......................... 2.09 11.79 NA 0.70 14.58 NA XXX 

77470 ......... 26 ....... A Special radiation treatment .......................... 2.09 0.67 0.67 0.11 2.87 2.87 XXX 

77470 ......... TC ...... A Special radiation treatment .......................... 0.00 11.13 NA 0.59 11.72 NA XXX 

77600 ......... ............ R Hyperthermia treatment ............................... 1.56 3.54 NA 0.24 5.34 NA XXX 

77600 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.50 0.50 0.08 2.14 2.14 XXX 

77600 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 

77605 ......... ............ R Hyperthermia treatment ............................... 2.09 4.72 NA 0.33 7.14 NA XXX 

77605 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 

77605 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.05 NA 0.22 4.27 NA XXX 

77610 ......... ............ R Hyperthermia treatment ............................... 1.56 3.55 NA 0.24 5.35 NA XXX 

77610 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.51 0.51 0.07 2.14 2.14 XXX 

77610 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 

77615 ......... ............ R Hyperthermia treatment ............................... 2.09 4.72 NA 0.33 7.14 NA XXX 

77615 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 

77615 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.05 NA 0.22 4.27 NA XXX 

77620 ......... ............ R Hyperthermia treatment ............................... 1.56 3.56 NA 0.23 5.35 NA XXX 

77620 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.52 0.52 0.19 2.27 2.27 XXX 

77620 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.04 NA 0.16 3.20 NA XXX 

77750 ......... ............ A Infuse radioactive materials ......................... 4.90 2.91 NA 0.32 8.13 NA 090 

47669

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

77750 ......... 26 ....... A Infuse radioactive materials ......................... 4.90 1.58 1.58 0.25 6.73 6.73 090 

77750 ......... TC ...... A Infuse radioactive materials ......................... 0.00 1.33 NA 0.07 1.40 NA 090 

77761 ......... ............ A Apply intrcav radiat simple .......................... 3.80 3.59 NA 0.33 7.72 NA 090 

77761 ......... 26 ....... A Apply intrcav radiat simple .......................... 3.80 1.09 1.09 0.19 5.08 5.08 090 

77761 ......... TC ...... A Apply intrcav radiat simple .......................... 0.00 2.50 NA 0.14 2.64 NA 090 

77762 ......... ............ A Apply intrcav radiat interm ........................... 5.71 5.43 NA 0.48 11.62 NA 090 

77762 ......... 26 ....... A Apply intrcav radiat interm ........................... 5.71 1.83 1.83 0.29 7.83 7.83 090 

77762 ......... TC ...... A Apply intrcav radiat interm ........................... 0.00 3.60 NA 0.19 3.79 NA 090 

77763 ......... ............ A Apply intrcav radiat compl ........................... 8.56 7.21 NA 0.67 16.44 NA 090 

77763 ......... 26 ....... A Apply intrcav radiat compl ........................... 8.56 2.73 2.73 0.44 11.73 11.73 090 

77763 ......... TC ...... A Apply intrcav radiat compl ........................... 0.00 4.48 NA 0.23 4.71 NA 090 

77776 ......... ............ A Apply interstit radiat simpl ........................... 4.65 3.12 NA 0.48 8.25 NA 090 

77776 ......... 26 ....... A Apply interstit radiat simpl ........................... 4.65 0.95 0.95 0.35 5.95 5.95 090 

77776 ......... TC ...... A Apply interstit radiat simpl ........................... 0.00 2.17 NA 0.13 2.30 NA 090 

77777 ......... ............ A Apply interstit radiat inter ............................. 7.47 6.59 NA 0.62 14.68 NA 090 

77777 ......... 26 ....... A Apply interstit radiat inter ............................. 7.47 2.37 2.37 0.40 10.24 10.24 090 

77777 ......... TC ...... A Apply interstit radiat inter ............................. 0.00 4.23 NA 0.22 4.45 NA 090 

77778 ......... ............ A Apply interstit radiat compl .......................... 11.17 8.69 NA 0.85 20.71 NA 090 

77778 ......... 26 ....... A Apply interstit radiat compl .......................... 11.17 3.56 3.56 0.58 15.31 15.31 090 

77778 ......... TC ...... A Apply interstit radiat compl .......................... 0.00 5.12 NA 0.27 5.39 NA 090 

77781 ......... ............ A High intensity brachytherapy ....................... 1.66 20.80 NA 1.14 23.60 NA 090 

77781 ......... 26 ....... A High intensity brachytherapy ....................... 1.66 0.53 0.53 0.08 2.27 2.27 090 

77781 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 

77782 ......... ............ A High intensity brachytherapy ....................... 2.49 21.07 NA 1.19 24.75 NA 090 

77782 ......... 26 ....... A High intensity brachytherapy ....................... 2.49 0.80 0.80 0.13 3.42 3.42 090 

77782 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 

77783 ......... ............ A High intensity brachytherapy ....................... 3.72 21.46 NA 1.25 26.43 NA 090 

77783 ......... 26 ....... A High intensity brachytherapy ....................... 3.72 1.19 1.19 0.19 5.10 5.10 090 

77783 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 

77784 ......... ............ A High intensity brachytherapy ....................... 5.60 22.06 NA 1.35 29.01 NA 090 

77784 ......... 26 ....... A High intensity brachytherapy ....................... 5.60 1.79 1.79 0.29 7.68 7.68 090 

77784 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.27 NA 1.06 21.33 NA 090 

77789 ......... ............ A Apply surface radiation ................................ 1.12 0.82 NA 0.08 2.02 NA 000 

77789 ......... 26 ....... A Apply surface radiation ................................ 1.12 0.37 0.37 0.06 1.55 1.55 000 

77789 ......... TC ...... A Apply surface radiation ................................ 0.00 0.45 NA 0.02 0.47 NA 000 

77790 ......... ............ A Radiation handling ....................................... 1.05 0.84 NA 0.07 1.96 NA XXX 

77790 ......... 26 ....... A Radiation handling ....................................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77790 ......... TC ...... A Radiation handling ....................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

78000 ......... ............ A Thyroid, single uptake ................................. 0.19 1.03 NA 0.07 1.29 NA XXX 

78000 ......... 26 ....... A Thyroid, single uptake ................................. 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

78000 ......... TC ...... A Thyroid, single uptake ................................. 0.00 0.97 NA 0.06 1.03 NA XXX 

78001 ......... ............ A Thyroid, multiple uptakes ............................. 0.26 1.39 NA 0.08 1.73 NA XXX 

78001 ......... 26 ....... A Thyroid, multiple uptakes ............................. 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

78001 ......... TC ...... A Thyroid, multiple uptakes ............................. 0.00 1.30 NA 0.07 1.37 NA XXX 

78003 ......... ............ A Thyroid suppress/stimul ............................... 0.33 1.07 NA 0.07 1.47 NA XXX 

78003 ......... 26 ....... A Thyroid suppress/stimul ............................... 0.33 0.11 0.11 0.01 0.45 0.45 XXX 

78003 ......... TC ...... A Thyroid suppress/stimul ............................... 0.00 0.97 NA 0.06 1.03 NA XXX 

78006 ......... ............ A Thyroid imaging with uptake ........................ 0.49 2.54 NA 0.15 3.18 NA XXX 

78006 ......... 26 ....... A Thyroid imaging with uptake ........................ 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78006 ......... TC ...... A Thyroid imaging with uptake ........................ 0.00 2.37 NA 0.13 2.50 NA XXX 

78007 ......... ............ A Thyroid image, mult uptakes ....................... 0.50 2.73 NA 0.16 3.39 NA XXX 

78007 ......... 26 ....... A Thyroid image, mult uptakes ....................... 0.50 0.17 0.17 0.02 0.69 0.69 XXX 

78007 ......... TC ...... A Thyroid image, mult uptakes ....................... 0.00 2.57 NA 0.14 2.71 NA XXX 

78010 ......... ............ A Thyroid imaging ........................................... 0.39 1.94 NA 0.13 2.46 NA XXX 

78010 ......... 26 ....... A Thyroid imaging ........................................... 0.39 0.13 0.13 0.02 0.54 0.54 XXX 

78010 ......... TC ...... A Thyroid imaging ........................................... 0.00 1.81 NA 0.11 1.92 NA XXX 

78011 ......... ............ A Thyroid imaging with flow ............................ 0.45 2.55 NA 0.15 3.15 NA XXX 

78011 ......... 26 ....... A Thyroid imaging with flow ............................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78011 ......... TC ...... A Thyroid imaging with flow ............................ 0.00 2.40 NA 0.13 2.53 NA XXX 

78015 ......... ............ A Thyroid met imaging .................................... 0.67 2.79 NA 0.17 3.63 NA XXX 

78015 ......... 26 ....... A Thyroid met imaging .................................... 0.67 0.23 0.23 0.03 0.93 0.93 XXX 

78015 ......... TC ...... A Thyroid met imaging .................................... 0.00 2.57 NA 0.14 2.71 NA XXX 

78016 ......... ............ A Thyroid met imaging/studies ........................ 0.82 3.76 NA 0.21 4.79 NA XXX 

78016 ......... 26 ....... A Thyroid met imaging/studies ........................ 0.82 0.28 0.28 0.03 1.13 1.13 XXX 

78016 ......... TC ...... A Thyroid met imaging/studies ........................ 0.00 3.47 NA 0.18 3.65 NA XXX 

78018 ......... ............ A Thyroid met imaging, body .......................... 0.86 5.71 NA 0.33 6.90 NA XXX 

78018 ......... 26 ....... A Thyroid met imaging, body .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 

78018 ......... TC ...... A Thyroid met imaging, body .......................... 0.00 5.41 NA 0.29 5.70 NA XXX 

78020 ......... ............ A Thyroid met uptake ...................................... 0.60 1.51 NA 0.17 2.28 NA ZZZ 

78020 ......... 26 ....... A Thyroid met uptake ...................................... 0.60 0.21 0.21 0.03 0.84 0.84 ZZZ 

78020 ......... TC ...... A Thyroid met uptake ...................................... 0.00 1.30 NA 0.14 1.44 NA ZZZ 

78070 ......... ............ A Parathyroid nuclear imaging ........................ 0.82 4.54 NA 0.15 5.51 NA XXX 

78070 ......... 26 ....... A Parathyroid nuclear imaging ........................ 0.82 0.28 0.28 0.04 1.14 1.14 XXX 

78070 ......... TC ...... A Parathyroid nuclear imaging ........................ 0.00 4.27 NA 0.11 4.38 NA XXX 

78075 ......... ............ A Adrenal nuclear imaging .............................. 0.74 5.68 NA 0.32 6.74 NA XXX 

47670

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

78075 ......... 26 ....... A Adrenal nuclear imaging .............................. 0.74 0.26 0.26 0.03 1.03 1.03 XXX 

78075 ......... TC ...... A Adrenal nuclear imaging .............................. 0.00 5.41 NA 0.29 5.70 NA XXX 

78102 ......... ............ A Bone marrow imaging, ltd ............................ 0.55 2.23 NA 0.14 2.92 NA XXX 

78102 ......... 26 ....... A Bone marrow imaging, ltd ............................ 0.55 0.19 0.19 0.02 0.76 0.76 XXX 

78102 ......... TC ...... A Bone marrow imaging, ltd ............................ 0.00 2.04 NA 0.12 2.16 NA XXX 

78103 ......... ............ A Bone marrow imaging, mult ......................... 0.75 3.42 NA 0.20 4.37 NA XXX 

78103 ......... 26 ....... A Bone marrow imaging, mult ......................... 0.75 0.26 0.26 0.03 1.04 1.04 XXX 

78103 ......... TC ...... A Bone marrow imaging, mult ......................... 0.00 3.17 NA 0.17 3.34 NA XXX 

78104 ......... ............ A Bone marrow imaging, body ........................ 0.80 4.33 NA 0.26 5.39 NA XXX 

78104 ......... 26 ....... A Bone marrow imaging, body ........................ 0.80 0.27 0.27 0.04 1.11 1.11 XXX 

78104 ......... TC ...... A Bone marrow imaging, body ........................ 0.00 4.06 NA 0.22 4.28 NA XXX 

78110 ......... ............ A Plasma volume, single ................................. 0.19 1.02 NA 0.07 1.28 NA XXX 

78110 ......... 26 ....... A Plasma volume, single ................................. 0.19 0.07 0.07 0.01 0.27 0.27 XXX 

78110 ......... TC ...... A Plasma volume, single ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 

78111 ......... ............ A Plasma volume, multiple .............................. 0.22 2.65 NA 0.15 3.02 NA XXX 

78111 ......... 26 ....... A Plasma volume, multiple .............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

78111 ......... TC ...... A Plasma volume, multiple .............................. 0.00 2.57 NA 0.14 2.71 NA XXX 

78120 ......... ............ A Red cell mass, single .................................. 0.23 1.81 NA 0.12 2.16 NA XXX 

78120 ......... 26 ....... A Red cell mass, single .................................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 

78120 ......... TC ...... A Red cell mass, single .................................. 0.00 1.73 NA 0.11 1.84 NA XXX 

78121 ......... ............ A Red cell mass, multiple ............................... 0.32 3.02 NA 0.15 3.49 NA XXX 

78121 ......... 26 ....... A Red cell mass, multiple ............................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

78121 ......... TC ...... A Red cell mass, multiple ............................... 0.00 2.91 NA 0.14 3.05 NA XXX 

78122 ......... ............ A Blood volume ............................................... 0.45 4.75 NA 0.26 5.46 NA XXX 

78122 ......... 26 ....... A Blood volume ............................................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78122 ......... TC ...... A Blood volume ............................................... 0.00 4.59 NA 0.24 4.83 NA XXX 

78130 ......... ............ A Red cell survival study ................................. 0.61 3.06 NA 0.17 3.84 NA XXX 

78130 ......... 26 ....... A Red cell survival study ................................. 0.61 0.21 0.21 0.03 0.85 0.85 XXX 

78130 ......... TC ...... A Red cell survival study ................................. 0.00 2.85 NA 0.14 2.99 NA XXX 

78135 ......... ............ A Red cell survival kinetics ............................. 0.64 5.08 NA 0.28 6.00 NA XXX 

78135 ......... 26 ....... A Red cell survival kinetics ............................. 0.64 0.22 0.22 0.03 0.89 0.89 XXX 

78135 ......... TC ...... A Red cell survival kinetics ............................. 0.00 4.86 NA 0.25 5.11 NA XXX 

78140 ......... ............ A Red cell sequestration ................................. 0.61 4.13 NA 0.24 4.98 NA XXX 

78140 ......... 26 ....... A Red cell sequestration ................................. 0.61 0.20 0.20 0.03 0.84 0.84 XXX 

78140 ......... TC ...... A Red cell sequestration ................................. 0.00 3.93 NA 0.21 4.14 NA XXX 

78160 ......... ............ A Plasma iron turnover ................................... 0.33 3.78 NA 0.20 4.31 NA XXX 

78160 ......... 26 ....... A Plasma iron turnover ................................... 0.33 0.12 0.12 0.01 0.46 0.46 XXX 

78160 ......... TC ...... A Plasma iron turnover ................................... 0.00 3.66 NA 0.19 3.85 NA XXX 

78162 ......... ............ A Radioiron absorption exam .......................... 0.45 3.38 NA 0.18 4.01 NA XXX 

78162 ......... 26 ....... A Radioiron absorption exam .......................... 0.45 0.19 0.19 0.01 0.65 0.65 XXX 

78162 ......... TC ...... A Radioiron absorption exam .......................... 0.00 3.19 NA 0.17 3.36 NA XXX 

78170 ......... ............ A Red cell iron utilization ................................ 0.41 5.44 NA 0.30 6.15 NA XXX 

78170 ......... 26 ....... A Red cell iron utilization ................................ 0.41 0.14 0.14 0.02 0.57 0.57 XXX 

78170 ......... TC ...... A Red cell iron utilization ................................ 0.00 5.30 NA 0.28 5.58 NA XXX 

78172 ......... 26 ....... A Total body iron estimation ........................... 0.53 0.17 0.17 0.02 0.72 0.72 XXX 

78185 ......... ............ A Spleen imaging ............................................ 0.40 2.49 NA 0.15 3.04 NA XXX 

78185 ......... 26 ....... A Spleen imaging ............................................ 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

78185 ......... TC ...... A Spleen imaging ............................................ 0.00 2.35 NA 0.13 2.48 NA XXX 

78190 ......... ............ A Platelet survival, kinetics ............................. 1.09 6.10 NA 0.34 7.53 NA XXX 

78190 ......... 26 ....... A Platelet survival, kinetics ............................. 1.09 0.39 0.39 0.04 1.52 1.52 XXX 

78190 ......... TC ...... A Platelet survival, kinetics ............................. 0.00 5.70 NA 0.30 6.00 NA XXX 

78191 ......... ............ A Platelet survival ............................................ 0.61 7.53 NA 0.40 8.54 NA XXX 

78191 ......... 26 ....... A Platelet survival ............................................ 0.61 0.20 0.20 0.03 0.84 0.84 XXX 

78191 ......... TC ...... A Platelet survival ............................................ 0.00 7.33 NA 0.37 7.70 NA XXX 

78195 ......... ............ A Lymph system imaging ................................ 1.20 4.47 NA 0.28 5.95 NA XXX 

78195 ......... 26 ....... A Lymph system imaging ................................ 1.20 0.41 0.41 0.06 1.67 1.67 XXX 

78195 ......... TC ...... A Lymph system imaging ................................ 0.00 4.06 NA 0.22 4.28 NA XXX 

78201 ......... ............ A Liver imaging ............................................... 0.44 2.50 NA 0.15 3.09 NA XXX 

78201 ......... 26 ....... A Liver imaging ............................................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

78201 ......... TC ...... A Liver imaging ............................................... 0.00 2.35 NA 0.13 2.48 NA XXX 

78202 ......... ............ A Liver imaging with flow ................................ 0.51 3.05 NA 0.16 3.72 NA XXX 

78202 ......... 26 ....... A Liver imaging with flow ................................ 0.51 0.17 0.17 0.02 0.70 0.70 XXX 

78202 ......... TC ...... A Liver imaging with flow ................................ 0.00 2.88 NA 0.14 3.02 NA XXX 

78205 ......... ............ A Liver imaging (3D) ....................................... 0.71 6.14 NA 0.34 7.19 NA XXX 

78205 ......... 26 ....... A Liver imaging (3D) ....................................... 0.71 0.24 0.24 0.03 0.98 0.98 XXX 

78205 ......... TC ...... A Liver imaging (3D) ....................................... 0.00 5.90 NA 0.31 6.21 NA XXX 

78206 ......... ............ A Liver image (3d) with flow ........................... 0.96 6.23 NA 0.15 7.34 NA XXX 

78206 ......... 26 ....... A Liver image (3d) with flow ........................... 0.96 0.33 0.33 0.04 1.33 1.33 XXX 

78206 ......... TC ...... A Liver image (3d) with flow ........................... 0.00 5.90 NA 0.11 6.01 NA XXX 

78215 ......... ............ A Liver and spleen imaging ............................ 0.49 3.10 NA 0.16 3.75 NA XXX 

78215 ......... 26 ....... A Liver and spleen imaging ............................ 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78215 ......... TC ...... A Liver and spleen imaging ............................ 0.00 2.93 NA 0.14 3.07 NA XXX 

78216 ......... ............ A Liver & spleen image/flow ........................... 0.57 3.67 NA 0.20 4.44 NA XXX 

78216 ......... 26 ....... A Liver & spleen image/flow ........................... 0.57 0.19 0.19 0.02 0.78 0.78 XXX 

78216 ......... TC ...... A Liver & spleen image/flow ........................... 0.00 3.47 NA 0.18 3.65 NA XXX 

47671

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

78220 ......... ............ A Liver function study ...................................... 0.49 3.88 NA 0.21 4.58 NA XXX 

78220 ......... 26 ....... A Liver function study ...................................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78220 ......... TC ...... A Liver function study ...................................... 0.00 3.72 NA 0.19 3.91 NA XXX 

78223 ......... ............ A Hepatobiliary imaging .................................. 0.84 3.94 NA 0.23 5.01 NA XXX 

78223 ......... 26 ....... A Hepatobiliary imaging .................................. 0.84 0.28 0.28 0.04 1.16 1.16 XXX 

78223 ......... TC ...... A Hepatobiliary imaging .................................. 0.00 3.66 NA 0.19 3.85 NA XXX 

78230 ......... ............ A Salivary gland imaging ................................ 0.45 2.32 NA 0.15 2.92 NA XXX 

78230 ......... 26 ....... A Salivary gland imaging ................................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78230 ......... TC ...... A Salivary gland imaging ................................ 0.00 2.17 NA 0.13 2.30 NA XXX 

78231 ......... ............ A Serial salivary imaging ................................. 0.52 3.35 NA 0.19 4.06 NA XXX 

78231 ......... 26 ....... A Serial salivary imaging ................................. 0.52 0.18 0.18 0.02 0.72 0.72 XXX 

78231 ......... TC ...... A Serial salivary imaging ................................. 0.00 3.17 NA 0.17 3.34 NA XXX 

78232 ......... ............ A Salivary gland function exam ...................... 0.47 3.70 NA 0.20 4.37 NA XXX 

78232 ......... 26 ....... A Salivary gland function exam ...................... 0.47 0.16 0.16 0.02 0.65 0.65 XXX 

78232 ......... TC ...... A Salivary gland function exam ...................... 0.00 3.53 NA 0.18 3.71 NA XXX 

78258 ......... ............ A Esophageal motility study ............................ 0.74 3.12 NA 0.17 4.03 NA XXX 

78258 ......... 26 ....... A Esophageal motility study ............................ 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

78258 ......... TC ...... A Esophageal motility study ............................ 0.00 2.88 NA 0.14 3.02 NA XXX 

78261 ......... ............ A Gastric mucosa imaging .............................. 0.69 4.33 NA 0.25 5.27 NA XXX 

78261 ......... 26 ....... A Gastric mucosa imaging .............................. 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

78261 ......... TC ...... A Gastric mucosa imaging .............................. 0.00 4.09 NA 0.22 4.31 NA XXX 

78262 ......... ............ A Gastroesophageal reflux exam .................... 0.68 4.48 NA 0.25 5.41 NA XXX 

78262 ......... 26 ....... A Gastroesophageal reflux exam .................... 0.68 0.23 0.23 0.03 0.94 0.94 XXX 

78262 ......... TC ...... A Gastroesophageal reflux exam .................... 0.00 4.25 NA 0.22 4.47 NA XXX 

78264 ......... ............ A Gastric emptying study ................................ 0.78 4.38 NA 0.25 5.41 NA XXX 

78264 ......... 26 ....... A Gastric emptying study ................................ 0.78 0.26 0.26 0.03 1.07 1.07 XXX 

78264 ......... TC ...... A Gastric emptying study ................................ 0.00 4.12 NA 0.22 4.34 NA XXX 

78270 ......... ............ A Vit B-12 absorption exam ............................ 0.20 1.61 NA 0.11 1.92 NA XXX 

78270 ......... 26 ....... A Vit B-12 absorption exam ............................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78270 ......... TC ...... A Vit B-12 absorption exam ............................ 0.00 1.54 NA 0.10 1.64 NA XXX 

78271 ......... ............ A Vit b-12 absrp exam, int fac ........................ 0.20 1.71 NA 0.11 2.02 NA XXX 

78271 ......... 26 ....... A Vit b-12 absrp exam, int fac ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78271 ......... TC ...... A Vit b-12 absrp exam, int fac ........................ 0.00 1.64 NA 0.10 1.74 NA XXX 

78272 ......... ............ A Vit B-12 absorp, combined .......................... 0.27 2.41 NA 0.14 2.82 NA XXX 

78272 ......... 26 ....... A Vit B-12 absorp, combined .......................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

78272 ......... TC ...... A Vit B-12 absorp, combined .......................... 0.00 2.32 NA 0.13 2.45 NA XXX 

78278 ......... ............ A Acute GI blood loss imaging ....................... 0.99 5.19 NA 0.29 6.47 NA XXX 

78278 ......... 26 ....... A Acute GI blood loss imaging ....................... 0.99 0.33 0.33 0.04 1.36 1.36 XXX 

78278 ......... TC ...... A Acute GI blood loss imaging ....................... 0.00 4.86 NA 0.25 5.11 NA XXX 

78282 ......... 26 ....... A GI protein loss exam ................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

78290 ......... ............ A Meckel-s divert exam ................................... 0.68 3.27 NA 0.19 4.14 NA XXX 

78290 ......... 26 ....... A Meckel-s divert exam ................................... 0.68 0.23 0.23 0.03 0.94 0.94 XXX 

78290 ......... TC ...... A Meckel-s divert exam ................................... 0.00 3.04 NA 0.16 3.20 NA XXX 

78291 ......... ............ A Leveen/shunt patency exam ........................ 0.88 3.36 NA 0.20 4.44 NA XXX 

78291 ......... 26 ....... A Leveen/shunt patency exam ........................ 0.88 0.30 0.30 0.04 1.22 1.22 XXX 

78291 ......... TC ...... A Leveen/shunt patency exam ........................ 0.00 3.06 NA 0.16 3.22 NA XXX 

78300 ......... ............ A Bone imaging, limited area .......................... 0.62 2.69 NA 0.17 3.48 NA XXX 

78300 ......... 26 ....... A Bone imaging, limited area .......................... 0.62 0.21 0.21 0.03 0.86 0.86 XXX 

78300 ......... TC ...... A Bone imaging, limited area .......................... 0.00 2.48 NA 0.14 2.62 NA XXX 

78305 ......... ............ A Bone imaging, multiple areas ...................... 0.83 3.93 NA 0.23 4.99 NA XXX 

78305 ......... 26 ....... A Bone imaging, multiple areas ...................... 0.83 0.28 0.28 0.04 1.15 1.15 XXX 

78305 ......... TC ...... A Bone imaging, multiple areas ...................... 0.00 3.66 NA 0.19 3.85 NA XXX 

78306 ......... ............ A Bone imaging, whole body .......................... 0.86 4.55 NA 0.26 5.67 NA XXX 

78306 ......... 26 ....... A Bone imaging, whole body .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 

78306 ......... TC ...... A Bone imaging, whole body .......................... 0.00 4.27 NA 0.22 4.49 NA XXX 

78315 ......... ............ A Bone imaging, 3 phase ................................ 1.02 5.11 NA 0.29 6.42 NA XXX 

78315 ......... 26 ....... A Bone imaging, 3 phase ................................ 1.02 0.34 0.34 0.04 1.40 1.40 XXX 

78315 ......... TC ...... A Bone imaging, 3 phase ................................ 0.00 4.77 NA 0.25 5.02 NA XXX 

78320 ......... ............ A Bone imaging (3D) ....................................... 1.04 6.26 NA 0.36 7.66 NA XXX 

78320 ......... 26 ....... A Bone imaging (3D) ....................................... 1.04 0.36 0.36 0.05 1.45 1.45 XXX 

78320 ......... TC ...... A Bone imaging (3D) ....................................... 0.00 5.90 NA 0.31 6.21 NA XXX 

78350 ......... ............ A Bone mineral, single photon ........................ 0.22 0.83 NA 0.06 1.11 NA XXX 

78350 ......... 26 ....... A Bone mineral, single photon ........................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

78350 ......... TC ...... A Bone mineral, single photon ........................ 0.00 0.75 NA 0.05 0.80 NA XXX 

78414 ......... 26 ....... A Non-imaging heart function ......................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78428 ......... ............ A Cardiac shunt imaging ................................. 0.78 2.54 NA 0.16 3.48 NA XXX 

78428 ......... 26 ....... A Cardiac shunt imaging ................................. 0.78 0.29 0.29 0.03 1.10 1.10 XXX 

78428 ......... TC ...... A Cardiac shunt imaging ................................. 0.00 2.25 NA 0.13 2.38 NA XXX 

78445 ......... ............ A Vascular flow imaging .................................. 0.49 2.02 NA 0.13 2.64 NA XXX 

78445 ......... 26 ....... A Vascular flow imaging .................................. 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78445 ......... TC ...... A Vascular flow imaging .................................. 0.00 1.85 NA 0.11 1.96 NA XXX 

78455 ......... ............ A Venous thrombosis study ............................ 0.73 4.22 NA 0.24 5.19 NA XXX 

78455 ......... 26 ....... A Venous thrombosis study ............................ 0.73 0.25 0.25 0.03 1.01 1.01 XXX 

78455 ......... TC ...... A Venous thrombosis study ............................ 0.00 3.98 NA 0.21 4.19 NA XXX 

78456 ......... ............ A Acute venous thrombus image .................... 1.00 4.32 NA 0.33 5.65 NA XXX 

47672

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

78456 ......... 26 ....... A Acute venous thrombus image .................... 1.00 0.34 0.34 0.04 1.38 1.38 XXX 

78456 ......... TC ...... A Acute venous thrombus image .................... 0.00 3.98 NA 0.29 4.27 NA XXX 

78457 ......... ............ A Venous thrombosis imaging ........................ 0.77 2.91 NA 0.18 3.86 NA XXX 

78457 ......... 26 ....... A Venous thrombosis imaging ........................ 0.77 0.26 0.26 0.04 1.07 1.07 XXX 

78457 ......... TC ...... A Venous thrombosis imaging ........................ 0.00 2.65 NA 0.14 2.79 NA XXX 

78458 ......... ............ A Ven thrombosis images, bilat ...................... 0.90 4.34 NA 0.25 5.49 NA XXX 

78458 ......... 26 ....... A Ven thrombosis images, bilat ...................... 0.90 0.32 0.32 0.04 1.26 1.26 XXX 

78458 ......... TC ...... A Ven thrombosis images, bilat ...................... 0.00 4.02 NA 0.21 4.23 NA XXX 

78459 ......... 26 ....... R Heart muscle imaging (PET) ....................... 1.50 0.57 0.57 0.06 2.13 2.13 XXX 

78460 ......... ............ A Heart muscle blood, single .......................... 0.86 2.65 NA 0.17 3.68 NA XXX 

78460 ......... 26 ....... A Heart muscle blood, single .......................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 

78460 ......... TC ...... A Heart muscle blood, single .......................... 0.00 2.35 NA 0.13 2.48 NA XXX 

78461 ......... ............ A Heart muscle blood, multiple ....................... 1.23 5.14 NA 0.30 6.67 NA XXX 

78461 ......... 26 ....... A Heart muscle blood, multiple ....................... 1.23 0.43 0.43 0.05 1.71 1.71 XXX 

78461 ......... TC ...... A Heart muscle blood, multiple ....................... 0.00 4.71 NA 0.25 4.96 NA XXX 

78464 ......... ............ A Heart image (3d), single .............................. 1.09 7.44 NA 0.41 8.94 NA XXX 

78464 ......... 26 ....... A Heart image (3d), single .............................. 1.09 0.38 0.38 0.04 1.51 1.51 XXX 

78464 ......... TC ...... A Heart image (3d), single .............................. 0.00 7.06 NA 0.37 7.43 NA XXX 

78465 ......... ............ A Heart image (3d), multiple ........................... 1.46 12.30 NA 0.68 14.44 NA XXX 

78465 ......... 26 ....... A Heart image (3d), multiple ........................... 1.46 0.52 0.52 0.06 2.04 2.04 XXX 

78465 ......... TC ...... A Heart image (3d), multiple ........................... 0.00 11.77 NA 0.62 12.39 NA XXX 

78466 ......... ............ A Heart infarct image ...................................... 0.69 2.86 NA 0.17 3.72 NA XXX 

78466 ......... 26 ....... A Heart infarct image ...................................... 0.69 0.24 0.24 0.03 0.96 0.96 XXX 

78466 ......... TC ...... A Heart infarct image ...................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

78468 ......... ............ A Heart infarct image (ef) ................................ 0.80 3.93 NA 0.22 4.95 NA XXX 

78468 ......... 26 ....... A Heart infarct image (ef) ................................ 0.80 0.27 0.27 0.03 1.10 1.10 XXX 

78468 ......... TC ...... A Heart infarct image (ef) ................................ 0.00 3.66 NA 0.19 3.85 NA XXX 

78469 ......... ............ A Heart infarct image (3D) .............................. 0.92 5.53 NA 0.31 6.76 NA XXX 

78469 ......... 26 ....... A Heart infarct image (3D) .............................. 0.92 0.31 0.31 0.03 1.26 1.26 XXX 

78469 ......... TC ...... A Heart infarct image (3D) .............................. 0.00 5.21 NA 0.28 5.49 NA XXX 

78472 ......... ............ A Gated heart, planar, single .......................... 0.98 5.84 NA 0.34 7.16 NA XXX 

78472 ......... 26 ....... A Gated heart, planar, single .......................... 0.98 0.34 0.34 0.04 1.36 1.36 XXX 

78472 ......... TC ...... A Gated heart, planar, single .......................... 0.00 5.50 NA 0.30 5.80 NA XXX 

78473 ......... ............ A Gated heart, multiple ................................... 1.47 8.75 NA 0.48 10.70 NA XXX 

78473 ......... 26 ....... A Gated heart, multiple ................................... 1.47 0.51 0.51 0.06 2.04 2.04 XXX 

78473 ......... TC ...... A Gated heart, multiple ................................... 0.00 8.24 NA 0.42 8.66 NA XXX 

78478 ......... ............ A Heart wall motion add-on ............................ 0.62 1.78 NA 0.12 2.52 NA XXX 

78478 ......... 26 ....... A Heart wall motion add-on ............................ 0.62 0.22 0.22 0.02 0.86 0.86 XXX 

78478 ......... TC ...... A Heart wall motion add-on ............................ 0.00 1.55 NA 0.10 1.65 NA XXX 

78480 ......... ............ A Heart function add-on .................................. 0.62 1.78 NA 0.12 2.52 NA XXX 

78480 ......... 26 ....... A Heart function add-on .................................. 0.62 0.22 0.22 0.02 0.86 0.86 XXX 

78480 ......... TC ...... A Heart function add-on .................................. 0.00 1.55 NA 0.10 1.65 NA XXX 

78481 ......... ............ A Heart first pass, single ................................. 0.98 5.57 NA 0.32 6.87 NA XXX 

78481 ......... 26 ....... A Heart first pass, single ................................. 0.98 0.36 0.36 0.04 1.38 1.38 XXX 

78481 ......... TC ...... A Heart first pass, single ................................. 0.00 5.21 NA 0.28 5.49 NA XXX 

78483 ......... ............ A Heart first pass, multiple .............................. 1.47 8.39 NA 0.46 10.32 NA XXX 

78483 ......... 26 ....... A Heart first pass, multiple .............................. 1.47 0.54 0.54 0.05 2.06 2.06 XXX 

78483 ......... TC ...... A Heart first pass, multiple .............................. 0.00 7.86 NA 0.41 8.27 NA XXX 

78494 ......... ............ A Heart image, spect ...................................... 1.19 7.47 NA 0.35 9.01 NA XXX 

78494 ......... 26 ....... A Heart image, spect ...................................... 1.19 0.42 0.42 0.05 1.66 1.66 XXX 

78494 ......... TC ...... A Heart image, spect ...................................... 0.00 7.06 NA 0.30 7.36 NA XXX 

78496 ......... ............ A Heart first pass add-on ................................ 0.50 7.24 NA 0.32 8.06 NA ZZZ 

78496 ......... 26 ....... A Heart first pass add-on ................................ 0.50 0.18 0.18 0.02 0.70 0.70 ZZZ 

78496 ......... TC ...... A Heart first pass add-on ................................ 0.00 7.06 NA 0.30 7.36 NA ZZZ 

78580 ......... ............ A Lung perfusion imaging ............................... 0.74 3.67 NA 0.21 4.62 NA XXX 

78580 ......... 26 ....... A Lung perfusion imaging ............................... 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

78580 ......... TC ...... A Lung perfusion imaging ............................... 0.00 3.43 NA 0.18 3.61 NA XXX 

78584 ......... ............ A Lung V/Q image single breath ..................... 0.99 3.52 NA 0.21 4.72 NA XXX 

78584 ......... 26 ....... A Lung V/Q image single breath ..................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX 

78584 ......... TC ...... A Lung V/Q image single breath ..................... 0.00 3.19 NA 0.17 3.36 NA XXX 

78585 ......... ............ A Lung V/Q imaging ........................................ 1.09 5.99 NA 0.35 7.43 NA XXX 

78585 ......... 26 ....... A Lung V/Q imaging ........................................ 1.09 0.36 0.36 0.05 1.50 1.50 XXX 

78585 ......... TC ...... A Lung V/Q imaging ........................................ 0.00 5.63 NA 0.30 5.93 NA XXX 

78586 ......... ............ A Aerosol lung image, single .......................... 0.40 2.72 NA 0.16 3.28 NA XXX 

78586 ......... 26 ....... A Aerosol lung image, single .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 

78586 ......... TC ...... A Aerosol lung image, single .......................... 0.00 2.59 NA 0.14 2.73 NA XXX 

78587 ......... ............ A Aerosol lung image, multiple ....................... 0.49 2.96 NA 0.16 3.61 NA XXX 

78587 ......... 26 ....... A Aerosol lung image, multiple ....................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78587 ......... TC ...... A Aerosol lung image, multiple ....................... 0.00 2.80 NA 0.14 2.94 NA XXX 

78588 ......... ............ A Perfusion lung image ................................... 1.09 3.56 NA 0.23 4.88 NA XXX 

78588 ......... 26 ....... A Perfusion lung image ................................... 1.09 0.36 0.36 0.05 1.50 1.50 XXX 

78588 ......... TC ...... A Perfusion lung image ................................... 0.00 3.19 NA 0.18 3.37 NA XXX 

78591 ......... ............ A Vent image, 1 breath, 1 proj ........................ 0.40 2.98 NA 0.16 3.54 NA XXX 

78591 ......... 26 ....... A Vent image, 1 breath, 1 proj ........................ 0.40 0.13 0.13 0.02 0.55 0.55 XXX 

78591 ......... TC ...... A Vent image, 1 breath, 1 proj ........................ 0.00 2.85 NA 0.14 2.99 NA XXX 

47673

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

78593 ......... ............ A Vent image, 1 proj, gas ............................... 0.49 3.61 NA 0.20 4.30 NA XXX 

78593 ......... 26 ....... A Vent image, 1 proj, gas ............................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78593 ......... TC ...... A Vent image, 1 proj, gas ............................... 0.00 3.45 NA 0.18 3.63 NA XXX 

78594 ......... ............ A Vent image, mult proj, gas .......................... 0.53 5.15 NA 0.27 5.95 NA XXX 

78594 ......... 26 ....... A Vent image, mult proj, gas .......................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78594 ......... TC ...... A Vent image, mult proj, gas .......................... 0.00 4.97 NA 0.25 5.22 NA XXX 

78596 ......... ............ A Lung differential function ............................. 1.27 7.48 NA 0.43 9.18 NA XXX 

78596 ......... 26 ....... A Lung differential function ............................. 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

78596 ......... TC ...... A Lung differential function ............................. 0.00 7.06 NA 0.37 7.43 NA XXX 

78600 ......... ............ A Brain imaging, ltd static ............................... 0.44 3.03 NA 0.16 3.63 NA XXX 

78600 ......... 26 ....... A Brain imaging, ltd static ............................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

78600 ......... TC ...... A Brain imaging, ltd static ............................... 0.00 2.88 NA 0.14 3.02 NA XXX 

78601 ......... ............ A Brain imaging, ltd w/flow .............................. 0.51 3.57 NA 0.20 4.28 NA XXX 

78601 ......... 26 ....... A Brain imaging, ltd w/flow .............................. 0.51 0.17 0.17 0.02 0.70 0.70 XXX 

78601 ......... TC ...... A Brain imaging, ltd w/flow .............................. 0.00 3.40 NA 0.18 3.58 NA XXX 

78605 ......... ............ A Brain imaging, complete .............................. 0.53 3.58 NA 0.20 4.31 NA XXX 

78605 ......... 26 ....... A Brain imaging, complete .............................. 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78605 ......... TC ...... A Brain imaging, complete .............................. 0.00 3.40 NA 0.18 3.58 NA XXX 

78606 ......... ............ A Brain imaging, compl w/flow ........................ 0.64 4.07 NA 0.24 4.95 NA XXX 

78606 ......... 26 ....... A Brain imaging, compl w/flow ........................ 0.64 0.21 0.21 0.03 0.88 0.88 XXX 

78606 ......... TC ...... A Brain imaging, compl w/flow ........................ 0.00 3.86 NA 0.21 4.07 NA XXX 

78607 ......... ............ A Brain imaging (3D) ....................................... 1.23 6.97 NA 0.40 8.60 NA XXX 

78607 ......... 26 ....... A Brain imaging (3D) ....................................... 1.23 0.43 0.43 0.05 1.71 1.71 XXX 

78607 ......... TC ...... A Brain imaging (3D) ....................................... 0.00 6.54 NA 0.35 6.89 NA XXX 

78610 ......... ............ A Brain flow imaging only ............................... 0.30 1.68 NA 0.11 2.09 NA XXX 

78610 ......... 26 ....... A Brain flow imaging only ............................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78610 ......... TC ...... A Brain flow imaging only ............................... 0.00 1.57 NA 0.10 1.67 NA XXX 

78615 ......... ............ A Cerebral vascular flow image ...................... 0.42 3.99 NA 0.23 4.64 NA XXX 

78615 ......... 26 ....... A Cerebral vascular flow image ...................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

78615 ......... TC ...... A Cerebral vascular flow image ...................... 0.00 3.84 NA 0.21 4.05 NA XXX 

78630 ......... ............ A Cerebrospinal fluid scan .............................. 0.68 5.26 NA 0.30 6.24 NA XXX 

78630 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.68 0.23 0.23 0.03 0.94 0.94 XXX 

78630 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.03 NA 0.27 5.30 NA XXX 

78635 ......... ............ A CSF ventriculography .................................. 0.61 2.77 NA 0.16 3.54 NA XXX 

78635 ......... 26 ....... A CSF ventriculography .................................. 0.61 0.23 0.23 0.02 0.86 0.86 XXX 

78635 ......... TC ...... A CSF ventriculography .................................. 0.00 2.54 NA 0.14 2.68 NA XXX 

78645 ......... ............ A CSF shunt evaluation .................................. 0.57 3.62 NA 0.20 4.39 NA XXX 

78645 ......... 26 ....... A CSF shunt evaluation .................................. 0.57 0.19 0.19 0.02 0.78 0.78 XXX 

78645 ......... TC ...... A CSF shunt evaluation .................................. 0.00 3.43 NA 0.18 3.61 NA XXX 

78647 ......... ............ A Cerebrospinal fluid scan .............................. 0.90 6.21 NA 0.35 7.46 NA XXX 

78647 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.90 0.31 0.31 0.04 1.25 1.25 XXX 

78647 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.90 NA 0.31 6.21 NA XXX 

78650 ......... ............ A CSF leakage imaging .................................. 0.61 4.84 NA 0.27 5.72 NA XXX 

78650 ......... 26 ....... A CSF leakage imaging .................................. 0.61 0.21 0.21 0.03 0.85 0.85 XXX 

78650 ......... TC ...... A CSF leakage imaging .................................. 0.00 4.63 NA 0.24 4.87 NA XXX 

78660 ......... ............ A Nuclear exam of tear flow ........................... 0.53 2.29 NA 0.14 2.96 NA XXX 

78660 ......... 26 ....... A Nuclear exam of tear flow ........................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78660 ......... TC ...... A Nuclear exam of tear flow ........................... 0.00 2.11 NA 0.12 2.23 NA XXX 

78700 ......... ............ A Kidney imaging, static .................................. 0.45 3.19 NA 0.18 3.82 NA XXX 

78700 ......... 26 ....... A Kidney imaging, static .................................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78700 ......... TC ...... A Kidney imaging, static .................................. 0.00 3.04 NA 0.16 3.20 NA XXX 

78701 ......... ............ A Kidney imaging with flow ............................. 0.49 3.71 NA 0.20 4.40 NA XXX 

78701 ......... 26 ....... A Kidney imaging with flow ............................. 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

78701 ......... TC ...... A Kidney imaging with flow ............................. 0.00 3.55 NA 0.18 3.73 NA XXX 

78704 ......... ............ A Imaging renogram ........................................ 0.74 4.19 NA 0.24 5.17 NA XXX 

78704 ......... 26 ....... A Imaging renogram ........................................ 0.74 0.25 0.25 0.03 1.02 1.02 XXX 

78704 ......... TC ...... A Imaging renogram ........................................ 0.00 3.95 NA 0.21 4.16 NA XXX 

78707 ......... ............ A Kidney flow/function image .......................... 0.96 4.78 NA 0.27 6.01 NA XXX 

78707 ......... 26 ....... A Kidney flow/function image .......................... 0.96 0.32 0.32 0.04 1.32 1.32 XXX 

78707 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 

78708 ......... ............ A Kidney flow/function image .......................... 1.21 4.87 NA 0.28 6.36 NA XXX 

78708 ......... 26 ....... A Kidney flow/function image .......................... 1.21 0.41 0.41 0.05 1.67 1.67 XXX 

78708 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 

78709 ......... ............ A Kidney flow/function image .......................... 1.41 4.93 NA 0.29 6.63 NA XXX 

78709 ......... 26 ....... A Kidney flow/function image .......................... 1.41 0.47 0.47 0.06 1.94 1.94 XXX 

78709 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.46 NA 0.23 4.69 NA XXX 

78710 ......... ............ A Kidney imaging (3D) .................................... 0.66 6.12 NA 0.34 7.12 NA XXX 

78710 ......... 26 ....... A Kidney imaging (3D) .................................... 0.66 0.22 0.22 0.03 0.91 0.91 XXX 

78710 ......... TC ...... A Kidney imaging (3D) .................................... 0.00 5.90 NA 0.31 6.21 NA XXX 

78715 ......... ............ A Renal vascular flow exam ........................... 0.30 1.68 NA 0.11 2.09 NA XXX 

78715 ......... 26 ....... A Renal vascular flow exam ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78715 ......... TC ...... A Renal vascular flow exam ........................... 0.00 1.57 NA 0.10 1.67 NA XXX 

78725 ......... ............ A Kidney function study .................................. 0.38 1.90 NA 0.13 2.41 NA XXX 

78725 ......... 26 ....... A Kidney function study .................................. 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

78725 ......... TC ...... A Kidney function study .................................. 0.00 1.78 NA 0.11 1.89 NA XXX 

47674

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

78730 ......... ............ A Urinary bladder retention ............................. 0.36 1.58 NA 0.10 2.04 NA XXX 

78730 ......... 26 ....... A Urinary bladder retention ............................. 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

78730 ......... TC ...... A Urinary bladder retention ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

78740 ......... ............ A Ureteral reflux study .................................... 0.57 2.30 NA 0.15 3.02 NA XXX 

78740 ......... 26 ....... A Ureteral reflux study .................................... 0.57 0.19 0.19 0.03 0.79 0.79 XXX 

78740 ......... TC ...... A Ureteral reflux study .................................... 0.00 2.11 NA 0.12 2.23 NA XXX 

78760 ......... ............ A Testicular imaging ........................................ 0.66 2.89 NA 0.17 3.72 NA XXX 

78760 ......... 26 ....... A Testicular imaging ........................................ 0.66 0.22 0.22 0.03 0.91 0.91 XXX 

78760 ......... TC ...... A Testicular imaging ........................................ 0.00 2.67 NA 0.14 2.81 NA XXX 

78761 ......... ............ A Testicular imaging/flow ................................ 0.71 3.43 NA 0.20 4.34 NA XXX 

78761 ......... 26 ....... A Testicular imaging/flow ................................ 0.71 0.24 0.24 0.03 0.98 0.98 XXX 

78761 ......... TC ...... A Testicular imaging/flow ................................ 0.00 3.19 NA 0.17 3.36 NA XXX 

78800 ......... ............ A Tumor imaging, limited area ........................ 0.66 3.62 NA 0.22 4.50 NA XXX 

78800 ......... 26 ....... A Tumor imaging, limited area ........................ 0.66 0.22 0.22 0.04 0.92 0.92 XXX 

78800 ......... TC ...... A Tumor imaging, limited area ........................ 0.00 3.40 NA 0.18 3.58 NA XXX 

78801 ......... ............ A Tumor imaging, mult areas .......................... 0.79 4.48 NA 0.27 5.54 NA XXX 

78801 ......... 26 ....... A Tumor imaging, mult areas .......................... 0.79 0.27 0.27 0.05 1.11 1.11 XXX 

78801 ......... TC ...... A Tumor imaging, mult areas .......................... 0.00 4.22 NA 0.22 4.44 NA XXX 

78802 ......... ............ A Tumor imaging, whole body ........................ 0.86 5.81 NA 0.34 7.01 NA XXX 

78802 ......... 26 ....... A Tumor imaging, whole body ........................ 0.86 0.29 0.29 0.04 1.19 1.19 XXX 

78802 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 5.52 NA 0.30 5.82 NA XXX 

78803 ......... ............ A Tumor imaging (3D) ..................................... 1.09 6.93 NA 0.40 8.42 NA XXX 

78803 ......... 26 ....... A Tumor imaging (3D) ..................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78803 ......... TC ...... A Tumor imaging (3D) ..................................... 0.00 6.54 NA 0.35 6.89 NA XXX 

78804 ......... ............ A Tumor imaging, whole body ........................ 1.07 11.41 NA 0.34 12.82 NA XXX 

78804 ......... 26 ....... A Tumor imaging, whole body ........................ 1.07 0.37 0.37 0.04 1.48 1.48 XXX 

78804 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 11.04 NA 0.30 11.34 NA XXX 

78805 ......... ............ A Abscess imaging, ltd area ........................... 0.73 3.65 NA 0.21 4.59 NA XXX 

78805 ......... 26 ....... A Abscess imaging, ltd area ........................... 0.73 0.25 0.25 0.03 1.01 1.01 XXX 

78805 ......... TC ...... A Abscess imaging, ltd area ........................... 0.00 3.40 NA 0.18 3.58 NA XXX 

78806 ......... ............ A Abscess imaging, whole body ..................... 0.86 6.71 NA 0.39 7.96 NA XXX 

78806 ......... 26 ....... A Abscess imaging, whole body ..................... 0.86 0.29 0.29 0.04 1.19 1.19 XXX 

78806 ......... TC ...... A Abscess imaging, whole body ..................... 0.00 6.42 NA 0.35 6.77 NA XXX 

78807 ......... ............ A Nuclear localization/abscess ....................... 1.09 6.93 NA 0.40 8.42 NA XXX 

78807 ......... 26 ....... A Nuclear localization/abscess ....................... 1.09 0.39 0.39 0.05 1.53 1.53 XXX 

78807 ......... TC ...... A Nuclear localization/abscess ....................... 0.00 6.54 NA 0.35 6.89 NA XXX 

78890 ......... ............ B Nuclear medicine data proc ......................... 0.05 1.32 NA 0.07 1.44 NA XXX 

78890 ......... 26 ....... B Nuclear medicine data proc ......................... 0.05 0.02 0.02 0.01 0.08 0.08 XXX 

78890 ......... TC ...... B Nuclear medicine data proc ......................... 0.00 1.30 NA 0.06 1.36 NA XXX 

78891 ......... ............ B Nuclear med data proc ................................ 0.10 2.65 NA 0.14 2.89 NA XXX 

78891 ......... 26 ....... B Nuclear med data proc ................................ 0.10 0.04 0.04 0.01 0.15 0.15 XXX 

78891 ......... TC ...... B Nuclear med data proc ................................ 0.00 2.62 NA 0.13 2.75 NA XXX 

79000 ......... ............ A Init hyperthyroid therapy .............................. 1.80 3.22 NA 0.22 5.24 NA XXX 

79000 ......... 26 ....... A Init hyperthyroid therapy .............................. 1.80 0.60 0.60 0.08 2.48 2.48 XXX 

79000 ......... TC ...... A Init hyperthyroid therapy .............................. 0.00 2.62 NA 0.14 2.76 NA XXX 

79001 ......... ............ A Repeat hyperthyroid therapy ....................... 1.05 1.66 NA 0.12 2.83 NA XXX 

79001 ......... 26 ....... A Repeat hyperthyroid therapy ....................... 1.05 0.36 0.36 0.05 1.46 1.46 XXX 

79001 ......... TC ...... A Repeat hyperthyroid therapy ....................... 0.00 1.30 NA 0.07 1.37 NA XXX 

79020 ......... ............ A Thyroid ablation ........................................... 1.81 3.21 NA 0.22 5.24 NA XXX 

79020 ......... 26 ....... A Thyroid ablation ........................................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 

79020 ......... TC ...... A Thyroid ablation ........................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79030 ......... ............ A Thyroid ablation, carcinoma ........................ 2.10 3.32 NA 0.23 5.65 NA XXX 

79030 ......... 26 ....... A Thyroid ablation, carcinoma ........................ 2.10 0.71 0.71 0.09 2.90 2.90 XXX 

79030 ......... TC ...... A Thyroid ablation, carcinoma ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 

79035 ......... ............ A Thyroid metastatic therapy .......................... 2.52 3.49 NA 0.25 6.26 NA XXX 

79035 ......... 26 ....... A Thyroid metastatic therapy .......................... 2.52 0.87 0.87 0.11 3.50 3.50 XXX 

79035 ......... TC ...... A Thyroid metastatic therapy .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79100 ......... ............ A Hematopoetic nuclear therapy ..................... 1.32 3.08 NA 0.20 4.60 NA XXX 

79100 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 1.32 0.46 0.46 0.06 1.84 1.84 XXX 

79100 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79200 ......... ............ A Intracavitary nuclear trmt ............................. 1.99 3.30 NA 0.23 5.52 NA XXX 

79200 ......... 26 ....... A Intracavitary nuclear trmt ............................. 1.99 0.69 0.69 0.09 2.77 2.77 XXX 

79200 ......... TC ...... A Intracavitary nuclear trmt ............................. 0.00 2.62 NA 0.14 2.76 NA XXX 

79300 ......... 26 ....... A Interstitial nuclear therapy ........................... 1.60 0.56 0.56 0.08 2.24 2.24 XXX 

79400 ......... ............ A Nonhemato nuclear therapy ........................ 1.96 3.29 NA 0.23 5.48 NA XXX 

79400 ......... 26 ....... A Nonhemato nuclear therapy ........................ 1.96 0.67 0.67 0.09 2.72 2.72 XXX 

79400 ......... TC ...... A Nonhemato nuclear therapy ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 

79403 ......... ............ A Hematopoetic nuclear therapy ..................... 2.25 5.16 NA 0.24 7.65 NA XXX 

79403 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 2.25 0.89 0.89 0.10 3.24 3.24 XXX 

79403 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 4.27 NA 0.14 4.41 NA XXX 

79420 ......... 26 ....... A Intravascular nuclear ther ............................ 1.51 0.49 0.49 0.07 2.07 2.07 XXX 

79440 ......... ............ A Nuclear joint therapy .................................... 1.99 3.34 NA 0.24 5.57 NA XXX 

79440 ......... 26 ....... A Nuclear joint therapy .................................... 1.99 0.72 0.72 0.10 2.81 2.81 XXX 

79440 ......... TC ...... A Nuclear joint therapy .................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

80500 ......... ............ A Lab pathology consultation .......................... 0.37 0.21 0.16 0.01 0.59 0.54 XXX 

47675

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

80502 ......... ............ A Lab pathology consultation .......................... 1.33 0.55 0.55 0.06 1.94 1.94 XXX 

83020 ......... 26 ....... A Hemoglobin electrophoresis ........................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

83912 ......... 26 ....... A Genetic examination .................................... 0.37 0.12 0.12 0.01 0.50 0.50 XXX 

84165 ......... 26 ....... A Electrophoreisis of proteins ......................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

84181 ......... 26 ....... A Western blot test .......................................... 0.37 0.14 0.14 0.02 0.53 0.53 XXX 

84182 ......... 26 ....... A Protein, western blot test ............................. 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

85060 ......... ............ A Blood smear interpretation .......................... 0.45 0.18 0.18 0.02 0.65 0.65 XXX 

85097 ......... ............ A Bone marrow interpretation ......................... 0.94 2.02 0.42 0.04 3.00 1.40 XXX 

85390 ......... 26 ....... A Fibrinolysins screen ..................................... 0.37 0.13 0.13 0.02 0.52 0.52 XXX 

85396 ......... ............ A Clotting assay, whole blood ......................... 0.37 NA 0.16 0.04 NA 0.57 XXX 

85576 ......... 26 ....... A Blood platelet aggregation ........................... 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

86077 ......... ............ A Physician blood bank service ...................... 0.94 0.40 0.40 0.04 1.38 1.38 XXX 

86078 ......... ............ A Physician blood bank service ...................... 0.94 0.47 0.41 0.04 1.45 1.39 XXX 

86079 ......... ............ A Physician blood bank service ...................... 0.94 0.45 0.41 0.04 1.43 1.39 XXX 

86255 ......... 26 ....... A Fluorescent antibody, screen ...................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86256 ......... 26 ....... A Fluorescent antibody, titer ........................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86320 ......... 26 ....... A Serum immunoelectrophoresis .................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

86325 ......... 26 ....... A Other immunoelectrophoresis ...................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 

86327 ......... 26 ....... A Immunoelectrophoresis assay ..................... 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

86334 ......... 26 ....... A Immunofixation procedure ........................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86490 ......... ............ A Coccidioidomycosis skin test ....................... 0.00 0.29 NA 0.02 0.31 NA XXX 

86510 ......... ............ A Histoplasmosis skin test .............................. 0.00 0.32 NA 0.02 0.34 NA XXX 

86580 ......... ............ A TB intradermal test ...................................... 0.00 0.25 NA 0.02 0.27 NA XXX 

86585 ......... ............ A TB tine test .................................................. 0.00 0.20 NA 0.01 0.21 NA XXX 

87164 ......... 26 ....... A Dark field examination ................................. 0.37 0.12 0.12 0.01 0.50 0.50 XXX 

87207 ......... 26 ....... A Smear, special stain .................................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

88104 ......... ............ A Cytopathology, fluids ................................... 0.56 0.86 NA 0.04 1.46 NA XXX 

88104 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 

88104 ......... TC ...... A Cytopathology, fluids ................................... 0.00 0.62 NA 0.02 0.64 NA XXX 

88106 ......... ............ A Cytopathology, fluids ................................... 0.56 1.37 NA 0.04 1.97 NA XXX 

88106 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 

88106 ......... TC ...... A Cytopathology, fluids ................................... 0.00 1.13 NA 0.02 1.15 NA XXX 

88107 ......... ............ A Cytopathology, fluids ................................... 0.76 1.56 NA 0.05 2.37 NA XXX 

88107 ......... 26 ....... A Cytopathology, fluids ................................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 

88107 ......... TC ...... A Cytopathology, fluids ................................... 0.00 1.23 NA 0.02 1.25 NA XXX 

88108 ......... ............ A Cytopath, concentrate tech .......................... 0.56 1.22 NA 0.04 1.82 NA XXX 

88108 ......... 26 ....... A Cytopath, concentrate tech .......................... 0.56 0.24 0.24 0.02 0.82 0.82 XXX 

88108 ......... TC ...... A Cytopath, concentrate tech .......................... 0.00 0.98 NA 0.02 1.00 NA XXX 

88112 ......... ............ A Cytopath, cell enhance tech ........................ 1.18 1.98 NA 0.04 3.20 NA XXX 

88112 ......... 26 ....... A Cytopath, cell enhance tech ........................ 1.18 0.51 0.51 0.02 1.71 1.71 XXX 

88112 ......... TC ...... A Cytopath, cell enhance tech ........................ 0.00 1.47 NA 0.02 1.49 NA XXX 

88125 ......... ............ A Forensic cytopathology ................................ 0.26 0.09 NA 0.02 0.37 NA XXX 

88125 ......... 26 ....... A Forensic cytopathology ................................ 0.26 0.11 0.11 0.01 0.38 0.38 XXX 

88125 ......... TC ...... A Forensic cytopathology ................................ 0.00 -0.03 NA 0.01 -0.02 NA XXX 

88141 ......... ............ A Cytopath, c/v, interpret ................................ 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

88160 ......... ............ A Cytopath smear, other source ..................... 0.50 0.85 NA 0.04 1.39 NA XXX 

88160 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.22 0.22 0.02 0.74 0.74 XXX 

88160 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.63 NA 0.02 0.65 NA XXX 

88161 ......... ............ A Cytopath smear, other source ..................... 0.50 0.95 NA 0.04 1.49 NA XXX 

88161 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.21 0.21 0.02 0.73 0.73 XXX 

88161 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.74 NA 0.02 0.76 NA XXX 

88162 ......... ............ A Cytopath smear, other source ..................... 0.76 1.04 NA 0.05 1.85 NA XXX 

88162 ......... 26 ....... A Cytopath smear, other source ..................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 

88162 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.71 NA 0.02 0.73 NA XXX 

88172 ......... ............ A Cytopathology eval of fna ............................ 0.60 0.74 NA 0.04 1.38 NA XXX 

88172 ......... 26 ....... A Cytopathology eval of fna ............................ 0.60 0.26 0.26 0.02 0.88 0.88 XXX 

88172 ......... TC ...... A Cytopathology eval of fna ............................ 0.00 0.48 NA 0.02 0.50 NA XXX 

88173 ......... ............ A Cytopath eval, fna, report ............................ 1.39 2.18 NA 0.07 3.64 NA XXX 

88173 ......... 26 ....... A Cytopath eval, fna, report ............................ 1.39 0.60 0.60 0.05 2.04 2.04 XXX 

88173 ......... TC ...... A Cytopath eval, fna, report ............................ 0.00 1.58 NA 0.02 1.60 NA XXX 

88180 ......... ............ A Cell marker study ......................................... 0.36 1.27 NA 0.03 1.66 NA XXX 

88180 ......... 26 ....... A Cell marker study ......................................... 0.36 0.16 0.16 0.01 0.53 0.53 XXX 

88180 ......... TC ...... A Cell marker study ......................................... 0.00 1.11 NA 0.02 1.13 NA XXX 

88182 ......... ............ A Cell marker study ......................................... 0.77 2.04 NA 0.07 2.88 NA XXX 

88182 ......... 26 ....... A Cell marker study ......................................... 0.77 0.33 0.33 0.03 1.13 1.13 XXX 

88182 ......... TC ...... A Cell marker study ......................................... 0.00 1.70 NA 0.04 1.74 NA XXX 

88291 ......... ............ A Cyto/molecular report .................................. 0.52 0.18 0.18 0.03 0.73 0.73 XXX 

88300 ......... ............ A Surgical path, gross ..................................... 0.08 0.46 NA 0.01 0.55 NA XXX 

88300 ......... 26 ....... A Surgical path, gross ..................................... 0.08 0.03 0.03 0.00 0.11 0.11 XXX 

88300 ......... TC ...... A Surgical path, gross ..................................... 0.00 0.42 NA 0.01 0.43 NA XXX 

88302 ......... ............ A Tissue exam by pathologist ......................... 0.13 1.03 NA 0.02 1.18 NA XXX 

88302 ......... 26 ....... A Tissue exam by pathologist ......................... 0.13 0.06 0.06 0.00 0.19 0.19 XXX 

88302 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 0.97 NA 0.02 0.99 NA XXX 

88304 ......... ............ A Tissue exam by pathologist ......................... 0.22 1.34 NA 0.03 1.59 NA XXX 

88304 ......... 26 ....... A Tissue exam by pathologist ......................... 0.22 0.10 0.10 0.01 0.33 0.33 XXX 

47676

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

88304 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.24 NA 0.02 1.26 NA XXX 

88305 ......... ............ A Tissue exam by pathologist ......................... 0.75 1.92 NA 0.07 2.74 NA XXX 

88305 ......... 26 ....... A Tissue exam by pathologist ......................... 0.75 0.33 0.33 0.03 1.11 1.11 XXX 

88305 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.59 NA 0.04 1.63 NA XXX 

88307 ......... ............ A Tissue exam by pathologist ......................... 1.59 3.16 NA 0.12 4.87 NA XXX 

88307 ......... 26 ....... A Tissue exam by pathologist ......................... 1.59 0.69 0.69 0.06 2.34 2.34 XXX 

88307 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 2.47 NA 0.06 2.53 NA XXX 

88309 ......... ............ A Tissue exam by pathologist ......................... 2.28 4.41 NA 0.15 6.84 NA XXX 

88309 ......... 26 ....... A Tissue exam by pathologist ......................... 2.28 0.99 0.99 0.09 3.36 3.36 XXX 

88309 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 3.43 NA 0.06 3.49 NA XXX 

88311 ......... ............ A Decalcify tissue ............................................ 0.24 0.24 NA 0.02 0.50 NA XXX 

88311 ......... 26 ....... A Decalcify tissue ............................................ 0.24 0.10 0.10 0.01 0.35 0.35 XXX 

88311 ......... TC ...... A Decalcify tissue ............................................ 0.00 0.13 NA 0.01 0.14 NA XXX 

88312 ......... ............ A Special stains ............................................... 0.54 1.52 NA 0.03 2.09 NA XXX 

88312 ......... 26 ....... A Special stains ............................................... 0.54 0.23 0.23 0.02 0.79 0.79 XXX 

88312 ......... TC ...... A Special stains ............................................... 0.00 1.28 NA 0.01 1.29 NA XXX 

88313 ......... ............ A Special stains ............................................... 0.24 1.25 NA 0.02 1.51 NA XXX 

88313 ......... 26 ....... A Special stains ............................................... 0.24 0.10 0.10 0.01 0.35 0.35 XXX 

88313 ......... TC ...... A Special stains ............................................... 0.00 1.14 NA 0.01 1.15 NA XXX 

88314 ......... ............ A Histochemical stain ...................................... 0.45 2.05 NA 0.04 2.54 NA XXX 

88314 ......... 26 ....... A Histochemical stain ...................................... 0.45 0.19 0.19 0.02 0.66 0.66 XXX 

88314 ......... TC ...... A Histochemical stain ...................................... 0.00 1.86 NA 0.02 1.88 NA XXX 

88318 ......... ............ A Chemical histochemistry .............................. 0.42 1.66 NA 0.03 2.11 NA XXX 

88318 ......... 26 ....... A Chemical histochemistry .............................. 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

88318 ......... TC ...... A Chemical histochemistry .............................. 0.00 1.48 NA 0.01 1.49 NA XXX 

88319 ......... ............ A Enzyme histochemistry ................................ 0.53 3.44 NA 0.04 4.01 NA XXX 

88319 ......... 26 ....... A Enzyme histochemistry ................................ 0.53 0.23 0.23 0.02 0.78 0.78 XXX 

88319 ......... TC ...... A Enzyme histochemistry ................................ 0.00 3.21 NA 0.02 3.23 NA XXX 

88321 ......... ............ A Microslide consultation ................................ 1.30 0.80 0.56 0.05 2.15 1.91 XXX 

88323 ......... ............ A Microslide consultation ................................ 1.35 1.80 NA 0.07 3.22 NA XXX 

88323 ......... 26 ....... A Microslide consultation ................................ 1.35 0.58 0.58 0.05 1.98 1.98 XXX 

88323 ......... TC ...... A Microslide consultation ................................ 0.00 1.22 NA 0.02 1.24 NA XXX 

88325 ......... ............ A Comprehensive review of data .................... 2.22 2.97 0.96 0.10 5.29 3.28 XXX 

88329 ......... ............ A Path consult introp ....................................... 0.67 0.65 0.29 0.03 1.35 0.99 XXX 

88331 ......... ............ A Path consult intraop, 1 bloc ......................... 1.19 1.11 NA 0.09 2.39 NA XXX 

88331 ......... 26 ....... A Path consult intraop, 1 bloc ......................... 1.19 0.52 0.52 0.05 1.76 1.76 XXX 

88331 ......... TC ...... A Path consult intraop, 1 bloc ......................... 0.00 0.60 NA 0.04 0.64 NA XXX 

88332 ......... ............ A Path consult intraop, add-l ........................... 0.59 0.46 NA 0.04 1.09 NA XXX 

88332 ......... 26 ....... A Path consult intraop, add-l ........................... 0.59 0.26 0.26 0.02 0.87 0.87 XXX 

88332 ......... TC ...... A Path consult intraop, add-l ........................... 0.00 0.21 NA 0.02 0.23 NA XXX 

88342 ......... ............ A Immunohistochemistry ................................. 0.85 1.48 NA 0.05 2.38 NA XXX 

88342 ......... 26 ....... A Immunohistochemistry ................................. 0.85 0.37 0.37 0.03 1.25 1.25 XXX 

88342 ......... TC ...... A Immunohistochemistry ................................. 0.00 1.11 NA 0.02 1.13 NA XXX 

88346 ......... ............ A Immunofluorescent study ............................. 0.86 1.57 NA 0.05 2.48 NA XXX 

88346 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.37 0.37 0.03 1.26 1.26 XXX 

88346 ......... TC ...... A Immunofluorescent study ............................. 0.00 1.21 NA 0.02 1.23 NA XXX 

88347 ......... ............ A Immunofluorescent study ............................. 0.86 1.27 NA 0.05 2.18 NA XXX 

88347 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.35 0.35 0.03 1.24 1.24 XXX 

88347 ......... TC ...... A Immunofluorescent study ............................. 0.00 0.92 NA 0.02 0.94 NA XXX 

88348 ......... ............ A Electron microscopy .................................... 1.51 9.58 NA 0.13 11.22 NA XXX 

88348 ......... 26 ....... A Electron microscopy .................................... 1.51 0.65 0.65 0.06 2.22 2.22 XXX 

88348 ......... TC ...... A Electron microscopy .................................... 0.00 8.93 NA 0.07 9.00 NA XXX 

88349 ......... ............ A Scanning electron microscopy ..................... 0.76 3.67 NA 0.09 4.52 NA XXX 

88349 ......... 26 ....... A Scanning electron microscopy ..................... 0.76 0.33 0.33 0.03 1.12 1.12 XXX 

88349 ......... TC ...... A Scanning electron microscopy ..................... 0.00 3.34 NA 0.06 3.40 NA XXX 

88355 ......... ............ A Analysis, skeletal muscle ............................. 1.85 6.71 NA 0.13 8.69 NA XXX 

88355 ......... 26 ....... A Analysis, skeletal muscle ............................. 1.85 0.80 0.80 0.07 2.72 2.72 XXX 

88355 ......... TC ...... A Analysis, skeletal muscle ............................. 0.00 5.91 NA 0.06 5.97 NA XXX 

88356 ......... ............ A Analysis, nerve ............................................ 3.02 3.80 NA 0.20 7.02 NA XXX 

88356 ......... 26 ....... A Analysis, nerve ............................................ 3.02 1.27 1.27 0.13 4.42 4.42 XXX 

88356 ......... TC ...... A Analysis, nerve ............................................ 0.00 2.53 NA 0.07 2.60 NA XXX 

88358 ......... ............ A Analysis, tumor ............................................ 0.95 0.71 NA 0.18 1.84 NA XXX 

88358 ......... 26 ....... A Analysis, tumor ............................................ 0.95 0.41 0.41 0.11 1.47 1.47 XXX 

88358 ......... TC ...... A Analysis, tumor ............................................ 0.00 0.30 NA 0.07 0.37 NA XXX 

88361 ......... ............ A Immunohistochemistry, tumor ...................... 0.94 2.59 NA 0.18 3.71 NA XXX 

88361 ......... 26 ....... A Immunohistochemistry, tumor ...................... 0.94 0.40 0.40 0.11 1.45 1.45 XXX 

88361 ......... TC ...... A Immunohistochemistry, tumor ...................... 0.00 2.19 NA 0.07 2.26 NA XXX 

88362 ......... ............ A Nerve teasing preparations ......................... 2.17 4.73 NA 0.15 7.05 NA XXX 

88362 ......... 26 ....... A Nerve teasing preparations ......................... 2.17 0.92 0.92 0.09 3.18 3.18 XXX 

88362 ......... TC ...... A Nerve teasing preparations ......................... 0.00 3.80 NA 0.06 3.86 NA XXX 

88365 ......... ............ A Tissue hybridization ..................................... 0.93 3.04 NA 0.06 4.03 NA XXX 

88365 ......... 26 ....... A Tissue hybridization ..................................... 0.93 0.40 0.40 0.04 1.37 1.37 XXX 

88365 ......... TC ...... A Tissue hybridization ..................................... 0.00 2.63 NA 0.02 2.65 NA XXX 

88371 ......... 26 ....... A Protein, western blot tissue ......................... 0.37 0.13 0.13 0.02 0.52 0.52 XXX 

88372 ......... 26 ....... A Protein analysis w/probe ............................. 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

47677

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

89060 ......... 26 ....... A Exam,synovial fluid crystals ......................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

89100 ......... ............ A Sample intestinal contents ........................... 0.60 1.85 0.21 0.03 2.48 0.84 XXX 

89105 ......... ............ A Sample intestinal contents ........................... 0.50 2.24 0.17 0.02 2.76 0.69 XXX 

89130 ......... ............ A Sample stomach contents ........................... 0.45 1.74 0.13 0.03 2.22 0.61 XXX 

89132 ......... ............ A Sample stomach contents ........................... 0.19 1.54 0.06 0.01 1.74 0.26 XXX 

89135 ......... ............ A Sample stomach contents ........................... 0.79 1.91 0.25 0.03 2.73 1.07 XXX 

89136 ......... ............ A Sample stomach contents ........................... 0.21 1.78 0.09 0.01 2.00 0.31 XXX 

89140 ......... ............ A Sample stomach contents ........................... 0.94 2.12 0.27 0.04 3.10 1.25 XXX 

89141 ......... ............ A Sample stomach contents ........................... 0.85 2.82 0.34 0.03 3.70 1.22 XXX 

89220 ......... ............ A Sputum specimen collection ........................ 0.00 NA NA 0.00 NA NA XXX 

89230 ......... ............ A Collect sweat for test ................................... 0.00 NA NA 0.00 NA NA XXX 

90471 ......... ............ A Immunization admin ..................................... 0.00 0.20 NA 0.01 0.21 NA XXX 

90472 ......... ............ A Immunization admin, each add ................... 0.00 0.14 NA 0.01 0.15 NA ZZZ 

90780 ......... ............ A IV infusion therapy, 1 hour .......................... 0.17 2.14 NA 0.07 2.38 NA XXX 

90781 ......... ............ A IV infusion, additional hour .......................... 0.17 0.46 NA 0.04 0.67 NA ZZZ 

90782 ......... ............ T Injection, sc/im ............................................. 0.17 0.31 NA 0.01 0.49 NA XXX 

90783 ......... ............ T Injection, ia ................................................... 0.17 0.32 NA 0.02 0.51 NA XXX 

90784 ......... ............ T Injection, iv ................................................... 0.17 0.80 NA 0.04 1.01 NA XXX 

90788 ......... ............ T Injection of antibiotic .................................... 0.17 0.27 NA 0.01 0.45 NA XXX 

90801 ......... ............ A Psy dx interview ........................................... 2.80 1.17 0.93 0.08 4.05 3.81 XXX 

90802 ......... ............ A Intac psy dx interview .................................. 3.01 1.20 0.97 0.08 4.29 4.06 XXX 

90804 ......... ............ A Psytx, office, 20-30 min ............................... 1.21 0.49 0.38 0.03 1.73 1.62 XXX 

90805 ......... ............ A Psytx, off, 20-30 min w/e&m ....................... 1.37 0.50 0.42 0.04 1.91 1.83 XXX 

90806 ......... ............ A Psytx, off, 45-50 min .................................... 1.86 0.70 0.60 0.05 2.61 2.51 XXX 

90807 ......... ............ A Psytx, off, 45-50 min w/e&m ....................... 2.02 0.70 0.63 0.05 2.77 2.70 XXX 

90808 ......... ............ A Psytx, office, 75-80 min ............................... 2.79 1.02 0.90 0.07 3.88 3.76 XXX 

90809 ......... ............ A Psytx, off, 75-80, w/e&m ............................. 2.95 1.00 0.92 0.08 4.03 3.95 XXX 

90810 ......... ............ A Intac psytx, off, 20-30 min ........................... 1.32 0.51 0.42 0.04 1.87 1.78 XXX 

90811 ......... ............ A Intac psytx, 20-30, w/e&m ........................... 1.48 0.57 0.46 0.04 2.09 1.98 XXX 

90812 ......... ............ A Intac psytx, off, 45-50 min ........................... 1.97 0.78 0.64 0.05 2.80 2.66 XXX 

90813 ......... ............ A Intac psytx, 45-50 min w/e&m ..................... 2.13 0.77 0.67 0.05 2.95 2.85 XXX 

90814 ......... ............ A Intac psytx, off, 75-80 min ........................... 2.90 1.10 0.98 0.07 4.07 3.95 XXX 

90815 ......... ............ A Intac psytx, 75-80 w/e&m ............................ 3.06 1.05 0.95 0.07 4.18 4.08 XXX 

90816 ......... ............ A Psytx, hosp, 20-30 min ................................ 1.25 NA 0.46 0.03 NA 1.74 XXX 

90817 ......... ............ A Psytx, hosp, 20-30 min w/e&m .................... 1.41 NA 0.46 0.04 NA 1.91 XXX 

90818 ......... ............ A Psytx, hosp, 45-50 min ................................ 1.89 NA 0.69 0.05 NA 2.63 XXX 

90819 ......... ............ A Psytx, hosp, 45-50 min w/e&m .................... 2.05 NA 0.65 0.05 NA 2.75 XXX 

90821 ......... ............ A Psytx, hosp, 75-80 min ................................ 2.83 NA 1.00 0.07 NA 3.90 XXX 

90822 ......... ............ A Psytx, hosp, 75-80 min w/e&m .................... 2.99 NA 0.94 0.09 NA 4.02 XXX 

90823 ......... ............ A Intac psytx, hosp, 20-30 min ....................... 1.36 NA 0.48 0.03 NA 1.87 XXX 

90824 ......... ............ A Intac psytx, hsp 20-30 w/e&m ..................... 1.52 NA 0.49 0.04 NA 2.05 XXX 

90826 ......... ............ A Intac psytx, hosp, 45-50 min ....................... 2.01 NA 0.72 0.05 NA 2.78 XXX 

90827 ......... ............ A Intac psytx, hsp 45-50 w/e&m ..................... 2.16 NA 0.68 0.05 NA 2.89 XXX 

90828 ......... ............ A Intac psytx, hosp, 75-80 min ....................... 2.94 NA 1.06 0.07 NA 4.07 XXX 

90829 ......... ............ A Intac psytx, hsp 75-80 w/e&m ..................... 3.10 NA 0.98 0.07 NA 4.15 XXX 

90845 ......... ............ A Psychoanalysis ............................................ 1.79 0.58 0.55 0.04 2.41 2.38 XXX 

90846 ......... ............ R Family psytx w/o patient .............................. 1.83 0.65 0.64 0.05 2.53 2.52 XXX 

90847 ......... ............ R Family psytx w/patient ................................. 2.21 0.81 0.76 0.06 3.08 3.03 XXX 

90849 ......... ............ R Multiple family group psytx .......................... 0.59 0.27 0.24 0.02 0.88 0.85 XXX 

90853 ......... ............ A Group psychotherapy .................................. 0.59 0.25 0.23 0.02 0.86 0.84 XXX 

90857 ......... ............ A Intac group psytx ......................................... 0.63 0.29 0.25 0.02 0.94 0.90 XXX 

90862 ......... ............ A Medication management ............................. 0.95 0.40 0.32 0.03 1.38 1.30 XXX 

90865 ......... ............ A Narcosynthesis ............................................ 2.84 1.38 0.91 0.11 4.33 3.86 XXX 

90870 ......... ............ A Electroconvulsive therapy ............................ 1.88 1.43 0.59 0.05 3.36 2.52 000 

90880 ......... ............ A Hypnotherapy ............................................... 2.19 1.04 0.69 0.06 3.29 2.94 XXX 

90885 ......... ............ B Psy evaluation of records ............................ 0.97 0.37 0.37 0.02 1.36 1.36 XXX 

90887 ......... ............ B Consultation with family ............................... 1.48 0.82 0.56 0.04 2.34 2.08 XXX 

90901 ......... ............ A Biofeedback train, any meth ........................ 0.41 0.65 0.14 0.02 1.08 0.57 000 

90911 ......... ............ A Biofeedback peri/uro/rectal .......................... 0.89 1.56 0.31 0.06 2.51 1.26 000 

90918 ......... ............ A ESRD related services, month .................... 11.16 7.29 7.29 0.36 18.81 18.81 XXX 

90919 ......... ............ A ESRD related services, month .................... 8.53 4.04 4.04 0.29 12.86 12.86 XXX 

90920 ......... ............ A ESRD related services, month .................... 7.26 3.78 3.78 0.23 11.27 11.27 XXX 

90921 ......... ............ A ESRD related services, month .................... 4.46 2.45 2.45 0.14 7.05 7.05 XXX 

90922 ......... ............ A ESRD related services, day ........................ 0.37 0.21 0.21 0.01 0.59 0.59 XXX 

90923 ......... ............ A Esrd related services, day ........................... 0.28 0.13 0.13 0.01 0.42 0.42 XXX 

90924 ......... ............ A Esrd related services, day ........................... 0.24 0.12 0.12 0.01 0.37 0.37 XXX 

90925 ......... ............ A Esrd related services, day ........................... 0.15 0.08 0.08 0.01 0.24 0.24 XXX 

90935 ......... ............ A Hemodialysis, one evaluation ...................... 1.22 NA 0.67 0.04 NA 1.93 000 

90937 ......... ............ A Hemodialysis, repeated eval ....................... 2.11 NA 0.97 0.08 NA 3.16 000 

90945 ......... ............ A Dialysis, one evaluation ............................... 1.28 NA 0.69 0.05 NA 2.02 000 

90947 ......... ............ A Dialysis, repeated eval ................................ 2.16 NA 1.00 0.08 NA 3.24 000 

90997 ......... ............ A Hemoperfusion ............................................. 1.84 NA 0.66 0.06 NA 2.56 000 

91000 ......... ............ A Esophageal intubation ................................. 0.73 0.32 NA 0.04 1.09 NA 000 

91000 ......... 26 ....... A Esophageal intubation ................................. 0.73 0.24 0.24 0.03 1.00 1.00 000 

91000 ......... TC ...... A Esophageal intubation ................................. 0.00 0.08 NA 0.01 0.09 NA 000 

47678

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

91010 ......... ............ A Esophagus motility study ............................. 1.25 4.45 NA 0.12 5.82 NA 000 

91010 ......... 26 ....... A Esophagus motility study ............................. 1.25 0.44 0.44 0.06 1.75 1.75 000 

91010 ......... TC ...... A Esophagus motility study ............................. 0.00 4.01 NA 0.06 4.07 NA 000 

91011 ......... ............ A Esophagus motility study ............................. 1.50 5.27 NA 0.13 6.90 NA 000 

91011 ......... 26 ....... A Esophagus motility study ............................. 1.50 0.53 0.53 0.07 2.10 2.10 000 

91011 ......... TC ...... A Esophagus motility study ............................. 0.00 4.74 NA 0.06 4.80 NA 000 

91012 ......... ............ A Esophagus motility study ............................. 1.46 5.79 NA 0.14 7.39 NA 000 

91012 ......... 26 ....... A Esophagus motility study ............................. 1.46 0.51 0.51 0.07 2.04 2.04 000 

91012 ......... TC ...... A Esophagus motility study ............................. 0.00 5.28 NA 0.07 5.35 NA 000 

91020 ......... ............ A Gastric motility ............................................. 1.44 4.58 NA 0.13 6.15 NA 000 

91020 ......... 26 ....... A Gastric motility ............................................. 1.44 0.49 0.49 0.07 2.00 2.00 000 

91020 ......... TC ...... A Gastric motility ............................................. 0.00 4.10 NA 0.06 4.16 NA 000 

91030 ......... ............ A Acid perfusion of esophagus ....................... 0.91 2.45 NA 0.06 3.42 NA 000 

91030 ......... 26 ....... A Acid perfusion of esophagus ....................... 0.91 0.32 0.32 0.04 1.27 1.27 000 

91030 ......... TC ...... A Acid perfusion of esophagus ....................... 0.00 2.13 NA 0.02 2.15 NA 000 

91032 ......... ............ A Esophagus, acid reflux test ......................... 1.21 4.16 NA 0.12 5.49 NA 000 

91032 ......... 26 ....... A Esophagus, acid reflux test ......................... 1.21 0.42 0.42 0.06 1.69 1.69 000 

91032 ......... TC ...... A Esophagus, acid reflux test ......................... 0.00 3.74 NA 0.06 3.80 NA 000 

91033 ......... ............ A Prolonged acid reflux test ............................ 1.30 4.24 NA 0.18 5.72 NA 000 

91033 ......... 26 ....... A Prolonged acid reflux test ............................ 1.30 0.45 0.45 0.07 1.82 1.82 000 

91033 ......... TC ...... A Prolonged acid reflux test ............................ 0.00 3.78 NA 0.11 3.89 NA 000 

91052 ......... ............ A Gastric analysis test .................................... 0.79 2.47 NA 0.06 3.32 NA 000 

91052 ......... 26 ....... A Gastric analysis test .................................... 0.79 0.28 0.28 0.04 1.11 1.11 000 

91052 ......... TC ...... A Gastric analysis test .................................... 0.00 2.19 NA 0.02 2.21 NA 000 

91055 ......... ............ A Gastric intubation for smear ........................ 0.94 2.94 NA 0.07 3.95 NA 000 

91055 ......... 26 ....... A Gastric intubation for smear ........................ 0.94 0.27 0.27 0.05 1.26 1.26 000 

91055 ......... TC ...... A Gastric intubation for smear ........................ 0.00 2.67 NA 0.02 2.69 NA 000 

91060 ......... ............ A Gastric saline load test ................................ 0.45 1.98 NA 0.04 2.47 NA 000 

91060 ......... 26 ....... A Gastric saline load test ................................ 0.45 0.14 0.14 0.02 0.61 0.61 000 

91060 ......... TC ...... A Gastric saline load test ................................ 0.00 1.84 NA 0.02 1.86 NA 000 

91065 ......... ............ A Breath hydrogen test ................................... 0.20 1.47 NA 0.03 1.70 NA 000 

91065 ......... 26 ....... A Breath hydrogen test ................................... 0.20 0.07 0.07 0.01 0.28 0.28 000 

91065 ......... TC ...... A Breath hydrogen test ................................... 0.00 1.40 NA 0.02 1.42 NA 000 

91100 ......... ............ A Pass intestine bleeding tube ....................... 1.08 2.85 0.28 0.07 4.00 1.43 000 

91105 ......... ............ A Gastric intubation treatment ........................ 0.37 2.13 0.09 0.03 2.53 0.49 000 

91110 ......... ............ A Gi tract capsule endoscopy ......................... 3.64 22.19 NA 0.09 25.92 NA XXX 

91110 ......... 26 ....... A Gi tract capsule endoscopy ......................... 3.64 1.27 1.27 0.02 4.93 4.93 XXX 

91110 ......... TC ...... A Gi tract capsule endoscopy ......................... 0.00 20.92 NA 0.07 20.99 NA XXX 

91122 ......... ............ A Anal pressure record ................................... 1.77 5.10 NA 0.20 7.07 NA 000 

91122 ......... 26 ....... A Anal pressure record ................................... 1.77 0.60 0.60 0.12 2.49 2.49 000 

91122 ......... TC ...... A Anal pressure record ................................... 0.00 4.50 NA 0.08 4.58 NA 000 

91132 ......... 26 ....... A Electrogastrography ..................................... 0.52 0.18 0.18 0.03 0.73 0.73 XXX 

91133 ......... 26 ....... A Electrogastrography w/test .......................... 0.66 0.23 0.23 0.03 0.92 0.92 XXX 

92002 ......... ............ A Eye exam, new patient ................................ 0.88 0.97 0.34 0.02 1.87 1.24 XXX 

92004 ......... ............ A Eye exam, new patient ................................ 1.67 1.70 0.67 0.05 3.42 2.39 XXX 

92012 ......... ............ A Eye exam established pat ........................... 0.67 1.03 0.29 0.02 1.72 0.98 XXX 

92014 ......... ............ A Eye exam & treatment ................................. 1.10 1.41 0.47 0.03 2.54 1.60 XXX 

92018 ......... ............ A New eye exam & treatment ......................... 2.50 NA 1.07 0.07 NA 3.64 XXX 

92019 ......... ............ A Eye exam & treatment ................................. 1.31 NA 0.56 0.04 NA 1.91 XXX 

92020 ......... ............ A Special eye evaluation ................................. 0.37 0.34 0.16 0.01 0.72 0.54 XXX 

92060 ......... ............ A Special eye evaluation ................................. 0.69 0.74 NA 0.03 1.46 NA XXX 

92060 ......... 26 ....... A Special eye evaluation ................................. 0.69 0.29 0.29 0.02 1.00 1.00 XXX 

92060 ......... TC ...... A Special eye evaluation ................................. 0.00 0.45 NA 0.01 0.46 NA XXX 

92065 ......... ............ A Orthoptic/pleoptic training ............................ 0.37 0.55 NA 0.02 0.94 NA XXX 

92065 ......... 26 ....... A Orthoptic/pleoptic training ............................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

92065 ......... TC ...... A Orthoptic/pleoptic training ............................ 0.00 0.40 NA 0.01 0.41 NA XXX 

92070 ......... ............ A Fitting of contact lens .................................. 0.70 1.07 0.32 0.02 1.79 1.04 XXX 

92081 ......... ............ A Visual field examination(s) ........................... 0.36 0.95 NA 0.02 1.33 NA XXX 

92081 ......... 26 ....... A Visual field examination(s) ........................... 0.36 0.15 0.15 0.01 0.52 0.52 XXX 

92081 ......... TC ...... A Visual field examination(s) ........................... 0.00 0.79 NA 0.01 0.80 NA XXX 

92082 ......... ............ A Visual field examination(s) ........................... 0.44 1.23 NA 0.02 1.69 NA XXX 

92082 ......... 26 ....... A Visual field examination(s) ........................... 0.44 0.19 0.19 0.01 0.64 0.64 XXX 

92082 ......... TC ...... A Visual field examination(s) ........................... 0.00 1.05 NA 0.01 1.06 NA XXX 

92083 ......... ............ A Visual field examination(s) ........................... 0.50 1.43 NA 0.02 1.95 NA XXX 

92083 ......... 26 ....... A Visual field examination(s) ........................... 0.50 0.22 0.22 0.01 0.73 0.73 XXX 

92083 ......... TC ...... A Visual field examination(s) ........................... 0.00 1.21 NA 0.01 1.22 NA XXX 

92100 ......... ............ A Serial tonometry exam(s) ............................ 0.92 1.35 0.36 0.03 2.30 1.31 XXX 

92120 ......... ............ A Tonography & eye evaluation ...................... 0.81 1.07 0.32 0.02 1.90 1.15 XXX 

92130 ......... ............ A Water provocation tonography .................... 0.81 1.28 0.37 0.02 2.11 1.20 XXX 

92135 ......... ............ A Opthalmic dx imaging .................................. 0.35 0.80 NA 0.02 1.17 NA XXX 

92135 ......... 26 ....... A Opthalmic dx imaging .................................. 0.35 0.15 0.15 0.01 0.51 0.51 XXX 

92135 ......... TC ...... A Opthalmic dx imaging .................................. 0.00 0.65 NA 0.01 0.66 NA XXX 

92136 ......... ............ A Ophthalmic biometry .................................... 0.54 1.54 NA 0.08 2.16 NA XXX 

92136 ......... 26 ....... A Ophthalmic biometry .................................... 0.54 0.24 0.24 0.01 0.79 0.79 XXX 

92136 ......... TC ...... A Ophthalmic biometry .................................... 0.00 1.30 NA 0.07 1.37 NA XXX 

47679

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

92140 ......... ............ A Glaucoma provocative tests ........................ 0.50 0.99 0.21 0.01 1.50 0.72 XXX 

92225 ......... ............ A Special eye exam, initial .............................. 0.38 0.22 0.16 0.01 0.61 0.55 XXX 

92226 ......... ............ A Special eye exam, subsequent ................... 0.33 0.21 0.14 0.01 0.55 0.48 XXX 

92230 ......... ............ A Eye exam with photos ................................. 0.60 1.54 0.20 0.02 2.16 0.82 XXX 

92235 ......... ............ A Eye exam with photos ................................. 0.81 2.61 NA 0.08 3.50 NA XXX 

92235 ......... 26 ....... A Eye exam with photos ................................. 0.81 0.37 0.37 0.02 1.20 1.20 XXX 

92235 ......... TC ...... A Eye exam with photos ................................. 0.00 2.25 NA 0.06 2.31 NA XXX 

92240 ......... ............ A Icg angiography ........................................... 1.10 6.13 NA 0.09 7.32 NA XXX 

92240 ......... 26 ....... A Icg angiography ........................................... 1.10 0.50 0.50 0.03 1.63 1.63 XXX 

92240 ......... TC ...... A Icg angiography ........................................... 0.00 5.64 NA 0.06 5.70 NA XXX 

92250 ......... ............ A Eye exam with photos ................................. 0.44 1.53 NA 0.02 1.99 NA XXX 

92250 ......... 26 ....... A Eye exam with photos ................................. 0.44 0.19 0.19 0.01 0.64 0.64 XXX 

92250 ......... TC ...... A Eye exam with photos ................................. 0.00 1.34 NA 0.01 1.35 NA XXX 

92260 ......... ............ A Ophthalmoscopy/dynamometry ................... 0.20 0.26 0.09 0.01 0.47 0.30 XXX 

92265 ......... ............ A Eye muscle evaluation ................................. 0.81 1.51 NA 0.06 2.38 NA XXX 

92265 ......... 26 ....... A Eye muscle evaluation ................................. 0.81 0.28 0.28 0.04 1.13 1.13 XXX 

92265 ......... TC ...... A Eye muscle evaluation ................................. 0.00 1.23 NA 0.02 1.25 NA XXX 

92270 ......... ............ A Electro-oculography ..................................... 0.81 1.54 NA 0.05 2.40 NA XXX 

92270 ......... 26 ....... A Electro-oculography ..................................... 0.81 0.33 0.33 0.03 1.17 1.17 XXX 

92270 ......... TC ...... A Electro-oculography ..................................... 0.00 1.21 NA 0.02 1.23 NA XXX 

92275 ......... ............ A Electroretinography ...................................... 1.01 1.94 NA 0.05 3.00 NA XXX 

92275 ......... 26 ....... A Electroretinography ...................................... 1.01 0.43 0.43 0.03 1.47 1.47 XXX 

92275 ......... TC ...... A Electroretinography ...................................... 0.00 1.52 NA 0.02 1.54 NA XXX 

92283 ......... ............ A Color vision examination ............................. 0.17 0.84 NA 0.02 1.03 NA XXX 

92283 ......... 26 ....... A Color vision examination ............................. 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

92283 ......... TC ...... A Color vision examination ............................. 0.00 0.77 NA 0.01 0.78 NA XXX 

92284 ......... ............ A Dark adaptation eye exam .......................... 0.24 1.88 NA 0.02 2.14 NA XXX 

92284 ......... 26 ....... A Dark adaptation eye exam .......................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

92284 ......... TC ...... A Dark adaptation eye exam .......................... 0.00 1.80 NA 0.01 1.81 NA XXX 

92285 ......... ............ A Eye photography .......................................... 0.20 0.99 NA 0.02 1.21 NA XXX 

92285 ......... 26 ....... A Eye photography .......................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX 

92285 ......... TC ...... A Eye photography .......................................... 0.00 0.91 NA 0.01 0.92 NA XXX 

92286 ......... ............ A Internal eye photography ............................. 0.66 3.07 NA 0.04 3.77 NA XXX 

92286 ......... 26 ....... A Internal eye photography ............................. 0.66 0.29 0.29 0.02 0.97 0.97 XXX 

92286 ......... TC ...... A Internal eye photography ............................. 0.00 2.78 NA 0.02 2.80 NA XXX 

92287 ......... ............ A Internal eye photography ............................. 0.81 2.39 0.31 0.02 3.22 1.14 XXX 

92311 ......... ............ A Contact lens fitting ....................................... 1.08 1.10 0.35 0.04 2.22 1.47 XXX 

92312 ......... ............ A Contact lens fitting ....................................... 1.26 1.08 0.49 0.04 2.38 1.79 XXX 

92313 ......... ............ A Contact lens fitting ....................................... 0.92 1.07 0.28 0.02 2.01 1.22 XXX 

92315 ......... ............ A Prescription of contact lens ......................... 0.45 0.85 0.16 0.01 1.31 0.62 XXX 

92316 ......... ............ A Prescription of contact lens ......................... 0.68 0.91 0.29 0.02 1.61 0.99 XXX 

92317 ......... ............ A Prescription of contact lens ......................... 0.45 0.94 0.15 0.01 1.40 0.61 XXX 

92325 ......... ............ A Modification of contact lens ......................... 0.00 0.40 NA 0.01 0.41 NA XXX 

92326 ......... ............ A Replacement of contact lens ....................... 0.00 1.63 NA 0.06 1.69 NA XXX 

92330 ......... ............ A Fitting of artificial eye ................................... 1.08 0.99 0.32 0.03 2.10 1.43 XXX 

92335 ......... ............ A Fitting of artificial eye ................................... 0.45 0.91 0.16 0.02 1.38 0.63 XXX 

92352 ......... ............ B Special spectacles fitting ............................. 0.37 0.68 0.14 0.01 1.06 0.52 XXX 

92353 ......... ............ B Special spectacles fitting ............................. 0.50 0.73 0.19 0.02 1.25 0.71 XXX 

92354 ......... ............ B Special spectacles fitting ............................. 0.00 8.84 NA 0.10 8.94 NA XXX 

92355 ......... ............ B Special spectacles fitting ............................. 0.00 4.32 NA 0.01 4.33 NA XXX 

92358 ......... ............ B Eye prosthesis service ................................. 0.00 0.97 NA 0.05 1.02 NA XXX 

92371 ......... ............ B Repair & adjust spectacles .......................... 0.00 0.62 NA 0.02 0.64 NA XXX 

92502 ......... ............ A Ear and throat examination ......................... 1.51 NA 1.11 0.05 NA 2.67 000 

92504 ......... ............ A Ear microscopy examination ....................... 0.18 0.50 0.09 0.01 0.69 0.28 XXX 

92506 ......... ............ A Speech/hearing evaluation .......................... 0.86 2.60 0.40 0.03 3.49 1.29 XXX 

92507 ......... ............ A Speech/hearing therapy ............................... 0.52 1.12 0.23 0.02 1.66 0.77 XXX 

92508 ......... ............ A Speech/hearing therapy ............................... 0.26 0.51 0.12 0.01 0.78 0.39 XXX 

92511 ......... ............ A Nasopharyngoscopy .................................... 0.84 3.32 0.78 0.03 4.19 1.65 000 

92512 ......... ............ A Nasal function studies ................................. 0.55 1.14 0.18 0.02 1.71 0.75 XXX 

92516 ......... ............ A Facial nerve function test ............................ 0.43 1.17 0.22 0.02 1.62 0.67 XXX 

92520 ......... ............ A Laryngeal function studies ........................... 0.76 0.51 0.39 0.03 1.30 1.18 XXX 

92526 ......... ............ A Oral function therapy ................................... 0.55 1.64 0.20 0.02 2.21 0.77 XXX 

92541 ......... ............ A Spontaneous nystagmus test ...................... 0.40 1.03 NA 0.04 1.47 NA XXX 

92541 ......... 26 ....... A Spontaneous nystagmus test ...................... 0.40 0.19 0.19 0.02 0.61 0.61 XXX 

92541 ......... TC ...... A Spontaneous nystagmus test ...................... 0.00 0.84 NA 0.02 0.86 NA XXX 

92542 ......... ............ A Positional nystagmus test ............................ 0.33 1.14 NA 0.03 1.50 NA XXX 

92542 ......... 26 ....... A Positional nystagmus test ............................ 0.33 0.16 0.16 0.01 0.50 0.50 XXX 

92542 ......... TC ...... A Positional nystagmus test ............................ 0.00 0.98 NA 0.02 1.00 NA XXX 

92543 ......... ............ A Caloric vestibular test .................................. 0.10 0.57 NA 0.01 0.68 NA XXX 

92543 ......... 26 ....... A Caloric vestibular test .................................. 0.10 0.05 0.05 0.00 0.15 0.15 XXX 

92543 ......... TC ...... A Caloric vestibular test .................................. 0.00 0.52 NA 0.01 0.53 NA XXX 

92544 ......... ............ A Optokinetic nystagmus test ......................... 0.26 0.90 NA 0.03 1.19 NA XXX 

92544 ......... 26 ....... A Optokinetic nystagmus test ......................... 0.26 0.12 0.12 0.01 0.39 0.39 XXX 

92544 ......... TC ...... A Optokinetic nystagmus test ......................... 0.00 0.78 NA 0.02 0.80 NA XXX 

92545 ......... ............ A Oscillating tracking test ................................ 0.23 0.80 NA 0.03 1.06 NA XXX 

47680

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

92545 ......... 26 ....... A Oscillating tracking test ................................ 0.23 0.11 0.11 0.01 0.35 0.35 XXX 

92545 ......... TC ...... A Oscillating tracking test ................................ 0.00 0.69 NA 0.02 0.71 NA XXX 

92546 ......... ............ A Sinusoidal rotational test ............................. 0.29 1.99 NA 0.03 2.31 NA XXX 

92546 ......... 26 ....... A Sinusoidal rotational test ............................. 0.29 0.13 0.13 0.01 0.43 0.43 XXX 

92546 ......... TC ...... A Sinusoidal rotational test ............................. 0.00 1.86 NA 0.02 1.88 NA XXX 

92547 ......... ............ A Supplemental electrical test ......................... 0.00 0.08 NA 0.06 0.14 NA ZZZ 

92548 ......... ............ A Posturography .............................................. 0.50 2.26 NA 0.15 2.91 NA XXX 

92548 ......... 26 ....... A Posturography .............................................. 0.50 0.26 0.26 0.02 0.78 0.78 XXX 

92548 ......... TC ...... A Posturography .............................................. 0.00 2.00 NA 0.13 2.13 NA XXX 

92552 ......... ............ A Pure tone audiometry, air ............................ 0.00 0.44 NA 0.04 0.48 NA XXX 

92553 ......... ............ A Audiometry, air & bone ................................ 0.00 0.66 NA 0.06 0.72 NA XXX 

92555 ......... ............ A Speech threshold audiometry ...................... 0.00 0.38 NA 0.04 0.42 NA XXX 

92556 ......... ............ A Speech audiometry, complete ..................... 0.00 0.57 NA 0.06 0.63 NA XXX 

92557 ......... ............ A Comprehensive hearing test ........................ 0.00 1.19 NA 0.12 1.31 NA XXX 

92561 ......... ............ A Bekesy audiometry, diagnosis ..................... 0.00 0.71 NA 0.06 0.77 NA XXX 

92562 ......... ............ A Loudness balance test ................................. 0.00 0.41 NA 0.04 0.45 NA XXX 

92563 ......... ............ A Tone decay hearing test .............................. 0.00 0.38 NA 0.04 0.42 NA XXX 

92564 ......... ............ A Sisi hearing test ........................................... 0.00 0.47 NA 0.05 0.52 NA XXX 

92565 ......... ............ A Stenger test, pure tone ................................ 0.00 0.40 NA 0.04 0.44 NA XXX 

92567 ......... ............ A Tympanometry ............................................. 0.00 0.52 NA 0.06 0.58 NA XXX 

92568 ......... ............ A Acoustic reflex testing .................................. 0.00 0.38 NA 0.04 0.42 NA XXX 

92569 ......... ............ A Acoustic reflex decay test ............................ 0.00 0.41 NA 0.04 0.45 NA XXX 

92571 ......... ............ A Filtered speech hearing test ........................ 0.00 0.39 NA 0.04 0.43 NA XXX 

92572 ......... ............ A Staggered spondaic word test ..................... 0.00 0.09 NA 0.01 0.10 NA XXX 

92573 ......... ............ A Lombard test ................................................ 0.00 0.35 NA 0.04 0.39 NA XXX 

92575 ......... ............ A Sensorineural acuity test ............................. 0.00 0.30 NA 0.02 0.32 NA XXX 

92576 ......... ............ A Synthetic sentence test ............................... 0.00 0.44 NA 0.05 0.49 NA XXX 

92577 ......... ............ A Stenger test, speech .................................... 0.00 0.71 NA 0.07 0.78 NA XXX 

92579 ......... ............ A Visual audiometry (vra) ................................ 0.00 0.72 NA 0.06 0.78 NA XXX 

92582 ......... ............ A Conditioning play audiometry ...................... 0.00 0.72 NA 0.06 0.78 NA XXX 

92583 ......... ............ A Select picture audiometry ............................ 0.00 0.89 NA 0.08 0.97 NA XXX 

92584 ......... ............ A Electrocochleography .................................. 0.00 2.47 NA 0.21 2.68 NA XXX 

92585 ......... ............ A Auditor evoke potent, compre ..................... 0.50 2.06 NA 0.17 2.73 NA XXX 

92585 ......... 26 ....... A Auditor evoke potent, compre ..................... 0.50 0.21 0.21 0.03 0.74 0.74 XXX 

92585 ......... TC ...... A Auditor evoke potent, compre ..................... 0.00 1.84 NA 0.14 1.98 NA XXX 

92586 ......... ............ A Auditor evoke potent, limit ........................... 0.00 1.84 NA 0.14 1.98 NA XXX 

92587 ......... ............ A Evoked auditory test .................................... 0.13 1.37 NA 0.11 1.61 NA XXX 

92587 ......... 26 ....... A Evoked auditory test .................................... 0.13 0.06 0.06 0.00 0.19 0.19 XXX 

92587 ......... TC ...... A Evoked auditory test .................................... 0.00 1.30 NA 0.11 1.41 NA XXX 

92588 ......... ............ A Evoked auditory test .................................... 0.36 1.63 NA 0.14 2.13 NA XXX 

92588 ......... 26 ....... A Evoked auditory test .................................... 0.36 0.16 0.16 0.01 0.53 0.53 XXX 

92588 ......... TC ...... A Evoked auditory test .................................... 0.00 1.47 NA 0.13 1.60 NA XXX 

92589 ......... ............ A Auditory function test(s) ............................... 0.00 0.53 NA 0.06 0.59 NA XXX 

92596 ......... ............ A Ear protector evaluation .............................. 0.00 0.59 NA 0.06 0.65 NA XXX 

92597 ......... ............ A Oral speech device eval .............................. 0.86 1.69 0.45 0.05 2.60 1.36 XXX 

92601 ......... ............ A Cochlear implt f/up exam < 7 ...................... 0.00 3.51 NA 0.05 3.56 NA XXX 

92602 ......... ............ A Reprogram cochlear implt < 7 ..................... 0.00 2.38 NA 0.05 2.43 NA XXX 

92603 ......... ............ A Cochlear implt f/up exam 7 > ...................... 0.00 2.15 NA 0.05 2.20 NA XXX 

92604 ......... ............ A Reprogram cochlear implt 7 > ..................... 0.00 1.35 NA 0.05 1.40 NA XXX 

92607 ......... ............ A Ex for speech device rx, 1hr ....................... 0.00 3.08 NA 0.04 3.12 NA XXX 

92608 ......... ............ A Ex for speech device rx addl ....................... 0.00 0.56 NA 0.04 0.60 NA XXX 

92609 ......... ............ A Use of speech device service ..................... 0.00 1.65 NA 0.03 1.68 NA XXX 

92610 ......... ............ A Evaluate swallowing function ....................... 0.00 3.43 NA 0.06 3.49 NA XXX 

92611 ......... ............ A Motion fluoroscopy/swallow ......................... 0.00 3.43 NA 0.07 3.50 NA XXX 

92612 ......... ............ A Endoscopy swallow tst (fees) ...................... 1.27 2.75 0.66 0.08 4.10 2.01 XXX 

92613 ......... ............ A Endoscopy swallow tst (fees) ...................... 0.71 0.40 0.39 0.05 1.16 1.15 XXX 

92614 ......... ............ A Laryngoscopic sensory test ......................... 1.27 2.00 0.66 0.08 3.35 2.01 XXX 

92615 ......... ............ A Eval laryngoscopy sense tst ........................ 0.63 0.35 0.35 0.05 1.03 1.03 XXX 

92616 ......... ............ A Fees w/laryngeal sense test ........................ 1.88 2.67 0.99 0.08 4.63 2.95 XXX 

92617 ......... ............ A Interprt fees/laryngeal test ........................... 0.79 0.44 0.44 0.05 1.28 1.28 XXX 

92950 ......... ............ A Heart/lung resuscitation cpr ......................... 3.79 4.25 0.97 0.26 8.30 5.02 000 

92953 ......... ............ A Temporary external pacing .......................... 0.23 NA 0.07 0.01 NA 0.31 000 

92960 ......... ............ A Cardioversion electric, ext ........................... 2.25 6.45 1.17 0.08 8.78 3.50 000 

92961 ......... ............ A Cardioversion, electric, int ........................... 4.59 NA 2.07 0.27 NA 6.93 000 

92970 ......... ............ A Cardioassist, internal ................................... 3.51 NA 1.05 0.19 NA 4.75 000 

92971 ......... ............ A Cardioassist, external .................................. 1.77 NA 0.85 0.06 NA 2.68 000 

92973 ......... ............ A Percut coronary thrombectomy ................... 3.28 NA 1.29 0.11 NA 4.68 ZZZ 

92974 ......... ............ A Cath place, cardio brachytx ......................... 3.00 NA 1.18 0.10 NA 4.28 ZZZ 

92975 ......... ............ A Dissolve clot, heart vessel ........................... 7.24 NA 2.80 0.23 NA 10.27 000 

92977 ......... ............ A Dissolve clot, heart vessel ........................... 0.00 8.04 NA 0.46 8.50 NA XXX 

92978 ......... ............ A Intravasc us, heart add-on ........................... 1.80 5.26 NA 0.30 7.36 NA ZZZ 

92978 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.80 0.71 0.71 0.06 2.57 2.57 ZZZ 

92978 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 4.56 NA 0.24 4.80 NA ZZZ 

92979 ......... ............ A Intravasc us, heart add-on ........................... 1.44 2.85 NA 0.20 4.49 NA ZZZ 

92979 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.44 0.56 0.56 0.07 2.07 2.07 ZZZ 

47681

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

92979 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 2.29 NA 0.13 2.42 NA ZZZ 

92980 ......... ............ A Insert intracoronary stent ............................. 14.82 NA 6.03 1.04 NA 21.89 000 

92981 ......... ............ A Insert intracoronary stent ............................. 4.16 NA 1.63 0.29 NA 6.08 ZZZ 

92982 ......... ............ A Coronary artery dilation ............................... 10.96 NA 4.52 0.77 NA 16.25 000 

92984 ......... ............ A Coronary artery dilation ............................... 2.97 NA 1.16 0.21 NA 4.34 ZZZ 

92986 ......... ............ A Revision of aortic valve ............................... 21.77 NA 11.85 1.52 NA 35.14 090 

92987 ......... ............ A Revision of mitral valve ............................... 22.67 NA 12.23 1.58 NA 36.48 090 

92990 ......... ............ A Revision of pulmonary valve ....................... 17.31 NA 9.83 1.21 NA 28.35 090 

92995 ......... ............ A Coronary atherectomy ................................. 12.07 NA 4.95 0.84 NA 17.86 000 

92996 ......... ............ A Coronary atherectomy add-on ..................... 3.26 NA 1.27 0.23 NA 4.76 ZZZ 

92997 ......... ............ A Pul art balloon repr, percut .......................... 11.98 NA 4.81 0.84 NA 17.63 000 

92998 ......... ............ A Pul art balloon repr, percut .......................... 5.99 NA 2.20 0.42 NA 8.61 ZZZ 

93000 ......... ............ A Electrocardiogram, complete ....................... 0.17 0.51 NA 0.03 0.71 NA XXX 

93005 ......... ............ A Electrocardiogram, tracing ........................... 0.00 0.45 NA 0.02 0.47 NA XXX 

93010 ......... ............ A Electrocardiogram report ............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

93012 ......... ............ A Transmission of ecg .................................... 0.00 6.00 NA 0.18 6.18 NA XXX 

93014 ......... ............ A Report on transmitted ecg ........................... 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93015 ......... ............ A Cardiovascular stress test ........................... 0.75 1.96 NA 0.14 2.85 NA XXX 

93016 ......... ............ A Cardiovascular stress test ........................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX 

93017 ......... ............ A Cardiovascular stress test ........................... 0.00 1.68 NA 0.11 1.79 NA XXX 

93018 ......... ............ A Cardiovascular stress test ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

93024 ......... ............ A Cardiac drug stress test .............................. 1.17 1.57 NA 0.13 2.87 NA XXX 

93024 ......... 26 ....... A Cardiac drug stress test .............................. 1.17 0.45 0.45 0.05 1.67 1.67 XXX 

93024 ......... TC ...... A Cardiac drug stress test .............................. 0.00 1.12 NA 0.08 1.20 NA XXX 

93025 ......... ............ A Microvolt t-wave assess .............................. 0.75 7.84 NA 0.14 8.73 NA XXX 

93025 ......... 26 ....... A Microvolt t-wave assess .............................. 0.75 0.29 0.29 0.03 1.07 1.07 XXX 

93025 ......... TC ...... A Microvolt t-wave assess .............................. 0.00 7.55 NA 0.11 7.66 NA XXX 

93040 ......... ............ A Rhythm ECG with report ............................. 0.16 0.19 NA 0.02 0.37 NA XXX 

93041 ......... ............ A Rhythm ECG, tracing ................................... 0.00 0.14 NA 0.01 0.15 NA XXX 

93042 ......... ............ A Rhythm ECG, report .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93224 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.61 NA 0.24 4.37 NA XXX 

93225 ......... ............ A ECG monitor/record, 24 hrs ........................ 0.00 1.24 NA 0.08 1.32 NA XXX 

93226 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.18 NA 0.14 2.32 NA XXX 

93227 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93230 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.88 NA 0.26 4.66 NA XXX 

93231 ......... ............ A Ecg monitor/record, 24 hrs .......................... 0.00 1.52 NA 0.11 1.63 NA XXX 

93232 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.17 NA 0.13 2.30 NA XXX 

93233 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93235 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.45 2.78 NA 0.16 3.39 NA XXX 

93236 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

93237 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

93268 ......... ............ A ECG record/review ...................................... 0.52 7.43 NA 0.28 8.23 NA XXX 

93270 ......... ............ A ECG recording ............................................. 0.00 1.24 NA 0.08 1.32 NA XXX 

93271 ......... ............ A Ecg/monitoring and analysis ........................ 0.00 6.00 NA 0.18 6.18 NA XXX 

93272 ......... ............ A Ecg/review, interpret only ............................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93278 ......... ............ A ECG/signal-averaged ................................... 0.25 1.24 NA 0.12 1.61 NA XXX 

93278 ......... 26 ....... A ECG/signal-averaged ................................... 0.25 0.10 0.10 0.01 0.36 0.36 XXX 

93278 ......... TC ...... A ECG/signal-averaged ................................... 0.00 1.15 NA 0.11 1.26 NA XXX 

93303 ......... ............ A Echo transthoracic ....................................... 1.30 4.33 NA 0.28 5.91 NA XXX 

93303 ......... 26 ....... A Echo transthoracic ....................................... 1.30 0.48 0.48 0.05 1.83 1.83 XXX 

93303 ......... TC ...... A Echo transthoracic ....................................... 0.00 3.85 NA 0.23 4.08 NA XXX 

93304 ......... ............ A Echo transthoracic ....................................... 0.75 2.22 NA 0.16 3.13 NA XXX 

93304 ......... 26 ....... A Echo transthoracic ....................................... 0.75 0.28 0.28 0.03 1.06 1.06 XXX 

93304 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.94 NA 0.13 2.07 NA XXX 

93307 ......... ............ A Echo exam of heart ..................................... 0.92 4.20 NA 0.26 5.38 NA XXX 

93307 ......... 26 ....... A Echo exam of heart ..................................... 0.92 0.35 0.35 0.03 1.30 1.30 XXX 

93307 ......... TC ...... A Echo exam of heart ..................................... 0.00 3.85 NA 0.23 4.08 NA XXX 

93308 ......... ............ A Echo exam of heart ..................................... 0.53 2.14 NA 0.15 2.82 NA XXX 

93308 ......... 26 ....... A Echo exam of heart ..................................... 0.53 0.20 0.20 0.02 0.75 0.75 XXX 

93308 ......... TC ...... A Echo exam of heart ..................................... 0.00 1.94 NA 0.13 2.07 NA XXX 

93312 ......... ............ A Echo transesophageal ................................. 2.20 4.56 NA 0.37 7.13 NA XXX 

93312 ......... 26 ....... A Echo transesophageal ................................. 2.20 0.79 0.79 0.08 3.07 3.07 XXX 

93312 ......... TC ...... A Echo transesophageal ................................. 0.00 3.77 NA 0.29 4.06 NA XXX 

93313 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.21 0.06 NA 1.22 XXX 

93314 ......... ............ A Echo transesophageal ................................. 1.25 4.24 NA 0.34 5.83 NA XXX 

93314 ......... 26 ....... A Echo transesophageal ................................. 1.25 0.47 0.47 0.05 1.77 1.77 XXX 

93314 ......... TC ...... A Echo transesophageal ................................. 0.00 3.77 NA 0.29 4.06 NA XXX 

93315 ......... 26 ....... A Echo transesophageal ................................. 2.78 1.01 1.01 0.13 3.92 3.92 XXX 

93316 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.23 0.05 NA 1.23 XXX 

93317 ......... 26 ....... A Echo transesophageal ................................. 1.83 0.66 0.66 0.09 2.58 2.58 XXX 

93318 ......... 26 ....... A Echo transesophageal intraop ..................... 2.20 0.48 0.48 0.13 2.81 2.81 XXX 

93320 ......... ............ A Doppler echo exam, heart ........................... 0.38 1.85 NA 0.13 2.36 NA ZZZ 

93320 ......... 26 ....... A Doppler echo exam, heart ........................... 0.38 0.15 0.15 0.01 0.54 0.54 ZZZ 

93320 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.71 NA 0.12 1.83 NA ZZZ 

93321 ......... ............ A Doppler echo exam, heart ........................... 0.15 1.17 NA 0.09 1.41 NA ZZZ 

47682

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

93321 ......... 26 ....... A Doppler echo exam, heart ........................... 0.15 0.06 0.06 0.01 0.22 0.22 ZZZ 

93321 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.11 NA 0.08 1.19 NA ZZZ 

93325 ......... ............ A Doppler color flow add-on ........................... 0.07 2.92 NA 0.21 3.20 NA ZZZ 

93325 ......... 26 ....... A Doppler color flow add-on ........................... 0.07 0.03 0.03 0.00 0.10 0.10 ZZZ 

93325 ......... TC ...... A Doppler color flow add-on ........................... 0.00 2.90 NA 0.21 3.11 NA ZZZ 

93350 ......... ............ A Echo transthoracic ....................................... 1.48 2.32 NA 0.18 3.98 NA XXX 

93350 ......... 26 ....... A Echo transthoracic ....................................... 1.48 0.57 0.57 0.05 2.10 2.10 XXX 

93350 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.76 NA 0.13 1.89 NA XXX 

93501 ......... ............ A Right heart catheterization ........................... 3.02 18.02 NA 1.26 22.30 NA 000 

93501 ......... 26 ....... A Right heart catheterization ........................... 3.02 1.15 1.15 0.21 4.38 4.38 000 

93501 ......... TC ...... A Right heart catheterization ........................... 0.00 16.87 NA 1.05 17.92 NA 000 

93503 ......... ............ A Insert/place heart catheter ........................... 2.91 NA 0.68 0.20 NA 3.79 000 

93505 ......... ............ A Biopsy of heart lining ................................... 4.37 3.66 NA 0.48 8.51 NA 000 

93505 ......... 26 ....... A Biopsy of heart lining ................................... 4.37 1.68 1.68 0.32 6.37 6.37 000 

93505 ......... TC ...... A Biopsy of heart lining ................................... 0.00 1.98 NA 0.16 2.14 NA 000 

93508 ......... ............ A Cath placement, angiography ...................... 4.09 14.65 NA 0.94 19.68 NA 000 

93508 ......... 26 ....... A Cath placement, angiography ...................... 4.09 2.07 2.07 0.29 6.45 6.45 000 

93508 ......... TC ...... A Cath placement, angiography ...................... 0.00 12.58 NA 0.65 13.23 NA 000 

93510 ......... ............ A Left heart catheterization ............................. 4.32 39.06 NA 2.60 45.98 NA 000 

93510 ......... 26 ....... A Left heart catheterization ............................. 4.32 2.17 2.17 0.30 6.79 6.79 000 

93510 ......... TC ...... A Left heart catheterization ............................. 0.00 36.89 NA 2.30 39.19 NA 000 

93511 ......... ............ A Left heart catheterization ............................. 5.02 38.35 NA 2.58 45.95 NA 000 

93511 ......... 26 ....... A Left heart catheterization ............................. 5.02 2.44 2.44 0.35 7.81 7.81 000 

93511 ......... TC ...... A Left heart catheterization ............................. 0.00 35.91 NA 2.23 38.14 NA 000 

93514 ......... ............ A Left heart catheterization ............................. 7.04 39.03 NA 2.72 48.79 NA 000 

93514 ......... 26 ....... A Left heart catheterization ............................. 7.04 3.12 3.12 0.49 10.65 10.65 000 

93514 ......... TC ...... A Left heart catheterization ............................. 0.00 35.91 NA 2.23 38.14 NA 000 

93524 ......... ............ A Left heart catheterization ............................. 6.94 50.10 NA 3.42 60.46 NA 000 

93524 ......... 26 ....... A Left heart catheterization ............................. 6.94 3.17 3.17 0.49 10.60 10.60 000 

93524 ......... TC ...... A Left heart catheterization ............................. 0.00 46.93 NA 2.93 49.86 NA 000 

93526 ......... ............ A Rt & Lt heart catheters ................................ 5.98 51.02 NA 3.44 60.44 NA 000 

93526 ......... 26 ....... A Rt & Lt heart catheters ................................ 5.98 2.81 2.81 0.42 9.21 9.21 000 

93526 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 48.21 NA 3.02 51.23 NA 000 

93527 ......... ............ A Rt & Lt heart catheters ................................ 7.27 50.24 NA 3.44 60.95 NA 000 

93527 ......... 26 ....... A Rt & Lt heart catheters ................................ 7.27 3.31 3.31 0.51 11.09 11.09 000 

93527 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 46.93 NA 2.93 49.86 NA 000 

93528 ......... ............ A Rt & Lt heart catheters ................................ 8.99 50.95 NA 3.56 63.50 NA 000 

93528 ......... 26 ....... A Rt & Lt heart catheters ................................ 8.99 4.02 4.02 0.63 13.64 13.64 000 

93528 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 46.93 NA 2.93 49.86 NA 000 

93529 ......... ............ A Rt, lt heart catheterization ........................... 4.79 49.20 NA 3.26 57.25 NA 000 

93529 ......... 26 ....... A Rt, lt heart catheterization ........................... 4.79 2.27 2.27 0.33 7.39 7.39 000 

93529 ......... TC ...... A Rt, lt heart catheterization ........................... 0.00 46.93 NA 2.93 49.86 NA 000 

93530 ......... ............ A Rt heart cath, congenital ............................. 4.22 18.80 NA 1.35 24.37 NA 000 

93530 ......... 26 ....... A Rt heart cath, congenital ............................. 4.22 1.93 1.93 0.30 6.45 6.45 000 

93530 ......... TC ...... A Rt heart cath, congenital ............................. 0.00 16.87 NA 1.05 17.92 NA 000 

93531 ......... ............ A R & l heart cath, congenital ......................... 8.34 51.79 NA 3.60 63.73 NA 000 

93531 ......... 26 ....... A R & l heart cath, congenital ......................... 8.34 3.58 3.58 0.58 12.50 12.50 000 

93531 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 48.21 NA 3.02 51.23 NA 000 

93532 ......... ............ A R & l heart cath, congenital ......................... 9.99 51.17 NA 3.63 64.79 NA 000 

93532 ......... 26 ....... A R & l heart cath, congenital ......................... 9.99 4.25 4.25 0.70 14.94 14.94 000 

93532 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 46.93 NA 2.93 49.86 NA 000 

93533 ......... ............ A R & l heart cath, congenital ......................... 6.69 49.72 NA 3.40 59.81 NA 000 

93533 ......... 26 ....... A R & l heart cath, congenital ......................... 6.69 2.80 2.80 0.47 9.96 9.96 000 

93533 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 46.93 NA 2.93 49.86 NA 000 

93539 ......... ............ A Injection, cardiac cath .................................. 0.40 NA 0.16 0.01 NA 0.57 000 

93540 ......... ............ A Injection, cardiac cath .................................. 0.43 NA 0.17 0.01 NA 0.61 000 

93541 ......... ............ A Injection for lung angiogram ........................ 0.29 NA 0.11 0.01 NA 0.41 000 

93542 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.11 0.01 NA 0.41 000 

93543 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.11 0.01 NA 0.41 000 

93544 ......... ............ A Injection for aortography .............................. 0.25 NA 0.10 0.01 NA 0.36 000 

93545 ......... ............ A Inject for coronary x-rays ............................. 0.40 NA 0.16 0.01 NA 0.57 000 

93555 ......... ............ A Imaging, cardiac cath .................................. 0.81 6.58 NA 0.37 7.76 NA XXX 

93555 ......... 26 ....... A Imaging, cardiac cath .................................. 0.81 0.32 0.32 0.03 1.16 1.16 XXX 

93555 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 6.26 NA 0.34 6.60 NA XXX 

93556 ......... ............ A Imaging, cardiac cath .................................. 0.83 10.20 NA 0.54 11.57 NA XXX 

93556 ......... 26 ....... A Imaging, cardiac cath .................................. 0.83 0.32 0.32 0.03 1.18 1.18 XXX 

93556 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 9.87 NA 0.51 10.38 NA XXX 

93561 ......... ............ A Cardiac output measurement ...................... 0.50 0.68 NA 0.09 1.27 NA 000 

93561 ......... 26 ....... A Cardiac output measurement ...................... 0.50 0.16 0.16 0.03 0.69 0.69 000 

93561 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.52 NA 0.06 0.58 NA 000 

93562 ......... ............ A Cardiac output measurement ...................... 0.16 0.37 NA 0.05 0.58 NA 000 

93562 ......... 26 ....... A Cardiac output measurement ...................... 0.16 0.05 0.05 0.01 0.22 0.22 000 

93562 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.32 NA 0.04 0.36 NA 000 

93571 ......... ............ A Heart flow reserve measure ........................ 1.80 5.24 NA 0.30 7.34 NA ZZZ 

93571 ......... 26 ....... A Heart flow reserve measure ........................ 1.80 0.68 0.68 0.06 2.54 2.54 ZZZ 

47683

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

93571 ......... TC ...... A Heart flow reserve measure ........................ 0.00 4.56 NA 0.24 4.80 NA ZZZ 

93572 ......... ............ A Heart flow reserve measure ........................ 1.44 2.79 NA 0.18 4.41 NA ZZZ 

93572 ......... 26 ....... A Heart flow reserve measure ........................ 1.44 0.50 0.50 0.05 1.99 1.99 ZZZ 

93572 ......... TC ...... A Heart flow reserve measure ........................ 0.00 2.29 NA 0.13 2.42 NA ZZZ 

93580 ......... ............ A Transcath closure of asd ............................. 17.97 NA 7.37 1.37 NA 26.71 000 

93581 ......... ............ A Transcath closure of vsd ............................. 24.39 NA 9.38 1.37 NA 35.14 000 

93600 ......... ............ A Bundle of His recording ............................... 2.12 2.78 NA 0.29 5.19 NA 000 

93600 ......... 26 ....... A Bundle of His recording ............................... 2.12 0.83 0.83 0.16 3.11 3.11 000 

93600 ......... TC ...... A Bundle of His recording ............................... 0.00 1.95 NA 0.13 2.08 NA 000 

93602 ......... ............ A Intra-atrial recording ..................................... 2.12 1.93 NA 0.24 4.29 NA 000 

93602 ......... 26 ....... A Intra-atrial recording ..................................... 2.12 0.82 0.82 0.17 3.11 3.11 000 

93602 ......... TC ...... A Intra-atrial recording ..................................... 0.00 1.11 NA 0.07 1.18 NA 000 

93603 ......... ............ A Right ventricular recording ........................... 2.12 2.49 NA 0.29 4.90 NA 000 

93603 ......... 26 ....... A Right ventricular recording ........................... 2.12 0.81 0.81 0.18 3.11 3.11 000 

93603 ......... TC ...... A Right ventricular recording ........................... 0.00 1.68 NA 0.11 1.79 NA 000 

93609 ......... ............ A Map tachycardia, add-on ............................. 4.99 4.65 NA 0.50 10.14 NA ZZZ 

93609 ......... 26 ....... A Map tachycardia, add-on ............................. 4.99 1.94 1.94 0.33 7.26 7.26 ZZZ 

93609 ......... TC ...... A Map tachycardia, add-on ............................. 0.00 2.71 NA 0.17 2.88 NA ZZZ 

93610 ......... ............ A Intra-atrial pacing ......................................... 3.02 2.51 NA 0.35 5.88 NA 000 

93610 ......... 26 ....... A Intra-atrial pacing ......................................... 3.02 1.16 1.16 0.25 4.43 4.43 000 

93610 ......... TC ...... A Intra-atrial pacing ......................................... 0.00 1.35 NA 0.10 1.45 NA 000 

93612 ......... ............ A Intraventricular pacing ................................. 3.02 2.77 NA 0.36 6.15 NA 000 

93612 ......... 26 ....... A Intraventricular pacing ................................. 3.02 1.16 1.16 0.25 4.43 4.43 000 

93612 ......... TC ...... A Intraventricular pacing ................................. 0.00 1.61 NA 0.11 1.72 NA 000 

93613 ......... ............ A Electrophys map 3d, add-on ....................... 6.99 NA 2.75 0.63 NA 10.37 ZZZ 

93615 ......... ............ A Esophageal recording .................................. 0.99 0.58 NA 0.05 1.62 NA 000 

93615 ......... 26 ....... A Esophageal recording .................................. 0.99 0.27 0.27 0.03 1.29 1.29 000 

93615 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 

93616 ......... ............ A Esophageal recording .................................. 1.49 0.74 NA 0.10 2.33 NA 000 

93616 ......... 26 ....... A Esophageal recording .................................. 1.49 0.43 0.43 0.08 2.00 2.00 000 

93616 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 

93618 ......... ............ A Heart rhythm pacing .................................... 4.25 5.62 NA 0.54 10.41 NA 000 

93618 ......... 26 ....... A Heart rhythm pacing .................................... 4.25 1.66 1.66 0.30 6.21 6.21 000 

93618 ......... TC ...... A Heart rhythm pacing .................................... 0.00 3.96 NA 0.24 4.20 NA 000 

93619 ......... ............ A Electrophysiology evaluation ....................... 7.31 10.87 NA 0.98 19.16 NA 000 

93619 ......... 26 ....... A Electrophysiology evaluation ....................... 7.31 3.18 3.18 0.51 11.00 11.00 000 

93619 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.69 NA 0.47 8.16 NA 000 

93620 ......... 26 ....... A Electrophysiology evaluation ....................... 11.57 4.83 4.83 0.81 17.21 17.21 000 

93621 ......... 26 ....... A Electrophysiology evaluation ....................... 2.10 0.82 0.82 0.15 3.07 3.07 ZZZ 

93622 ......... 26 ....... A Electrophysiology evaluation ....................... 3.10 1.20 1.20 0.22 4.52 4.52 ZZZ 

93623 ......... 26 ....... A Stimulation, pacing heart ............................. 2.85 1.11 1.11 0.20 4.16 4.16 ZZZ 

93624 ......... ............ A Electrophysiologic study .............................. 4.80 4.17 NA 0.47 9.44 NA 000 

93624 ......... 26 ....... A Electrophysiologic study .............................. 4.80 2.19 2.19 0.34 7.33 7.33 000 

93624 ......... TC ...... A Electrophysiologic study .............................. 0.00 1.98 NA 0.13 2.11 NA 000 

93631 ......... ............ A Heart pacing, mapping ................................ 7.59 8.90 NA 1.47 17.96 NA 000 

93631 ......... 26 ....... A Heart pacing, mapping ................................ 7.59 2.76 2.76 0.85 11.20 11.20 000 

93631 ......... TC ...... A Heart pacing, mapping ................................ 0.00 6.14 NA 0.62 6.76 NA 000 

93640 ......... ............ A Evaluation heart device ............................... 3.51 8.52 NA 0.67 12.70 NA 000 

93640 ......... 26 ....... A Evaluation heart device ............................... 3.51 1.36 1.36 0.25 5.12 5.12 000 

93640 ......... TC ...... A Evaluation heart device ............................... 0.00 7.16 NA 0.42 7.58 NA 000 

93641 ......... ............ A Electrophysiology evaluation ....................... 5.92 9.46 NA 0.84 16.22 NA 000 

93641 ......... 26 ....... A Electrophysiology evaluation ....................... 5.92 2.30 2.30 0.42 8.64 8.64 000 

93641 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.16 NA 0.42 7.58 NA 000 

93642 ......... ............ A Electrophysiology evaluation ....................... 4.88 9.37 NA 0.58 14.83 NA 000 

93642 ......... 26 ....... A Electrophysiology evaluation ....................... 4.88 2.21 2.21 0.16 7.25 7.25 000 

93642 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.16 NA 0.42 7.58 NA 000 

93650 ......... ............ A Ablate heart dysrhythm focus ...................... 10.49 NA 4.42 0.74 NA 15.65 000 

93651 ......... ............ A Ablate heart dysrhythm focus ...................... 16.23 NA 6.31 1.13 NA 23.67 000 

93652 ......... ............ A Ablate heart dysrhythm focus ...................... 17.65 NA 6.86 1.23 NA 25.74 000 

93660 ......... ............ A Tilt table evaluation ...................................... 1.89 2.42 NA 0.08 4.39 NA 000 

93660 ......... 26 ....... A Tilt table evaluation ...................................... 1.89 0.74 0.74 0.06 2.69 2.69 000 

93660 ......... TC ...... A Tilt table evaluation ...................................... 0.00 1.68 NA 0.02 1.70 NA 000 

93662 ......... 26 ....... A Intracardiac ecg (ice) ................................... 2.80 1.10 1.10 0.09 3.99 3.99 ZZZ 

93701 ......... ............ A Bioimpedance, thoracic ............................... 0.17 1.00 NA 0.02 1.19 NA XXX 

93701 ......... 26 ....... A Bioimpedance, thoracic ............................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93701 ......... TC ...... A Bioimpedance, thoracic ............................... 0.00 0.94 NA 0.01 0.95 NA XXX 

93720 ......... ............ A Total body plethysmography ....................... 0.17 1.16 NA 0.07 1.40 NA XXX 

93721 ......... ............ A Plethysmography tracing ............................. 0.00 0.70 NA 0.06 0.76 NA XXX 

93722 ......... ............ A Plethysmography report ............................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

93724 ......... ............ A Analyze pacemaker system ......................... 4.88 5.86 NA 0.43 11.17 NA 000 

93724 ......... 26 ....... A Analyze pacemaker system ......................... 4.88 1.91 1.91 0.19 6.98 6.98 000 

93724 ......... TC ...... A Analyze pacemaker system ......................... 0.00 3.96 NA 0.24 4.20 NA 000 

93727 ......... ............ A Analyze ilr system ........................................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

93731 ......... ............ A Analyze pacemaker system ......................... 0.45 0.67 NA 0.06 1.18 NA XXX 

93731 ......... 26 ....... A Analyze pacemaker system ......................... 0.45 0.17 0.17 0.02 0.64 0.64 XXX 

47684

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

93731 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.49 NA 0.04 0.53 NA XXX 

93732 ......... ............ A Analyze pacemaker system ......................... 0.92 0.86 NA 0.07 1.85 NA XXX 

93732 ......... 26 ....... A Analyze pacemaker system ......................... 0.92 0.35 0.35 0.03 1.30 1.30 XXX 

93732 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.51 NA 0.04 0.55 NA XXX 

93733 ......... ............ A Telephone analy, pacemaker ...................... 0.17 0.79 NA 0.07 1.03 NA XXX 

93733 ......... 26 ....... A Telephone analy, pacemaker ...................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93733 ......... TC ...... A Telephone analy, pacemaker ...................... 0.00 0.72 NA 0.06 0.78 NA XXX 

93734 ......... ............ A Analyze pacemaker system ......................... 0.38 0.49 NA 0.03 0.90 NA XXX 

93734 ......... 26 ....... A Analyze pacemaker system ......................... 0.38 0.14 0.14 0.01 0.53 0.53 XXX 

93734 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.35 NA 0.02 0.37 NA XXX 

93735 ......... ............ A Analyze pacemaker system ......................... 0.74 0.73 NA 0.07 1.54 NA XXX 

93735 ......... 26 ....... A Analyze pacemaker system ......................... 0.74 0.28 0.28 0.03 1.05 1.05 XXX 

93735 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.44 NA 0.04 0.48 NA XXX 

93736 ......... ............ A Telephonic analy, pacemaker ...................... 0.15 0.69 NA 0.07 0.91 NA XXX 

93736 ......... 26 ....... A Telephonic analy, pacemaker ...................... 0.15 0.06 0.06 0.01 0.22 0.22 XXX 

93736 ......... TC ...... A Telephonic analy, pacemaker ...................... 0.00 0.63 NA 0.06 0.69 NA XXX 

93740 ......... ............ B Temperature gradient studies ...................... 0.16 0.19 NA 0.02 0.37 NA XXX 

93740 ......... 26 ....... B Temperature gradient studies ...................... 0.16 0.04 0.04 0.01 0.21 0.21 XXX 

93740 ......... TC ...... B Temperature gradient studies ...................... 0.00 0.15 NA 0.01 0.16 NA XXX 

93741 ......... ............ A Analyze ht pace device sngl ........................ 0.80 0.98 NA 0.07 1.85 NA XXX 

93741 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.80 0.31 0.31 0.03 1.14 1.14 XXX 

93741 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 

93742 ......... ............ A Analyze ht pace device sngl ........................ 0.91 1.02 NA 0.07 2.00 NA XXX 

93742 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.91 0.36 0.36 0.03 1.30 1.30 XXX 

93742 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 

93743 ......... ............ A Analyze ht pace device dual ....................... 1.03 1.13 NA 0.08 2.24 NA XXX 

93743 ......... 26 ....... A Analyze ht pace device dual ....................... 1.03 0.40 0.40 0.04 1.47 1.47 XXX 

93743 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.73 NA 0.04 0.77 NA XXX 

93744 ......... ............ A Analyze ht pace device dual ....................... 1.18 1.12 NA 0.08 2.38 NA XXX 

93744 ......... 26 ....... A Analyze ht pace device dual ....................... 1.18 0.46 0.46 0.04 1.68 1.68 XXX 

93744 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 

93770 ......... ............ B Measure venous pressure ........................... 0.16 0.08 NA 0.02 0.26 NA XXX 

93770 ......... 26 ....... B Measure venous pressure ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93770 ......... TC ...... B Measure venous pressure ........................... 0.00 0.03 NA 0.01 0.04 NA XXX 

93784 ......... ............ A Ambulatory BP monitoring ........................... 0.38 1.55 NA 0.03 1.96 NA XXX 

93786 ......... ............ A Ambulatory BP recording ............................. 0.00 0.91 NA 0.01 0.92 NA XXX 

93788 ......... ............ A Ambulatory BP analysis ............................... 0.00 0.51 NA 0.01 0.52 NA XXX 

93790 ......... ............ A Review/report BP recording ......................... 0.38 0.13 0.13 0.01 0.52 0.52 XXX 

93797 ......... ............ A Cardiac rehab .............................................. 0.18 0.30 0.07 0.01 0.49 0.26 000 

93798 ......... ............ A Cardiac rehab/monitor ................................. 0.28 0.47 0.11 0.01 0.76 0.40 000 

93875 ......... ............ A Extracranial study ........................................ 0.22 2.10 NA 0.12 2.44 NA XXX 

93875 ......... 26 ....... A Extracranial study ........................................ 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

93875 ......... TC ...... A Extracranial study ........................................ 0.00 2.02 NA 0.11 2.13 NA XXX 

93880 ......... ............ A Extracranial study ........................................ 0.60 5.06 NA 0.39 6.05 NA XXX 

93880 ......... 26 ....... A Extracranial study ........................................ 0.60 0.20 0.20 0.04 0.84 0.84 XXX 

93880 ......... TC ...... A Extracranial study ........................................ 0.00 4.85 NA 0.35 5.20 NA XXX 

93882 ......... ............ A Extracranial study ........................................ 0.40 3.31 NA 0.26 3.97 NA XXX 

93882 ......... 26 ....... A Extracranial study ........................................ 0.40 0.14 0.14 0.04 0.58 0.58 XXX 

93882 ......... TC ...... A Extracranial study ........................................ 0.00 3.17 NA 0.22 3.39 NA XXX 

93886 ......... ............ A Intracranial study ......................................... 0.94 6.05 NA 0.45 7.44 NA XXX 

93886 ......... 26 ....... A Intracranial study ......................................... 0.94 0.37 0.37 0.06 1.37 1.37 XXX 

93886 ......... TC ...... A Intracranial study ......................................... 0.00 5.68 NA 0.39 6.07 NA XXX 

93888 ......... ............ A Intracranial study ......................................... 0.62 3.85 NA 0.32 4.79 NA XXX 

93888 ......... 26 ....... A Intracranial study ......................................... 0.62 0.23 0.23 0.05 0.90 0.90 XXX 

93888 ......... TC ...... A Intracranial study ......................................... 0.00 3.62 NA 0.27 3.89 NA XXX 

93922 ......... ............ A Extremity study ............................................ 0.25 2.43 NA 0.15 2.83 NA XXX 

93922 ......... 26 ....... A Extremity study ............................................ 0.25 0.08 0.08 0.02 0.35 0.35 XXX 

93922 ......... TC ...... A Extremity study ............................................ 0.00 2.34 NA 0.13 2.47 NA XXX 

93923 ......... ............ A Extremity study ............................................ 0.45 3.68 NA 0.26 4.39 NA XXX 

93923 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.04 0.64 0.64 XXX 

93923 ......... TC ...... A Extremity study ............................................ 0.00 3.53 NA 0.22 3.75 NA XXX 

93924 ......... ............ A Extremity study ............................................ 0.50 4.42 NA 0.30 5.22 NA XXX 

93924 ......... 26 ....... A Extremity study ............................................ 0.50 0.17 0.17 0.05 0.72 0.72 XXX 

93924 ......... TC ...... A Extremity study ............................................ 0.00 4.25 NA 0.25 4.50 NA XXX 

93925 ......... ............ A Lower extremity study .................................. 0.58 6.11 NA 0.39 7.08 NA XXX 

93925 ......... 26 ....... A Lower extremity study .................................. 0.58 0.20 0.20 0.04 0.82 0.82 XXX 

93925 ......... TC ...... A Lower extremity study .................................. 0.00 5.91 NA 0.35 6.26 NA XXX 

93926 ......... ............ A Lower extremity study .................................. 0.39 3.82 NA 0.27 4.48 NA XXX 

93926 ......... 26 ....... A Lower extremity study .................................. 0.39 0.13 0.13 0.04 0.56 0.56 XXX 

93926 ......... TC ...... A Lower extremity study .................................. 0.00 3.69 NA 0.23 3.92 NA XXX 

93930 ......... ............ A Upper extremity study .................................. 0.46 4.85 NA 0.41 5.72 NA XXX 

93930 ......... 26 ....... A Upper extremity study .................................. 0.46 0.16 0.16 0.04 0.66 0.66 XXX 

93930 ......... TC ...... A Upper extremity study .................................. 0.00 4.69 NA 0.37 5.06 NA XXX 

93931 ......... ............ A Upper extremity study .................................. 0.31 3.22 NA 0.27 3.80 NA XXX 

93931 ......... 26 ....... A Upper extremity study .................................. 0.31 0.10 0.10 0.03 0.44 0.44 XXX 

47685

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

93931 ......... TC ...... A Upper extremity study .................................. 0.00 3.12 NA 0.24 3.36 NA XXX 

93965 ......... ............ A Extremity study ............................................ 0.35 2.48 NA 0.14 2.97 NA XXX 

93965 ......... 26 ....... A Extremity study ............................................ 0.35 0.12 0.12 0.02 0.49 0.49 XXX 

93965 ......... TC ...... A Extremity study ............................................ 0.00 2.36 NA 0.12 2.48 NA XXX 

93970 ......... ............ A Extremity study ............................................ 0.68 4.77 NA 0.45 5.90 NA XXX 

93970 ......... 26 ....... A Extremity study ............................................ 0.68 0.23 0.23 0.05 0.96 0.96 XXX 

93970 ......... TC ...... A Extremity study ............................................ 0.00 4.54 NA 0.40 4.94 NA XXX 

93971 ......... ............ A Extremity study ............................................ 0.45 3.28 NA 0.30 4.03 NA XXX 

93971 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.03 0.63 0.63 XXX 

93971 ......... TC ...... A Extremity study ............................................ 0.00 3.13 NA 0.27 3.40 NA XXX 

93975 ......... ............ A Vascular study ............................................. 1.80 6.91 NA 0.56 9.27 NA XXX 

93975 ......... 26 ....... A Vascular study ............................................. 1.80 0.60 0.60 0.13 2.53 2.53 XXX 

93975 ......... TC ...... A Vascular study ............................................. 0.00 6.32 NA 0.43 6.75 NA XXX 

93976 ......... ............ A Vascular study ............................................. 1.21 3.92 NA 0.36 5.49 NA XXX 

93976 ......... 26 ....... A Vascular study ............................................. 1.21 0.40 0.40 0.06 1.67 1.67 XXX 

93976 ......... TC ...... A Vascular study ............................................. 0.00 3.52 NA 0.30 3.82 NA XXX 

93978 ......... ............ A Vascular study ............................................. 0.65 4.17 NA 0.43 5.25 NA XXX 

93978 ......... 26 ....... A Vascular study ............................................. 0.65 0.22 0.22 0.06 0.93 0.93 XXX 

93978 ......... TC ...... A Vascular study ............................................. 0.00 3.95 NA 0.37 4.32 NA XXX 

93979 ......... ............ A Vascular study ............................................. 0.44 3.00 NA 0.28 3.72 NA XXX 

93979 ......... 26 ....... A Vascular study ............................................. 0.44 0.15 0.15 0.04 0.63 0.63 XXX 

93979 ......... TC ...... A Vascular study ............................................. 0.00 2.85 NA 0.24 3.09 NA XXX 

93980 ......... ............ A Penile vascular study ................................... 1.25 2.88 NA 0.43 4.56 NA XXX 

93980 ......... 26 ....... A Penile vascular study ................................... 1.25 0.41 0.41 0.09 1.75 1.75 XXX 

93980 ......... TC ...... A Penile vascular study ................................... 0.00 2.48 NA 0.34 2.82 NA XXX 

93981 ......... ............ A Penile vascular study ................................... 0.44 2.96 NA 0.33 3.73 NA XXX 

93981 ......... 26 ....... A Penile vascular study ................................... 0.44 0.14 0.14 0.02 0.60 0.60 XXX 

93981 ......... TC ...... A Penile vascular study ................................... 0.00 2.81 NA 0.31 3.12 NA XXX 

93990 ......... ............ A Doppler flow testing ..................................... 0.25 3.76 NA 0.26 4.27 NA XXX 

93990 ......... 26 ....... A Doppler flow testing ..................................... 0.25 0.09 0.09 0.03 0.37 0.37 XXX 

93990 ......... TC ...... A Doppler flow testing ..................................... 0.00 3.67 NA 0.23 3.90 NA XXX 

94010 ......... ............ A Breathing capacity test ................................ 0.17 0.69 NA 0.03 0.89 NA XXX 

94010 ......... 26 ....... A Breathing capacity test ................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

94010 ......... TC ...... A Breathing capacity test ................................ 0.00 0.63 NA 0.02 0.65 NA XXX 

94014 ......... ............ A Patient recorded spirometry ........................ 0.52 0.77 NA 0.04 1.33 NA XXX 

94015 ......... ............ A Patient recorded spirometry ........................ 0.00 0.60 NA 0.01 0.61 NA XXX 

94016 ......... ............ A Review patient spirometry ........................... 0.52 0.16 0.16 0.03 0.71 0.71 XXX 

94060 ......... ............ A Evaluation of wheezing ................................ 0.31 1.10 NA 0.07 1.48 NA XXX 

94060 ......... 26 ....... A Evaluation of wheezing ................................ 0.31 0.09 0.09 0.01 0.41 0.41 XXX 

94060 ......... TC ...... A Evaluation of wheezing ................................ 0.00 1.01 NA 0.06 1.07 NA XXX 

94070 ......... ............ A Evaluation of wheezing ................................ 0.60 0.84 NA 0.13 1.57 NA XXX 

94070 ......... 26 ....... A Evaluation of wheezing ................................ 0.60 0.18 0.18 0.03 0.81 0.81 XXX 

94070 ......... TC ...... A Evaluation of wheezing ................................ 0.00 0.66 NA 0.10 0.76 NA XXX 

94150 ......... ............ B Vital capacity test ......................................... 0.07 0.48 NA 0.02 0.57 NA XXX 

94150 ......... 26 ....... B Vital capacity test ......................................... 0.07 0.03 0.03 0.01 0.11 0.11 XXX 

94150 ......... TC ...... B Vital capacity test ......................................... 0.00 0.45 NA 0.01 0.46 NA XXX 

94200 ......... ............ A Lung function test (MBC/MVV) .................... 0.11 0.46 NA 0.03 0.60 NA XXX 

94200 ......... 26 ....... A Lung function test (MBC/MVV) .................... 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94200 ......... TC ...... A Lung function test (MBC/MVV) .................... 0.00 0.42 NA 0.02 0.44 NA XXX 

94240 ......... ............ A Residual lung capacity ................................. 0.26 0.67 NA 0.06 0.99 NA XXX 

94240 ......... 26 ....... A Residual lung capacity ................................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94240 ......... TC ...... A Residual lung capacity ................................. 0.00 0.59 NA 0.05 0.64 NA XXX 

94250 ......... ............ A Expired gas collection .................................. 0.11 0.65 NA 0.02 0.78 NA XXX 

94250 ......... 26 ....... A Expired gas collection .................................. 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94250 ......... TC ...... A Expired gas collection .................................. 0.00 0.62 NA 0.01 0.63 NA XXX 

94260 ......... ............ A Thoracic gas volume ................................... 0.13 0.59 NA 0.05 0.77 NA XXX 

94260 ......... 26 ....... A Thoracic gas volume ................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

94260 ......... TC ...... A Thoracic gas volume ................................... 0.00 0.55 NA 0.04 0.59 NA XXX 

94350 ......... ............ A Lung nitrogen washout curve ...................... 0.26 0.77 NA 0.05 1.08 NA XXX 

94350 ......... 26 ....... A Lung nitrogen washout curve ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94350 ......... TC ...... A Lung nitrogen washout curve ...................... 0.00 0.70 NA 0.04 0.74 NA XXX 

94360 ......... ............ A Measure airflow resistance .......................... 0.26 0.71 NA 0.07 1.04 NA XXX 

94360 ......... 26 ....... A Measure airflow resistance .......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94360 ......... TC ...... A Measure airflow resistance .......................... 0.00 0.63 NA 0.06 0.69 NA XXX 

94370 ......... ............ A Breath airway closing volume ...................... 0.26 0.74 NA 0.03 1.03 NA XXX 

94370 ......... 26 ....... A Breath airway closing volume ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94370 ......... TC ...... A Breath airway closing volume ...................... 0.00 0.66 NA 0.02 0.68 NA XXX 

94375 ......... ............ A Respiratory flow volume loop ...................... 0.31 0.62 NA 0.03 0.96 NA XXX 

94375 ......... 26 ....... A Respiratory flow volume loop ...................... 0.31 0.09 0.09 0.01 0.41 0.41 XXX 

94375 ......... TC ...... A Respiratory flow volume loop ...................... 0.00 0.53 NA 0.02 0.55 NA XXX 

94400 ......... ............ A CO2 breathing response curve ................... 0.40 0.86 NA 0.09 1.35 NA XXX 

94400 ......... 26 ....... A CO2 breathing response curve ................... 0.40 0.12 0.12 0.03 0.55 0.55 XXX 

94400 ......... TC ...... A CO2 breathing response curve ................... 0.00 0.74 NA 0.06 0.80 NA XXX 

94450 ......... ............ A Hypoxia response curve .............................. 0.40 0.87 NA 0.04 1.31 NA XXX 

94450 ......... 26 ....... A Hypoxia response curve .............................. 0.40 0.12 0.12 0.02 0.54 0.54 XXX 

47686

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

94450 ......... TC ...... A Hypoxia response curve .............................. 0.00 0.75 NA 0.02 0.77 NA XXX 

94620 ......... ............ A Pulmonary stress test/simple ....................... 0.64 2.54 NA 0.13 3.31 NA XXX 

94620 ......... 26 ....... A Pulmonary stress test/simple ....................... 0.64 0.20 0.20 0.03 0.87 0.87 XXX 

94620 ......... TC ...... A Pulmonary stress test/simple ....................... 0.00 2.34 NA 0.10 2.44 NA XXX 

94621 ......... ............ A Pulm stress test/complex ............................. 1.42 2.24 NA 0.16 3.82 NA XXX 

94621 ......... 26 ....... A Pulm stress test/complex ............................. 1.42 0.43 0.43 0.06 1.91 1.91 XXX 

94621 ......... TC ...... A Pulm stress test/complex ............................. 0.00 1.80 NA 0.10 1.90 NA XXX 

94640 ......... ............ A Airway inhalation treatment ......................... 0.00 0.31 NA 0.02 0.33 NA XXX 

94656 ......... ............ A Initial ventilator mgmt ................................... 1.22 1.18 0.31 0.07 2.47 1.60 XXX 

94657 ......... ............ A Continued ventilator mgmt ........................... 0.83 1.00 0.25 0.04 1.87 1.12 XXX 

94660 ......... ............ A Pos airway pressure, CPAP ........................ 0.76 0.66 0.23 0.04 1.46 1.03 XXX 

94662 ......... ............ A Neg press ventilation, cnp ........................... 0.76 NA 0.23 0.06 NA 1.05 XXX 

94664 ......... ............ A Evaluate pt use of inhaler ............................ 0.00 0.32 NA 0.04 0.36 NA XXX 

94667 ......... ............ A Chest wall manipulation ............................... 0.00 0.54 NA 0.05 0.59 NA XXX 

94668 ......... ............ A Chest wall manipulation ............................... 0.00 0.46 NA 0.02 0.48 NA XXX 

94680 ......... ............ A Exhaled air analysis, o2 .............................. 0.26 1.89 NA 0.07 2.22 NA XXX 

94680 ......... 26 ....... A Exhaled air analysis, o2 .............................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94680 ......... TC ...... A Exhaled air analysis, o2 .............................. 0.00 1.81 NA 0.06 1.87 NA XXX 

94681 ......... ............ A Exhaled air analysis, o2/co2 ........................ 0.20 2.58 NA 0.13 2.91 NA XXX 

94681 ......... 26 ....... A Exhaled air analysis, o2/co2 ........................ 0.20 0.06 0.06 0.01 0.27 0.27 XXX 

94681 ......... TC ...... A Exhaled air analysis, o2/co2 ........................ 0.00 2.52 NA 0.12 2.64 NA XXX 

94690 ......... ............ A Exhaled air analysis ..................................... 0.07 2.02 NA 0.04 2.13 NA XXX 

94690 ......... 26 ....... A Exhaled air analysis ..................................... 0.07 0.02 0.02 0.00 0.09 0.09 XXX 

94690 ......... TC ...... A Exhaled air analysis ..................................... 0.00 2.00 NA 0.04 2.04 NA XXX 

94720 ......... ............ A Monoxide diffusing capacity ........................ 0.26 1.02 NA 0.07 1.35 NA XXX 

94720 ......... 26 ....... A Monoxide diffusing capacity ........................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94720 ......... TC ...... A Monoxide diffusing capacity ........................ 0.00 0.94 NA 0.06 1.00 NA XXX 

94725 ......... ............ A Membrane diffusion capacity ....................... 0.26 2.94 NA 0.13 3.33 NA XXX 

94725 ......... 26 ....... A Membrane diffusion capacity ....................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94725 ......... TC ...... A Membrane diffusion capacity ....................... 0.00 2.86 NA 0.12 2.98 NA XXX 

94750 ......... ............ A Pulmonary compliance study ....................... 0.23 1.35 NA 0.05 1.63 NA XXX 

94750 ......... 26 ....... A Pulmonary compliance study ....................... 0.23 0.07 0.07 0.01 0.31 0.31 XXX 

94750 ......... TC ...... A Pulmonary compliance study ....................... 0.00 1.29 NA 0.04 1.33 NA XXX 

94760 ......... ............ T Measure blood oxygen level ........................ 0.00 0.04 NA 0.02 0.06 NA XXX 

94761 ......... ............ T Measure blood oxygen level ........................ 0.00 0.07 NA 0.06 0.13 NA XXX 

94762 ......... ............ A Measure blood oxygen level ........................ 0.00 0.49 NA 0.10 0.59 NA XXX 

94770 ......... ............ A Exhaled carbon dioxide test ........................ 0.15 0.76 NA 0.08 0.99 NA XXX 

94770 ......... 26 ....... A Exhaled carbon dioxide test ........................ 0.15 0.04 0.04 0.01 0.20 0.20 XXX 

94770 ......... TC ...... A Exhaled carbon dioxide test ........................ 0.00 0.72 NA 0.07 0.79 NA XXX 

95004 ......... ............ A Percut allergy skin tests .............................. 0.00 0.10 NA 0.01 0.11 NA XXX 

95010 ......... ............ A Percut allergy titrate test .............................. 0.15 0.32 0.06 0.00 0.47 0.21 XXX 

95015 ......... ............ A Id allergy titrate-drug/bug ............................. 0.15 0.14 0.06 0.01 0.30 0.22 XXX 

95024 ......... ............ A Id allergy test, drug/bug ............................... 0.00 0.14 NA 0.01 0.15 NA XXX 

95027 ......... ............ A Id allergy titrate-airborne .............................. 0.00 0.14 NA 0.01 0.15 NA XXX 

95028 ......... ............ A Id allergy test-delayed type ......................... 0.00 0.23 NA 0.01 0.24 NA XXX 

95044 ......... ............ A Allergy patch tests ....................................... 0.00 0.20 NA 0.01 0.21 NA XXX 

95052 ......... ............ A Photo patch test ........................................... 0.00 0.25 NA 0.01 0.26 NA XXX 

95056 ......... ............ A Photosensitivity tests ................................... 0.00 0.17 NA 0.01 0.18 NA XXX 

95060 ......... ............ A Eye allergy tests .......................................... 0.00 0.35 NA 0.02 0.37 NA XXX 

95065 ......... ............ A Nose allergy test .......................................... 0.00 0.20 NA 0.01 0.21 NA XXX 

95070 ......... ............ A Bronchial allergy tests ................................. 0.00 2.28 NA 0.02 2.30 NA XXX 

95071 ......... ............ A Bronchial allergy tests ................................. 0.00 2.91 NA 0.02 2.93 NA XXX 

95075 ......... ............ A Ingestion challenge test ............................... 0.95 0.83 0.38 0.03 1.81 1.36 XXX 

95078 ......... ............ A Provocative testing ...................................... 0.00 0.25 NA 0.02 0.27 NA XXX 

95115 ......... ............ A Immunotherapy, one injection ..................... 0.00 0.39 NA 0.02 0.41 NA 000 

95117 ......... ............ A Immunotherapy injections ............................ 0.00 0.50 NA 0.02 0.52 NA 000 

95144 ......... ............ A Antigen therapy services ............................. 0.06 0.19 0.02 0.00 0.25 0.08 000 

95145 ......... ............ A Antigen therapy services ............................. 0.06 0.32 0.02 0.00 0.38 0.08 000 

95146 ......... ............ A Antigen therapy services ............................. 0.06 0.44 0.03 0.00 0.50 0.09 000 

95147 ......... ............ A Antigen therapy services ............................. 0.06 0.42 0.02 0.00 0.48 0.08 000 

95148 ......... ............ A Antigen therapy services ............................. 0.06 0.58 0.03 0.00 0.64 0.09 000 

95149 ......... ............ A Antigen therapy services ............................. 0.06 0.80 0.03 0.00 0.86 0.09 000 

95165 ......... ............ A Antigen therapy services ............................. 0.06 0.19 0.02 0.00 0.25 0.08 000 

95170 ......... ............ A Antigen therapy services ............................. 0.06 0.13 0.02 0.00 0.19 0.08 000 

95180 ......... ............ A Rapid desensitization ................................... 2.01 2.05 0.93 0.05 4.11 2.99 000 

95250 ......... ............ A Glucose monitoring, cont ............................. 0.00 4.22 NA 0.01 4.23 NA XXX 

95805 ......... ............ A Multiple sleep latency test ........................... 1.88 18.00 NA 0.43 20.31 NA XXX 

95805 ......... 26 ....... A Multiple sleep latency test ........................... 1.88 0.66 0.66 0.09 2.63 2.63 XXX 

95805 ......... TC ...... A Multiple sleep latency test ........................... 0.00 17.35 NA 0.34 17.69 NA XXX 

95806 ......... ............ A Sleep study, unattended .............................. 1.66 3.40 NA 0.39 5.45 NA XXX 

95806 ......... 26 ....... A Sleep study, unattended .............................. 1.66 0.53 0.53 0.08 2.27 2.27 XXX 

95806 ......... TC ...... A Sleep study, unattended .............................. 0.00 2.87 NA 0.31 3.18 NA XXX 

95807 ......... ............ A Sleep study, attended .................................. 1.66 12.10 NA 0.50 14.26 NA XXX 

95807 ......... 26 ....... A Sleep study, attended .................................. 1.66 0.53 0.53 0.08 2.27 2.27 XXX 

95807 ......... TC ...... A Sleep study, attended .................................. 0.00 11.57 NA 0.42 11.99 NA XXX 

47687

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

95808 ......... ............ A Polysomnography, 1-3 ................................. 2.65 13.54 NA 0.55 16.74 NA XXX 

95808 ......... 26 ....... A Polysomnography, 1-3 ................................. 2.65 0.92 0.92 0.13 3.70 3.70 XXX 

95808 ......... TC ...... A Polysomnography, 1-3 ................................. 0.00 12.62 NA 0.42 13.04 NA XXX 

95810 ......... ............ A Polysomnography, 4 or more ...................... 3.52 18.02 NA 0.59 22.13 NA XXX 

95810 ......... 26 ....... A Polysomnography, 4 or more ...................... 3.52 1.18 1.18 0.17 4.87 4.87 XXX 

95810 ......... TC ...... A Polysomnography, 4 or more ...................... 0.00 16.84 NA 0.42 17.26 NA XXX 

95811 ......... ............ A Polysomnography w/cpap ............................ 3.79 19.53 NA 0.61 23.93 NA XXX 

95811 ......... 26 ....... A Polysomnography w/cpap ............................ 3.79 1.27 1.27 0.18 5.24 5.24 XXX 

95811 ......... TC ...... A Polysomnography w/cpap ............................ 0.00 18.26 NA 0.43 18.69 NA XXX 

95812 ......... ............ A Eeg, 41-60 minutes ..................................... 1.08 4.03 NA 0.17 5.28 NA XXX 

95812 ......... 26 ....... A Eeg, 41-60 minutes ..................................... 1.08 0.45 0.45 0.06 1.59 1.59 XXX 

95812 ......... TC ...... A Eeg, 41-60 minutes ..................................... 0.00 3.58 NA 0.11 3.69 NA XXX 

95813 ......... ............ A Eeg, over 1 hour .......................................... 1.73 5.04 NA 0.21 6.98 NA XXX 

95813 ......... 26 ....... A Eeg, over 1 hour .......................................... 1.73 0.70 0.70 0.10 2.53 2.53 XXX 

95813 ......... TC ...... A Eeg, over 1 hour .......................................... 0.00 4.35 NA 0.11 4.46 NA XXX 

95816 ......... ............ A Eeg, awake and drowsy .............................. 1.08 4.78 NA 0.16 6.02 NA XXX 

95816 ......... 26 ....... A Eeg, awake and drowsy .............................. 1.08 0.46 0.46 0.06 1.60 1.60 XXX 

95816 ......... TC ...... A Eeg, awake and drowsy .............................. 0.00 4.32 NA 0.10 4.42 NA XXX 

95819 ......... ............ A Eeg, awake and asleep ............................... 1.08 2.76 NA 0.16 4.00 NA XXX 

95819 ......... 26 ....... A Eeg, awake and asleep ............................... 1.08 0.46 0.46 0.06 1.60 1.60 XXX 

95819 ......... TC ...... A Eeg, awake and asleep ............................... 0.00 2.30 NA 0.10 2.40 NA XXX 

95822 ......... ............ A Eeg, coma or sleep only .............................. 1.08 4.63 NA 0.19 5.90 NA XXX 

95822 ......... 26 ....... A Eeg, coma or sleep only .............................. 1.08 0.46 0.46 0.06 1.60 1.60 XXX 

95822 ......... TC ...... A Eeg, coma or sleep only .............................. 0.00 4.18 NA 0.13 4.31 NA XXX 

95824 ......... 26 ....... A Eeg, cerebral death only ............................. 0.74 0.31 0.31 0.04 1.09 1.09 XXX 

95827 ......... ............ A Eeg, all night recording ................................ 1.08 2.69 NA 0.20 3.97 NA XXX 

95827 ......... 26 ....... A Eeg, all night recording ................................ 1.08 0.41 0.41 0.06 1.55 1.55 XXX 

95827 ......... TC ...... A Eeg, all night recording ................................ 0.00 2.29 NA 0.14 2.43 NA XXX 

95829 ......... ............ A Surgery electrocorticogram .......................... 6.20 31.16 NA 0.51 37.87 NA XXX 

95829 ......... 26 ....... A Surgery electrocorticogram .......................... 6.20 2.31 2.31 0.49 9.00 9.00 XXX 

95829 ......... TC ...... A Surgery electrocorticogram .......................... 0.00 28.85 NA 0.02 28.87 NA XXX 

95830 ......... ............ A Insert electrodes for EEG ............................ 1.70 3.29 0.73 0.10 5.09 2.53 XXX 

95831 ......... ............ A Limb muscle testing, manual ....................... 0.28 0.46 0.13 0.02 0.76 0.43 XXX 

95832 ......... ............ A Hand muscle testing, manual ...................... 0.29 0.33 0.12 0.02 0.64 0.43 XXX 

95833 ......... ............ A Body muscle testing, manual ...................... 0.47 0.59 0.23 0.02 1.08 0.72 XXX 

95834 ......... ............ A Body muscle testing, manual ...................... 0.60 0.64 0.28 0.03 1.27 0.91 XXX 

95851 ......... ............ A Range of motion measurements ................. 0.16 0.37 0.08 0.01 0.54 0.25 XXX 

95852 ......... ............ A Range of motion measurements ................. 0.11 0.26 0.05 0.01 0.38 0.17 XXX 

95857 ......... ............ A Tensilon test ................................................ 0.53 0.60 0.23 0.03 1.16 0.79 XXX 

95858 ......... ............ A Tensilon test & myogram ............................. 1.56 1.06 NA 0.12 2.74 NA XXX 

95858 ......... 26 ....... A Tensilon test & myogram ............................. 1.56 0.67 0.67 0.08 2.31 2.31 XXX 

95858 ......... TC ...... A Tensilon test & myogram ............................. 0.00 0.40 NA 0.04 0.44 NA XXX 

95860 ......... ............ A Muscle test, one limb ................................... 0.96 1.43 NA 0.07 2.46 NA XXX 

95860 ......... 26 ....... A Muscle test, one limb ................................... 0.96 0.42 0.42 0.05 1.43 1.43 XXX 

95860 ......... TC ...... A Muscle test, one limb ................................... 0.00 1.01 NA 0.02 1.03 NA XXX 

95861 ......... ............ A Muscle test, 2 limbs ..................................... 1.54 1.41 NA 0.14 3.09 NA XXX 

95861 ......... 26 ....... A Muscle test, 2 limbs ..................................... 1.54 0.67 0.67 0.08 2.29 2.29 XXX 

95861 ......... TC ...... A Muscle test, 2 limbs ..................................... 0.00 0.73 NA 0.06 0.79 NA XXX 

95863 ......... ............ A Muscle test, 3 limbs ..................................... 1.87 1.74 NA 0.15 3.76 NA XXX 

95863 ......... 26 ....... A Muscle test, 3 limbs ..................................... 1.87 0.80 0.80 0.09 2.76 2.76 XXX 

95863 ......... TC ...... A Muscle test, 3 limbs ..................................... 0.00 0.94 NA 0.06 1.00 NA XXX 

95864 ......... ............ A Muscle test, 4 limbs ..................................... 1.99 2.64 NA 0.22 4.85 NA XXX 

95864 ......... 26 ....... A Muscle test, 4 limbs ..................................... 1.99 0.87 0.87 0.10 2.96 2.96 XXX 

95864 ......... TC ...... A Muscle test, 4 limbs ..................................... 0.00 1.78 NA 0.12 1.90 NA XXX 

95867 ......... ............ A Muscle test cran nerv unilat ........................ 0.79 0.92 NA 0.08 1.79 NA XXX 

95867 ......... 26 ....... A Muscle test cran nerv unilat ........................ 0.79 0.35 0.35 0.04 1.18 1.18 XXX 

95867 ......... TC ...... A Muscle test cran nerv unilat ........................ 0.00 0.58 NA 0.04 0.62 NA XXX 

95868 ......... ............ A Muscle test cran nerve bilat ........................ 1.18 1.21 NA 0.11 2.50 NA XXX 

95868 ......... 26 ....... A Muscle test cran nerve bilat ........................ 1.18 0.51 0.51 0.06 1.75 1.75 XXX 

95868 ......... TC ...... A Muscle test cran nerve bilat ........................ 0.00 0.69 NA 0.05 0.74 NA XXX 

95869 ......... ............ A Muscle test, thor paraspinal ........................ 0.37 0.37 NA 0.04 0.78 NA XXX 

95869 ......... 26 ....... A Muscle test, thor paraspinal ........................ 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

95869 ......... TC ...... A Muscle test, thor paraspinal ........................ 0.00 0.21 NA 0.02 0.23 NA XXX 

95870 ......... ............ A Muscle test, nonparaspinal .......................... 0.37 0.37 NA 0.04 0.78 NA XXX 

95870 ......... 26 ....... A Muscle test, nonparaspinal .......................... 0.37 0.16 0.16 0.02 0.55 0.55 XXX 

95870 ......... TC ...... A Muscle test, nonparaspinal .......................... 0.00 0.21 NA 0.02 0.23 NA XXX 

95872 ......... ............ A Muscle test, one fiber .................................. 1.50 1.23 NA 0.14 2.87 NA XXX 

95872 ......... 26 ....... A Muscle test, one fiber .................................. 1.50 0.63 0.63 0.09 2.22 2.22 XXX 

95872 ......... TC ...... A Muscle test, one fiber .................................. 0.00 0.60 NA 0.05 0.65 NA XXX 

95875 ......... ............ A Limb exercise test ........................................ 1.10 1.45 NA 0.14 2.69 NA XXX 

95875 ......... 26 ....... A Limb exercise test ........................................ 1.10 0.47 0.47 0.08 1.65 1.65 XXX 

95875 ......... TC ...... A Limb exercise test ........................................ 0.00 0.98 NA 0.06 1.04 NA XXX 

95900 ......... ............ A Motor nerve conduction test ........................ 0.42 1.26 NA 0.04 1.72 NA XXX 

95900 ......... 26 ....... A Motor nerve conduction test ........................ 0.42 0.18 0.18 0.02 0.62 0.62 XXX 

95900 ......... TC ...... A Motor nerve conduction test ........................ 0.00 1.08 NA 0.02 1.10 NA XXX 

47688

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

95903 ......... ............ A Motor nerve conduction test ........................ 0.60 1.20 NA 0.05 1.85 NA XXX 

95903 ......... 26 ....... A Motor nerve conduction test ........................ 0.60 0.26 0.26 0.03 0.89 0.89 XXX 

95903 ......... TC ...... A Motor nerve conduction test ........................ 0.00 0.94 NA 0.02 0.96 NA XXX 

95904 ......... ............ A Sense nerve conduction test ....................... 0.34 1.09 NA 0.04 1.47 NA XXX 

95904 ......... 26 ....... A Sense nerve conduction test ....................... 0.34 0.15 0.15 0.02 0.51 0.51 XXX 

95904 ......... TC ...... A Sense nerve conduction test ....................... 0.00 0.95 NA 0.02 0.97 NA XXX 

95920 ......... ............ A Intraop nerve test add-on ............................ 2.11 2.23 NA 0.24 4.58 NA ZZZ 

95920 ......... 26 ....... A Intraop nerve test add-on ............................ 2.11 0.93 0.93 0.17 3.21 3.21 ZZZ 

95920 ......... TC ...... A Intraop nerve test add-on ............................ 0.00 1.30 NA 0.07 1.37 NA ZZZ 

95921 ......... ............ A Autonomic nerv function test ....................... 0.90 0.70 NA 0.06 1.66 NA XXX 

95921 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.33 0.33 0.04 1.27 1.27 XXX 

95921 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.38 NA 0.02 0.40 NA XXX 

95922 ......... ............ A Autonomic nerv function test ....................... 0.96 0.78 NA 0.07 1.81 NA XXX 

95922 ......... 26 ....... A Autonomic nerv function test ....................... 0.96 0.40 0.40 0.05 1.41 1.41 XXX 

95922 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.38 NA 0.02 0.40 NA XXX 

95923 ......... ............ A Autonomic nerv function test ....................... 0.90 1.95 NA 0.07 2.92 NA XXX 

95923 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.38 0.38 0.05 1.33 1.33 XXX 

95923 ......... TC ...... A Autonomic nerv function test ....................... 0.00 1.57 NA 0.02 1.59 NA XXX 

95925 ......... ............ A Somatosensory testing ................................ 0.54 1.13 NA 0.09 1.76 NA XXX 

95925 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.22 0.22 0.03 0.79 0.79 XXX 

95925 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

95926 ......... ............ A Somatosensory testing ................................ 0.54 1.14 NA 0.09 1.77 NA XXX 

95926 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.23 0.23 0.03 0.80 0.80 XXX 

95926 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

95927 ......... ............ A Somatosensory testing ................................ 0.54 1.16 NA 0.09 1.79 NA XXX 

95927 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.25 0.25 0.03 0.82 0.82 XXX 

95927 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

95930 ......... ............ A Visual evoked potential test ......................... 0.35 2.25 NA 0.03 2.63 NA XXX 

95930 ......... 26 ....... A Visual evoked potential test ......................... 0.35 0.15 0.15 0.02 0.52 0.52 XXX 

95930 ......... TC ...... A Visual evoked potential test ......................... 0.00 2.10 NA 0.01 2.11 NA XXX 

95933 ......... ............ A Blink reflex test ............................................ 0.59 1.02 NA 0.10 1.71 NA XXX 

95933 ......... 26 ....... A Blink reflex test ............................................ 0.59 0.24 0.24 0.04 0.87 0.87 XXX 

95933 ......... TC ...... A Blink reflex test ............................................ 0.00 0.78 NA 0.06 0.84 NA XXX 

95934 ......... ............ A H-reflex test ................................................. 0.51 0.43 NA 0.04 0.98 NA XXX 

95934 ......... 26 ....... A H-reflex test ................................................. 0.51 0.22 0.22 0.02 0.75 0.75 XXX 

95934 ......... TC ...... A H-reflex test ................................................. 0.00 0.21 NA 0.02 0.23 NA XXX 

95936 ......... ............ A H-reflex test ................................................. 0.55 0.45 NA 0.05 1.05 NA XXX 

95936 ......... 26 ....... A H-reflex test ................................................. 0.55 0.24 0.24 0.03 0.82 0.82 XXX 

95936 ......... TC ...... A H-reflex test ................................................. 0.00 0.21 NA 0.02 0.23 NA XXX 

95937 ......... ............ A Neuromuscular junction test ........................ 0.65 0.60 NA 0.08 1.33 NA XXX 

95937 ......... 26 ....... A Neuromuscular junction test ........................ 0.65 0.27 0.27 0.06 0.98 0.98 XXX 

95937 ......... TC ...... A Neuromuscular junction test ........................ 0.00 0.34 NA 0.02 0.36 NA XXX 

95950 ......... ............ A Ambulatory eeg monitoring .......................... 1.51 4.98 NA 0.51 7.00 NA XXX 

95950 ......... 26 ....... A Ambulatory eeg monitoring .......................... 1.51 0.63 0.63 0.08 2.22 2.22 XXX 

95950 ......... TC ...... A Ambulatory eeg monitoring .......................... 0.00 4.35 NA 0.43 4.78 NA XXX 

95951 ......... 26 ....... A EEG monitoring/videorecord ........................ 5.99 2.54 2.54 0.34 8.87 8.87 XXX 

95953 ......... ............ A EEG monitoring/computer ........................... 3.08 7.61 NA 0.61 11.30 NA XXX 

95953 ......... 26 ....... A EEG monitoring/computer ........................... 3.08 1.29 1.29 0.18 4.55 4.55 XXX 

95953 ......... TC ...... A EEG monitoring/computer ........................... 0.00 6.32 NA 0.43 6.75 NA XXX 

95954 ......... ............ A EEG monitoring/giving drugs ....................... 2.45 4.28 NA 0.19 6.92 NA XXX 

95954 ......... 26 ....... A EEG monitoring/giving drugs ....................... 2.45 1.04 1.04 0.13 3.62 3.62 XXX 

95954 ......... TC ...... A EEG monitoring/giving drugs ....................... 0.00 3.24 NA 0.06 3.30 NA XXX 

95955 ......... ............ A EEG during surgery ..................................... 1.01 2.32 NA 0.23 3.56 NA XXX 

95955 ......... 26 ....... A EEG during surgery ..................................... 1.01 0.36 0.36 0.06 1.43 1.43 XXX 

95955 ......... TC ...... A EEG during surgery ..................................... 0.00 1.96 NA 0.17 2.13 NA XXX 

95956 ......... ............ A Eeg monitoring, cable/radio ......................... 3.08 15.93 NA 0.60 19.61 NA XXX 

95956 ......... 26 ....... A Eeg monitoring, cable/radio ......................... 3.08 1.30 1.30 0.17 4.55 4.55 XXX 

95956 ......... TC ...... A Eeg monitoring, cable/radio ......................... 0.00 14.63 NA 0.43 15.06 NA XXX 

95957 ......... ............ A EEG digital analysis ..................................... 1.98 2.55 NA 0.23 4.76 NA XXX 

95957 ......... 26 ....... A EEG digital analysis ..................................... 1.98 0.85 0.85 0.11 2.94 2.94 XXX 

95957 ......... TC ...... A EEG digital analysis ..................................... 0.00 1.70 NA 0.12 1.82 NA XXX 

95958 ......... ............ A EEG monitoring/function test ....................... 4.24 3.47 NA 0.39 8.10 NA XXX 

95958 ......... 26 ....... A EEG monitoring/function test ....................... 4.24 1.73 1.73 0.26 6.23 6.23 XXX 

95958 ......... TC ...... A EEG monitoring/function test ....................... 0.00 1.74 NA 0.13 1.87 NA XXX 

95961 ......... ............ A Electrode stimulation, brain ......................... 2.97 2.62 NA 0.53 6.12 NA XXX 

95961 ......... 26 ....... A Electrode stimulation, brain ......................... 2.97 1.32 1.32 0.46 4.75 4.75 XXX 

95961 ......... TC ...... A Electrode stimulation, brain ......................... 0.00 1.30 NA 0.07 1.37 NA XXX 

95962 ......... ............ A Electrode stim, brain add-on ....................... 3.21 2.69 NA 0.38 6.28 NA ZZZ 

95962 ......... 26 ....... A Electrode stim, brain add-on ....................... 3.21 1.39 1.39 0.31 4.91 4.91 ZZZ 

95962 ......... TC ...... A Electrode stim, brain add-on ....................... 0.00 1.30 NA 0.07 1.37 NA ZZZ 

95965 ......... 26 ....... A Meg, spontaneous ....................................... 7.99 3.41 3.41 0.41 11.81 11.81 XXX 

95966 ......... 26 ....... A Meg, evoked, single ..................................... 3.99 1.71 1.71 0.21 5.91 5.91 XXX 

95967 ......... 26 ....... A Meg, evoked, each add-l ............................. 3.49 1.18 1.18 0.16 4.83 4.83 ZZZ 

95970 ......... ............ A Analyze neurostim, no prog ......................... 0.45 0.86 0.14 0.03 1.34 0.62 XXX 

95971 ......... ............ A Analyze neurostim, simple ........................... 0.78 0.68 0.22 0.07 1.53 1.07 XXX 

47689

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

95972 ......... ............ A Analyze neurostim, complex ........................ 1.50 1.21 0.49 0.14 2.85 2.13 XXX 

95973 ......... ............ A Analyze neurostim, complex ........................ 0.92 0.62 0.34 0.07 1.61 1.33 ZZZ 

95974 ......... ............ A Cranial neurostim, complex ......................... 3.00 1.70 1.29 0.18 4.88 4.47 XXX 

95975 ......... ............ A Cranial neurostim, complex ......................... 1.70 0.89 0.73 0.11 2.70 2.54 ZZZ 

95990 ......... ............ A Spin/brain pump refil & main ....................... 0.00 1.50 NA 0.06 1.56 NA XXX 

95991 ......... ............ A Spin/brain pump refil & main ....................... 0.77 1.53 0.17 0.06 2.36 1.00 XXX 

96000 ......... ............ A Motion analysis, video/3d ............................ 1.80 NA 0.53 0.05 NA 2.38 XXX 

96001 ......... ............ A Motion test w/ft press meas ........................ 2.15 NA 0.66 0.06 NA 2.87 XXX 

96002 ......... ............ A Dynamic surface emg .................................. 0.41 NA 0.15 0.01 NA 0.57 XXX 

96003 ......... ............ A Dynamic fine wire emg ................................ 0.37 NA 0.12 0.04 NA 0.53 XXX 

96004 ......... ............ A Phys review of motion tests ........................ 2.14 0.94 0.94 0.07 3.15 3.15 XXX 

96100 ......... ............ A Psychological testing ................................... 0.00 1.76 NA 0.18 1.94 NA XXX 

96105 ......... ............ A Assessment of aphasia ............................... 0.00 1.76 NA 0.18 1.94 NA XXX 

96110 ......... ............ A Developmental test, lim ............................... 0.00 0.18 NA 0.18 0.36 NA XXX 

96111 ......... ............ A Developmental test, extend ......................... 2.60 1.05 NA 0.18 3.83 NA XXX 

96115 ......... ............ A Neurobehavior status exam ......................... 0.00 1.76 NA 0.18 1.94 NA XXX 

96117 ......... ............ A Neuropsych test battery ............................... 0.00 1.76 NA 0.18 1.94 NA XXX 

96150 ......... ............ A Assess lth/behave, init ................................. 0.50 0.18 0.18 0.01 0.69 0.69 XXX 

96151 ......... ............ A Assess hlth/behave, subseq ........................ 0.48 0.18 0.17 0.01 0.67 0.66 XXX 

96152 ......... ............ A Intervene hlth/behave, indiv ......................... 0.46 0.17 0.16 0.01 0.64 0.63 XXX 

96153 ......... ............ A Intervene hlth/behave, group ....................... 0.10 0.04 0.03 0.00 0.14 0.13 XXX 

96154 ......... ............ A Interv hlth/behav, fam w/pt .......................... 0.45 0.17 0.16 0.01 0.63 0.62 XXX 

96400 ......... ............ A Chemotherapy, sc/im ................................... 0.17 1.13 NA 0.01 1.31 NA XXX 

96405 ......... ............ A Intralesional chemo admin ........................... 0.52 2.33 0.24 0.03 2.88 0.79 000 

96406 ......... ............ A Intralesional chemo admin ........................... 0.80 3.11 0.29 0.03 3.94 1.12 000 

96408 ......... ............ A Chemotherapy, push technique ................... 0.17 2.92 NA 0.06 3.15 NA XXX 

96410 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.15 NA 0.08 4.40 NA XXX 

96412 ......... ............ A Chemo, infuse method add-on .................... 0.17 0.73 NA 0.07 0.97 NA ZZZ 

96414 ......... ............ A Chemo, infuse method add-on .................... 0.17 5.23 NA 0.08 5.48 NA XXX 

96420 ......... ............ A Chemotherapy, push technique ................... 0.17 2.82 NA 0.08 3.07 NA XXX 

96422 ......... ............ A Chemotherapy,infusion method ................... 0.17 5.18 NA 0.08 5.43 NA XXX 

96423 ......... ............ A Chemo, infuse method add-on .................... 0.17 2.00 NA 0.02 2.19 NA ZZZ 

96425 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.74 NA 0.08 4.99 NA XXX 

96440 ......... ............ A Chemotherapy, intracavitary ........................ 2.37 8.44 1.24 0.16 10.97 3.77 000 

96445 ......... ............ A Chemotherapy, intracavitary ........................ 2.20 8.56 1.19 0.12 10.88 3.51 000 

96450 ......... ............ A Chemotherapy, into CNS ............................. 1.89 7.37 1.09 0.09 9.35 3.07 000 

96520 ......... ............ A Port pump refill & main ................................ 0.17 3.94 NA 0.06 4.17 NA XXX 

96530 ......... ............ A Syst pump refill & main ............................... 0.17 2.86 NA 0.06 3.09 NA XXX 

96542 ......... ............ A Chemotherapy injection ............................... 1.42 4.45 0.65 0.07 5.94 2.14 XXX 

96567 ......... ............ A Photodynamic tx, skin .................................. 0.00 0.94 NA 0.04 0.98 NA XXX 

96570 ......... ............ A Photodynamic tx, 30 min ............................. 1.10 NA 0.37 0.11 NA 1.58 ZZZ 

96571 ......... ............ A Photodynamic tx, addl 15 min ..................... 0.55 NA 0.19 0.03 NA 0.77 ZZZ 

96900 ......... ............ A Ultraviolet light therapy ................................ 0.00 0.44 NA 0.02 0.46 NA XXX 

96902 ......... ............ B Trichogram ................................................... 0.41 0.18 0.15 0.01 0.60 0.57 XXX 

96910 ......... ............ A Photochemotherapy with UV-B ................... 0.00 0.99 NA 0.04 1.03 NA XXX 

96912 ......... ............ A Photochemotherapy with UV-A ................... 0.00 1.26 NA 0.05 1.31 NA XXX 

96913 ......... ............ A Photochemotherapy, UV-A or B .................. 0.00 1.68 NA 0.10 1.78 NA XXX 

96920 ......... ............ A Laser tx, skin < 250 sq cm .......................... 1.15 2.52 0.56 0.11 3.78 1.82 000 

96921 ......... ............ A Laser tx, skin 250-500 sq cm ...................... 1.17 2.60 0.57 0.11 3.88 1.85 000 

96922 ......... ............ A Laser tx, skin > 500 sq cm .......................... 2.10 3.48 0.62 0.19 5.77 2.91 000 

97001 ......... ............ A Pt evaluation ................................................ 1.20 0.75 0.45 0.06 2.01 1.71 XXX 

97002 ......... ............ A Pt re-evaluation ............................................ 0.60 0.45 0.23 0.02 1.07 0.85 XXX 

97003 ......... ............ A Ot evaluation ................................................ 1.20 0.88 0.40 0.07 2.15 1.67 XXX 

97004 ......... ............ A Ot re-evaluation ........................................... 0.60 0.67 0.19 0.02 1.29 0.81 XXX 

97010 ......... ............ B Hot or cold packs therapy ........................... 0.06 0.05 NA 0.01 0.12 NA XXX 

97012 ......... ............ A Mechanical traction therapy ......................... 0.25 0.13 NA 0.01 0.39 NA XXX 

97016 ......... ............ A Vasopneumatic device therapy ................... 0.18 0.18 NA 0.01 0.37 NA XXX 

97018 ......... ............ A Paraffin bath therapy ................................... 0.06 0.10 NA 0.00 0.16 NA XXX 

97020 ......... ............ A Microwave therapy ....................................... 0.06 0.05 NA 0.00 0.11 NA XXX 

97022 ......... ............ A Whirlpool therapy ......................................... 0.17 0.21 NA 0.01 0.39 NA XXX 

97024 ......... ............ A Diathermy treatment .................................... 0.06 0.07 NA 0.00 0.13 NA XXX 

97026 ......... ............ A Infrared therapy ........................................... 0.06 0.06 NA 0.00 0.12 NA XXX 

97028 ......... ............ A Ultraviolet therapy ........................................ 0.08 0.07 NA 0.00 0.15 NA XXX 

97032 ......... ............ A Electrical stimulation .................................... 0.25 0.16 NA 0.01 0.42 NA XXX 

97033 ......... ............ A Electric current therapy ................................ 0.26 0.27 NA 0.01 0.54 NA XXX 

97034 ......... ............ A Contrast bath therapy .................................. 0.21 0.15 NA 0.01 0.37 NA XXX 

97035 ......... ............ A Ultrasound therapy ...................................... 0.21 0.10 NA 0.01 0.32 NA XXX 

97036 ......... ............ A Hydrotherapy ............................................... 0.28 0.32 NA 0.01 0.61 NA XXX 

97039 ......... ............ A Physical therapy treatment .......................... 0.20 0.10 NA 0.01 0.31 NA XXX 

97110 ......... ............ A Therapeutic exercises .................................. 0.45 0.27 NA 0.02 0.74 NA XXX 

97112 ......... ............ A Neuromuscular reeducation ......................... 0.45 0.31 NA 0.02 0.78 NA XXX 

97113 ......... ............ A Aquatic therapy/exercises ............................ 0.44 0.39 NA 0.02 0.85 NA XXX 

97116 ......... ............ A Gait training therapy .................................... 0.40 0.24 NA 0.01 0.65 NA XXX 

97124 ......... ............ A Massage therapy ......................................... 0.35 0.23 NA 0.01 0.59 NA XXX 

97139 ......... ............ A Physical medicine procedure ....................... 0.21 0.20 NA 0.01 0.42 NA XXX 

47690

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

97140 ......... ............ A Manual therapy ............................................ 0.43 0.25 NA 0.02 0.70 NA XXX 

97150 ......... ............ A Group therapeutic procedures ..................... 0.27 0.18 NA 0.02 0.47 NA XXX 

97504 ......... ............ A Orthotic training ........................................... 0.45 0.33 NA 0.03 0.81 NA XXX 

97520 ......... ............ A Prosthetic training ........................................ 0.45 0.27 NA 0.02 0.74 NA XXX 

97530 ......... ............ A Therapeutic activities ................................... 0.44 0.32 NA 0.02 0.78 NA XXX 

97532 ......... ............ A Cognitive skills development ....................... 0.44 0.20 NA 0.01 0.65 NA XXX 

97533 ......... ............ A Sensory integration ...................................... 0.44 0.24 NA 0.01 0.69 NA XXX 

97535 ......... ............ A Self care mngment training ......................... 0.45 0.33 NA 0.01 0.79 NA XXX 

97537 ......... ............ A Community/work reintegration ..................... 0.45 0.26 NA 0.01 0.72 NA XXX 

97542 ......... ............ A Wheelchair mngment training ...................... 0.45 0.28 NA 0.01 0.74 NA XXX 

97601 ......... ............ A Wound(s) care, selective ............................. 0.50 0.49 NA 0.03 1.02 NA XXX 

97703 ......... ............ A Prosthetic checkout ..................................... 0.25 0.41 NA 0.02 0.68 NA XXX 

97750 ......... ............ A Physical performance test ........................... 0.45 0.32 NA 0.02 0.79 NA XXX 

97755 ......... ............ A Assistive technology assess ........................ 0.62 0.28 NA 0.02 0.92 NA XXX 

97802 ......... ............ A Medical nutrition, indiv, in ............................ 0.00 0.47 NA 0.01 0.48 NA XXX 

97803 ......... ............ A Med nutrition, indiv, subseq ......................... 0.00 0.47 NA 0.01 0.48 NA XXX 

97804 ......... ............ A Medical nutrition, group ............................... 0.00 0.18 NA 0.01 0.19 NA XXX 

98925 ......... ............ A Osteopathic manipulation ............................ 0.45 0.32 0.14 0.02 0.79 0.61 000 

98926 ......... ............ A Osteopathic manipulation ............................ 0.65 0.42 0.25 0.03 1.10 0.93 000 

98927 ......... ............ A Osteopathic manipulation ............................ 0.87 0.51 0.29 0.03 1.41 1.19 000 

98928 ......... ............ A Osteopathic manipulation ............................ 1.03 0.60 0.34 0.04 1.67 1.41 000 

98929 ......... ............ A Osteopathic manipulation ............................ 1.19 0.68 0.37 0.05 1.92 1.61 000 

98940 ......... ............ A Chiropractic manipulation ............................ 0.45 0.23 0.12 0.01 0.69 0.58 000 

98941 ......... ............ A Chiropractic manipulation ............................ 0.65 0.30 0.17 0.02 0.97 0.84 000 

98942 ......... ............ A Chiropractic manipulation ............................ 0.87 0.36 0.23 0.02 1.25 1.12 000 

99141 ......... ............ B Sedation, iv/im or inhalant ........................... 0.80 1.89 0.38 0.05 2.74 1.23 XXX 

99142 ......... ............ B Sedation, oral/rectal/nasal ........................... 0.60 0.96 0.31 0.04 1.60 0.95 XXX 

99170 ......... ............ A Anogenital exam, child ................................ 1.75 1.80 0.55 0.10 3.65 2.40 000 

99175 ......... ............ A Induction of vomiting .................................... 0.00 1.39 NA 0.10 1.49 NA XXX 

99183 ......... ............ A Hyperbaric oxygen therapy .......................... 2.34 4.07 0.72 0.16 6.57 3.22 XXX 

99185 ......... ............ A Regional hypothermia .................................. 0.00 0.64 NA 0.04 0.68 NA XXX 

99186 ......... ............ A Total body hypothermia ............................... 0.00 1.78 NA 0.45 2.23 NA XXX 

99195 ......... ............ A Phlebotomy .................................................. 0.00 0.44 NA 0.02 0.46 NA XXX 

99201 ......... ............ A Office/outpatient visit, new ........................... 0.45 0.50 0.15 0.03 0.98 0.63 XXX 

99202 ......... ............ A Office/outpatient visit, new ........................... 0.88 0.79 0.31 0.05 1.72 1.24 XXX 

99203 ......... ............ A Office/outpatient visit, new ........................... 1.34 1.14 0.48 0.09 2.57 1.91 XXX 

99204 ......... ............ A Office/outpatient visit, new ........................... 2.00 1.51 0.71 0.12 3.63 2.83 XXX 

99205 ......... ............ A Office/outpatient visit, new ........................... 2.67 1.79 0.94 0.15 4.61 3.76 XXX 

99211 ......... ............ A Office/outpatient visit, est ............................ 0.17 0.40 0.06 0.01 0.58 0.24 XXX 

99212 ......... ............ A Office/outpatient visit, est ............................ 0.45 0.54 0.16 0.03 1.02 0.64 XXX 

99213 ......... ............ A Office/outpatient visit, est ............................ 0.67 0.70 0.23 0.03 1.40 0.93 XXX 

99214 ......... ............ A Office/outpatient visit, est ............................ 1.10 1.04 0.40 0.05 2.19 1.55 XXX 

99215 ......... ............ A Office/outpatient visit, est ............................ 1.77 1.34 0.65 0.09 3.20 2.51 XXX 

99217 ......... ............ A Observation care discharge ......................... 1.28 NA 0.53 0.06 NA 1.87 XXX 

99218 ......... ............ A Observation care ......................................... 1.28 NA 0.44 0.06 NA 1.78 XXX 

99219 ......... ............ A Observation care ......................................... 2.14 NA 0.72 0.10 NA 2.96 XXX 

99220 ......... ............ A Observation care ......................................... 2.99 NA 1.02 0.14 NA 4.15 XXX 

99221 ......... ............ A Initial hospital care ....................................... 1.28 NA 0.45 0.07 NA 1.80 XXX 

99222 ......... ............ A Initial hospital care ....................................... 2.14 NA 0.74 0.10 NA 2.98 XXX 

99223 ......... ............ A Initial hospital care ....................................... 2.99 NA 1.03 0.13 NA 4.15 XXX 

99231 ......... ............ A Subsequent hospital care ............................ 0.64 NA 0.23 0.03 NA 0.90 XXX 

99232 ......... ............ A Subsequent hospital care ............................ 1.06 NA 0.37 0.05 NA 1.48 XXX 

99233 ......... ............ A Subsequent hospital care ............................ 1.51 NA 0.52 0.07 NA 2.10 XXX 

99234 ......... ............ A Observ/hosp same date .............................. 2.56 NA 0.88 0.13 NA 3.57 XXX 

99235 ......... ............ A Observ/hosp same date .............................. 3.41 NA 1.15 0.16 NA 4.72 XXX 

99236 ......... ............ A Observ/hosp same date .............................. 4.26 NA 1.44 0.20 NA 5.90 XXX 

99238 ......... ............ A Hospital discharge day ................................ 1.28 NA 0.54 0.05 NA 1.87 XXX 

99239 ......... ............ A Hospital discharge day ................................ 1.75 NA 0.60 0.07 NA 2.42 XXX 

99241 ......... ............ A Office consultation ....................................... 0.64 0.64 0.22 0.05 1.33 0.91 XXX 

99242 ......... ............ A Office consultation ....................................... 1.29 1.05 0.46 0.10 2.44 1.85 XXX 

99243 ......... ............ A Office consultation ....................................... 1.72 1.39 0.63 0.13 3.24 2.48 XXX 

99244 ......... ............ A Office consultation ....................................... 2.58 1.82 0.92 0.16 4.56 3.66 XXX 

99245 ......... ............ A Office consultation ....................................... 3.42 2.29 1.24 0.21 5.92 4.87 XXX 

99251 ......... ............ A Initial inpatient consult ................................. 0.66 NA 0.24 0.05 NA 0.95 XXX 

99252 ......... ............ A Initial inpatient consult ................................. 1.32 NA 0.50 0.10 NA 1.92 XXX 

99253 ......... ............ A Initial inpatient consult ................................. 1.82 NA 0.68 0.11 NA 2.61 XXX 

99254 ......... ............ A Initial inpatient consult ................................. 2.64 NA 0.98 0.13 NA 3.75 XXX 

99255 ......... ............ A Initial inpatient consult ................................. 3.64 NA 1.34 0.18 NA 5.16 XXX 

99261 ......... ............ A Follow-up inpatient consult .......................... 0.42 NA 0.15 0.02 NA 0.59 XXX 

99262 ......... ............ A Follow-up inpatient consult .......................... 0.85 NA 0.31 0.04 NA 1.20 XXX 

99263 ......... ............ A Follow-up inpatient consult .......................... 1.27 NA 0.45 0.06 NA 1.78 XXX 

99271 ......... ............ A Confirmatory consultation ............................ 0.45 0.56 0.16 0.03 1.04 0.64 XXX 

99272 ......... ............ A Confirmatory consultation ............................ 0.84 0.83 0.31 0.06 1.73 1.21 XXX 

99273 ......... ............ A Confirmatory consultation ............................ 1.19 1.12 0.45 0.10 2.41 1.74 XXX 

99274 ......... ............ A Confirmatory consultation ............................ 1.73 1.38 0.64 0.12 3.23 2.49 XXX 

47691

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

99275 ......... ............ A Confirmatory consultation ............................ 2.31 1.66 0.84 0.15 4.12 3.30 XXX 

99281 ......... ............ A Emergency dept visit ................................... 0.33 NA 0.09 0.02 NA 0.44 XXX 

99282 ......... ............ A Emergency dept visit ................................... 0.55 NA 0.14 0.04 NA 0.73 XXX 

99283 ......... ............ A Emergency dept visit ................................... 1.24 NA 0.31 0.09 NA 1.64 XXX 

99284 ......... ............ A Emergency dept visit ................................... 1.95 NA 0.47 0.14 NA 2.56 XXX 

99285 ......... ............ A Emergency dept visit ................................... 3.06 NA 0.72 0.23 NA 4.01 XXX 

99289 ......... ............ A Ped crit care transport ................................. 4.79 NA 1.45 0.17 NA 6.41 XXX 

99290 ......... ............ A Ped crit care transport addl ......................... 2.40 NA 0.81 0.08 NA 3.29 ZZZ 

99291 ......... ............ A Critical care, first hour ................................. 3.99 2.59 1.28 0.21 6.79 5.48 XXX 

99292 ......... ............ A Critical care, add-l 30 min ........................... 2.00 0.91 0.63 0.11 3.02 2.74 ZZZ 

99293 ......... ............ A Ped critical care, initial ................................. 15.98 NA 4.74 0.21 NA 20.93 XXX 

99294 ......... ............ A Ped critical care, subseq ............................. 7.99 NA 2.39 0.21 NA 10.59 XXX 

99295 ......... ............ A Neonate crit care, initial ............................... 18.46 NA 5.35 1.00 NA 24.81 XXX 

99296 ......... ............ A Neonate critical care subseq ....................... 7.99 NA 2.53 0.34 NA 10.86 XXX 

99298 ......... ............ A Ic for lbw infant < 1500 gm ......................... 2.75 NA 0.93 0.14 NA 3.82 XXX 

99299 ......... ............ A Ic, lbw infant 1500-2500 gm ........................ 2.50 NA 0.85 0.12 NA 3.47 XXX 

99301 ......... ............ A Nursing facility care ..................................... 1.20 0.50 0.50 0.05 1.75 1.75 XXX 

99302 ......... ............ A Nursing facility care ..................................... 1.61 0.64 0.64 0.07 2.32 2.32 XXX 

99303 ......... ............ A Nursing facility care ..................................... 2.01 0.76 0.76 0.09 2.86 2.86 XXX 

99311 ......... ............ A Nursing fac care, subseq ............................. 0.60 0.28 0.28 0.03 0.91 0.91 XXX 

99312 ......... ............ A Nursing fac care, subseq ............................. 1.00 0.45 0.45 0.05 1.50 1.50 XXX 

99313 ......... ............ A Nursing fac care, subseq ............................. 1.42 0.62 0.62 0.07 2.11 2.11 XXX 

99315 ......... ............ A Nursing fac discharge day ........................... 1.13 0.46 0.46 0.05 1.64 1.64 XXX 

99316 ......... ............ A Nursing fac discharge day ........................... 1.50 0.59 0.59 0.07 2.16 2.16 XXX 

99321 ......... ............ A Rest home visit, new patient ....................... 0.71 0.34 NA 0.04 1.09 NA XXX 

99322 ......... ............ A Rest home visit, new patient ....................... 1.01 0.46 NA 0.06 1.53 NA XXX 

99323 ......... ............ A Rest home visit, new patient ....................... 1.28 0.55 NA 0.06 1.89 NA XXX 

99331 ......... ............ A Rest home visit, est pat ............................... 0.60 0.32 NA 0.03 0.95 NA XXX 

99332 ......... ............ A Rest home visit, est pat ............................... 0.80 0.39 NA 0.04 1.23 NA XXX 

99333 ......... ............ A Rest home visit, est pat ............................... 1.00 0.46 NA 0.05 1.51 NA XXX 

99341 ......... ............ A Home visit, new patient ............................... 1.01 0.48 NA 0.06 1.55 NA XXX 

99342 ......... ............ A Home visit, new patient ............................... 1.52 0.68 NA 0.09 2.29 NA XXX 

99343 ......... ............ A Home visit, new patient ............................... 2.27 0.94 NA 0.12 3.33 NA XXX 

99344 ......... ............ A Home visit, new patient ............................... 3.03 1.18 NA 0.15 4.36 NA XXX 

99345 ......... ............ A Home visit, new patient ............................... 3.78 1.43 NA 0.18 5.39 NA XXX 

99347 ......... ............ A Home visit, est patient ................................. 0.76 0.40 NA 0.04 1.20 NA XXX 

99348 ......... ............ A Home visit, est patient ................................. 1.26 0.58 NA 0.06 1.90 NA XXX 

99349 ......... ............ A Home visit, est patient ................................. 2.02 0.84 NA 0.10 2.96 NA XXX 

99350 ......... ............ A Home visit, est patient ................................. 3.03 1.18 NA 0.15 4.36 NA XXX 

99354 ......... ............ A Prolonged service, office ............................. 1.77 0.77 0.65 0.08 2.62 2.50 ZZZ 

99355 ......... ............ A Prolonged service, office ............................. 1.77 0.75 0.62 0.08 2.60 2.47 ZZZ 

99356 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.62 0.08 NA 2.41 ZZZ 

99357 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.63 0.08 NA 2.42 ZZZ 

99374 ......... ............ B Home health care supervision ..................... 1.10 0.70 0.42 0.05 1.85 1.57 XXX 

99377 ......... ............ B Hospice care supervision ............................ 1.10 0.70 0.42 0.05 1.85 1.57 XXX 

99379 ......... ............ B Nursing fac care supervision ....................... 1.10 0.70 0.42 0.04 1.84 1.56 XXX 

99380 ......... ............ B Nursing fac care supervision ....................... 1.73 1.00 0.65 0.06 2.79 2.44 XXX 

99431 ......... ............ A Initial care, normal newborn ........................ 1.17 NA 0.38 0.04 NA 1.59 XXX 

99432 ......... ............ A Newborn care, not in hosp .......................... 1.26 0.93 0.40 0.05 2.24 1.71 XXX 

99433 ......... ............ A Normal newborn care/hospital ..................... 0.62 NA 0.20 0.03 NA 0.85 XXX 

99435 ......... ............ A Newborn discharge day hosp ...................... 1.50 NA 0.59 0.06 NA 2.15 XXX 

99436 ......... ............ A Attendance, birth .......................................... 1.50 NA 0.47 0.11 NA 2.08 XXX 

99440 ......... ............ A Newborn resuscitation ................................. 2.93 NA 0.93 0.13 NA 3.99 XXX 

G0030 ........ 26 ....... A PET imaging prev PET single ..................... 1.50 0.58 0.58 0.05 2.13 2.13 XXX 

G0031 ........ 26 ....... A PET imaging prev PET multple ................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX 

G0032 ........ 26 ....... A PET follow SPECT 78464 singl ................... 1.50 0.54 0.54 0.07 2.11 2.11 XXX 

G0033 ........ 26 ....... A PET follow SPECT 78464 mult ................... 1.87 0.73 0.73 0.07 2.67 2.67 XXX 

G0034 ........ 26 ....... A PET follow SPECT 76865 singl ................... 1.50 0.57 0.57 0.05 2.12 2.12 XXX 

G0035 ........ 26 ....... A PET follow SPECT 78465 mult ................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX 

G0036 ........ 26 ....... A PET follow cornry angio sing ....................... 1.50 0.56 0.56 0.05 2.11 2.11 XXX 

G0037 ........ 26 ....... A PET follow cornry angio mult ...................... 1.87 0.71 0.71 0.06 2.64 2.64 XXX 

G0038 ........ 26 ....... A PET follow myocard perf sing ..................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0039 ........ 26 ....... A PET follow myocard perf mult ..................... 1.87 0.71 0.71 0.07 2.65 2.65 XXX 

G0040 ........ 26 ....... A PET follow stress echo singl ....................... 1.50 0.59 0.59 0.07 2.16 2.16 XXX 

G0041 ........ 26 ....... A PET follow stress echo mult ........................ 1.87 0.73 0.73 0.07 2.67 2.67 XXX 

G0042 ........ 26 ....... A PET follow ventriculogm sing ...................... 1.50 0.61 0.61 0.05 2.16 2.16 XXX 

G0043 ........ 26 ....... A PET follow ventriculogm mult ...................... 1.87 0.75 0.75 0.06 2.68 2.68 XXX 

G0044 ........ 26 ....... A PET following rest ECG singl ...................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0045 ........ 26 ....... A PET following rest ECG mult ....................... 1.87 0.72 0.72 0.06 2.65 2.65 XXX 

G0046 ........ 26 ....... A PET follow stress ECG singl ....................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0047 ........ 26 ....... A PET follow stress ECG mult ........................ 1.87 0.73 0.73 0.06 2.66 2.66 XXX 

G0101 ........ ............ A CA screen;pelvic/breast exam ..................... 0.45 0.52 0.17 0.02 0.99 0.64 XXX 

G0102 ........ ............ A Prostate ca screening; dre .......................... 0.17 0.40 0.06 0.01 0.58 0.24 XXX 

G0104 ........ ............ A CA screen;flexi sigmoidscope ..................... 0.96 2.30 0.50 0.08 3.34 1.54 000 

G0105 ........ ............ A Colorectal scrn; hi risk ind ........................... 3.69 6.20 1.47 0.24 10.13 5.40 000 

47692

——————————

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare Payments. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

G0105 ........ 53 ....... A Colorectal scrn; hi risk ind ........................... 0.96 2.30 0.50 0.08 3.34 1.54 000 

G0106 ........ ............ A Colon CA screen;barium enema ................. 0.99 2.55 NA 0.17 3.71 NA XXX 

G0106 ........ 26 ....... A Colon CA screen;barium enema ................. 0.99 0.32 0.32 0.04 1.35 1.35 XXX 

G0106 ........ TC ...... A Colon CA screen;barium enema ................. 0.00 2.23 NA 0.13 2.36 NA XXX 

G0108 ........ ............ A Diab manage trn per indiv ........................... 0.00 0.83 NA 0.01 0.84 NA XXX 

G0109 ........ ............ A Diab manage trn ind/group .......................... 0.00 0.48 NA 0.01 0.49 NA XXX 

G0110 ........ ............ R Nett pulm-rehab educ; ind ........................... 0.90 0.68 0.29 0.04 1.62 1.23 XXX 

G0111 ........ ............ R Nett pulm-rehab educ; group ....................... 0.27 0.29 0.13 0.01 0.57 0.41 XXX 

G0112 ........ ............ R Nett;nutrition guid, initial .............................. 1.72 1.21 0.65 0.07 3.00 2.44 XXX 

G0113 ........ ............ R Nett;nutrition guid,subseqnt ......................... 1.29 0.82 0.41 0.05 2.16 1.75 XXX 

G0114 ........ ............ R Nett; psychosocial consult ........................... 1.20 0.48 0.37 0.04 1.72 1.61 XXX 

G0115 ........ ............ R Nett; psychological testing ........................... 1.20 0.84 0.37 0.03 2.07 1.60 XXX 

G0116 ........ ............ R Nett; psychosocial counsel .......................... 1.11 0.98 0.33 0.03 2.12 1.47 XXX 

G0117 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.45 0.72 0.19 0.01 1.18 0.65 XXX 

G0118 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.17 0.53 0.06 0.00 0.70 0.23 XXX 

G0120 ........ ............ A Colon ca scrn; barium enema ..................... 0.99 2.55 NA 0.17 3.71 NA XXX 

G0120 ........ 26 ....... A Colon ca scrn; barium enema ..................... 0.99 0.32 0.32 0.04 1.35 1.35 XXX 

G0120 ........ TC ...... A Colon ca scrn; barium enema ..................... 0.00 2.23 NA 0.13 2.36 NA XXX 

G0121 ........ ............ A Colon ca scrn not hi rsk ind ........................ 3.69 6.20 1.47 0.24 10.13 5.40 000 

G0121 ........ 53 ....... A Colon ca scrn not hi rsk ind ........................ 0.96 2.30 0.50 0.08 3.34 1.54 000 

G0124 ........ ............ A Screen c/v thin layer by MD ........................ 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

G0125 ........ 26 ....... A PET image pulmonary nodule ..................... 1.50 0.52 0.52 0.07 2.09 2.09 XXX 

G0127 ........ ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 

G0128 ........ ............ R CORF skilled nursing service ...................... 0.08 0.03 0.03 0.01 0.12 0.12 XXX 

G0130 ........ ............ A Single energy x-ray study ............................ 0.22 0.87 NA 0.06 1.15 NA XXX 

G0130 ........ 26 ....... A Single energy x-ray study ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

G0130 ........ TC ...... A Single energy x-ray study ............................ 0.00 0.80 NA 0.05 0.85 NA XXX 

G0141 ........ ............ A Scr c/v cyto,autosys and md ....................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

G0166 ........ ............ A Extrnl counterpulse, per tx ........................... 0.07 3.22 0.03 0.00 3.29 0.10 XXX 

G0168 ........ ............ A Wound closure by adhesive ........................ 0.45 1.94 0.22 0.03 2.42 0.70 000 

G0179 ........ ............ A MD recertification HHA PT .......................... 0.45 1.06 NA 0.02 1.53 NA XXX 

G0180 ........ ............ A MD certification HHA patient ....................... 0.67 1.29 NA 0.04 2.00 NA XXX 

G0181 ........ ............ A Home health care supervision ..................... 1.73 1.51 NA 0.08 3.32 NA XXX 

G0182 ........ ............ A Hospice care supervision ............................ 1.73 1.71 NA 0.07 3.51 NA XXX 

G0202 ........ ............ A Screeningmammographydigital ................... 0.70 2.77 NA 0.10 3.57 NA XXX 

G0202 ........ 26 ....... A Screeningmammographydigital ................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

G0202 ........ TC ...... A Screeningmammographydigital ................... 0.00 2.54 NA 0.07 2.61 NA XXX 

G0204 ........ ............ A Diagnosticmammographydigital ................... 0.87 2.78 NA 0.11 3.76 NA XXX 

G0204 ........ 26 ....... A Diagnosticmammographydigital ................... 0.87 0.28 0.28 0.04 1.19 1.19 XXX 

G0204 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.50 NA 0.07 2.57 NA XXX 

G0206 ........ ............ A Diagnosticmammographydigital ................... 0.70 2.25 NA 0.09 3.04 NA XXX 

G0206 ........ 26 ....... A Diagnosticmammographydigital ................... 0.70 0.23 0.23 0.03 0.96 0.96 XXX 

G0206 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.02 NA 0.06 2.08 NA XXX 

G0210 ........ 26 ....... A PET img wholebody dxlung ......................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX 

G0211 ........ 26 ....... A PET img wholbody init lung ......................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX 

G0212 ........ 26 ....... A PET img wholebod restag lung ................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0213 ........ 26 ....... A PET img wholbody dx .................................. 1.50 0.51 0.51 0.07 2.08 2.08 XXX 

G0214 ........ 26 ....... A PET img wholebod init ................................. 1.50 0.51 0.51 0.07 2.08 2.08 XXX 

G0215 ........ 26 ....... A PETimg wholebod restag ............................ 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0216 ........ 26 ....... A PET img wholebod dx melanoma ............... 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0217 ........ 26 ....... A PET img wholebod init melan ...................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0218 ........ 26 ....... A PET img wholebod restag mela .................. 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0220 ........ 26 ....... A PET img wholebod dx lymphoma ................ 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0221 ........ 26 ....... A PET imag wholbod init lympho .................... 1.50 0.51 0.51 0.07 2.08 2.08 XXX 

G0222 ........ 26 ....... A PET imag wholbod resta lymph .................. 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0223 ........ 26 ....... A PET imag wholbod reg dx head .................. 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0224 ........ 26 ....... A PET imag wholbod reg ini hea .................... 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0225 ........ 26 ....... A PET whol restag headneckonly ................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0226 ........ 26 ....... A PET img wholbody dx esophagl .................. 1.50 0.53 0.53 0.06 2.09 2.09 XXX 

G0227 ........ 26 ....... A PET img wholbod ini esophage ................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0228 ........ 26 ....... A PET img wholbod restg esopha .................. 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0229 ........ 26 ....... A PET img metaboloc brain pres .................... 1.50 0.52 0.52 0.07 2.09 2.09 XXX 

G0230 ........ 26 ....... A PET myocard viability post .......................... 1.50 0.53 0.53 0.06 2.09 2.09 XXX 

G0231 ........ 26 ....... A PET WhBD colorec; gamma cam ............... 1.50 0.51 0.51 0.06 2.07 2.07 XXX 

G0232 ........ 26 ....... A PET whbd lymphoma; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0233 ........ 26 ....... A PET whbd melanoma; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0234 ........ 26 ....... A PET WhBD pulm nod; gamma cam ............ 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0237 ........ ............ A Therapeutic procd strg endur ...................... 0.00 0.47 NA 0.02 0.49 NA XXX 

G0238 ........ ............ A Oth resp proc, indiv ..................................... 0.00 0.47 NA 0.02 0.49 NA XXX 

G0239 ........ ............ A Oth resp proc, group ................................... 0.00 0.32 NA 0.02 0.34 NA XXX 

G0245 ........ ............ R Initial foot exam pt lops ............................... 0.88 0.79 0.31 0.05 1.72 1.24 XXX 

G0246 ........ ............ R Followup eval of foot pt lop ......................... 0.45 0.54 0.16 0.03 1.02 0.64 XXX 

G0247 ........ ............ R Routine footcare pt w lops ........................... 0.50 0.52 0.21 0.03 1.05 0.74 ZZZ 

G0248 ........ ............ R Demonstrate use home inr mon .................. 0.00 6.61 NA 0.01 6.62 NA XXX 

G0249 ........ ............ R Provide test material,equipm ....................... 0.00 3.97 NA 0.01 3.98 NA XXX 

47693

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT 1/

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

Total 

Facility

total Global 

G0250 ........ ............ R MD review interpret of test .......................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

G0253 ........ 26 ....... A PET image brst dection recur ...................... 1.87 0.63 0.63 0.06 2.56 2.56 XXX 

G0254 ........ 26 ....... A PET image brst eval to tx ............................ 1.87 0.65 0.65 0.06 2.58 2.58 XXX 

G0268 ........ ............ A Removal of impacted wax md ..................... 0.61 0.63 0.24 0.02 1.26 0.87 000 

G0270 ........ ............ A MNT subs tx for change dx ......................... 0.00 0.47 NA 0.01 0.48 NA XXX 

G0271 ........ ............ A Group MNT 2 or more 30 mins ................... 0.00 0.18 NA 0.01 0.19 NA XXX 

G0275 ........ ............ A Renal angio, cardiac cath ............................ 0.25 NA 0.10 0.01 NA 0.36 ZZZ 

G0278 ........ ............ A Iliac art angio,cardiac cath ........................... 0.25 NA 0.10 0.01 NA 0.36 ZZZ 

G0281 ........ ............ A Elec stim unattend for press ........................ 0.18 0.11 NA 0.01 0.30 NA XXX 

G0283 ........ ............ A Elec stim other than wound ......................... 0.18 0.11 NA 0.01 0.30 NA XXX 

G0288 ........ ............ A Recon, CTA for surg plan ............................ 0.00 10.60 NA 0.18 10.78 NA XXX 

G0289 ........ ............ A Arthro, loose body + chondro ...................... 1.48 NA 0.80 0.33 NA 2.61 ZZZ 

G0296 ........ 26 ....... A PET imge restag thyrod cance .................... 1.87 0.71 0.71 0.08 2.66 2.66 XXX 

G0308 ........ ............ A ESRD related svc 4+mo<2yrs ..................... 12.74 8.54 8.54 0.42 21.70 21.70 XXX 

G0309 ........ ............ A ESRD related svc 2-3mo<2yrs .................... 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0310 ........ ............ A ESRD related svc 1 visit<2yr ...................... 8.49 5.68 5.68 0.28 14.45 14.45 XXX 

G0311 ........ ............ A ESRD related svs 4+mo 2-11yr .................. 9.73 4.72 4.72 0.34 14.79 14.79 XXX 

G0312 ........ ............ A ESRD relate svs 2-3 mo 2-11y ................... 8.11 3.92 3.92 0.29 12.32 12.32 XXX 

G0313 ........ ............ A ESRD related svs 1 mon 2-11y ................... 6.49 3.14 3.14 0.22 9.85 9.85 XXX 

G0314 ........ ............ A ESRD related svs 4+ mo 12-19 .................. 8.28 4.42 4.42 0.27 12.97 12.97 XXX 

G0315 ........ ............ A ESRD related svs 2-3mo 12-19 .................. 6.90 3.67 3.67 0.23 10.80 10.80 XXX 

G0316 ........ ............ A ESRD relate svs 1 vist 12-19 ...................... 5.52 2.94 2.94 0.17 8.63 8.63 XXX 

G0317 ........ ............ A ESRD related svs 4+mo 20+yrs .................. 5.09 2.86 2.86 0.17 8.12 8.12 XXX 

G0318 ........ ............ A ESRD related svs 2-3 mo 20+y .................. 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0319 ........ ............ A ESRD related svs 1 visit 20+ ...................... 3.39 1.90 1.90 0.11 5.40 5.40 XXX 

G0320 ........ ............ A ESRD related svs home under2 .................. 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0321 ........ ............ A ESRDrelatedsvs home mo 2-11y ................ 8.11 3.92 3.92 0.23 12.26 12.26 XXX 

G0322 ........ ............ A ESRD relate svs home mo12-19 ................. 6.90 3.67 3.67 0.29 10.86 10.86 XXX 

G0323 ........ ............ A ESRD related svs home mo 20+ ................ 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0324 ........ ............ A ESRD related svs home/dy<2y ................... 0.35 0.24 0.24 0.01 0.60 0.60 XXX 

G0325 ........ ............ A ESRD relate home/dy 2-11 yr ..................... 0.23 0.12 0.12 0.01 0.36 0.36 XXX 

G0326 ........ ............ A ESRD relate home/dy 12-19y ...................... 0.27 0.13 0.13 0.01 0.41 0.41 XXX 

G0327 ........ ............ A ESRD relate home/dy 20+yrs ...................... 0.14 0.08 0.08 0.01 0.23 0.23 XXX 

G0329 ........ ............ A Electromagntic tx for ulcers ......................... 0.06 0.12 0.02 0.01 0.19 0.09 XXX 

G0XX1 ........ ............ A Bone marrow aspir ...................................... 0.16 0.21 0.08 0.04 0.41 0.28 ZZZ 

G0XX2 ........ ............ A Preventative exam ....................................... 1.51 1.65 0.54 0.13 3.29 2.18 XXX 

G0XX3 ........ ............ A Venous mapping .......................................... 0.45 3.28 NA 0.30 4.03 NA XXX 

G0XX3 ........ 26 ....... A Venous mapping .......................................... 0.45 0.15 0.15 0.03 0.63 0.63 XXX 

G0XX3 ........ TC ...... A Venous mapping .......................................... 0.00 3.13 NA 0.27 3.40 NA XXX 

G0XX4 ........ ............ X Hospice, pre-elect ........................................ 1.34 0.00 0.00 0.10 1.44 1.44 XXX 

M0064 ........ ............ A Visit for drug monitoring .............................. 0.37 0.34 0.12 0.01 0.72 0.50 XXX 

P3001 ......... ............ A Screening pap smear by phys ..................... 0.42 0.15 0.15 0.02 0.59 0.59 XXX 

Q0035 ........ ............ A Cardiokymography ....................................... 0.17 0.45 NA 0.03 0.65 NA XXX 

Q0035 ........ 26 ....... A Cardiokymography ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

Q0035 ........ TC ...... A Cardiokymography ....................................... 0.00 0.39 NA 0.02 0.41 NA XXX 

Q0091 ........ ............ A Obtaining screen pap smear ....................... 0.37 0.67 0.14 0.02 1.06 0.53 XXX 

Q0092 ........ ............ A Set up port xray equipment ......................... 0.00 0.32 NA 0.01 0.33 NA XXX 

1 CPT codes and descriptions only are copyright 2004 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2004 American Dental Association. All rights reserved. 

3 + Indicates RVUs are not used for Medicare payment. 

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS

CPT

code Short descriptors 

00100 Disability examination 

00102 Anesth, salivary gland 

00103 Anesth, repair of cleft lip 

00120 Anesth, blepharoplasty 

00126 Anesth, ear surgery 

00140 Anesth, tympanotomy 

00142 Anesth, procedures on eye 

00144 Anesth, lens surgery 

00145 Anesth, corneal transplant 

00147 Anesth, vitreoretinal surg 

00148 Anesth, iridectomy 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

00160 Anesth, eye exam 

00162 Anesth, nose/sinus surgery 

00164 Anesth, nose/sinus surgery 

00170 Anesth, biopsy of nose 

00172 Anesth, procedure on mouth 

00174 Anesth, cleft palate repair 

00176 Anesth, pharyngeal surgery 

00190 Anesth, pharyngeal surgery 

00192 Anesth, face/skull bone surg 

00210 Anesth, facial bone surgery 

00212 Anesth, open head surgery 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

00214 Anesth, skull drainage 

00215 Anesth, skull drainage 

00216 Anesth, skull repair/fract 

00218 Anesth, head vessel surgery 

00220 Anesth, special head surgery 

00222 Anesth, intrcrn nerve 

00300 Anesth, head nerve surgery 

00320 Anesth, head/neck/ptrunk 

00322 Anesth, neck organ, 1 & over 

00326 Anesth, biopsy of thyroid 

00350 Anesth, larynx/trach, < 1 yr 

47694

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

00352 Anesth, neck vessel surgery 

00400 Anesth, neck vessel surgery 

00402 Anesth, skin, ext/per/atrunk 

00404 Anesth, surgery of breast 

00406 Anesth, surgery of breast 

00410 Anesth, surgery of breast 

00450 Anesth, correct heart rhythm 

00452 Anesth, surgery of shoulder 

00454 Anesth, surgery of shoulder 

00470 Anesth, collar bone biopsy 

00472 Anesth, removal of rib 

00474 Anesth, chest wall repair 

00500 Anesth, surgery of rib(s) 

00520 Anesth, esophageal surgery 

00522 Anesth, chest procedure 

00524 Anesth, chest lining biopsy 

00528 Anesth, chest drainage 

00529 Anesth, chest partition view 

00530 Anesth, chest partition view 

00532 Anesth, pacemaker insertion 

00534 Anesth, vascular access 

00537 Anesth, cardioverter/defib 

00539 Anesth, cardiac electrophys 

00540 Anesth, trach-bronch reconst 

00541 Anesth, chest surgery 

00542 Anesth, one lung ventilation 

00546 Anesth, release of lung 

00548 Anesth, lung,chest wall surg 

00550 Anesth, trachea,bronchi surg 

00560 Anesth, sternal debridement 

00562 Anesth, open heart surgery 

00563 Anesth, open heart surgery 

00566 Anesth, heart proc w/pump 

00580 Anesth, cabg w/o pump 

00600 Anesth, heart/lung transplnt 

00604 Anesth, spine, cord surgery 

00620 Anesth, sitting procedure 

00622 Anesth, spine, cord surgery 

00630 Anesth, removal of nerves 

00632 Anesth, spine, cord surgery 

00634 Anesth, removal of nerves 

00635 Anesth for chemonucleolysis 

00640 Anesth, lumbar puncture 

00670 Anesth, spine manipulation 

00700 Anesth, spine, cord surgery 

00702 Anesth, abdominal wall surg 

00730 Anesth, for liver biopsy 

00740 Anesth, abdominal wall surg 

00750 Anesth, upper gi visualize 

00752 Anesth, repair of hernia 

00754 Anesth, repair of hernia 

00756 Anesth, repair of hernia 

00770 Anesth, repair of hernia 

00790 Anesth, blood vessel repair 

00792 Anesth, surg upper abdomen 

00794 Anesth, hemorr/excise liver 

00796 Anesth, pancreas removal 

00797 Anesth, for liver transplant 

00800 Anesth, surgery for obesity 

00802 Anesth, abdominal wall surg 

00810 Anesth, fat layer removal 

00820 Anesth, low intestine scope 

00830 Anesth, abdominal wall surg 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

00832 Anesth, repair of hernia 

00834 Anesth, repair of hernia 

00836 Anesth, hernia repair< 1 yr 

00840 Anesth hernia repair preemie 

00842 Anesth, surg lower abdomen 

00844 Anesth, amniocentesis 

00846 Anesth, pelvis surgery 

00848 Anesth, hysterectomy 

00851 Anesth, pelvic organ surg 

00860 Anesth, tubal ligation 

00862 Anesth, surgery of abdomen 

00864 Anesth, kidney/ureter surg 

00865 Anesth, removal of bladder 

00866 Anesth, removal of prostate 

00868 Anesth, removal of adrenal 

00870 Anesth, kidney transplant 

00872 Anesth, bladder stone surg 

00873 Anesth kidney stone destruct 

00880 Anesth kidney stone destruct 

00882 Anesth, abdomen vessel surg 

00902 Anesth, major vein ligation 

00904 Anesth, anorectal surgery 

00906 Anesth, perineal surgery 

00908 Anesth, removal of vulva 

00910 Anesth, removal of prostate 

00912 Anesth, bladder surgery 

00914 Anesth, bladder tumor surg 

00916 Anesth, removal of prostate 

00918 Anesth, bleeding control 

00920 Anesth, stone removal 

00921 Anesth, genitalia surgery 

00922 Anesth, vasectomy 

00924 Anesth, sperm duct surgery 

00926 Anesth, testis exploration 

00928 Anesth, removal of testis 

00930 Anesth, removal of testis 

00932 Anesth, testis suspension 

00934 Anesth, amputation of penis 

00936 Anesth, penis, nodes removal 

00938 Anesth, penis, nodes removal 

00940 Anesth, insert penis device 

00942 Anesth, vaginal procedures 

00944 Anesth, surg on vag/urethral 

00948 Anesth, vaginal hysterectomy 

00950 Anesth, repair of cervix 

00952 Anesth, vaginal endoscopy 

01112 Anesth, hysteroscope/graph 

01120 Anesth, bone aspirate/bx 

01130 Anesth, pelvis surgery 

01140 Anesth, body cast procedure 

01150 Anesth, amputation at pelvis 

01160 Anesth, pelvic tumor surgery 

01170 Anesth, pelvis procedure 

01173 Anesth, pelvis surgery 

01180 Anesth, fx repair, pelvis 

01190 Anesth, pelvis nerve removal 

01200 Anesth, pelvis nerve removal 

01202 Anesth, hip joint procedure 

01210 Anesth, arthroscopy of hip 

01212 Anesth, hip joint surgery 

01214 Anesth, hip disarticulation 

01215 Anesth, hip arthroplasty 

01220 Anesth, revise hip repair 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

01230 Anesth, procedure on femur 

01232 Anesth, surgery of femur 

01234 Anesth, amputation of femur 

01250 Anesth, radical femur surg 

01260 Anesth, upper leg surgery 

01270 Anesth, upper leg veins surg 

01272 Anesth, thigh arteries surg 

01274 Anesth, femoral artery surg 

01320 Anesth, femoral embolectomy 

01340 Anesth, knee area surgery 

01360 Anesth, knee area procedure 

01380 Anesth, knee area surgery 

01382 Anesth, knee joint procedure 

01390 Anesth, dx knee arthroscopy 

01392 Anesth, knee area procedure 

01400 Anesth, knee area surgery 

01402 Anesth, knee joint surgery 

01404 Anesth, knee arthroplasty 

01420 Anesth, amputation at knee 

01430 Anesth, knee joint casting 

01432 Anesth, knee veins surgery 

01440 Anesth, knee vessel surg 

01442 Anesth, knee arteries surg 

01444 Anesth, knee artery surg 

01462 Anesth, knee artery repair 

01464 Anesth, lower leg procedure 

01470 Anesth, ankle/ft arthroscopy 

01472 Anesth, lower leg surgery 

01474 Anesth, achilles tendon surg 

01480 Anesth, lower leg surgery 

01482 Anesth, lower leg bone surg 

01484 Anesth, radical leg surgery 

01486 Anesth, lower leg revision 

01490 Anesth, ankle replacement 

01500 Anesth, lower leg casting 

01502 Anesth, leg arteries surg 

01520 Anesth, lwr leg embolectomy 

01522 Anesth, lower leg vein surg 

01610 Anesth, lower leg vein surg 

01620 Anesth, surgery of shoulder 

01622 Anesth, shoulder procedure 

01630 Anes dx shoulder arthroscopy 

01632 Anesth, surgery of shoulder 

01634 Anesth, surgery of shoulder 

01636 Anesth, shoulder joint amput 

01638 Anesth, forequarter amput 

01650 Anesth, shoulder replacement 

01652 Anesth, shoulder artery surg 

01654 Anesth, shoulder vessel surg 

01656 Anesth, shoulder vessel surg 

01670 Anesth, arm-leg vessel surg 

01680 Anesth, shoulder vein surg 

01682 Anesth, shoulder casting 

01710 Anesth, airplane cast 

01712 Anesth, elbow area surgery 

01714 Anesth, uppr arm tendon surg 

01716 Anesth, uppr arm tendon surg 

01730 Anesth, biceps tendon repair 

01732 Anesth, uppr arm procedure 

01740 Anesth, dx elbow arthroscopy 

01742 Anesth, upper arm surgery 

01744 Anesth, humerus surgery 

01756 Anesth, humerus repair 

47695

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

01758 Anesth, radical humerus surg 

01760 Anesth, humeral lesion surg 

01770 Anesth, elbow replacement 

01772 Anesth, uppr arm artery surg 

01780 Anesth, uppr arm embolectomy 

01782 Anesth, upper arm vein surg 

01810 Anesth, uppr arm vein repair 

01820 Anesth, lower arm surgery 

01829 Anesth, lower arm procedure 

01830 Anesth, dx wrist arthroscopy 

01832 Anesth, lower arm surgery 

01840 Anesth, wrist replacement 

01842 Anesth, lwr arm artery surg 

01844 Anesth, lwr arm embolectomy 

01850 Anesth, vascular shunt surg 

01852 Anesth, lower arm vein surg 

01860 Anesth, lwr arm vein repair 

01905 Anesth, lower arm casting 

01916 Anes, spine inject, x-ray/re 

01920 Anesth, dx arteriography 

01922 Anesth, catheterize heart 

01924 Anesth, cat or MRI scan 

01925 Anes, ther interven rad, art 

01926 Anes, ther interven rad, car 

01930 Anes, tx interv rad hrt/cran 

01931 Anes, ther interven rad, vei 

01932 Anes, ther interven rad, tip 

01933 Anes, tx interv rad, th vein 

01951 Anes, tx interv rad, cran v 

01952 Anesth, burn, less 4 percent 

01953 Anesth, burn, 4-9 percent 

01958 Anesth, burn, each 9 percent 

01960 Anesth, antepartum manipul 

01961 Anesth, vaginal delivery 

01962 Anesth, cs delivery 

01963 Anesth, emer hysterectomy 

01964 Anesth, cs hysterectomy 

01967 Anesth, abortion procedures 

01968 Anesth/analg, vag delivery 

01969 Anes/analg cs deliver add-on 

01990 Anesth/analg cs hyst add-on 

01991 Support for organ donor 

01992 Anesth, nerve block/inj 

01995 Anesth, n block/inj, prone 

01996 Regional anesthesia limb 

01999 Hosp manage cont drug admin 

10120 Remove foreign body 

10121 Remove foreign body 

10140 Drainage of hematoma/fluid 

10160 Puncture drainage of lesion 

10180 Complex drainage, wound 

11010 Debride skin, fx 

11011 Debride skin/muscle, fx 

11012 Debride skin/muscle/bone, fx 

11740 Drain blood from under nail 

11755 Biopsy, nail unit 

11760 Repair of nail bed 

11762 Reconstruction of nail bed 

11765 Excision of nail fold, toe 

11772 Removal of pilonidal lesion 

11920 Correct skin color defects 

11921 Correct skin color defects 

11922 Correct skin color defects 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

11971 Remove tissue expander(s) 

12020 Closure of split wound 

12021 Closure of split wound 

12036 Layer closure of wound(s) 

12037 Layer closure of wound(s) 

12045 Layer closure of wound(s) 

13100 Repair of wound or lesion 

13101 Repair of wound or lesion 

13102 Repair wound/lesion add-on 

13120 Repair of wound or lesion 

13121 Repair of wound or lesion 

13122 Repair wound/lesion add-on 

13131 Repair of wound or lesion 

13132 Repair of wound or lesion 

13133 Repair wound/lesion add-on 

13150 Repair of wound or lesion 

13151 Repair of wound or lesion 

13152 Repair of wound or lesion 

13153 Repair wound/lesion add-on 

14000 Skin tissue rearrangement 

14001 Skin tissue rearrangement 

14020 Skin tissue rearrangement 

14021 Skin tissue rearrangement 

14040 Skin tissue rearrangement 

14060 Skin tissue rearrangement 

15050 Skin pinch graft 

15200 Skin full graft 

15201 Skin full graft add-on 

15220 Skin full graft 

15221 Skin full graft add-on 

15240 Skin full graft 

15241 Skin full graft add-on 

15260 Skin full graft 

15350 Skin homograft 

15351 Skin homograft add-on 

15400 Skin heterograft 

15401 Skin heterograft add-on 

15570 Form skin pedicle flap 

15572 Form skin pedicle flap 

15574 Form skin pedicle flap 

15576 Form skin pedicle flap 

15600 Skin graft 

15610 Skin graft 

15620 Skin graft 

15630 Skin graft 

15650 Transfer skin pedicle flap 

15740 Island pedicle flap graft 

15760 Composite skin graft 

15780 Abrasion treatment of skin 

15781 Abrasion treatment of skin 

15782 Abrasion treatment of skin 

15783 Abrasion treatment of skin 

15786 Abrasion, lesion, single 

15787 Abrasion, lesions, add-on 

15788 Chemical peel, face, epiderm 

15789 Chemical peel, face, dermal 

15792 Chemical peel, nonfacial 

15793 Chemical peel, nonfacial 

15810 Salabrasion 

15811 Salabrasion 

15835 Excise excessive skin tissue 

15837 Excise excessive skin tissue 

15839 Excise excessive skin tissue 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

15860 Test for blood flow in graft 

19000 Drainage of breast lesion 

19001 Drain breast lesion add-on 

19020 Incision of breast lesion 

19030 Injection for breast x-ray 

19110 Nipple exploration 

19112 Excise breast duct fistula 

19291 Place needle wire, breast 

19295 Place breast clip, percut 

19350 Breast reconstruction 

19355 Correct inverted nipple(s) 

20000 Incision of abscess 

20005 Incision of deep abscess 

20100 Explore wound, neck 

20101 Explore wound, chest 

20102 Explore wound, abdomen 

20103 Explore wound, extremity 

20150 Excise epiphyseal bar 

20206 Needle biopsy, muscle 

20220 Bone biopsy, trocar/needle 

20225 Bone biopsy, trocar/needle 

20240 Bone biopsy, excisional 

20245 Bone biopsy, excisional 

20250 Open bone biopsy 

20251 Open bone biopsy 

20520 Removal of foreign body 

20525 Removal of foreign body 

20615 Treatment of bone cyst 

20650 Insert and remove bone pin 

20670 Removal of support implant 

20680 Removal of support implant 

20690 Apply bone fixation device 

20694 Remove bone fixation device 

20900 Removal of bone for graft 

20910 Remove cartilage for graft 

20922 Removal of fascia for graft 

20950 Fluid pressure, muscle 

20972 Bone/skin graft, metatarsal 

20974 Electrical bone stimulation 

20975 Electrical bone stimulation 

21025 Excision of bone, lower jaw 

21026 Excision of facial bone(s) 

21029 Contour of face bone lesion 

21030 Excise max/zygoma b9 tumor 

21031 Remove exostosis, mandible 

21032 Remove exostosis, maxilla 

21034 Excise max/zygoma mlg tumor 

21040 Excise mandible lesion 

21044 Removal of jaw bone lesion 

21045 Extensive jaw surgery 

21050 Removal of jaw joint 

21060 Remove jaw joint cartilage 

21070 Remove coronoid process 

21100 Maxillofacial fixation 

21110 Interdental fixation 

21116 Injection, jaw joint x-ray 

21120 Reconstruction of chin 

21121 Reconstruction of chin 

21122 Reconstruction of chin 

21123 Reconstruction of chin 

21125 Augmentation, lower jaw bone 

21127 Augmentation, lower jaw bone 

21137 Reduction of forehead 

47696

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

21138 Reduction of forehead 

21139 Reduction of forehead 

21143 Reconstruct midface, lefort 

21150 Reconstruct midface, lefort 

21151 Reconstruct midface, lefort 

21154 Reconstruct midface, lefort 

21155 Reconstruct midface, lefort 

21159 Reconstruct midface, lefort 

21160 Reconstruct midface, lefort 

21188 Reconstruction of midface 

21195 Reconst lwr jaw w/o fixation 

21196 Reconst lwr jaw w/fixation 

21198 Reconstr lwr jaw segment 

21206 Reconstruct upper jaw bone 

21208 Augmentation of facial bones 

21209 Reduction of facial bones 

21210 Face bone graft 

21215 Lower jaw bone graft 

21235 Ear cartilage graft 

21244 Reconstruction of lower jaw 

21245 Reconstruction of jaw 

21246 Reconstruction of jaw 

21248 Reconstruction of jaw 

21249 Reconstruction of jaw 

21255 Reconstruct lower jaw bone 

21260 Revise eye sockets 

21261 Revise eye sockets 

21263 Revise eye sockets 

21267 Revise eye sockets 

21268 Revise eye sockets 

21270 Augmentation, cheek bone 

21295 Revision of jaw muscle/bone 

21296 Revision of jaw muscle/bone 

21315 Treatment of nose fracture 

21320 Treatment of nose fracture 

21325 Treatment of nose fracture 

21330 Treatment of nose fracture 

21335 Treatment of nose fracture 

21336 Treat nasal septal fracture 

21337 Treat nasal septal fracture 

21338 Treat nasoethmoid fracture 

21339 Treat nasoethmoid fracture 

21343 Treatment of sinus fracture 

21344 Treatment of sinus fracture 

21345 Treat nose/jaw fracture 

21346 Treat nose/jaw fracture 

21347 Treat nose/jaw fracture 

21355 Treat cheek bone fracture 

21356 Treat cheek bone fracture 

21360 Treat cheek bone fracture 

21365 Treat cheek bone fracture 

21385 Treat eye socket fracture 

21386 Treat eye socket fracture 

21387 Treat eye socket fracture 

21400 Treat eye socket fracture 

21401 Treat eye socket fracture 

21421 Treat mouth roof fracture 

21422 Treat mouth roof fracture 

21423 Treat mouth roof fracture 

21431 Treat craniofacial fracture 

21432 Treat craniofacial fracture 

21440 Treat dental ridge fracture 

21445 Treat dental ridge fracture 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

21450 Treat lower jaw fracture 

21451 Treat lower jaw fracture 

21452 Treat lower jaw fracture 

21453 Treat lower jaw fracture 

21461 Treat lower jaw fracture 

21462 Treat lower jaw fracture 

21485 Reset dislocated jaw 

21493 Treat hyoid bone fracture 

21494 Treat hyoid bone fracture 

21495 Treat hyoid bone fracture 

21497 Interdental wiring 

21501 Drain neck/chest lesion 

21555 Remove lesion, neck/chest 

21700 Revision of neck muscle 

21720 Revision of neck muscle 

21800 Treatment of rib fracture 

21820 Treat sternum fracture 

21925 Biopsy soft tissue of back 

21930 Remove lesion, back or flank 

22305 Treat spine process fracture 

22310 Treat spine fracture 

22315 Treat spine fracture 

23000 Removal of calcium deposits 

23030 Drain shoulder lesion 

23031 Drain shoulder bursa 

23065 Biopsy shoulder tissues 

23066 Biopsy shoulder tissues 

23075 Removal of shoulder lesion 

23330 Remove shoulder foreign body 

23350 Injection for shoulder x-ray 

23500 Treat clavicle fracture 

23505 Treat clavicle fracture 

23520 Treat clavicle dislocation 

23525 Treat clavicle dislocation 

23540 Treat clavicle dislocation 

23545 Treat clavicle dislocation 

23570 Treat shoulder blade fx 

23575 Treat shoulder blade fx 

23600 Treat humerus fracture 

23605 Treat humerus fracture 

23620 Treat humerus fracture 

23625 Treat humerus fracture 

23650 Treat shoulder dislocation 

23665 Treat dislocation/fracture 

23675 Treat dislocation/fracture 

23700 Fixation of shoulder 

23921 Amputation follow-up surgery 

23930 Drainage of arm lesion 

23931 Drainage of arm bursa 

24065 Biopsy arm/elbow soft tissue 

24066 Biopsy arm/elbow soft tissue 

24075 Remove arm/elbow lesion 

24200 Removal of arm foreign body 

24201 Removal of arm foreign body 

24220 Injection for elbow x-ray 

24500 Treat humerus fracture 

24505 Treat humerus fracture 

24530 Treat humerus fracture 

24535 Treat humerus fracture 

24560 Treat humerus fracture 

24565 Treat humerus fracture 

24576 Treat humerus fracture 

24577 Treat humerus fracture 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

24600 Treat elbow dislocation 

24640 Treat elbow dislocation 

24650 Treat radius fracture 

24655 Treat radius fracture 

24670 Treat ulnar fracture 

24675 Treat ulnar fracture 

25065 Biopsy forearm soft tissues 

25246 Injection for wrist x-ray 

25500 Treat fracture of radius 

25505 Treat fracture of radius 

25520 Treat fracture of radius 

25530 Treat fracture of ulna 

25535 Treat fracture of ulna 

25560 Treat fracture radius & ulna 

25565 Treat fracture radius & ulna 

25600 Treat fracture radius/ulna 

25605 Treat fracture radius/ulna 

25622 Treat wrist bone fracture 

25624 Treat wrist bone fracture 

25630 Treat wrist bone fracture 

25635 Treat wrist bone fracture 

25650 Treat wrist bone fracture 

25675 Treat wrist dislocation 

26600 Treat metacarpal fracture 

26605 Treat metacarpal fracture 

26641 Treat thumb dislocation 

26645 Treat thumb fracture 

26670 Treat hand dislocation 

26675 Treat hand dislocation 

26700 Treat knuckle dislocation 

26705 Treat knuckle dislocation 

26720 Treat finger fracture, each 

26725 Treat finger fracture, each 

26740 Treat finger fracture, each 

26742 Treat finger fracture, each 

26750 Treat finger fracture, each 

26755 Treat finger fracture, each 

26770 Treat finger dislocation 

26775 Treat finger dislocation 

26863 Fuse/graft added joint 

26991 Drainage of pelvis bursa 

27040 Biopsy of soft tissues 

27047 Remove hip/pelvis lesion 

27086 Remove hip foreign body 

27093 Injection for hip x-ray 

27095 Injection for hip x-ray 

27193 Treat pelvic ring fracture 

27194 Treat pelvic ring fracture 

27200 Treat tail bone fracture 

27220 Treat hip socket fracture 

27230 Treat thigh fracture 

27246 Treat thigh fracture 

27256 Treat hip dislocation 

27257 Treat hip dislocation 

27275 Manipulation of hip joint 

27301 Drain thigh/knee lesion 

27323 Biopsy, thigh soft tissues 

27327 Removal of thigh lesion 

27370 Injection for knee x-ray 

27372 Removal of foreign body 

27500 Treatment of thigh fracture 

27501 Treatment of thigh fracture 

27508 Treatment of thigh fracture 

47697

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

27516 Treat thigh fx growth plate 

27517 Treat thigh fx growth plate 

27520 Treat kneecap fracture 

27530 Treat knee fracture 

27532 Treat knee fracture 

27538 Treat knee fracture(s) 

27550 Treat knee dislocation 

27560 Treat kneecap dislocation 

27570 Fixation of knee joint 

27603 Drain lower leg lesion 

27604 Drain lower leg bursa 

27605 Incision of achilles tendon 

27606 Incision of achilles tendon 

27613 Biopsy lower leg soft tissue 

27614 Biopsy lower leg soft tissue 

27618 Remove lower leg lesion 

27619 Remove lower leg lesion 

27630 Removal of tendon lesion 

27648 Injection for ankle x-ray 

27656 Repair leg fascia defect 

27658 Repair of leg tendon, each 

27659 Repair of leg tendon, each 

27664 Repair of leg tendon, each 

27665 Repair of leg tendon, each 

27685 Revision of lower leg tendon 

27686 Revise lower leg tendons 

27692 Revise additional leg tendon 

27730 Repair of tibia epiphysis 

27732 Repair of fibula epiphysis 

27740 Repair of leg epiphyses 

27742 Repair of leg epiphyses 

27750 Treatment of tibia fracture 

27752 Treatment of tibia fracture 

27760 Treatment of ankle fracture 

27762 Treatment of ankle fracture 

27780 Treatment of fibula fracture 

27781 Treatment of fibula fracture 

27786 Treatment of ankle fracture 

27788 Treatment of ankle fracture 

27808 Treatment of ankle fracture 

27810 Treatment of ankle fracture 

27816 Treatment of ankle fracture 

27818 Treatment of ankle fracture 

27824 Treat lower leg fracture 

27825 Treat lower leg fracture 

27830 Treat lower leg dislocation 

27860 Fixation of ankle joint 

28001 Drainage of bursa of foot 

28002 Treatment of foot infection 

28003 Treatment of foot infection 

28008 Incision of foot fascia 

28010 Incision of toe tendon 

28011 Incision of toe tendons 

28020 Exploration of foot joint 

28022 Exploration of foot joint 

28024 Exploration of toe joint 

28035 Decompression of tibia nerve 

28043 Excision of foot lesion 

28045 Excision of foot lesion 

28046 Resection of tumor, foot 

28050 Biopsy of foot joint lining 

28052 Biopsy of foot joint lining 

28054 Biopsy of toe joint lining 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

28060 Partial removal, foot fascia 

28062 Removal of foot fascia 

28070 Removal of foot joint lining 

28072 Removal of foot joint lining 

28080 Removal of foot lesion 

28086 Excise foot tendon sheath 

28088 Excise foot tendon sheath 

28090 Removal of foot lesion 

28092 Removal of toe lesions 

28100 Removal of ankle/heel lesion 

28103 Remove/graft foot lesion 

28104 Removal of foot lesion 

28107 Remove/graft foot lesion 

28108 Removal of toe lesions 

28110 Part removal of metatarsal 

28111 Part removal of metatarsal 

28112 Part removal of metatarsal 

28113 Part removal of metatarsal 

28114 Removal of metatarsal heads 

28116 Revision of foot 

28118 Removal of heel bone 

28119 Removal of heel spur 

28120 Part removal of ankle/heel 

28122 Partial removal of foot bone 

28124 Partial removal of toe 

28126 Partial removal of toe 

28140 Removal of metatarsal 

28150 Removal of toe 

28153 Partial removal of toe 

28160 Partial removal of toe 

28173 Extensive foot surgery 

28175 Extensive foot surgery 

28190 Removal of foot foreign body 

28192 Removal of foot foreign body 

28193 Removal of foot foreign body 

28200 Repair of foot tendon 

28202 Repair/graft of foot tendon 

28208 Repair of foot tendon 

28210 Repair/graft of foot tendon 

28220 Release of foot tendon 

28222 Release of foot tendons 

28225 Release of foot tendon 

28226 Release of foot tendons 

28230 Incision of foot tendon(s) 

28232 Incision of toe tendon 

28234 Incision of foot tendon 

28238 Revision of foot tendon 

28288 Partial removal of foot bone 

28289 Repair hallux rigidus 

28290 Correction of bunion 

28292 Correction of bunion 

28294 Correction of bunion 

28296 Correction of bunion 

28297 Correction of bunion 

28298 Correction of bunion 

28299 Correction of bunion 

28300 Incision of heel bone 

28302 Incision of ankle bone 

28305 Incise/graft midfoot bones 

28400 Treatment of heel fracture 

28405 Treatment of heel fracture 

28430 Treatment of ankle fracture 

28435 Treatment of ankle fracture 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

28450 Treat midfoot fracture, each 

28455 Treat midfoot fracture, each 

28470 Treat metatarsal fracture 

28475 Treat metatarsal fracture 

28490 Treat big toe fracture 

28495 Treat big toe fracture 

28510 Treatment of toe fracture 

28515 Treatment of toe fracture 

28530 Treat sesamoid bone fracture 

28540 Treat foot dislocation 

28545 Treat foot dislocation 

28570 Treat foot dislocation 

28575 Treat foot dislocation 

28600 Treat foot dislocation 

28605 Treat foot dislocation 

28630 Treat toe dislocation 

28635 Treat toe dislocation 

28636 Treat toe dislocation 

28660 Treat toe dislocation 

28665 Treat toe dislocation 

30115 Removal of nose polyp(s) 

30117 Removal of intranasal lesion 

30118 Removal of intranasal lesion 

30120 Revision of nose 

30124 Removal of nose lesion 

30125 Removal of nose lesion 

30130 Removal of turbinate bones 

30140 Removal of turbinate bones 

30150 Partial removal of nose 

30160 Removal of nose 

30320 Remove nasal foreign body 

30400 Reconstruction of nose 

30410 Reconstruction of nose 

30420 Reconstruction of nose 

30430 Revision of nose 

30435 Revision of nose 

30450 Revision of nose 

30460 Revision of nose 

30462 Revision of nose 

30465 Repair nasal stenosis 

30520 Repair of nasal septum 

30540 Repair nasal defect 

30545 Repair nasal defect 

30580 Repair upper jaw fistula 

30600 Repair mouth/nose fistula 

30620 Intranasal reconstruction 

30630 Repair nasal septum defect 

30801 Cauterization, inner nose 

30802 Cauterization, inner nose 

30915 Ligation, nasal sinus artery 

30920 Ligation, upper jaw artery 

31020 Exploration, maxillary sinus 

31030 Exploration, maxillary sinus 

31032 Explore sinus, remove polyps 

31040 Exploration behind upper jaw 

31050 Exploration, sphenoid sinus 

31051 Sphenoid sinus surgery 

31070 Exploration of frontal sinus 

31075 Exploration of frontal sinus 

31080 Removal of frontal sinus 

31081 Removal of frontal sinus 

31084 Removal of frontal sinus 

31085 Removal of frontal sinus 

47698

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

31086 Removal of frontal sinus 

31087 Removal of frontal sinus 

31090 Exploration of sinuses 

31200 Removal of ethmoid sinus 

31201 Removal of ethmoid sinus 

31205 Removal of ethmoid sinus 

31225 Removal of upper jaw 

31230 Removal of upper jaw 

31300 Removal of larynx lesion 

31320 Diagnostic incision, larynx 

31360 Removal of larynx 

31365 Removal of larynx 

31367 Partial removal of larynx 

31368 Partial removal of larynx 

31370 Partial removal of larynx 

31375 Partial removal of larynx 

31380 Partial removal of larynx 

31382 Partial removal of larynx 

31390 Removal of larynx & pharynx 

31395 Reconstruct larynx & pharynx 

31400 Revision of larynx 

31420 Removal of epiglottis 

31502 Change of windpipe airway 

31580 Revision of larynx 

31582 Revision of larynx 

31584 Treat larynx fracture 

31585 Treat larynx fracture 

31586 Treat larynx fracture 

31587 Revision of larynx 

31588 Revision of larynx 

31590 Reinnervate larynx 

31595 Larynx nerve surgery 

31610 Incision of windpipe 

31611 Surgery/speech prosthesis 

31613 Repair windpipe opening 

31614 Repair windpipe opening 

31622 Dx bronchoscope/wash 

31623 Dx bronchoscope/brush 

31624 Dx bronchoscope/lavage 

31625 Bronchoscopy w/biopsy(s) 

31628 Bronchoscopy/lung bx, each 

31629 Bronchoscopy/needle bx, each 

31630 Bronchoscopy dilate/fx repr 

31631 Bronchoscopy, dilate w/stent 

31635 Bronchoscopy w/fb removal 

31640 Bronchoscopy w/tumor excise 

31641 Bronchoscopy, treat blockage 

31643 Diag bronchoscope/catheter 

31645 Bronchoscopy, clear airways 

31646 Bronchoscopy, reclear airway 

31656 Bronchoscopy, inj for x-ray 

31708 Instill airway contrast dye 

31710 Insertion of airway catheter 

31715 Injection for bronchus x-ray 

31717 Bronchial brush biopsy 

31720 Clearance of airways 

31725 Clearance of airways 

31750 Repair of windpipe 

31755 Repair of windpipe 

31800 Repair of windpipe injury 

31820 Closure of windpipe lesion 

31825 Repair of windpipe defect 

31830 Revise windpipe scar 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

32002 Treatment of collapsed lung 

32020 Insertion of chest tube 

32201 Drain, percut, lung lesion 

32400 Needle biopsy chest lining 

32405 Biopsy, lung or mediastinum 

32420 Puncture/clear lung 

32851 Lung transplant, single 

32852 Lung transplant with bypass 

32853 Lung transplant, double 

32854 Lung transplant with bypass 

33010 Drainage of heart sac 

33011 Repeat drainage of heart sac 

33210 Insertion of heart electrode 

33211 Insertion of heart electrode 

33225 L ventric pacing lead add-on 

33508 Endoscopic vein harvest 

33935 Transplantation, heart/lung 

33945 Transplantation of heart 

33960 External circulation assist 

33967 Insert ia percut device 

33968 Remove aortic assist device 

33970 Aortic circulation assist 

33973 Insert balloon device 

33975 Implant ventricular device 

33976 Implant ventricular device 

33979 Insert intracorporeal device 

35450 Repair arterial blockage 

35452 Repair arterial blockage 

35454 Repair arterial blockage 

35456 Repair arterial blockage 

35458 Repair arterial blockage 

35459 Repair arterial blockage 

35460 Repair venous blockage 

35470 Repair arterial blockage 

35471 Repair arterial blockage 

35472 Repair arterial blockage 

35473 Repair arterial blockage 

35474 Repair arterial blockage 

35475 Repair arterial blockage 

35476 Repair venous blockage 

35480 Atherectomy, open 

35481 Atherectomy, open 

35482 Atherectomy, open 

35483 Atherectomy, open 

35484 Atherectomy, open 

35485 Atherectomy, open 

35572 Harvest femoropopliteal vein 

35697 Reimplant artery each 

36010 Place catheter in vein 

36011 Place catheter in vein 

36012 Place catheter in vein 

36013 Place catheter in artery 

36014 Place catheter in artery 

36015 Place catheter in artery 

36100 Establish access to artery 

36120 Establish access to artery 

36140 Establish access to artery 

36145 Artery to vein shunt 

36160 Establish access to aorta 

36200 Place catheter in aorta 

36215 Place catheter in artery 

36216 Place catheter in artery 

36217 Place catheter in artery 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

36218 Place catheter in artery 

36245 Place catheter in artery 

36246 Place catheter in artery 

36247 Place catheter in artery 

36248 Place catheter in artery 

36420 Vein access cutdown < 1 yr 

36430 Blood transfusion service 

36481 Insertion of catheter, vein 

36500 Insertion of catheter, vein 

36514 Apheresis plasma 

36515 Apheresis, adsorp/reinfuse 

36516 Apheresis, selective 

36625 Insertion catheter, artery 

36680 Insert needle, bone cavity 

37195 Thrombolytic therapy, stroke 

37200 Transcatheter biopsy 

37203 Transcatheter retrieval 

37204 Transcatheter occlusion 

37209 Exchange arterial catheter 

37785 Ligate/divide/excise vein 

38200 Injection for spleen x-ray 

38204 Bl donor search management 

38205 Harvest allogenic stem cells 

38206 Harvest auto stem cells 

38207 Cryopreserve stem cells 

38208 Thaw preserved stem cells 

38209 Wash harvest stem cells 

38210 T-cell depletion of harvest 

38211 Tumor cell deplete of harvst 

38212 Rbc depletion of harvest 

38213 Platelet deplete of harvest 

38214 Volume deplete of harvest 

38215 Harvest stem cell concentrte 

38240 Bone marrow/stem transplant 

38241 Bone marrow/stem transplant 

38242 Lymphocyte infuse transplant 

38305 Drainage, lymph node lesion 

38308 Incision of lymph channels 

38380 Thoracic duct procedure 

38520 Biopsy/removal, lymph nodes 

38542 Explore deep node(s), neck 

38700 Removal of lymph nodes, neck 

38720 Removal of lymph nodes, neck 

38724 Removal of lymph nodes, neck 

40500 Partial excision of lip 

40510 Partial excision of lip 

40520 Partial excision of lip 

40525 Reconstruct lip with flap 

40527 Reconstruct lip with flap 

40530 Partial removal of lip 

40650 Repair lip 

40652 Repair lip 

40654 Repair lip 

40700 Repair cleft lip/nasal 

40701 Repair cleft lip/nasal 

40702 Repair cleft lip/nasal 

40720 Repair cleft lip/nasal 

40761 Repair cleft lip/nasal 

40800 Drainage of mouth lesion 

40801 Drainage of mouth lesion 

40804 Removal, foreign body, mouth 

40805 Removal, foreign body, mouth 

40806 Incision of lip fold 

47699

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

40808 Biopsy of mouth lesion 

40810 Excision of mouth lesion 

40812 Excise/repair mouth lesion 

40814 Excise/repair mouth lesion 

40816 Excision of mouth lesion 

40818 Excise oral mucosa for graft 

40819 Excise lip or cheek fold 

40820 Treatment of mouth lesion 

40830 Repair mouth laceration 

40831 Repair mouth laceration 

40840 Reconstruction of mouth 

40842 Reconstruction of mouth 

40843 Reconstruction of mouth 

40844 Reconstruction of mouth 

40845 Reconstruction of mouth 

41005 Drainage of mouth lesion 

41006 Drainage of mouth lesion 

41007 Drainage of mouth lesion 

41008 Drainage of mouth lesion 

41009 Drainage of mouth lesion 

41010 Incision of tongue fold 

41015 Drainage of mouth lesion 

41016 Drainage of mouth lesion 

41017 Drainage of mouth lesion 

41018 Drainage of mouth lesion 

41110 Excision of tongue lesion 

41112 Excision of tongue lesion 

41113 Excision of tongue lesion 

41114 Excision of tongue lesion 

41115 Excision of tongue fold 

41116 Excision of mouth lesion 

41120 Partial removal of tongue 

41130 Partial removal of tongue 

41135 Tongue and neck surgery 

41140 Removal of tongue 

41145 Tongue removal, neck surgery 

41150 Tongue, mouth, jaw surgery 

41153 Tongue, mouth, neck surgery 

41155 Tongue, jaw, & neck surgery 

41500 Fixation of tongue 

41510 Tongue to lip surgery 

41520 Reconstruction, tongue fold 

41823 Excision of gum lesion 

41827 Excision of gum lesion 

41872 Repair gum 

41874 Repair tooth socket 

42107 Excision lesion, mouth roof 

42120 Remove palate/lesion 

42140 Excision of uvula 

42145 Repair palate, pharynx/uvula 

42200 Reconstruct cleft palate 

42205 Reconstruct cleft palate 

42210 Reconstruct cleft palate 

42215 Reconstruct cleft palate 

42220 Reconstruct cleft palate 

42225 Reconstruct cleft palate 

42226 Lengthening of palate 

42227 Lengthening of palate 

42235 Repair palate 

42260 Repair nose to lip fistula 

42305 Drainage of salivary gland 

42325 Create salivary cyst drain 

42326 Create salivary cyst drain 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

42335 Removal of salivary stone 

42340 Removal of salivary stone 

42408 Excision of salivary cyst 

42409 Drainage of salivary cyst 

42410 Excise parotid gland/lesion 

42415 Excise parotid gland/lesion 

42420 Excise parotid gland/lesion 

42425 Excise parotid gland/lesion 

42426 Excise parotid gland/lesion 

42440 Excise submaxillary gland 

42450 Excise sublingual gland 

42500 Repair salivary duct 

42505 Repair salivary duct 

42507 Parotid duct diversion 

42508 Parotid duct diversion 

42509 Parotid duct diversion 

42510 Parotid duct diversion 

42550 Injection for salivary x-ray 

42600 Closure of salivary fistula 

42665 Ligation of salivary duct 

42725 Drainage of throat abscess 

42810 Excision of neck cyst 

42815 Excision of neck cyst 

42820 Remove tonsils and adenoids 

42821 Remove tonsils and adenoids 

42825 Removal of tonsils 

42826 Removal of tonsils 

42830 Removal of adenoids 

42831 Removal of adenoids 

42835 Removal of adenoids 

42836 Removal of adenoids 

42842 Extensive surgery of throat 

42844 Extensive surgery of throat 

42845 Extensive surgery of throat 

42860 Excision of tonsil tags 

42870 Excision of lingual tonsil 

42890 Partial removal of pharynx 

42892 Revision of pharyngeal walls 

42894 Revision of pharyngeal walls 

42950 Reconstruction of throat 

42953 Repair throat, esophagus 

42955 Surgical opening of throat 

42961 Control throat bleeding 

42962 Control throat bleeding 

42970 Control nose/throat bleeding 

42971 Control nose/throat bleeding 

42972 Control nose/throat bleeding 

43020 Incision of esophagus 

43030 Throat muscle surgery 

43600 Biopsy of stomach 

43761 Reposition gastrostomy tube 

44100 Biopsy of bowel 

44385 Endoscopy of bowel pouch 

44386 Endoscopy, bowel pouch/biop 

44500 Intro, gastrointestinal tube 

44701 Intraop colon lavage add-on 

44901 Drain app abscess, percut 

45005 Drainage of rectal abscess 

45520 Treatment of rectal prolapse 

45915 Remove rectal obstruction 

46040 Incision of rectal abscess 

46200 Removal of anal fissure 

46210 Removal of anal crypt 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

46211 Removal of anal crypts 

46221 Ligation of hemorrhoid(s) 

46250 Hemorrhoidectomy 

46255 Hemorrhoidectomy 

46270 Removal of anal fistula 

46275 Removal of anal fistula 

46285 Removal of anal fistula 

46500 Injection into hemorrhoid(s) 

46900 Destruction, anal lesion(s) 

46910 Destruction, anal lesion(s) 

46934 Destruction of hemorrhoids 

46936 Destruction of hemorrhoids 

46938 Cryotherapy of rectal lesion 

46945 Ligation of hemorrhoids 

46946 Ligation of hemorrhoids 

47135 Transplantation of liver 

47136 Transplantation of liver 

47140 Partial removal, donor liver 

47141 Partial removal, donor liver 

47142 Partial removal, donor liver 

47500 Injection for liver x-rays 

47525 Change bile duct catheter 

47530 Revise/reinsert bile tube 

47553 Biliary endoscopy thru skin 

47556 Biliary endoscopy thru skin 

47561 Laparo w/cholangio/biopsy 

48511 Drain pancreatic pseudocyst 

48554 Transpl allograft pancreas 

48556 Removal, allograft pancreas 

49021 Drain abdominal abscess 

49041 Drain, percut, abdom abscess 

49061 Drain, percut, retroper absc 

49400 Air injection into abdomen 

49423 Exchange drainage catheter 

49424 Assess cyst, contrast inject 

49427 Injection, abdominal shunt 

49505 Prp i/hern init reduc>5 yr 

50010 Exploration of kidney 

50020 Renal abscess, open drain 

50021 Renal abscess, percut drain 

50040 Drainage of kidney 

50045 Exploration of kidney 

50060 Removal of kidney stone 

50065 Incision of kidney 

50070 Incision of kidney 

50075 Removal of kidney stone 

50080 Removal of kidney stone 

50081 Removal of kidney stone 

50100 Revise kidney blood vessels 

50120 Exploration of kidney 

50125 Explore and drain kidney 

50130 Removal of kidney stone 

50135 Exploration of kidney 

50200 Biopsy of kidney 

50205 Biopsy of kidney 

50220 Remove kidney, open 

50225 Removal kidney open, complex 

50230 Removal kidney open, radical 

50234 Removal of kidney & ureter 

50236 Removal of kidney & ureter 

50240 Partial removal of kidney 

50280 Removal of kidney lesion 

50290 Removal of kidney lesion 

47700

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

50300 Removal of donor kidney 

50320 Removal of donor kidney 

50340 Removal of kidney 

50360 Transplantation of kidney 

50365 Transplantation of kidney 

50370 Remove transplanted kidney 

50380 Reimplantation of kidney 

50390 Drainage of kidney lesion 

50392 Insert kidney drain 

50393 Insert ureteral tube 

50394 Injection for kidney x-ray 

50395 Create passage to kidney 

50396 Measure kidney pressure 

50398 Change kidney tube 

50400 Revision of kidney/ureter 

50405 Revision of kidney/ureter 

50500 Repair of kidney wound 

50520 Close kidney-skin fistula 

50525 Repair renal-abdomen fistula 

50526 Repair renal-abdomen fistula 

50540 Revision of horseshoe kidney 

50541 Laparo ablate renal cyst 

50542 Laparo ablate renal mass 

50544 Laparoscopy, pyeloplasty 

50545 Laparo radical nephrectomy 

50546 Laparoscopic nephrectomy 

50547 Laparo removal donor kidney 

50548 Laparo remove w/ ureter 

50551 Kidney endoscopy 

50553 Kidney endoscopy 

50555 Kidney endoscopy & biopsy 

50555 Kidney endoscopy & biopsy 

50557 Kidney endoscopy & treatment 

50559 Renal endoscopy/radiotracer 

50561 Kidney endoscopy & treatment 

50562 Renal scope w/tumor resect 

50570 Kidney endoscopy 

50572 Kidney endoscopy 

50574 Kidney endoscopy & biopsy 

50575 Kidney endoscopy 

50576 Kidney endoscopy & treatment 

50578 Renal endoscopy/radiotracer 

50580 Kidney endoscopy & treatment 

50590 Fragmenting of kidney stone 

50600 Exploration of ureter 

50605 Insert ureteral support 

50610 Removal of ureter stone 

50620 Removal of ureter stone 

50630 Removal of ureter stone 

50650 Removal of ureter 

50660 Removal of ureter 

50684 Injection for ureter x-ray 

50686 Measure ureter pressure 

50688 Change of ureter tube 

50690 Injection for ureter x-ray 

50700 Revision of ureter 

50715 Release of ureter 

50722 Release of ureter 

50725 Release/revise ureter 

50727 Revise ureter 

50728 Revise ureter 

50740 Fusion of ureter & kidney 

50750 Fusion of ureter & kidney 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

50760 Fusion of ureters 

50770 Splicing of ureters 

50780 Reimplant ureter in bladder 

50782 Reimplant ureter in bladder 

50783 Reimplant ureter in bladder 

50785 Reimplant ureter in bladder 

50800 Implant ureter in bowel 

50810 Fusion of ureter & bowel 

50815 Urine shunt to intestine 

50820 Construct bowel bladder 

50825 Construct bowel bladder 

50830 Revise urine flow 

50840 Replace ureter by bowel 

50845 Appendico-vesicostomy 

50860 Transplant ureter to skin 

50900 Repair of ureter 

50920 Closure ureter/skin fistula 

50930 Closure ureter/bowel fistula 

50940 Release of ureter 

50945 Laparoscopy ureterolithotomy 

50947 Laparo new ureter/bladder 

50948 Laparo new ureter/bladder 

50949 Laparoscope proc, ureter 

50951 Endoscopy of ureter 

50953 Endoscopy of ureter 

50955 Ureter endoscopy & biopsy 

50957 Ureter endoscopy & treatment 

50959 Ureter endoscopy & tracer 

50961 Ureter endoscopy & treatment 

50970 Ureter endoscopy 

50972 Ureter endoscopy & catheter 

50974 Ureter endoscopy & biopsy 

50976 Ureter endoscopy & treatment 

50978 Ureter endoscopy & tracer 

50980 Ureter endoscopy & treatment 

52007 Cystoscopy and biopsy 

52010 Cystoscopy & duct catheter 

52204 Cystoscopy 

52214 Cystoscopy and treatment 

52224 Cystoscopy and treatment 

52234 Cystoscopy and treatment 

52235 Cystoscopy and treatment 

52240 Cystoscopy and treatment 

52265 Cystoscopy and treatment 

52270 Cystoscopy & revise urethra 

52275 Cystoscopy & revise urethra 

52310 Cystoscopy and treatment 

52315 Cystoscopy and treatment 

52317 Remove bladder stone 

52327 Cystoscopy, inject material 

52330 Cystoscopy and treatment 

52332 Cystoscopy and treatment 

53040 Drainage of urethra abscess 

53060 Drainage of urethra abscess 

53200 Biopsy of urethra 

53260 Treatment of urethra lesion 

53265 Treatment of urethra lesion 

53270 Removal of urethra gland 

53605 Dilate urethra stricture 

53665 Dilation of urethra 

53850 Prostatic microwave thermotx 

53852 Prostatic rf thermotx 

53853 Prostatic water thermother 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

54000 Slitting of prepuce 

54001 Slitting of prepuce 

54056 Cryosurgery, penis lesion(s) 

54057 Laser surg, penis lesion(s) 

54060 Excision of penis lesion(s) 

54065 Destruction, penis lesion(s) 

54105 Biopsy of penis 

54110 Treatment of penis lesion 

54111 Treat penis lesion, graft 

54112 Treat penis lesion, graft 

54115 Treatment of penis lesion 

54120 Partial removal of penis 

54125 Removal of penis 

54130 Remove penis & nodes 

54135 Remove penis & nodes 

54150 Circumcision 

54160 Circumcision 

54162 Lysis penil circumic lesion 

55110 Explore scrotum 

55120 Removal of scrotum lesion 

55150 Removal of scrotum 

55175 Revision of scrotum 

55180 Revision of scrotum 

55200 Incision of sperm duct 

55250 Removal of sperm duct(s) 

55400 Repair of sperm duct 

56605 Biopsy of vulva/perineum 

56700 Partial removal of hymen 

56720 Incision of hymen 

56740 Remove vagina gland lesion 

57100 Biopsy of vagina 

57105 Biopsy of vagina 

57160 Insert pessary/other device 

57400 Dilation of vagina 

57452 Exam of cervix w/scope 

57454 Bx/curett of cervix w/scope 

57460 Bx of cervix w/scope, leep 

57500 Biopsy of cervix 

57520 Conization of cervix 

57522 Conization of cervix 

58555 Hysteroscopy, dx, sep proc 

58558 Hysteroscopy, biopsy 

58559 Hysteroscopy, lysis 

58560 Hysteroscopy, resect septum 

58561 Hysteroscopy, remove myoma 

58562 Hysteroscopy, remove fb 

58800 Drainage of ovarian cyst(s) 

58823 Drain pelvic abscess, percut 

59030 Fetal scalp blood sample 

59140 Treat ectopic pregnancy 

59320 Revision of cervix 

59325 Revision of cervix 

59350 Repair of uterus 

59820 Care of miscarriage 

59821 Treatment of miscarriage 

61107 Drill skull for implantation 

61210 Pierce skull, implant device 

61316 Implt cran bone flap to abdo 

61517 Implt brain chemotx add-on 

61576 Skull base/brainstem surgery 

61864 Implant neuroelectrde, add’l 

61868 Implant neuroelectrde, add’l 

62120 Repair skull cavity lesion 

47701

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

62121 Incise skull repair 

62148 Retr bone flap to fix skull 

62160 Neuroendoscopy add-on 

62270 Spinal fluid tap, diagnostic 

62272 Drain cerebro spinal fluid 

62273 Treat epidural spine lesion 

62280 Treat spinal cord lesion 

62281 Treat spinal cord lesion 

62282 Treat spinal canal lesion 

62284 Injection for myelogram 

62290 Inject for spine disk x-ray 

62291 Inject for spine disk x-ray 

62310 Inject spine c/t 

62311 Inject spine l/s (cd) 

62318 Inject spine w/cath, c/t 

62319 Inject spine w/cath l/s (cd) 

62367 Analyze spine infusion pump 

62368 Analyze spine infusion pump 

63048 Remove spinal lamina add-on 

63057 Decompress spine cord add-on 

63066 Decompress spine cord add-on 

63076 Neck spine disk surgery 

63078 Spine disk surgery, thorax 

63082 Remove vertebral body add-on 

63086 Remove vertebral body add-on 

63088 Remove vertebral body add-on 

63091 Remove vertebral body add-on 

63103 Remove vertebral body add-on 

63308 Remove vertebral body add-on 

64400 N block inj, trigeminal 

64402 N block inj, facial 

64405 N block inj, occipital 

64408 N block inj, vagus 

64410 N block inj, phrenic 

64412 N block inj, spinal accessor 

64413 N block inj, cervical plexus 

64415 N block inj, brachial plexus 

64417 N block inj, axillary 

64418 N block inj, suprascapular 

64420 N block inj, intercost, sng 

64421 N block inj, intercost, mlt 

64425 N block inj ilio-ing/hypogi 

64430 N block inj, pudendal 

64435 N block inj, paracervical 

64445 N block inj, sciatic, sng 

64450 N block, other peripheral 

64470 Inj paravertebral c/t 

64472 Inj paravertebral c/t add-on 

64475 Inj paravertebral l/s 

64476 Inj paravertebral l/s add-on 

64479 Inj foramen epidural c/t 

64480 Inj foramen epidural add-on 

64483 Inj foramen epidural l/s 

64484 Inj foramen epidural add-on 

64505 N block, spenopalatine gangl 

64508 N block, carotid sinus s/p 

64510 N block, stellate ganglion 

64520 N block, lumbar/thoracic 

64530 N block inj, celiac pelus 

64561 Implant neuroelectrodes 

64600 Injection treatment of nerve 

64605 Injection treatment of nerve 

64610 Injection treatment of nerve 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

64612 Destroy nerve, face muscle 

64613 Destroy nerve, spine muscle 

64614 Destroy nerve, extrem musc 

64620 Injection treatment of nerve 

64622 Destr paravertebrl nerve l/s 

64623 Destr paravertebral n add-on 

64626 Destr paravertebrl nerve c/t 

64627 Destr paravertebral n add-on 

64630 Injection treatment of nerve 

64640 Injection treatment of nerve 

64680 Injection treatment of nerve 

64716 Revision of cranial nerve 

64740 Incision of tongue nerve 

64778 Digit nerve surgery add-on 

64864 Repair of facial nerve 

64865 Repair of facial nerve 

64866 Fusion of facial/other nerve 

64868 Fusion of facial/other nerve 

64885 Nerve graft, head or neck 

64886 Nerve graft, head or neck 

65125 Revise ocular implant 

65205 Remove foreign body from eye 

65210 Remove foreign body from eye 

65220 Remove foreign body from eye 

65222 Remove foreign body from eye 

65270 Repair of eye wound 

65272 Repair of eye wound 

65273 Repair of eye wound 

65275 Repair of eye wound 

65280 Repair of eye wound 

65285 Repair of eye wound 

65286 Repair of eye wound 

65290 Repair of eye socket wound 

65400 Removal of eye lesion 

65410 Biopsy of cornea 

65420 Removal of eye lesion 

65426 Removal of eye lesion 

65430 Corneal smear 

65435 Curette/treat cornea 

65436 Curette/treat cornea 

65450 Treatment of corneal lesion 

65600 Revision of cornea 

65771 Radial keratotomy 

65772 Correction of astigmatism 

65800 Drainage of eye 

65805 Drainage of eye 

65810 Drainage of eye 

65815 Drainage of eye 

65855 Laser surgery of eye 

65860 Incise inner eye adhesions 

66020 Injection treatment of eye 

66030 Injection treatment of eye 

66130 Remove eye lesion 

66250 Follow-up surgery of eye 

66625 Removal of iris 

66630 Removal of iris 

66635 Removal of iris 

66990 Ophthalmic endoscope add-on 

67025 Replace eye fluid 

67027 Implant eye drug system 

67028 Injection eye drug 

67031 Laser surgery, eye strands 

67101 Repair detached retina 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

67105 Repair detached retina 

67107 Repair detached retina 

67108 Repair detached retina 

67110 Repair detached retina 

67112 Rerepair detached retina 

67115 Release encircling material 

67120 Remove eye implant material 

67121 Remove eye implant material 

67141 Treatment of retina 

67145 Treatment of retina 

67345 Destroy nerve of eye muscle 

67500 Inject/treat eye socket 

67505 Inject/treat eye socket 

67515 Inject/treat eye socket 

67700 Drainage of eyelid abscess 

67710 Incision of eyelid 

67715 Incision of eyelid fold 

67800 Remove eyelid lesion 

67801 Remove eyelid lesions 

67805 Remove eyelid lesions 

67808 Remove eyelid lesion(s) 

67820 Revise eyelashes 

67825 Revise eyelashes 

67830 Revise eyelashes 

67840 Remove eyelid lesion 

67850 Treat eyelid lesion 

67875 Closure of eyelid by suture 

67880 Revision of eyelid 

67882 Revision of eyelid 

67900 Repair brow defect 

67901 Repair eyelid defect 

67902 Repair eyelid defect 

67903 Repair eyelid defect 

67904 Repair eyelid defect 

67906 Repair eyelid defect 

67908 Repair eyelid defect 

67909 Repair eyelid defect 

67911 Repair eyelid defect 

67914 Repair eyelid defect 

67915 Repair eyelid defect 

67916 Repair eyelid defect 

67917 Repair eyelid defect 

67921 Repair eyelid defect 

67922 Repair eyelid defect 

67923 Repair eyelid defect 

67924 Repair eyelid defect 

67930 Repair eyelid wound 

67935 Repair eyelid wound 

67938 Remove eyelid foreign body 

67950 Revision of eyelid 

67961 Revision of eyelid 

67966 Revision of eyelid 

67971 Reconstruction of eyelid 

67973 Reconstruction of eyelid 

67974 Reconstruction of eyelid 

67975 Reconstruction of eyelid 

68020 Incise/drain eyelid lining 

68040 Treatment of eyelid lesions 

68100 Biopsy of eyelid lining 

68110 Remove eyelid lining lesion 

68115 Remove eyelid lining lesion 

68130 Remove eyelid lining lesion 

68135 Remove eyelid lining lesion 

47702

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

68200 Treat eyelid by injection 

68320 Revise/graft eyelid lining 

68325 Revise/graft eyelid lining 

68326 Revise/graft eyelid lining 

68328 Revise/graft eyelid lining 

68330 Revise eyelid lining 

68335 Revise/graft eyelid lining 

68340 Separate eyelid adhesions 

68360 Revise eyelid lining 

68362 Revise eyelid lining 

68440 Incise tear duct opening 

68700 Repair tear ducts 

68705 Revise tear duct opening 

68760 Close tear duct opening 

68761 Close tear duct opening 

68770 Close tear duct opening 

68801 Dilate tear duct opening 

68810 Probe nasolacrimal duct 

68811 Probe nasolacrimal duct 

68815 Probe nasolacrimal duct 

68840 Explore/irrigate tear ducts 

68850 Injection for tear sac x-ray 

69110 Remove external ear, partial 

69120 Removal of external ear 

69140 Remove ear canal lesion(s) 

69145 Remove ear canal lesion(s) 

69150 Extensive ear canal surgery 

69155 Extensive ear/neck surgery 

69310 Rebuild outer ear canal 

69320 Rebuild outer ear canal 

69440 Exploration of middle ear 

69450 Eardrum revision 

69501 Mastoidectomy 

69502 Mastoidectomy 

69505 Remove mastoid structures 

69511 Extensive mastoid surgery 

69530 Extensive mastoid surgery 

69535 Remove part of temporal bone 

69550 Remove ear lesion 

69552 Remove ear lesion 

69554 Remove ear lesion 

69601 Mastoid surgery revision 

69602 Mastoid surgery revision 

69603 Mastoid surgery revision 

69604 Mastoid surgery revision 

69605 Mastoid surgery revision 

69620 Repair of eardrum 

69631 Repair eardrum structures 

69632 Rebuild eardrum structures 

69633 Rebuild eardrum structures 

69635 Repair eardrum structures 

69636 Rebuild eardrum structures 

69637 Rebuild eardrum structures 

69641 Revise middle ear & mastoid 

69642 Revise middle ear & mastoid 

69643 Revise middle ear & mastoid 

69644 Revise middle ear & mastoid 

69645 Revise middle ear & mastoid 

69646 Revise middle ear & mastoid 

69650 Release middle ear bone 

69660 Revise middle ear bone 

69661 Revise middle ear bone 

69662 Revise middle ear bone 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

69666 Repair middle ear structures 

69667 Repair middle ear structures 

69670 Remove mastoid air cells 

69676 Remove middle ear nerve 

69700 Close mastoid fistula 

69711 Remove/repair hearing aid 

69714 Implant temple bone w/stimul 

69715 Temple bne implnt w/stimulat 

69717 Temple bone implant revision 

69718 Revise temple bone implant 

69720 Release facial nerve 

69725 Release facial nerve 

69740 Repair facial nerve 

69745 Repair facial nerve 

69801 Incise inner ear 

69802 Incise inner ear 

69805 Explore inner ear 

69806 Explore inner ear 

69820 Establish inner ear window 

69840 Revise inner ear window 

69905 Remove inner ear 

69910 Remove inner ear & mastoid 

69915 Incise inner ear nerve 

69930 Implant cochlear device 

69950 Incise inner ear nerve 

69955 Release facial nerve 

69960 Release inner ear canal 

69970 Remove inner ear lesion 

69990 Microsurgery add-on 

70010 Contrast x-ray of brain 

70015 Contrast x-ray of brain 

70030 X-ray eye for foreign body 

70100 X-ray exam of jaw 

70110 X-ray exam of jaw 

70120 X-ray exam of mastoids 

70130 X-ray exam of mastoids 

70134 X-ray exam of middle ear 

70140 X-ray exam of facial bones 

70150 X-ray exam of facial bones 

70160 X-ray exam of nasal bones 

70170 X-ray exam of tear duct 

70190 X-ray exam of eye sockets 

70200 X-ray exam of eye sockets 

70210 X-ray exam of sinuses 

70220 X-ray exam of sinuses 

70240 X-ray exam, pituitary saddle 

70250 X-ray exam of skull 

70260 X-ray exam of skull 

70300 X-ray exam of teeth 

70310 X-ray exam of teeth 

70320 Full mouth x-ray of teeth 

70328 X-ray exam of jaw joint 

70330 X-ray exam of jaw joints 

70332 X-ray exam of jaw joint 

70350 X-ray head for orthodontia 

70355 Panoramic x-ray of jaws 

70360 X-ray exam of neck 

70370 Throat x-ray & fluoroscopy 

70371 Speech evaluation, complex 

70373 Contrast x-ray of larynx 

70380 X-ray exam of salivary gland 

70390 X-ray exam of salivary duct 

70450 Ct head/brain w/o dye 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

70460 Ct head/brain w/dye 

70470 Ct head/brain w/o & w/ dye 

70480 Ct orbit/ear/fossa w/o dye 

70481 Ct orbit/ear/fossa w/dye 

70482 Ct orbit/ear/fossa w/o&w dye 

70486 Ct maxillofacial w/o dye 

70487 Ct maxillofacial w/dye 

70488 Ct maxillofacial w/o & w dye 

70490 Ct soft tissue neck w/o dye 

70491 Ct soft tissue neck w/dye 

70492 Ct sft tsue nck w/o & w/dye 

70542 Mri orbit/face/neck w/dye 

70543 Mri orbt/fac/nck w/o & w dye 

70552 Mri brain w/ dye 

70553 Mri brain w/o & w/ dye 

70557 Mri brain w/o dye 

70558 Mri brain w/ dye 

70559 Mri brain w/o & w/ dye 

71010 Chest x-ray 

71015 Chest x-ray 

71020 Chest x-ray 

71021 Chest x-ray 

71022 Chest x-ray 

71023 Chest x-ray and fluoroscopy 

71030 Chest x-ray 

71034 Chest x-ray and fluoroscopy 

71035 Chest x-ray 

71040 Contrast x-ray of bronchi 

71060 Contrast x-ray of bronchi 

71090 X-ray & pacemaker insertion 

71100 X-ray exam of ribs 

71101 X-ray exam of ribs/chest 

71110 X-ray exam of ribs 

71111 X-ray exam of ribs/ chest 

71120 X-ray exam of breastbone 

71130 X-ray exam of breastbone 

71250 Ct thorax w/o dye 

71260 Ct thorax w/dye 

71270 Ct thorax w/o & w/ dye 

71551 Mri chest w/dye 

71552 Mri chest w/o & w/dye 

71555 Mri angio chest w or w/o dye 

72010 X-ray exam of spine 

72020 X-ray exam of spine 

72040 X-ray exam of neck spine 

72050 X-ray exam of neck spine 

72052 X-ray exam of neck spine 

72069 X-ray exam of trunk spine 

72070 X-ray exam of thoracic spine 

72072 X-ray exam of thoracic spine 

72074 X-ray exam of thoracic spine 

72080 X-ray exam of trunk spine 

72090 X-ray exam of trunk spine 

72100 X-ray exam of lower spine 

72110 X-ray exam of lower spine 

72114 X-ray exam of lower spine 

72120 X-ray exam of lower spine 

72125 Ct neck spine w/o dye 

72126 Ct neck spine w/dye 

72127 Ct neck spine w/o & w/dye 

72128 Ct chest spine w/o dye 

72129 Ct chest spine w/dye 

72130 Ct chest spine w/o & w/dye 

47703

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

72131 Ct lumbar spine w/o dye 

72132 Ct lumbar spine w/dye 

72133 Ct lumbar spine w/o & w/dye 

72142 Mri neck spine w/dye 

72147 Mri chest spine w/dye 

72149 Mri lumbar spine w/dye 

72156 Mri neck spine w/o & w/dye 

72157 Mri chest spine w/o & w/dye 

72158 Mri lumbar spine w/o & w/dye 

72159 Mr angio spine w/o&w/dye 

72170 X-ray exam of pelvis 

72190 X-ray exam of pelvis 

72192 Ct pelvis w/o dye 

72193 Ct pelvis w/dye 

72194 Ct pelvis w/o & w/dye 

72196 Mri pelvis w/dye 

72197 Mri pelvis w/o & w/dye 

72198 Mr angio pelvis w/o & w/dye 

72200 X-ray exam sacroiliac joints 

72202 X-ray exam sacroiliac joints 

72220 X-ray exam of tailbone 

72240 Contrast x-ray of neck spine 

72255 Contrast x-ray, thorax spine 

72270 Contrast x-ray, spine 

72275 Epidurography 

72285 X-ray c/t spine disk 

72295 X-ray of lower spine disk 

73000 X-ray exam of collar bone 

73010 X-ray exam of shoulder blade 

73020 X-ray exam of shoulder 

73030 X-ray exam of shoulder 

73040 Contrast x-ray of shoulder 

73050 X-ray exam of shoulders 

73060 X-ray exam of humerus 

73070 X-ray exam of elbow 

73080 X-ray exam of elbow 

73085 Contrast x-ray of elbow 

73090 X-ray exam of forearm 

73092 X-ray exam of arm, infant 

73100 X-ray exam of wrist 

73110 X-ray exam of wrist 

73115 Contrast x-ray of wrist 

73120 X-ray exam of hand 

73130 X-ray exam of hand 

73140 X-ray exam of finger(s) 

73200 Ct upper extremity w/o dye 

73201 Ct upper extremity w/dye 

73202 Ct uppr extremity w/o&w/dye 

73219 Mri upper extremity w/dye 

73220 Mri uppr extremity w/o&w/dye 

73222 Mri joint upr extrem w/dye 

73223 Mri joint upr extr w/o&w/dye 

73225 Mr angio upr extr w/o&w/dye 

73500 X-ray exam of hip 

73510 X-ray exam of hip 

73520 X-ray exam of hips 

73525 Contrast x-ray of hip 

73530 X-ray exam of hip 

73540 X-ray exam of pelvis & hips 

73542 X-ray exam, sacroiliac joint 

73550 X-ray exam of thigh 

73560 X-ray exam of knee, 1 or 2 

73562 X-ray exam of knee, 3 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

73564 X-ray exam, knee, 4 or more 

73565 X-ray exam of knees 

73580 Contrast x-ray of knee joint 

73590 X-ray exam of lower leg 

73592 X-ray exam of leg, infant 

73600 X-ray exam of ankle 

73610 X-ray exam of ankle 

73615 Contrast x-ray of ankle 

73620 X-ray exam of foot 

73630 X-ray exam of foot 

73650 X-ray exam of heel 

73660 X-ray exam of toe(s) 

73700 Ct lower extremity w/o dye 

73701 Ct lower extremity w/dye 

73702 Ct lwr extremity w/o&w/dye 

73719 Mri lower extremity w/dye 

73720 Mri lwr extremity w/o&w/dye 

73722 Mri joint of lwr extr w/dye 

73723 Mri joint lwr extr w/o&w/dye 

73725 Mr ang lwr ext w or w/o dye 

74000 X-ray exam of abdomen 

74010 X-ray exam of abdomen 

74020 X-ray exam of abdomen 

74022 X-ray exam series, abdomen 

74150 Ct abdomen w/o dye 

74160 Ct abdomen w/dye 

74170 Ct abdomen w/o &w /dye 

74182 Mri abdomen w/dye 

74183 Mri abdomen w/o & w/dye 

74185 Mri angio, abdom w orw/o dye 

74190 X-ray exam of peritoneum 

74210 Contrst x-ray exam of throat 

74220 Contrast x-ray, esophagus 

74230 Cine/vid x-ray, throat/esoph 

74235 Remove esophagus obstruction 

74240 X-ray exam, upper gi tract 

74241 X-ray exam, upper gi tract 

74245 X-ray exam, upper gi tract 

74246 Contrst x-ray uppr gi tract 

74247 Contrst x-ray uppr gi tract 

74249 Contrst x-ray uppr gi tract 

74251 X-ray exam of small bowel 

74260 X-ray exam of small bowel 

74270 Contrast x-ray exam of colon 

74280 Contrast x-ray exam of colon 

74283 Contrast x-ray exam of colon 

74290 Contrast x-ray, gallbladder 

74291 Contrast x-rays, gallbladder 

74300 X-ray bile ducts/pancreas 

74305 X-ray bile ducts/pancreas 

74320 Contrast x-ray of bile ducts 

74327 X-ray bile stone removal 

74328 X-ray bile duct endoscopy 

74329 X-ray for pancreas endoscopy 

74330 X-ray bile/panc endoscopy 

74340 X-ray guide for GI tube 

74350 X-ray guide, stomach tube 

74355 X-ray guide, intestinal tube 

74360 X-ray guide, GI dilation 

74363 X-ray, bile duct dilation 

74420 Contrst x-ray, urinary tract 

74425 Contrst x-ray, urinary tract 

74440 X-ray, male genital tract 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

74445 X-ray exam of penis 

74450 X-ray, urethra/bladder 

74470 X-ray exam of kidney lesion 

74475 X-ray control, cath insert 

74480 X-ray control, cath insert 

74485 X-ray guide, GU dilation 

74710 X-ray measurement of pelvis 

74742 X-ray, fallopian tube 

74775 X-ray exam of perineum 

75553 Heart mri for morph w/dye 

75556 Cardiac MRI/flow mapping 

75600 Contrast x-ray exam of aorta 

75605 Contrast x-ray exam of aorta 

75625 Contrast x-ray exam of aorta 

75630 X-ray aorta, leg arteries 

75650 Artery x-rays, head & neck 

75658 Artery x-rays, arm 

75660 Artery x-rays, head & neck 

75662 Artery x-rays, head & neck 

75665 Artery x-rays, head & neck 

75671 Artery x-rays, head & neck 

75676 Artery x-rays, neck 

75680 Artery x-rays, neck 

75685 Artery x-rays, spine 

75705 Artery x-rays, spine 

74250 X-ray exam of small bowel 

75710 Artery x-rays, arm/leg 

75716 Artery x-rays, arms/legs 

75722 Artery x-rays, kidney 

75724 Artery x-rays, kidneys 

75726 Artery x-rays, abdomen 

75731 Artery x-rays, adrenal gland 

75733 Artery x-rays, adrenals 

75736 Artery x-rays, pelvis 

75741 Artery x-rays, lung 

75743 Artery x-rays, lungs 

75746 Artery x-rays, lung 

75756 Artery x-rays, chest 

75774 Artery x-ray, each vessel 

75790 Visualize A-V shunt 

75801 Lymph vessel x-ray, arm/leg 

75803 Lymph vessel x-ray,arms/legs 

75805 Lymph vessel x-ray, trunk 

75807 Lymph vessel x-ray, trunk 

75809 Nonvascular shunt, x-ray 

75810 Vein x-ray, spleen/liver 

75820 Vein x-ray, arm/leg 

75822 Vein x-ray, arms/legs 

75825 Vein x-ray, trunk 

75827 Vein x-ray, chest 

75831 Vein x-ray, kidney 

75833 Vein x-ray, kidneys 

75840 Vein x-ray, adrenal gland 

75842 Vein x-ray, adrenal glands 

75860 Vein x-ray, neck 

75870 Vein x-ray, skull 

75872 Vein x-ray, skull 

75880 Vein x-ray, eye socket 

75885 Vein x-ray, liver 

75887 Vein x-ray, liver 

75889 Vein x-ray, liver 

75891 Vein x-ray, liver 

75893 Venous sampling by catheter 

47704

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

75894 X-rays, transcath therapy 

75896 X-rays, transcath therapy 

75898 Follow-up angiography 

75900 Arterial catheter exchange 

75940 X-ray placement, vein filter 

75952 Endovasc repair abdom aorta 

75953 Abdom aneurysm endovas rpr 

75954 Iliac aneurysm endovas rpr 

75960 Transcatheter intro, stent 

75961 Retrieval, broken catheter 

75962 Repair arterial blockage 

75964 Repair artery blockage, each 

75966 Repair arterial blockage 

75968 Repair artery blockage, each 

75970 Vascular biopsy 

75978 Repair venous blockage 

75980 Contrast xray exam bile duct 

75982 Contrast xray exam bile duct 

75984 Xray control catheter change 

75989 Abscess drainage under x-ray 

75992 Atherectomy, x-ray exam 

75993 Atherectomy, x-ray exam 

75994 Atherectomy, x-ray exam 

75995 Atherectomy, x-ray exam 

75996 Atherectomy, x-ray exam 

76001 Fluoroscope exam, extensive 

76003 Needle localization by x-ray 

76005 Fluoroguide for spine inject 

76006 X-ray stress view 

76010 X-ray, nose to rectum 

76012 Percut vertebroplasty fluor 

76013 Percut vertebroplasty, ct 

76020 X-rays for bone age 

76040 X-rays, bone evaluation 

76061 X-rays, bone survey 

76062 X-rays, bone survey 

76065 X-rays, bone evaluation 

76066 Joint survey, single view 

76070 Ct bone density, axial 

76075 Dexa, axial skeleton study 

76076 Dexa, peripheral study 

76078 Radiographic absorptiometry 

76080 X-ray exam of fistula 

76086 X-ray of mammary duct 

76088 X-ray of mammary ducts 

76090 Mammogram, one breast 

76091 Mammogram, both breasts 

76092 Mammogram, screening 

76093 Magnetic image, breast 

76094 Magnetic image, both breasts 

76095 Stereotactic breast biopsy 

76096 X-ray of needle wire, breast 

76096 X-ray of needle wire, breast 

76098 X-ray exam, breast specimen 

76100 X-ray exam of body section 

76101 Complex body section x-ray 

76102 Complex body section x-rays 

76350 Special x-ray contrast study 

76355 Ct scan for localization 

76360 Ct scan for needle biopsy 

76362 Ct guide for tissue ablation 

76362 Ct guide for tissue ablation 

76370 Ct scan for therapy guide 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

76375 3d/holograph reconstr add-on 

76380 CAT scan follow-up study 

76390 Mr spectroscopy 

76394 Mri for tissue ablation 

76394 Mri for tissue ablation 

76604 Us exam, chest, b-scan 

76645 Us exam, breast(s) 

76700 Us exam, abdom, complete 

76705 Echo exam of abdomen 

76775 Us exam abdo back wall, lim 

76800 Us exam, spinal canal 

76886 Us exam infant hips, static 

76932 Echo guide for heart biopsy 

76936 Echo guide for artery repair 

76941 Us guide, tissue ablation 

76941 Echo guide for transfusion 

76945 Echo guide for transfusion 

76946 Echo guide, villus sampling 

76948 Echo guide for amniocentesis 

76950 Echo guide, ova aspiration 

76965 Echo guidance radiotherapy 

76970 Echo guidance radiotherapy 

76977 Ultrasound exam follow-up 

76986 Us bone density measure 

77295 Ultrasound guide intraoper 

77326 Set radiation therapy field 

77327 Brachytx isodose calc simp 

77328 Brachytx isodose calc interm 

77427 Brachytx isodose plan compl 

77431 Radiation tx management, x5 

77470 Stereotactic radiation trmt 

77600 Special radiation treatment 

77605 Hyperthermia treatment 

77610 Hyperthermia treatment 

77615 Hyperthermia treatment 

77620 Hyperthermia treatment 

77750 Hyperthermia treatment 

77761 Infuse radioactive materials 

77762 Apply intrcav radiat simple 

77763 Apply intrcav radiat interm 

77776 Apply intrcav radiat compl 

77777 Apply interstit radiat simpl 

77778 Apply interstit radiat inter 

77790 Apply surface radiation 

78000 Radiation handling 

78001 Thyroid, single uptake 

78003 Thyroid, multiple uptakes 

78006 Thyroid suppress/stimul 

78007 Thyroid imaging with uptake 

78010 Thyroid image, mult uptakes 

78011 Thyroid imaging 

78015 Thyroid imaging with flow 

78016 Thyroid met imaging 

78018 Thyroid met imaging/studies 

78020 Thyroid met imaging, body 

78070 Thyroid met uptake 

78075 Parathyroid nuclear imaging 

78102 Adrenal nuclear imaging 

78103 Bone marrow imaging, ltd 

78104 Bone marrow imaging, mult 

78110 Bone marrow imaging, body 

78111 Plasma volume, single 

78120 Plasma volume, multiple 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

78121 Red cell mass, single 

78122 Red cell mass, multiple 

78130 Blood volume 

78135 Red cell survival study 

78140 Red cell survival kinetics 

78185 Total body iron estimation 

78190 Spleen imaging 

78191 Platelet survival, kinetics 

78195 Platelet survival 

78201 Lymph system imaging 

78202 Liver imaging 

78205 Liver imaging with flow 

78215 Liver image (3d) with flow 

78216 Liver and spleen imaging 

78220 Liver & spleen image/flow 

78223 Liver function study 

78230 Hepatobiliary imaging 

78231 Salivary gland imaging 

78232 Serial salivary imaging 

78258 Salivary gland function exam 

78261 Esophageal motility study 

78262 Gastric mucosa imaging 

78264 Gastroesophageal reflux exam 

78270 Gastric emptying study 

78271 Vit B-12 absorption exam 

78272 Vit b-12 absrp exam, int fac 

78278 Vit B-12 absorp, combined 

78290 GI protein loss exam 

78291 Meckel’s divert exam 

78300 Leveen/shunt patency exam 

78305 Bone imaging, limited area 

78306 Bone imaging, multiple areas 

78315 Bone imaging, whole body 

78320 Bone imaging, 3 phase 

78428 Bone mineral, dual photon 

78445 Cardiac shunt imaging 

78456 Venous thrombosis study 

78457 Acute venous thrombus image 

78458 Venous thrombosis imaging 

78460 Ven thrombosis images, bilat 

78461 Heart muscle blood, single 

78464 Heart muscle blood, multiple 

78466 Heart image (3d), single 

78468 Heart infarct image 

78469 Heart infarct image (ef) 

78472 Heart infarct image (3D) 

78473 Gated heart, planar, single 

78478 Gated heart, multiple 

78480 Heart wall motion add-on 

78481 Heart function add-on 

78483 Heart first pass, single 

78494 Heart first pass, multiple 

78496 Heart image, spect 

78580 Heart first pass add-on 

78584 Lung perfusion imaging 

78585 Lung V/Q image single breath 

78586 Lung V/Q imaging 

78587 Aerosol lung image, single 

78588 Aerosol lung image, multiple 

78591 Perfusion lung image 

78593 Vent image, 1 breath, 1 proj 

78594 Vent image, 1 proj, gas 

78596 Vent image, mult proj, gas 

47705

——————————

Some of these codes have previously been refined and additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

78601 Brain imaging, ltd static 

78605 Brain imaging, ltd w/flow 

78606 Brain imaging, complete 

78610 Brain imaging (3D) 

78615 Brain flow imaging only 

78630 Cerebral vascular flow image 

78635 Cerebrospinal fluid scan 

78645 CSF ventriculography 

78650 Cerebrospinal fluid scan 

78660 CSF leakage imaging 

78700 Nuclear exam of tear flow 

78701 Kidney imaging, static 

78704 Kidney imaging with flow 

78707 Imaging renogram 

78708 Kidney flow/function image 

78709 Kidney flow/function image 

78710 Kidney flow/function image 

78715 Kidney imaging (3D) 

78725 Renal vascular flow exam 

78730 Kidney function study 

78740 Urinary bladder retention 

78760 Ureteral reflux study 

78761 Testicular imaging 

78800 Testicular imaging/flow 

78801 Tumor imaging, limited area 

78802 Tumor imaging, mult areas 

78804 Tumor imaging (3D) 

78805 Tumor imaging, whole body 

78806 Abscess imaging, ltd area 

78890 Nuclear localization/abscess 

78891 Nuclear medicine data proc 

85396 Nuclear joint therapy 

88125 TB tine test 

88141 Forensic cytopathology 

88348 Cytopath, c/v, interpret 

88349 Electron microscopy 

90865 Sample stomach contents 

90870 Narcosynthesis 

90875 Electroconvulsive therapy 

90876 Psychophysiological therapy 

90885 Hypnotherapy 

91000 Psy evaluation of records 

91010 Esophageal intubation 

91011 Esophagus motility study 

91012 Esophagus motility study 

91020 Esophagus motility study 

91030 Gastric motility 

91052 Prolonged acid reflux test 

91055 Gastric analysis test 

91060 Gastric intubation for smear 

91065 Gastric saline load test 

91100 Breath hydrogen test 

91105 Pass intestine bleeding tube 

91122 Gastric intubation treatment 

91123 Anal pressure record 

91132 Irrigate fecal impaction 

91133 Electrogastrography 

92325 Prescription of contact lens 

92326 Modification of contact lens 

92354 Fitting of artificial eye 

92355 Special spectacles fitting 

92358 Special spectacles fitting 

92371 Eye prosthesis service 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

92392 Repair & adjust spectacles 

92393 Supply of low vision aids 

92395 Supply of artificial eye 

92512 Supply of contact lenses 

92516 Nasal function studies 

92547 Facial nerve function test 

92548 Supplemental electrical test 

92565 Posturography 

92571 Stenger test, pure tone 

92572 Filtered speech hearing test 

92573 Staggered spondaic word test 

92575 Lombard test 

92576 Sensorineural acuity test 

92577 Synthetic sentence test 

92579 Stenger test, speech 

92582 Visual audiometry (vra) 

92583 Conditioning play audiometry 

92584 Select picture audiometry 

92585 Electrocochleography 

92586 Auditor evoke potent, compre 

92587 Auditor evoke potent, limit 

92588 Evoked auditory test 

92596 Evoked auditory test 

92950 Oral speech device eval 

92975 Cardioassist, external 

93012 Dissolve clot, heart vessel 

93014 Transmission of ecg 

93224 Cardiac drug stress test 

93225 ECG monitor/report, 24 hrs 

93226 ECG monitor/record, 24 hrs 

93227 ECG monitor/report, 24 hrs 

93230 ECG monitor/review, 24 hrs 

93231 ECG monitor/report, 24 hrs 

93232 Ecg monitor/record, 24 hrs 

93235 ECG monitor/report, 24 hrs 

93236 ECG monitor/report, 24 hrs 

93237 ECG monitor/report, 24 hrs 

93268 ECG monitor/review, 24 hrs 

93270 ECG record/review 

93271 ECG recording 

93272 Ecg/monitoring and analysis 

93278 Ecg/review, interpret only 

93318 Echo transesophageal 

93501 Echo transesophageal intraop 

93505 Right heart catheterization 

93508 Biopsy of heart lining 

93510 Cath placement, angiography 

93526 Left heart catheterization 

93555 R & l heart cath, congenital 

93556 Imaging, cardiac cath 

93609 Heart flow reserve measure 

93613 Map tachycardia, add-on 

93660 Electrophys map 3d, add-on 

93721 Tilt table evaluation 

93724 Plethysmography tracing 

93727 Analyze pacemaker system 

93731 Analyze ilr system 

93732 Analyze pacemaker system 

93734 Analyze pacemaker system 

93735 Analyze pacemaker system 

93741 Analyze pacemaker system 

93742 Analyze ht pace device sngl 

93743 Analyze ht pace device sngl 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

93744 Analyze ht pace device dual 

93798 Cardiac rehab 

93980 Cardiac rehab/monitor 

93981 Penile vascular study 

94070 Review patient spirometry 

94450 CO2 breathing response curve 

94770 Pulmonary compliance study 

95044 Breath recording, infant 

95052 Allergy patch tests 

95056 Photo patch test 

95070 Photosensitivity tests 

95180 Ingestion challenge test 

95250 Rapid desensitization 

95806 Multiple sleep latency test 

95819 Sleep study, attended 

95824 Eeg, awake and asleep 

95824 Eeg, cerebral death only 

95827 Eeg, cerebral death only 

95858 Tensilon test 

95869 Tensilon test & myogram 

95872 Muscle test, thor paraspinal 

95920 Limb exercise test 

95925 Intraop nerve test add-on 

95926 Somatosensory testing 

95927 Somatosensory testing 

95930 Somatosensory testing 

95936 Visual evoked potential test 

95957 Eeg monitoring, cable/radio 

95958 EEG digital analysis 

95961 EEG monitoring/function test 

95962 Electrode stimulation, brain 

95970 Meg, evoked, each add’l 

95971 Analyze neurostim, no prog 

95972 Analyze neurostim, simple 

95973 Analyze neurostim, complex 

95974 Analyze neurostim, complex 

95975 Cranial neurostim, complex 

96902 Ultraviolet light therapy 

99026 Wound(s) care, selective 

99027 In-hospital on call service 

99170 Out-of-hosp on call service 

99175 Anogenital exam, child 

99183 Induction of vomiting 

99217 Total body hypothermia 

99218 Observation care discharge 

99219 Observation care 

99220 Observation care 

99221 Observation care 

99222 Initial hospital care 

99223 Initial hospital care 

99231 Initial hospital care 

99232 Subsequent hospital care 

99233 Subsequent hospital care 

99234 Subsequent hospital care 

99235 Observ/hosp same date 

99236 Observ/hosp same date 

99238 Observ/hosp same date 

99239 Hospital discharge day 

99251 Office consultation 

99252 Initial inpatient consult 

99253 Initial inpatient consult 

99254 Initial inpatient consult 

99255 Initial inpatient consult 

47706

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

99261 Initial inpatient consult 

99262 Follow-up inpatient consult 

99263 Follow-up inpatient consult 

99271 Follow-up inpatient consult 

99272 Confirmatory consultation 

99273 Confirmatory consultation 

99274 Confirmatory consultation 

99275 Confirmatory consultation 

99281 Confirmatory consultation 

99282 Emergency dept visit 

99283 Emergency dept visit 

99284 Emergency dept visit 

99285 Emergency dept visit 

99288 Emergency dept visit 

99289 Direct advanced life support 

99290 Ped crit care transport 

99291 Ped crit care transport addl 

99292 Critical care, first hour 

99293 Critical care, add’l 30 min 

99294 Ped critical care, initial 

99295 Ped critical care, subseq 

99296 Neonate crit care, initial 

99298 Neonate critical care subseq 

99299 Ic for lbw infant < 1500 gm 

99301 Ic, lbw infant 1500-2500 gm 

99302 Nursing facility care 

99303 Nursing facility care 

99311 Nursing facility care 

99312 Nursing fac care, subseq 

99313 Nursing fac care, subseq 

99315 Nursing fac care, subseq 

99316 Nursing fac discharge day 

99321 Nursing fac discharge day 

99322 Rest home visit, new patient 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

99323 Rest home visit, new patient 

99331 Rest home visit, new patient 

99332 Rest home visit, est pat 

99333 Rest home visit, est pat 

99341 Rest home visit, est pat 

99342 Home visit, new patient 

99343 Home visit, new patient 

99344 Home visit, new patient 

99345 Home visit, new patient 

99347 Home visit, new patient 

99348 Home visit, est patient 

99349 Home visit, est patient 

99350 Home visit, est patient 

99354 Home visit, est patient 

99355 Prolonged service, office 

99356 Prolonged service, office 

99357 Prolonged service, inpatient 

99358 Prolonged service, inpatient 

99359 Prolonged serv, w/o contact 

99360 Prolonged serv, w/o contact 

99361 Physician standby services 

99362 Physician/team conference 

99371 Physician/team conference 

99372 Physician phone consultation 

99373 Physician phone consultation 

99374 Physician phone consultation 

99375 Home health care supervision 

99377 Home health care supervision 

99378 Hospice care supervision 

99379 Hospice care supervision 

99380 Nursing fac care supervision 

99381 Nursing fac care supervision 

99382 Prev visit, new, infant 

99383 Prev visit, new, age 1-4 

ADDENDUM C.—CODES FOR WHICH

WE RECEIVED PEAC RECOMMENDATIONS ON PRACTICE EXPENSE DIRECT COST INPUTS—Continued

CPT

code Short descriptors 

99384 Prev visit, new, age 5-11 

99385 Prev visit, new, age 12-17 

99386 Prev visit, new, age 18-39 

99387 Prev visit, new, age 40-64 

99391 Prev visit, new, 65 & over 

99392 Prev visit, est, infant 

99393 Prev visit, est, age 1-4 

99394 Prev visit, est, age 5-11 

99395 Prev visit, est, age 12-17 

99396 Prev visit, est, age 18-39 

99397 Prev visit, est, age 40-64 

99401 Prev visit, est, 65 & over 

99402 Preventive counseling, indiv 

99403 Preventive counseling, indiv 

99404 Preventive counseling, indiv 

99411 Preventive counseling, indiv 

99412 Preventive counseling, group 

99420 Preventive counseling, group 

99431 Health risk assessment test 

99432 Initial care, normal newborn 

99433 Newborn care, not in hosp 

99435 Normal newborn care/hospital 

99436 Newborn discharge day hosp 

99440 Attendance, birth 

99450 Newborn resuscitation 

99455 Life/disability evaluation 

99456 Disability examination 

Some of these codes have previously been refined and 

additional refinements were made by the PEAC. 

All anesthesia codes were reviewed with the exception of 

00104 abd 00124. 

CPT codes and descriptions are copyright 2004 by the 

AMA, all rights reserved. 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47707

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

E54006 ..... 22 channel EEG (split to separate systems) 7.0 $44,310.00 EEG, digital, prolonged testing system (computer w-remote camera). 7 $46,750.00 Other Equipment E54006 ..... 22 channel EEG (split to separate systems) 7.0 $44,310.00 EEG, digital, standard testing system (computer hardware & software). 7 $21,000.00 Other Equipment E54004 + .. 22 channel EMG-EP machine ....................... 7.0 $66,650.00 EMG-NCV-EP system, 8 channel .................. 10 $59,500.00 Other Equipment E51028 ..... 2-D Scanning Densitometer ........................... 5.0 $6,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E55002 ..... 3 Channel ECG machine ............................... 5.0 $4,800.00 ECG, 3-channel .............................................. 7 $1,845.42 Other Equipment E55005 ..... 3 channel ECG/BP monitor ............................ 5.0 $3,895.00 ECG, 3-channel (with SpO2, NIBP, temp, 

resp).

7 $4,322.50 Other Equipment 

E51034 ..... 30 cm Water Phantom w/ Manual positioner 5.0 $2,850.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E50002 ..... 35mm camera ................................................ 5.0 $1,150.00 camera, 35mm system (medical grade) ........ 5 $1,106.50 Documentation E13623 ..... 37*, 60*, 90* degree oven ............................. 10.0 $682.00 oven, convection (lab) .................................... 10 $640.73 Laboratory 

3-D Phantom .................................................. 5.0 $1,084.00 phantom, 3-D ................................................. 10 $1,084.00 Radiology 

E51032 ..... 3-D Water Scanning Phantom ....................... 5.0 $56,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E71025 ..... ABR machine, (Mikolay or Biologic) .............. 7.0 $23,000.00 ABR-auditory brainstem response system .... 7 $27,000.00 Other Equipment 

Accelerator, 4 MV .......................................... 5.0 $1,600,000.00 accelerator, 4-6 MV ........................................ 7 $1,408,491.00 Radiology Accelerator, 6 MV .......................................... 5.0 $1,770,708.00 accelerator, 4-6 MV ........................................ 7 $1,408,491.00 Radiology Accelerator, 18 MV ........................................ 5.0 $1,741,018.00 accelerator, 6-18 MV ...................................... 7 $1,832,941.00 Radiology Accelerator, 20 MV ........................................ 5.0 accelerator, 6-18 MV ...................................... 7 $1,832,941.00 Radiology.

E52020 ..... Acusonic Sequoia C0256 ............................... 5.0 $250,000.00 ultrasound, echocardiography w-4 transducers (Sequoia C256). 5 $248,000.00 Other Equipment 

Adjustable computer table ............................. 7.0 $895.00 table, motorized (for instruments-equipment) 15 $895.00 Furniture ADL kit ............................................................ 7.0 $587.00 kit, ADL ........................................................... 10 $586.50 Other Equipment ADL kit ............................................................ 10.0 $586.00 kit, ADL ........................................................... 10 $586.50 Other Equipment aerosol machine ............................................. 5.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Details air compressor, safety .................................... 10.0 $575.00 air compressor, safety .................................... 12 $575.00 Other Equipment 

E30026 ..... Albarran bridge ............................................... 7.5 $975.00 Albarran deflecting bridge, single channel ..... 3 $988.00 Scope 

alternans system, CH2000 ............................. 8.0 $29,400.00 cardiac monitor w-treadmill (microvolt, 

CH2000).

10 $32,600.00 Other Equipment 

ambulation kit (canes, walker, mirror, balance board, crutches, safety belt). 10.0 $750.00 kit, ambulation ................................................ 10 $763.70 Other Equipment 

E52015 ..... a-mode ultrasonic biometry unit ..................... 5.0 $6,950.00 ultrasonic biometry, A-scan ............................ 5 $5,247.50 Other Equipment 

aneroid barometer .......................................... 5.0 $550.00 barometer, aneroid ......................................... 7 $587.50 Radiology 

E30025 ..... anesthesia machine ....................................... 7.0 $49,035.00 anesthesia machine (w-vaporizers) ............... 7 $60,000.00 Other Equipment E51084 ..... angiographic room ......................................... 5.0 $1,580,000.00 room, angiography ......................................... 5 $1,386,816.00 Room - Lane E71010 ..... anomaloscopes - diagnostic .......................... 5.0 $10,500.00 anomaloscope, diagnostic (HMC) .................. 10 $6,146.00 Other Equipment E13116 ..... anoscope & light source ................................ 3.0 $550.00 anoscope with light source ............................ 3 $657.62 Scope E51038 ..... Anthropomorphic Phantom ............................ 5.0 $8,250.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E51066 ..... Applicator sets for HDR ................................. 5.0 $3,333.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E51068 ..... Applicator sets for LDR .................................. 5.0 $2,723.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E72001 ..... argon laser ..................................................... 5.0 $45,000.00 laser, argon (w-slit lamp adapter) .................. 5 $32,900.00 Other Equipment E72002 ..... argon-krypton laser ........................................ 5.0 $65,000.00 laser, argon-kripton ........................................ 5 $85,000.00 Other Equipment E55035 ..... ART signal averaging machine ...................... 7.5 $8,250.00 ECG signal averaging system ....................... 5 $8,250.00 Other Equipment 

audio system, MRI ......................................... 10.0 $16,000.00 intercom (incl. master, pt substation, power, 

wiring).

10 $1,630.00 Other Equipment 

E71029 ..... audiometer ..................................................... 7.0 $5,495.00 audiometer, clinical-diagnostic ....................... 10 $6,250.00 Other Equipment E71011 ..... auto lensometer ............................................. 5.0 $2,095.00 lensometer, auto ............................................ 7 $2,995.00 Other Equipment E71026 ..... Autoacustic Emission Equipment ................... 7.0 $7,995.00 OAE-otoacoustic emission system ................ 7 $7,780.00 Other Equipment E55024 ..... Autobox V6200 ............................................... 8.0 $22,985.00 Vmax 62j (body plethysmograph autobox) .... 8 $21,055.00 Other Equipment 

automated radio frequency generator ............ 5.0 $30,000.00 radiofrequency generator, TUNA procedure .. 5 $16,500.00 Other Equipment 

E52016 ..... b scan ultrasonography .................................. 5.0 $24,975.00 ultrasonic biometry, B-scan ............................ 5 $12,500.00 Other Equipment E13604 ..... balance ........................................................... 7.0 $2,400.00 balance, analytic ............................................ 10 $4,001.67 Laboratory 

47708 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

balance board ................................................ 10.0 $600.00 balance board ................................................ 15 $509.66 Other Equipment balance master ............................................... 10.0 $12,500.00 balance assessment-retraining system (Balance Master). 5 $13,500.00 Other Equipment balance scales ............................................... 10.0 $995.00 balance, scale ................................................ 7 $768.50 Laboratory balance, analytic ............................................ 7.0 $5,570.00 balance, analytic ............................................ 10 $4,001.67 Laboratory 

E51004 ..... basic radiology room ...................................... 5.0 $150,000.00 room, basic radiology ..................................... 5 $150,000.00 Room - Lane E92002 ..... bath tub .......................................................... 10.0 $1,224.00 bath tub .......................................................... 10 $1,150.00 Furniture 

bath, paraffin, institutional .............................. 10.0 $3,349.00 paraffin bath, hand-foot (institutional) ............ 7 $2,406.50 Other Equipment beat-to-beat bp unit ........................................ 7.0 $14,900.00 arterial tonometry monitor (Colin Pilot) .......... 7 $14,900.00 Other Equipment 

E50005 ..... Bio Impedance Body Weight Analysis Machine. 7.0 $4,490.00 body analysis machine, bioimpedence .......... 10 $2,151.32 Other Equipment 

biohazard hood .............................................. 10.0 $7,612.00 hood, biohazard ............................................. 10 $6,884.25 Laboratory bladder scanner with cart ............................... 5.0 $11,445.00 ultrasound, noninvasive bladder scanner wcart. 5 $11,450.00 Other Equipment 

E72005 ..... Blepharoplasty Tray ....................................... 4.0 $1,949.53 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment 

body analysis machine, bioimpedence .......... 7.0 $2,700.00 body analysis machine, bioimpedence .......... 10 $2,151.32 Other Equipment Body Plethysmography Unit ........................... 8.0 $45,000.00 Vmax 22d and 62j (PFT equip, autobox, 

computer system).

8 $47,930.00 Other Equipment 

bone drill system, surgical, small bone 

(Stryker).

4.0 $8,979.00 drill system, surgical, small-micro (Stryker) ... 3 $8,979.00 Other Equipment 

bone saw, electric (Stryker) ........................... 7.5 $6,080.00 saw, surgical, electric (Stryker) ...................... 10 $6,080.00 Other Equipment BTE primus .................................................... 10.0 $45,820.00 rehab and testing system (BTE primus) ........ 5 $45,820.00 Other Equipment CAD processor unit ........................................ 8.0 $210,000.00 CAD processor unit (mammography) ............ 5 $210,000.00 Documentation Calibrated Chamber ....................................... 5.0 $500.00 calibration (AAPM ADCL), ion chamber ........ 5 $500.00 Radiology Calibration Computer with Software .............. 5.0 $5,500.00 electrometer, PC-based, dual channel .......... 5 $5,675.00 Radiology calibration equipment ..................................... 5.0 $5,000.00 electrometer, PC-based, dual channel .......... 5 $5,675.00 Radiology caloric irrigator ................................................ 7.0 $4,875.00 caloric stimulator, air or water ........................ 7 $5,950.00 Other Equipment 

E55017 ..... camera (autoswitching) with 16X zoom lens 5.0 $6,300.00 camera, remote-autoswitching ....................... 5 $5,250.00 Documentation 

camera, retinal topcon ................................... 5.0 $78,000.00 camera, retinal (TRC 50IX, w-ICG, filters, 

motor drives).

5 $37,000.00 Documentation 

E13611 ..... carbon coater ................................................. 7.5 $6,200.00 Deleted (part of new system) ......................... .......... .............................. No Details 

cardiac gating device ..................................... 5.0 $40,000.00 ECG R-wave trigger (gating) device .............. 7 $5,671.00 Other Equipment 

E55016 ..... cardiac monitor - 12 lead- stress test monitor 

and treadmill.

5.0 $18,726.00 cardiac monitor w-treadmill (12-lead PCbased ECG). 10 $14,271.03 Other Equipment 

E53005 ..... Cardiac Nuclear Camera System .................. 7.5 $675,000.00 camera system, cardiac, nuclear ................... 5 $675,000.00 Documentation E55018 ..... cardiac output monitor ................................... 7.5 $22,790.00 ICG monitoring system (impedance cardiography). 5 $28,625.00 Other Equipment E53003 ..... Cardiac Phantom ........................................... 7.5 $3,990.00 phantom, SPECT with cardiac insert ............. 10 $3,042.00 Radiology E53026 ..... Cardiofocal Collimators (1Set) ....................... 5.0 $29,990.00 collimator, cardiofocal set .............................. 7 $29,990.00 Radiology 

cardio-pulmonary stress testing system ........ 8.0 $58,751.00 Vmax 29c (cardio-pulm stress test equip, 

treadmill, computer system).

8 $58,751.00 Other Equipment 

cardio-respiratory monitor .............................. 5.0 $12,000.00 ECG, 3-channel (with SpO2, NIBP, temp, 

resp).

7 $4,322.50 Other Equipment 

cart heating pan, Splint-Form 2000 ............... 10.0 $790.00 water bath, thermoplastic softener (20in x 

12in).

7 $722.36 Radiology 

cart, laboratory ............................................... 10.0 $585.00 cart, laboratory ............................................... 10 $677.83 Furniture cast cart .......................................................... 10.0 $5,000.00 cast cart .......................................................... 10 $3,808.00 Other Equipment 

E30022 ..... cast cutter ....................................................... 7.0 $1,295.00 cast cutter ....................................................... 10 $1,160.62 Other Equipment 

cast table ........................................................ 10.0 $25,000.00 casting table attachment, hip-spica cast ........ 10 $4,099.00 Furniture cast vacuum ................................................... 7.0 $1,476.00 cast vacuum ................................................... 8 $1,475.50 Other Equipment casting frame .................................................. 10.0 $12,500.00 casting table attachment, Risser .................... 10 $2,538.00 Furniture 

E72007 ..... Cataract Tray ................................................. 4.0 $11,261.33 Deleted through PEAC refinement. ............... .......... .............................. No Details 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47709

E71112 ..... Central (Pod) Equipment Lane ...................... 7.0 $30,442.01 lane, central pod (oph) ................................... 7 $23,029.00 Room - Lane E13656 ..... centrifuge ........................................................ 7.0 $3,250.00 centrifuge (with rotor) ..................................... 7 $4,291.65 Laboratory 

Cerrobend melting pots .................................. 7.0 $1,500.00 alloy melter, digital, 3 gallon .......................... 7 $1,393.00 Radiology 

E53046 ..... Cesium 137 sources (6-10mg, 6-15mg, 6-20 

mg, 2-25mg, 2-5mg) 3m.

7.0 $43,580.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

chair, medical recliner (chemo, phlebotomy) 10.0 $829.03 chair, medical recliner .................................... 10 $829.03 Furniture chair, phlebotomy-injection ............................ 10 1200 chair, medical recliner .................................... 10 $829.03 Furniture 

E91004 ..... Chemo couch ................................................. 10.0 $895.00 chair, medical recliner .................................... 10 $829.03 Furniture E51086 ..... chest room ..................................................... 5.0 $200,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E30007 ..... CO2 laser ....................................................... 5.0 $42,500.00 laser, CO2 (Star X) ........................................ 5 $7,795.00 Other Equipment E55025 ..... CO2 monitor ................................................... 7.0 $7,495.00 CO2 respiratory profile monitor ...................... 7 $7,995.00 Other Equipment E53002 ..... Colbalt-57 sheet flood source ........................ 0.5 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 Radiology E53002 ..... Colbalt-57 sheet flood source ........................ 7.5 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 Radiology E53002 ..... Colbalt-57 sheet flood source ........................ 8.0 $2,790.00 Cobalt-57 Flood Source (47cm dia) (10 mCi) 5 $2,243.00 Radiology E13110 ..... colonoscope, video (SPLIT: scope and video 

system).

3.0 $54,590.00 videoscope, colonoscopy ............................... 3 $23,650.00 Scope 

E13401 ..... colposcope ..................................................... 3.0 $4,550.00 colposcope ..................................................... 8 $3,946.67 Scope E71013 ..... computer and VDT and software ................... 5.0 $9,000.00 computer and VDT and software ................... 5 $9,000.00 Documentation E92013 ..... computerized spinal range of motion device 10.0 $9,995.00 range of motion (spinal) device and software 

(Myo-Logic).

5 $7,995.00 Other Equipment 

E71014 ..... corneal topography unit ................................. 5.0 $17,950.00 topography unit, corneal (Magellan) .............. 7 $13,495.00 Other Equipment 

CPAP/BiPAP remote clinical unit ................... 7.0 .............................. CPAP/BiPAP remote clinical unit ................... 7 .............................. Other Equipment 

E13609 ..... critical point dryer ........................................... 10.0 $8,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E30015 ..... cryostat ........................................................... 7.0 $13,950.00 cryostat ........................................................... 7 $17,197.50 Other Equipment E30014 ..... cryostat knife sharpener ................................. 7.0 $6,234.00 microtome sharpener ..................................... 10 $6,400.00 Radiology 

cryosurgery equipment package .................... 7.5 $2,750.00 cryosurgery equipment (for liquid nitrogen) ... 10 $2,394.30 Other Equipment cryosurgery system, non-ophthalmic ............. 7.5 $1,608.00 cryosurgery system, non-ophthalmic ............. 10 $1,607.50 Other Equipment cryosurgery system, ophthalmic .................... 7.5 $5,245.00 cryosurgery system, ophthalmic .................... 7 $5,245.00 Other Equipment cryo-thermal unit ............................................ 7.5 .............................. cryo-thermal unit ............................................ 10 .............................. Other Equipment csf shunt reprogramming device (hand-held) 5.0 $1,500.00 CSF shunt programmer unit .......................... 7 $2,392.00 Other Equipment 

E51082 ..... CT Room ........................................................ 5.0 $1,000,000.00 room, CT ........................................................ 5 $981,045.00 Room - Lane E51018 ..... CT-Based Virtual Simulator ........................... 5.0 $900,000.00 IMRT CT-based simulator .............................. 5 $975,000.00 Radiology E13657 ..... cytology thin prep processor .......................... 7.5 $35,000.00 cytology thinlayer processor (ThinPrep) ........ 7 $54,000.00 Laboratory E51054 ..... Daily Output QA Device, RMI (RBA-5) .......... 5.0 $5,795.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E13658 ..... dark field microscope ..................................... 7.0 $4,500.00 microscope, polarized (dark field) .................. 7 $5,374.50 Laboratory 

data acquisition beat-to-beat analysis system 7.0 $14,496.00 arterial tonometry acquisition system (WR 

Testworks).

7 $14,500.00 Other Equipment 

data acquisition/q-sart recording system ....... 7.0 $22,228.00 QSART acquisition system (Q-Sweat) ........... 5 $28,000.00 Other Equipment decloaking chamber ....................................... 7.5 $875.00 decloaking chamber (DC2002) ...................... 7 $1,249.00 Laboratory decloaking chamber (DC2002) ...................... 7.5 $1,249.00 decloaking chamber (DC2002) ...................... 7 $1,249.00 Laboratory 

E71001 ..... dedicated slit lamp for argon laser ................ 10.0 $6,561.00 slit lamp (Haag-Streit), dedicated to laser 

use.

10 $7,435.00 Other Equipment 

defibrillator ...................................................... 5.0 .............................. defibrillator ...................................................... 5 $2,853.33 Other Equipment DELETED ....................................................... .......... .............................. Deleted through PEAC refinement. ............... .......... .............................. No Details 

E51078 ..... Dental X-ray ................................................... 5.0 $80,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

dermatome ..................................................... 5.0 $4,030.00 dermatome, electric ........................................ 10 $4,399.00 Other Equipment 

E71102 ..... Designed for Vision loupes ............................ 7.0 $600.00 loupes, standard, up to 3.5x .......................... 7 $836.67 Other Equipment E53036 ..... Detector (Probe) ............................................. 5.0 $14,000.00 Detector (Probe) ............................................. 5 $14,000.00 Radiology E51010 ..... DEXA Unit Dual Energy X-ray 

Absorptiometry.

5.0 $49,500.00 densitometry unit, whole body, DXA .............. 5 $41,000.00 Radiology 

dialysis access flow monitor .......................... 5.0 $10,000.00 dialysis access flow monitor .......................... 5 $10,000.00 Other Equipment 

E13659 ..... diamond knife ................................................. 10.0 $3,100.00 diamond knife (4.0-4.4mm) (electron microscopy). 7 $3,400.00 Laboratory E13660 ..... diamond knife resharpener ............................ 7.0 $1,795.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E52002 ..... diasonic software ........................................... 5.0 $35,000.00 fetal monitor software ..................................... 5 $35,000.00 Other Equipment E71015 ..... diathermy machine ......................................... 5.0 $3,120.00 diathermy, short wave (AutoTherm 395) ....... 10 $8,185.00 Other Equipment E71015 ..... diathermy machine ......................................... 5.0 $10,000.00 diathermy, short wave (AutoTherm 395) ....... 10 $8,185.00 Other Equipment 

differential analyzer ........................................ 7.0 $38,500.00 differential analyzer, hematology ................... 7 $37,216.67 Laboratory differential counter, hematology ..................... 7.0 $1,238.00 differential tally counter, 12-channel .............. 5 $672.73 Laboratory 

47710 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

E52007 ..... Digital Aquisition Unit (Nova Microsonics 

Image Vue DCR or TomTec Freeland P90).

5.0 $29,900.00 ultrasound, echocardiography digital acquisition (Novo Microsonics, TomTec). 5 $29,900.00 Other Equipment 

digital camera ................................................. 5.0 $800.00 camera, digital (6 mexapixel) ......................... 5 $946.16 Documentation 

E51020 ..... Digital Camera ............................................... 5.0 $300,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

digital camera package .................................. 5.0 $3,060.00 camera, digital system, 12 megapixel (medical grade). 5 $3,570.98 Documentation 

E13113 ..... digitrapper (24-hr ambulatory pH monitor by 

Cynectics).

10.0 $9,685.00 pH recorder, 24-hr ambulatory (Digitrapper) 5 $6,900.00 Other Equipment 

discogram pressure monitor .......................... 7.0 .............................. discogram pressure monitor .......................... 7 $600.00 Other Equipment dissecting instrument kit ................................. 5.0 $596.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment DNA image analyzer (ACIS) .......................... 7.0 $200,000.00 DNA image analyzer (ACIS) .......................... 7 $200,000.00 Laboratory DNA image analyzer (ACIS) .......................... 7.5 $200,000.00 DNA image analyzer (ACIS) .......................... 7 $200,000.00 Laboratory 

E30016 ..... doppler ........................................................... 5.0 $1,350.00 doppler (fetal or vascular) .............................. 5 $708.22 Other Equipment 

dose calibration source vial set (Cs137, 

Co57, and Ba137).

5.0 $1,159.00 dose calibration source vial set (Cs137, 

Co57, and Ba137).

5 $1,159.00 Radiology 

E51064 ..... Dose Callibrator w/ Lead Glass Sheild & Ce137 Standard. 5.0 $6,000.00 dose calibrator (Atomlab) ............................... 5 $5,496.67 Radiology 

Dosimetry software ........................................ 5.0 $21,000.00 radiation therapy dosimetry software (Argus 

QC).

5 $21,000.00 Radiology 

E53034 ..... Dual Photon Densitometer/Computer ............ 5.0 $65,000.00 densitometry unit, whole body, DPA .............. 5 $65,000.00 Radiology 

dust extractor ................................................. 10.0 $1,982.00 dust extractor ................................................. 8 $500.00 Other Equipment Dynavox/Dynamyte Wireless Backup and 

computer backup.

7.0 $549.00 augmentative communication - DynaBeam 

access w-memory backup.

7 $604.00 Other Equipment 

Dynovox 3100 ................................................ 7.0 $6,995.00 augmentative communication - DynaVox 

3100.

7 $7,295.00 Other Equipment 

E55009 ..... ECG Burdick EK-10 ....................................... 7.0 $1,985.50 ECG, 1-channel (Burdick) .............................. 7 $1,506.00 Other Equipment 

EECP system ................................................. 5.0 $180,000.00 EECP, external counterpulsation system ...... 7 $150,000.00 Other Equipment 

E11015 ..... electric bed ..................................................... 12.0 $2,024.00 bed, hospital, electric ..................................... 12 $1,746.52 Furniture E11010 ..... electric table ................................................... 15.0 $935.71 table, motorized (for instruments-equipment).doc. 15 $895.00 Furniture E30005 ..... electrocautery ................................................. 7.0 $995.00 electrocautery-hyfrecator, up to 45 watts ...... 10 $975.08 Other Equipment 

electrogastrography machine system ............ 10.0 $20,750.00 EGG monitoring system ................................. 7 $32,900.00 Other Equipment electro-oculography machine ......................... 10.0 $50,000.00 EOG, ERG, VEP electrodiagnostic unit ......... 7 $33,500.00 Other Equipment electro-retinography machine ......................... 10.0 $50,000.00 EOG, ERG, VEP electrodiagnostic unit ......... 7 $33,500.00 Other Equipment 

E30008 ..... electro-surgical device ................................... 7.0 $1,225.00 electrosurgical generator, up to 120 watts .... 7 $1,838.42 Other Equipment E13641 ..... embedding station .......................................... 8.0 $8,200.00 tissue embedding center ................................ 8 $9,096.67 Laboratory 

EMG biofeedback continence training system 

(Pathway CTS2000).

5.0 $11,750.00 EMG biofeedback continence training system 

(Pathway CTS2000).

8 $11,750.00 Other Equipment 

E54012 ..... EMG botox ..................................................... 7.0 $1,500.00 EMG botox ..................................................... 7 $1,500.00 Other Equipment E54007 ..... EMG Machine ................................................ 7.0 $21,157.50 EMG-NCV-EP system, 2-4 channel ............... 10 $18,288.63 Other Equipment 

EMG, surface system (OT, PT, clinician) 

(Therapist System).

7.0 $10,995.00 EMG, surface system (OT, PT, clinician) 

(Therapist System).

8 $9,995.00 Other Equipment 

E13118 ..... endoscope, rigid, cystoscopy ......................... 3.0 $3,365.00 endoscope, rigid, cystoscopy ......................... 3 $3,394.00 Scope E13402 ..... endoscope, rigid, hysteroscopy ..................... 3.0 $8,878.00 endoscope, rigid, hysteroscopy ..................... 3 $4,990.50 Scope 

endoscope, rigid, laryngoscopy ..................... 3.0 $5,080.00 endoscope, rigid, laryngoscopy ..................... 3 $3,095.67 Scope endoscope, rigid, otology ............................... 3.0 $2,456.88 endoscope, rigid, otology ............................... 7 $2,456.88 Scope endoscope, rigid, sigmoidoscopy ................... 3.0 $841.00 endoscope, rigid, sigmoidoscopy ................... 3 $841.38 Scope 

E13126 ..... endoscope, rigid, sinoscopy ........................... 3.0 $5,080.00 endoscope, rigid, sinoscopy ........................... 7 $2,414.17 Scope 

endoscope, rigid, sinoscopy ........................... 3.0 $5,080.00 endoscope, rigid, sinoscopy ........................... 7 $2,414.17 Scope 

E11005 ..... endoscopy stretcher ....................................... 10.0 $1,010.00 stretcher, endoscopy ...................................... 10 $2,414.00 Furniture E71027 ..... ENG Recorder ................................................ 7.0 $19,900.00 ENG recording system ................................... 5 $19,900.00 Other Equipment 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47711

environmental module - car ........................... 10.0 $30,000.00 environmental module - car ........................... 15 $33,750.00 Room - Lane environmental module - kitchen ..................... 10.0 $50,000.00 environmental module - kitchen ..................... 15 $56,250.00 Room - Lane environmental module - the workshop ........... 10.0 $20,000.00 environmental module - the workshop ........... 15 $22,500.00 Room - Lane ergonomic kit .................................................. 10.0 $2,285.00 kit, ergonomic (office) ..................................... 10 $2,285.48 Other Equipment 

E13114 ..... esophogeal motility monitor (physiograph ) ... 10.0 $22,865.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

evaluation system for upper extremity/hand .. 10.0 $16,500.00 evaluation system for upper extremity-hand 

(Greenleaf).

5 $17,495.00 Other Equipment 

exam chair, reclining ...................................... 15.0 $1,000.00 chair, medical recliner .................................... 10 $829.03 Furniture 

E30006 ..... exam lamp ...................................................... 10.0 $1,850.00 light, exam ...................................................... 10 $1,630.12 Other Equipment E71109 ..... Exam Lane ..................................................... 7.0 $31,046.15 lane, exam (oph) ............................................ 7 $30,453.33 Room - Lane E11001 ..... exam table ...................................................... 15.0 $1,360.00 table, exam ..................................................... 15 $1,338.17 Furniture 

exercise kit aquatic (boots, fins, 

gloves,weights, cuffs, spine safety board).

5.0 $500.00 kit, aquatic exercise ....................................... 10 $500.00 Other Equipment 

exercise staircase .......................................... 10.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other Equipment exercise staircase .......................................... 15.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other Equipment 

E71016 ..... external 35 mm camera with medical lenses 5.0 $10,795.00 camera, 35mm system (medical grade) ........ 5 $1,106.50 Documentation E51062 ..... External Microwave Applicators (set of 5), 

BSD.

10.0 $7,250.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

Farmer Chamber ............................................ 5.0 $1,500.00 chamber, Farmer-type .................................... 7 $1,169.38 Radiology 

E71002 ..... Farnsworth-Munsell 100-Hue Test or Nagel 

anomoscoope, McBeth light.

7.5 $556.00 Farnsworth-Munsell 100-Hue color vision test 

w/software.

7 $626.50 Other Equipment 

E13404 ..... fetal monitor ................................................... 5.0 $9,435.00 fetal monitor ................................................... 5 $5,415.95 Other Equipment E11006 ..... fiberoptic exam light (combine with source) .. 10.0 $608.75 light, fiberoptic headlight w-source ................ 5 $1,992.92 Other Equipment E13123 ..... fiberscope, flexible, bronchoscopy ................. 3.0 $9,700.00 fiberscope, flexible, bronchoscopy ................. 3 $14,175.00 Scope 

fiberscope, flexible, bronchoscopy ................. 3.0 $14,175.00 fiberscope, flexible, bronchoscopy ................. 3 $14,175.00 Scope fiberscope, flexible, bronchoscopy w-forceps 

(SPLIT: Scope/Forceps).

3.0 $10,943.33 fiberscope, flexible, bronchoscopy ................. 3 $14,175.00 Scope 

fiberscope, flexible, cystoscopy ..................... 3.0 $7,410.00 fiberscope, flexible, cystoscopy ..................... 3 $7,408.33 Scope 

E13117 ..... fiberscope, flexible, cystoscopy, with light 

source.

3.0 $7,760.00 fiberscope, flexible, cystoscopy, with light 

source.

3 $9,082.50 Scope 

E13124 ..... fiberscope, flexible, rhinolaryngoscopy .......... 3.0 $5,080.00 fiberscope, flexible, rhinolaryngoscopy .......... 3 $6,301.93 Scope 

fiberscope, flexible, rhinolaryngoscopy .......... 3.0 $5,080.00 fiberscope, flexible, rhinolaryngoscopy .......... 3 $6,301.93 Scope 

E13101 ..... fiberscope, flexible, sigmoidoscopy ............... 3.0 $5,803.00 fiberscope, flexible, sigmoidoscopy ............... 3 $5,803.33 Scope 

fiberscope, flexible, sigmoidoscopy ............... 3.0 $5,803.00 fiberscope, flexible, sigmoidoscopy ............... 3 $5,803.33 Scope 

E13121 ..... fiberscope, flexible, ureteroscopy .................. 3.0 $12,920.00 fiberscope, flexible, ureteroscopy .................. 3 $12,595.00 Scope 

film alternator ................................................. 10.0 $30,000.00 film alternator (motorized film viewbox) ......... 10 $27,500.00 Radiology Film Densitometer .......................................... 5.0 $1,580.00 densitometer, film ........................................... 5 $1,435.00 Radiology film dosimetry equipment for IMRT ................ 5.0 $28,500.00 film dosimetry equipment-software (RIT) ....... 5 $30,840.00 Radiology film printer, laser ............................................ 5.0 $45,000.00 film processor, dry, laser ................................ 8 $69,950.00 Documentation film processor, precision calibrated ............... 8.0 $25,000.00 film processor, wet ......................................... 8 $26,325.00 Documentation fistula probes, set of 4 ................................... 5.0 $560.00 Deleted (less than $500) ................................ .......... .............................. No Details 

E13616 ..... flow cytometer ................................................ 5.0 $11,000.00 flow cytometer ................................................ 5 $119,850.00 Laboratory E13639 ..... fluorescence microscope ............................... 7.0 $12,000.00 microscope, fluorescence .............................. 7 $9,468.48 Laboratory E51070 ..... Fluroscopic unit, Mobile C-Arm ...................... 5.0 $205,000.00 fluoroscopic system, mobile C-Arm ............... 8 $73,000.00 Radiology 

food models .................................................... 5.0 $700.00 food models .................................................... 4 $700.00 Other Equipment 

E30021 ..... foot & ankle surgery instrument pack ............ 4.0 $1,530.40 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment 

forceps, biopsy ............................................... 4.0 $1,310.00 endoscope forceps, biopsy ............................ 3 $1,243.33 Scope forceps, grasping ............................................ 4.0 $735.00 endoscope forceps, grasping ......................... 3 $745.67 Scope 

E71103 ..... full diameter trial lens set ............................... 7.5 $1,180.00 lens set, trial, full diameter, w-frame .............. 10 $904.93 Other Equipment E13613 ..... fume hood ...................................................... 10.0 $6,500.00 hood, fume ..................................................... 15 $4,778.46 Laboratory 

gamma counter, automatic ............................ 7.5 $17,900.00 gamma counter, automatic ............................ 7 $17,665.00 Radiology 

E71003 ..... Ganzfeld stimulator ........................................ 10.0 $45,000.00 Ganzfeld stimulator ........................................ 7 $8,750.00 Other Equipment 

gas cylinders .................................................. 5.0 $8,000.00 laser gas cylinder (for excimer) ..................... 5 $1,140.00 Other Equipment 

E13104 ..... gastro cautery unit ......................................... 7.0 $5,450.00 electrosurgical generator, gastrocautery ........ 7 $11,375.00 Other Equipment E13106 ..... gastroscope video (SPLIT: scope and video 

system).

3.0 $52,990.00 videoscope, gastroscopy ................................ 3 $21,598.33 Scope 

E55022 ..... Gating Device ................................................. 5.0 $3,625.00 ECG R-wave trigger (gating) device .............. 7 $5,671.00 Other Equipment 

generator, constant current ............................ 3.0 $950.00 generator, constant current ............................ 20 $950.00 Other Equipment 

47712 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

glucose monitor continuous 

(incl.accessories).

5.0 $2,613.00 glucose continuous monitoring system .......... 5 $2,465.00 Other Equipment 

E13666 ..... GLX linear stainer .......................................... 7.5 $6,995.00 slide stainer, automated, standard throughput. 7 $8,265.64 Laboratory E13637 ..... grossing station .............................................. 10.0 $23,391.00 grossing station w-heavy duty disposal ......... 20 $20,175.50 Laboratory 

halogen light (Edit light type) ......................... 5.0 $5,080.00 light source, xenon ......................................... 5 $6,723.33 Other Equipment halogen light cable ......................................... 5.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Details hand dexterity/sensory/strength kit ................ 7.0 $1,407.00 kit, hand dexterity, sensory, strength ............. 10 $1,561.40 Other Equipment Hand Held Voice ............................................ 7.0 $645.00 augmentative communication - Hand Held 

Voice.

7 $695.00 Other Equipment 

Hand Measurement Kit (dynamometers, 

goniometers, etc).

7.0 $600.00 kit, hand evaluation ........................................ 10 $617.65 Other Equipment 

hand-case instrument set ............................... 4.0 $2,000.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment 

E51072 ..... HDR Afterload System, Nucletron - Oldelft ... 5.0 $375,000.00 HDR Afterload System, Nucletron - Oldelft ... 7 $375,000.00 Radiology 

headmaster adapters (Accessibility) .............. 5.0 $1,675.00 augmentative communication - HeadMaster 

w-adapters.

7 $1,695.00 Other Equipment 

E53006 ..... Heavy Duty Imaging Table ............................ 7.5 $4,550.00 table, imaging ................................................. 15 $5,188.33 Furniture 

heavy-duty disposer ....................................... 5.0 $1,506.00 Deleted (part of new system) ......................... .......... .............................. No Details 

E71037 ..... hilger nerve stimulator .................................... 7.5 $1,805.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E55008 ..... Holter Monitor ................................................. 7.0 $2,590.00 holter monitor ................................................. 7 $1,413.43 Other Equipment E55015 ..... Holter monitor reader ..................................... 7.0 $14,995.00 holter analysys system ................................... 7 $8,815.58 Other Equipment E55015 ..... Holter monitor reader ..................................... 7.0 $14,995.00 holter system with one recorder .................... 7 $11,303.90 Other Equipment 

hood, biohazard ............................................. 10.0 $7,612.00 hood, biohazard ............................................. 10 $6,884.25 Laboratory hot wire cutter, Heustis .................................. 7.0 $28,600.00 Huestis block cutting machine w-attachments 15 $22,030.00 Radiology 

E92016 ..... Hubbard tank .................................................. 15.0 $17,000.00 whirlpool (Hubbard tank) ................................ 10 $15,195.00 Furniture E71005 ..... Humphrey field analyzer (or octopus) ............ 7.5 $27,950.00 Humphrey field analyzer ................................ 7 $27,000.00 Other Equipment E92006 ..... hydroculator, cold ........................................... 10.0 $1,675.00 hydrocollator, cold .......................................... 10 $1,910.50 Other Equipment E92007 ..... hydroculator, hot ............................................ 10.0 $1,265.00 hydrocollator, hot ............................................ 10 $1,090.17 Other Equipment E55033 ..... Hydrogen gas analyzer .................................. 7.5 $6,117.00 breath hydrogen analyzer (MicroLyzer) ......... 8 $4,895.00 Other Equipment 

hyperbaric chamber ....................................... 10.0 $125,000.00 hyperbaric chamber ....................................... 15 $125,000.00 Other Equipment 

E13652 ..... image analyzer (CAS system) ....................... 5.0 $92,000.00 image analyzer (CAS system) ....................... 5 $92,000.00 Laboratory 

Immittance bridge ........................................... 7.0 $6,900.00 immittance, middle-ear analyzer .................... 10 $4,995.00 Other Equipment impedance meter ........................................... 7.0 $1,312.00 impedance meter, 32-channel ....................... 7 $1,120.00 Other Equipment IMRT physics tools ......................................... 5.0 $55,485.00 IMRT physics tools ......................................... 5 $55,485.00 Radiology 

E92012 ..... inclinometer .................................................... 10.0 $520.00 Deleted (less than $500) ................................ .......... .............................. No Details 

incubator ......................................................... 10.0 $795.00 incubator ......................................................... 10 $837.30 Laboratory 

E13631 ..... incubator (CO2) .............................................. 10.0 $6,000.00 incubator, CO2 (dry-wall) ............................... 10 $5,842.99 Laboratory 

infrared ceiling lamps/temperature control ..... 3.0 $2,000.00 light, infra-red, ceiling mount .......................... 10 $555.00 Other Equipment 

E30023 ..... infrared coagulator ......................................... 7.0 $3,550.00 infrared coagulator (with hand applicator) ..... 10 $3,087.50 Other Equipment 

infrared illuminator .......................................... 7.0 $1,050.00 Deleted (part of new system) ......................... .......... .............................. No Details 

E91001 ..... infusion pump ................................................. 10.0 $4,150.00 IV infusion pump ............................................ 10 $2,384.45 Other Equipment 

INR monitor, home ......................................... 4.0 $2,000.00 INR monitor, home ......................................... 5 $2,000.00 Other Equipment instrument pack, basic (auricle) ..................... 4.0 $500.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment instrument pack, basic (EPF) ......................... 4.0 $1,200.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment instrument pack, basic (surgery) .................... 4.0 $500.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment instrument pack, medium (ear) ...................... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment instrument pack, medium (intraoral biopsy) ... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment instrument pack, medium (nasal endoscopy) 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment instrument pack, medium (nasal) ................... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment instrument pack, medium (otology POV) ....... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipmentinstrument pack, medium (surgery) ............... 4.0 $1,500.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment 

E92009 ..... Intellect High Voltage electrical stimulator ..... 10.0 $1,395.00 electrotherapy stimulator, high volt, 2 channel. 7 $1,923.00 Other Equipment 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47713

Intellikeys ........................................................ 7.0 $525.00 augmentative communication - IntelliKeys, 

Overlay, ClickIt.

7 $560.00 Other Equipment 

E92020 ..... Intercom ......................................................... 10.0 $10,000.00 intercom (incl. master, pt substation, power, 

wiring).

10 $1,630.00 Other Equipment 

intestinal imaging workstation ........................ 7.0 $25,400.00 intestinal imaging workstation ........................ 5 Other Equipment.

E51042 ..... Ion Chamber Array ......................................... 5.0 $6,445.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E71030 ..... iontophoresis machine ................................... 7.5 $1,500.00 iontophoresis machine ................................... 8 $995.00 Other Equipment 

isoalign device ................................................ 5.0 $950.00 isocentric beam alignment device .................. 5 $995.00 Radiology 

E92014 ..... isokinetic strenghthening equipment .............. 10.0 $29,823.00 exercise equipment (treadmill, bike, stepper, 

UBE, pulleys, balance board).

15 $12,710.00 Other Equipment 

isokinetic testing equipment ........................... 7.0 $45,820.00 rehab and testing system (BTE primus) ........ 5 $45,820.00 Other Equipment 

E50003 ..... isokinetometer ................................................ 10.0 $11,995.00 isokinetic evaluation system (Cybex NORM) 5 $39,900.00 Other Equipment E91008 ..... IVAC Injection Automatic Pump ..................... 5.0 $2,500.00 IVAC Injection Automatic Pump ..................... 10 $2,500.00 Other Equipment E55010 ..... King of Hearts-20 (Instromedix) ..................... 7.0 $1,750.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

kit, capsule endoscopy recorder .................... .......... $6,950.00 kit, capsule endoscopy recorder .................... 10 $6,950.00 Other Equipment lacrimal probes ............................................... 4.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Details laryngeal injector ............................................ 4.0 $1,032.00 kit, laryngeal injector ...................................... 3 $1,032.00 Other Equipment 

E13405 ..... laser ................................................................ 5.0 $23,500.00 laser (gs, uro, obg, ge) (Indigo Optima) ........ 5 $59,890.00 Other Equipment 

laser generator ............................................... 5.0 $54,890.00 laser (gs, uro, obg, ge) (Indigo Optima) ........ 5 $59,890.00 Other Equipment laser printer for CT angiography .................... 5.0 $71,400.00 film processor, dry, laser ................................ 8 $69,950.00 Documentation Laser Targeting System ................................. 5.0 $11,625.00 laser targeting system (4 diodes) .................. 5 $10,350.00 Radiology laser, ablation (gs, uro, obg, ge) (Indigo Optima). 5.0 $59,890.00 laser (gs, uro, obg, ge) (Indigo Optima) ........ 5 $59,890.00 Other Equipment laser, diode, for patient positioning (Probe) ... 5.0 $7,678.00 laser, diode, for patient positioning (Probe) ... 5 $7,678.00 Radiology laser, excimer ................................................. 5.0 $155,000.00 laser, excimer ................................................. 5 $160,000.00 Other Equipment 

E53001 ..... lead safe ......................................................... 20.0 $3,375.00 safe, storage, lead-lined ................................. 15 $3,850.00 Radiology E13403 ..... LEEP system .................................................. 7.0 $4,670.00 electrosurgical system (w-smoke evac) 

(LEEP, Quantum).

7 $4,283.00 Other Equipment 

E55014 ..... life signs receiving center .............................. 7.0 $3,800.00 pacemaker receiving software (GEMS Lite) .. 5 $3,995.00 Other Equipment 

lift, chair and sling .......................................... 10.0 $3,000.00 lift, hydraulic, chair ......................................... 10 $4,848.65 Furniture lift, hydraulic ................................................... 10.0 $4,730.00 lift, hydraulic, chair ......................................... 10 $4,848.65 Furniture light for photodynamic therapy, 400MW 

(BLU-U).

5.0 $15,759.00 light, external PDT, w-probe set (LumaCare) 5 $8,810.00 Other Equipment 

E13122 ..... light source (combine with headlight) ............ 3.0 $1,700.00 light, fiberoptic headlight w-source ................ 5 $1,992.92 Other Equipment 

light, infrared .................................................. 3.0 $500.00 light, infra-red, pole mount ............................. 10 $512.50 Other Equipment light, ultraviolet ............................................... 3.0 $630.00 light, ultra-violet .............................................. 10 $618.22 Other Equipment 

E51056 ..... Linear Accelerator - Cliniac-2100 .................. 5.0 $1,600,000.00 accelerator, 6-18 MV ...................................... 7 $1,832,941.00 Radiology E30010 ..... Liquid Nitro Tank w/ Cryac ............................ 10.0 $1,529.00 cryosurgery system, non-ophthalmic ............. 10 $1,607.50 Other Equipment E30024 ..... lithotriptor ........................................................ 5.0 $1,375,000.00 lithotriptor, with C-arm (ESWL) ...................... 5 $440,000.00 Other Equipment E11001 ..... low mat table .................................................. 10.0 $5,000.00 table, mat, hi-lo, 6 x 8 platform ...................... 15 $4,521.67 Furniture 

low mat table .................................................. 10.0 $5,000.00 table, mat, hi-lo, 6 x 8 platform ...................... 15 $4,521.67 Furniture mammatome driver ........................................ 5.0 $27,750.00 breast biopsy device w-system 

(Mammotome).

5 $29,862.00 Other Equipment 

mammography cassettes (4) ......................... 5.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Details 

E51016 ..... Mammography Room ..................................... 5.0 $130,000.00 room, mammography ..................................... 5 $130,000.00 Room - Lane 

mayo stand ..................................................... 7.0 $585.00 mayo stand ..................................................... 15 $530.76 Furniture 

E30019 ..... McGrowan ligator/Bander .............................. 7.0 $625.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E92010 ..... mechanical traction ........................................ 10.0 $2,090.00 traction system (hi-low table, digital unit, accessories). 10 $5,654.83 Other Equipment 

medium energy collimator (siemens 

05232868).

5.0 $14,000.00 collimator, medium energy (set of 2) ............. 7 $14,000.00 Radiology 

E13608 ..... microprobe EDS x-ray analysis ..................... 7.0 $42,500.00 Deleted (part of new system) ......................... .......... .............................. No Details E13662 ..... Microscope camera Konan SP 9000 ............. 5.0 $6,995.00 camera system, specular microscope ........... 5 $26,100.00 Laboratory E13601 ..... microscope, compound .................................. 7.0 $11,600.00 microscope, compound .................................. 7 $11,621.35 Laboratory E13606 ..... microscope, dissecting ................................... 7.0 $1,700.00 microscope, binocular - dissecting ................. 7 $956.00 Laboratory E13618 ..... microtome ....................................................... 7.0 $31,500.00 microtome ....................................................... 7 $13,369.00 Radiology E13619 ..... microtome knife sharpener ............................ 7.0 $7,200.00 microtome sharpener ..................................... 10 $6,400.00 Radiology 

microwave ...................................................... 10.0 .............................. diathermy, microwave .................................... 10 .............................. Other Equipment 

47714 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

E51060 ..... Microwave Hypothermia System, BSD .......... 10.0 $550,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

mimic/controllers/crane .................................. 5.0 $448,680.00 collimator, multileaf system w-autocrane 

(MIMiC).

7 $355,030.00 Radiology 

E72004 ..... Minor Equipment Pack ................................... 4.0 $1,082.95 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment E72006 ..... Minor Surgical Pack ....................................... 4.0 $1,596.88 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment E30020 ..... minor surgical tray .......................................... 4.0 $572.20 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment E53008 ..... Mobile Source Storage Safes ........................ 20.0 $3,650.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E92017 ..... mobolization/manipulation table ..................... 10.0 $9,315.00 table, mobolization-manipulation (Lloyd’s) ..... 15 $8,195.00 Furniture 

motor coordination kit ..................................... 10.0 $643.00 kit, motor coordination .................................... 10 $643.75 Other Equipment Mount/wheel chair .......................................... 7.0 $830.00 augmentative communication - DynaVox 

wheelchair mount.doc.

7 $765.00 Other Equipment 

E51058 ..... MR Room ....................................................... 5.0 $3,140,000.00 room, MR ....................................................... 5 $1,961,375.00 Room - Lane 

nasal pressure transducer ............................. 7.0 $525.00 transducer, pressure, airflow sensor .............. 7 $582.50 Other Equipment naturally speaking software, dragon (Accessibility). 5.0 $696.00 augmentative communication - Dragon Natu- rally-Speaking. 7 $699.95 Other Equipment 

E91010 ..... Negative Flow Hood ....................................... 10.0 $2,000.00 hood, negative flow ........................................ 15 $2,400.00 Laboratory E30028 ..... nerve stimulator .............................................. 7.5 $523.80 nerve stimulator (eg, for nerve block) ............ 7 $572.30 Other Equipment E12002 ..... neurobehavioral status instrument-average ... 7.5 $717.00 neurobehavioral status instrument-average ... 5 $717.00 Other Equipment 

new item ......................................................... .......... .............................. biofeedback equipment .................................. 8 .............................. Other Equipment new item ......................................................... .......... .............................. blood warmer ................................................. 7 $3,840.00 Other Equipment new item ......................................................... .......... .............................. breast biopsy imaging system, stereotactic 

(imager, table, software).

5 $234,000.00 Other Equipment 

new item ......................................................... .......... .............................. camera, digital system, for electron microscopy. 5 $41,000.00 Documentation new item ......................................................... .......... .............................. cell separator system ..................................... 6 $59,320.00 Other Equipment new item ......................................................... .......... .............................. chair, thyroid imaging ..................................... 10 $2,200.00 Furniture new item ......................................................... .......... .............................. CO2 infrared analyzer (COSMO) ................... 7 $4,500.00 Other Equipment new item ......................................................... .......... .............................. computer workstation, 3D hyperthermia treatment planning. 5 $98,000.00 Documentation new item ......................................................... .......... .............................. computer workstation, 3D radiation treatment 

planning.

5 $130,216.50 Documentation 

new item ......................................................... .......... .............................. computer workstation, 3D reconstruction CTMR. 5 $45,926.00 Documentation new item ......................................................... .......... .............................. computer workstation, brachytherapy treatment planning. 5 $105,403.00 Documentation new item ......................................................... .......... .............................. computer workstation, cardiac cath monitoring. 5 $94,000.00 Documentation new item ......................................................... .......... .............................. computer workstation, MRA post processing 5 .............................. Documentation new item ......................................................... .......... .............................. contrast media warmer .................................. 7 $552.00 Other Equipment new item ......................................................... .......... .............................. cortical bipolar-biphasic stimulating equipment. 7 .............................. Other Equipment new item ......................................................... .......... .............................. crash cart (unstocked) ................................... 10 $868.50 Furniture new item ......................................................... .......... .............................. cryosurgical probe, retina ............................... 7 $1,984.00 Other Equipment new item ......................................................... .......... .............................. defibrillator w-ECG monitor ............................ 5 $3,150.67 Other Equipment new item ......................................................... .......... .............................. densitometry unit, peripheral, SXA ................ 5 $22,096.00 Radiology new item ......................................................... .......... .............................. densitometry unit, peripheral, ultrasound ....... 5 $13,225.00 Radiology new item ......................................................... .......... .............................. dermabrader (Osada) ..................................... 10 $1,590.00 Other Equipment new item ......................................................... .......... .............................. drill, ophthalmology ........................................ 3 .............................. Other Equipment new item ......................................................... .......... .............................. EEG analysis software ................................... 5 $82,000.00 Other Equipment new item ......................................................... .......... .............................. EEG monitor, digital, portable ........................ 7 .............................. Other Equipment new item ......................................................... .......... .............................. electroconvulsive therapy machine ................ 5 .............................. Other Equipment 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47715

new item ......................................................... .......... .............................. external fixation, craniofacial halo 

(BlueDevice).

4 $5,146.00 Other Equipment 

new item ......................................................... .......... .............................. external fixation, mandible (Joe Hall Morris) 4 $4,508.00 Other Equipment new item ......................................................... .......... .............................. gamma camera system, single-dual head ..... 5 $406,816.80 Radiology new item ......................................................... .......... .............................. hyperthermia system, RF-deep and microwave. 5 $790,353.00 Radiology new item ......................................................... .......... .............................. hyperthermia system, ultrasound, external .... 5 $360,000.00 Radiology new item ......................................................... .......... .............................. hyperthermia system, ultrasound, 

intracavitary.

5 $250,000.00 Radiology 

new item ......................................................... .......... .............................. intracavitary applicator set (tandem and 

ovoids).

4 $10,321.50 Radiology 

new item ......................................................... .......... .............................. intra-compartmental pressure monitor device 7 $1,737.00 Other Equipment new item ......................................................... .......... .............................. lens set, fitting, low vision .............................. 10 $4,750.00 Other Equipment new item ......................................................... .......... .............................. liposorber system ........................................... 7 $7,800.00 Other Equipment new item ......................................................... .......... .............................. mammography reporting software ................. 5 .............................. Documentation new item ......................................................... .......... .............................. manometry system (computer, transducers, 

catheter).

5 $39,400.00 Other Equipment 

new item ......................................................... .......... .............................. micropigmentation (tattoo) system ................. 7 $2,550.00 Other Equipment new item ......................................................... .......... .............................. microscope, electron, transmission (TEM) .... 7 $319,290.00 Laboratory new item ......................................................... .......... .............................. microtome, ultra ............................................. 7 $25,950.00 Radiology new item ......................................................... .......... .............................. nuclide rod source set .................................... 5 $1,395.00 Radiology new item ......................................................... .......... .............................. oximeter, whole blood .................................... 5 $6,950.00 Other Equipment new item ......................................................... .......... .............................. oxygen system, portable ................................ 8 $569.89 Other Equipment new item ......................................................... .......... .............................. phantom, mammography-accreditation .......... 10 $674.00 Radiology new item ......................................................... .......... .............................. phantom, QCT densitometry .......................... 10 $5,464.00 Radiology new item ......................................................... .......... .............................. pump, water perfusion (for manometry) ........ 7 $7,307.00 Other Equipment new item ......................................................... .......... .............................. radiation L-block tabletop shield .................... 10 $725.00 Radiology new item ......................................................... .......... .............................. radiusgauge .................................................... 7 $1,234.00 Other Equipment new item ......................................................... .......... .............................. resectoscope, continuous flow ....................... 3 $1,200.00 Scope new item ......................................................... .......... .............................. RGP lens modification unit ............................ 7 $540.00 Other Equipment new item ......................................................... .......... .............................. rhinomanometer system (w-transducers and 

software).

7 $10,800.00 Other Equipment 

new item ......................................................... .......... .............................. sleep screening system, ambulatory (incl. 

hardware, software).

5 $14,877.25 Other Equipment 

new item ......................................................... .......... .............................. stepper, stabilizer, template (for 

brachytherapy treatment).

7 $18,550.00 Radiology 

new item ......................................................... .......... .............................. stirrups (for brachytherapy table) ................... 10 $3,876.00 Radiology new item ......................................................... .......... .............................. stretcher chair ................................................ 10 $3,133.00 Furniture new item ......................................................... .......... .............................. table, brachytherapy treatment ...................... 15 $28,900.00 Furniture new item ......................................................... .......... .............................. table, cystoscopy ............................................ 15 .............................. Furniture new item ......................................................... .......... .............................. thyroid uptake system .................................... 5 $13,995.00 Radiology new item ......................................................... .......... .............................. urethrotome, optical ....................................... 3 $1,881.00 Scope new item ......................................................... .......... .............................. vacuum deposition system (Auto306) ............ 7 $38,070.00 Laboratory new item ......................................................... .......... .............................. x-ray, dental, intra-oral ................................... 5 $3,869.00 Radiology new item ......................................................... .......... .............................. x-ray, dental, panoramic ................................ 5 $24,405.00 Radiology Non-amplified auditory trainer ........................ 7.0 $1,295.00 augmentative communication - auditory trainer. 7 $1,096.00 Other Equipment 

E13406 ..... NST, Non Stress Test .................................... 5.0 $8,878.00 fetal monitor ................................................... 5 $5,415.95 Other Equipment 

nuclear pharmacy management software (wcomputer and printer) (NMIS). 5.0 $13,400.00 computer workstation, nuclear pharmacy management (hardware and software). 5 $13,400.00 Documentation Nucleus Crystal Integrity Testing System ...... 7.0 $9,450.00 cochlear implant testing system ..................... 10 $9,500.00 Other Equipment Nucleus PCI ................................................... 7.0 $8,000.00 cochlear implant programming system .......... 7 $9,000.00 Other Equipment nutrition therapy software ............................... 5.0 $500.00 nutrition therapy software (Nutritionist Pro) ... 5 $595.00 Other Equipment 

E13102 ..... Olympus halogen light ................................... 3.0 $950.00 Deleted (part of new system) ......................... .......... .............................. No Details E30013 ..... operating microscope ..................................... 7.0 $5,400.00 microscope, operating .................................... 7 $7,047.50 Other Equipment E71019 ..... ophthalmic telebinocular ................................ 7.5 $1,025.00 telebinocular, ophthalmic ............................... 7 $1,014.33 Other Equipment 

optical coherence biometer ............................ 5.0 $25,950.00 Deleted through PEAC refinement. ............... .......... .............................. No Details optical disk reader .......................................... 5.0 $4,000.00 optical drive (MO), external ............................ 5 $2,050.00 Documentation optical fibers ................................................... 5.0 $3,236.00 laser optical delivery system (for excimer) .... 5 $1,500.00 Other Equipment 

47716 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

Orthovoltage Machine .................................... 5.0 $140,000.00 orthovoltage radiotherapy system .................. 5 $140,000.00 Radiology OSHA ventilated hood ................................... 10.0 $5,000.00 OSHA ventilated hood ................................... 15 $5,000.00 Radiology 

E13602 ..... osmometer ..................................................... 7.0 $4,595.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

otoscope-ophthalmoscope ............................. 3.0 $505.00 otoscope-ophthalmoscope (wall unit) ............ 10 $694.00 Other Equipment 

E54008 ..... Oxford PT recorder ........................................ 7.0 $6,940.00 EEG recorder, ambulatory ............................. 7 $6,940.00 Other Equipment E54009 ..... Oxford review station ..................................... 7.0 $44,950.00 EEG review station, ambulatory .................... 5 $44,950.00 Other Equipment 

Oximetry Recorder, overnight/software ......... 5.0 $3,660.00 pulse oxymetry recording software (prolonged monitoring). 5 $3,660.00 Other Equipment oxygen concentrator ....................................... 15.0 $3,806.00 oxygen concentrator (5-6 lpm) ....................... 8 $1,035.83 Other Equipment oxygen tank .................................................... 10.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Details 

E55027 ..... Oxygen uptake expired gas analyzer ............ 7.0 $46,000.00 Vmax 229 (PFT equip, computer system) ..... 8 $44,681.00 Other Equipment 

pacemaker follow-up system (e.g. paceart) ... 7.0 $22,000.00 pacemaker follow-up system (incl software 

and hardware) (Paceart).

7 $23,507.00 Other Equipment 

E71020 ..... pachometer .................................................... 5.0 $3,650.00 ultrasonic biometry, pachymeter .................... 5 $3,945.00 Other Equipment E13638 ..... paraffin dispenser ........................................... 7.5 $995.00 paraffin dispenser (two-gallon) ....................... 10 $1,520.00 Laboratory 

paraffin dispenser, 5 gal. ............................... 7.0 $1,995.00 paraffin dispenser (five-gallon) ....................... 10 $2,222.50 Laboratory 

E92011 ..... parallel bars .................................................... 15.0 $1,755.00 parallel bars, platform mounted ..................... 15 $1,670.67 Other Equipment 

PC server ....................................................... 5.0 $25,000.00 computer, server ............................................ 5 $25,000.00 Documentation 

E52003 ..... Pentium computer .......................................... 5.0 $2,800.00 computer, desktop, w-monitor ........................ 5 $2,501.00 Documentation 

percutaneous neuro test stimulator ............... 4.0 $795.00 percutaneous neuro test stimulator ............... 7 $795.00 Other Equipment peripheral QCT scanner ................................. 5.0 $55,000.00 densitometry unit, peripheral, QCT ................ 5 $79,000.00 Radiology pessary stock kit ............................................ 10.0 $1,824.00 Deleted (less than $500) ................................ .......... .............................. No Details 

E13603 ..... pH meter ........................................................ 7.0 $1,000.00 pH conductivity meter .................................... 10 $1,028.00 Laboratory 

photochemotherapy unit & lamps (200 ea/yr) 5.0 $32,000.00 phototherapy unit, whole body, UVA-UVB ..... 10 $12,975.00 Other Equipment photochemotherapy unit, hand/foot combo ... 5.0 $1,525.00 phototherapy unit, hand-foot, UVA-UVB ........ 10 $1,675.00 Other Equipment 

E13620 ..... photographic enlarger .................................... 10.0 $15,000.00 photographic enlarger .................................... 5 $3,195.00 Documentation E13621 ..... photographic film processor ........................... 10.0 $6,000.00 film processor (electron microscopy) ............. 8 $4,400.00 Laboratory 

physician analysis and viewing station .......... 7.5 $35,000.00 computer workstation, nuclear medicine 

analysis-viewing.

5 $55,097.00 Documentation 

physician analysis/viewing station ................. 10.0 $35,000.00 computer workstation, nuclear medicine 

analysis-viewing.

5 $55,097.00 Documentation 

physics support package for intensity modulated radiotherapy. 5.0 $12,500.00 Deleted (weekly training cost) ........................ .......... .............................. No Details 

E91011 ..... Plasma pheresis machine w/UV light source 7.5 $37,900.00 plasma pheresis machine w/UV light source 6 $37,900.00 Other Equipment E11009 ..... pneumatic chairs ............................................ 15.0 $697.60 Deleted (less than $500) ................................ .......... .............................. No Details 

pneumatic tourniquet device .......................... 5.0 .............................. tourniquet system (Zimmer1200) ................... 7 $10,220.00 Other Equipment pool cleaner .................................................... 10.0 $1,500.00 pool cleaner .................................................... 15 $1,372.15 Other Equipment 

E11003 ..... Power Table ................................................... 7.5 $6,939.00 table, power .................................................... 10 $6,153.63 Furniture E11003 ..... Power Table ................................................... 10.0 $6,939.00 table, power .................................................... 10 $6,153.63 Furniture E11003 ..... Power Table ................................................... 15.0 $6,939.00 table, power .................................................... 10 $6,153.63 Furniture E13622 ..... print washer .................................................... 10.0 $670.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

Printer (HP) .................................................... 5.0 $1,200.00 printer, laser, paper ........................................ 5 $1,199.00 Documentation printer, dye, sublimated .................................. 5.0 $15,000.00 printer, dye sublimation (photo, color) ........... 5 $2,322.50 Documentation printer, laser for CT ........................................ 5.0 $75,000.00 film processor, dry, laser ................................ 8 $69,950.00 Documentation printer, laser for CT angiography ................... 5.0 $71,400.00 film processor, dry, laser ................................ 8 $69,950.00 Documentation 

E51080 ..... Processor (wet or dry) ................................... 8.0 $55,000.00 film processor, wet ......................................... 8 $26,325.00 Documentation E55011 ..... Programmer: Intermedics ............................... 7.0 $10,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E55013 ..... Programmers for Pacemakers ....................... 7.0 $10,000.00 programmer, pacemaker ................................ 7 $10,000.00 Other Equipment E55012 ..... Programmers: Medtronic, CPI, Ventritex ....... 7.0 $11,000.00 programmer, for implanted medication pump 

(spine).

7 $1,975.00 Other Equipment 

E55012 ..... Programmers: Medtronic, CPI, Ventritex ....... 7.0 $11,000.00 programmer, neurostimulator (w-printer) ....... 7 $1,975.00 Other Equipment E54011 ..... Pt. Bedroom Furniture .................................... 12.0 $1,824.00 bedroom furniture (hospital bed, table, reclining chair). 12 $2,416.99 Furniture 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47717

E30011 ..... pulse dye laser ............................................... 5.0 $125,000.00 laser, pulse dye .............................................. 5 $78,500.00 Other Equipment E55003 ..... pulse oximeter ................................................ 5.0 $885.00 pulse oximeter w-printer ................................. 7 $1,207.18 Other Equipment 

Radiation Source Meter ................................. 7.0 $600.00 Deleted through PEAC refinement. ............... .......... .............................. No Details Radiation Survey Meter ................................. 7.0 $1,117.00 radiation survey meter ................................... 8 $756.25 Radiology radiofrequency generator (NEURO) .............. 7.0 $32,900.00 radiofrequency generator (NEURO) .............. 5 $32,900.00 Other Equipment 

E51005 ..... Radiographic/ fluoroscopic room ................... 5.0 $475,000.00 room, radiographic-fluoroscopic ..................... 5 $475,000.00 Room - Lane E51030 ..... Radiographic/Fluroscopic Evaluation Unit, 

RMI 4000.

5.0 $15,995.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

radiopharmaceutical receiving area ............... 5.0 $51,545.00 Deleted (split into separate equipment items) .......... .............................. No Details 

E11011 ..... reclining exam chair with headrest ................ 10.0 $4,495.00 chair with headrest, exam, reclining .............. 15 $4,836.33 Furniture E51022 ..... Record and verify Computer (Varian) ............ 5.0 $60,000.00 computer system, record and verify .............. 5 $60,000.00 Documentation 

remote monitoring service .............................. 7.0 $9,500.00 remote monitoring service (neurodiagnostics) 5 $9,500.00 Other Equipment respiratory plethysmograph ............................ 7.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Details retractor, hand ................................................ 4.0 $1,566.20 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment 

E54010 ..... review master ................................................. 7.0 $23,500.00 review master ................................................. 5 $23,500.00 Other Equipment 

review software (e.g. Prosolve) ..................... 5.0 $8,000.00 ultrasound, echocardiography analyzer software (ProSolv). 5 $8,000.00 Other Equipment 

E52013 ..... Review Station: AG7300 SVHS,17in. ............ 5.0 $899.99 video SVHS VCR (medical grade) ................. 5 $1,250.00 Documentation E71036 ..... Rhinomenometer ............................................ 7.5 $3,150.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E72010 ..... Rigid Bone fixation system ............................ 7.5 $20,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E52014 ..... Rigiscan .......................................................... 7.5 $12,500.00 nocturnal penile tumescence monitor

(Rigiscan Plus).

7 $9,000.00 Other Equipment 

E13642 ..... robotic cover slipper ....................................... 7.5 $32,288.00 slide coverslipper, robotic .............................. 7 $30,143.00 Laboratory E51087 ..... Roesenthal dosimeter .................................... 5.0 $1,995.00 dosimeter, aerosol provocation ...................... 10 $1,795.00 Other Equipment 

rotation chair .................................................. 7.0 $91,059.00 CDP-computerized dynamic posturography 

system.

7 $86,957.50 Other Equipment 

E13643 ..... routine pap stainer ......................................... 7.0 $20,000.00 slide stainer, automated, high-volume 

throughput.

7 $14,085.68 Laboratory 

RVS System ................................................... 7.0 $54,000.00 radiation virtual simulation system ................. 5 $54,000.00 Radiology 

E50006 ..... scale, high capacity ........................................ 10.0 $1,995.00 scale, high capacity (800 lb) .......................... 10 $1,726.33 Furniture 

scale, new born electronic ............................. 7.0 $1,276.00 scale, new born, digital .................................. 15 $1,279.41 Furniture 

E13607 ..... scanning electron microscope ....................... 7.0 $120,000.00 microscope, electron, scanning (SEM) (with 

microprobe and x-ray microanalyzer).

7 $178,725.00 Laboratory 

Scanning Laser Device .................................. 5.0 $60,000.00 tomographic device, optical coherence 

(OCT).

7 $49,950.00 Other Equipment 

scope washer ................................................. 7.0 .............................. endoscope disinfector, rigid or fiberoptic, wcart. 7 $18,802.00 Scope 

E71111 ..... Screening Lane .............................................. 7.0 $28,234.95 lane, screening (oph) ..................................... 7 $28,463.33 Room - Lane E54003 ..... Seizure Detection Device ............................... 7.0 $21,000.00 EEG, digital, prolonged testing system (computer w-remote camera). 7 $46,750.00 Other Equipment 

sensitometer ................................................... 5.0 $2,500.00 sensitometer, film ........................................... 10 $1,050.00 Radiology sensory integration equipment ....................... 8.0 $3,600.00 sensory integration equip (eg, ball pit, glider, 

trampoline, ramp).

15 $3,600.00 Other Equipment 

sensory kit ...................................................... 10.0 $677.00 kit, sensory ..................................................... 10 $677.35 Other Equipment 

E72008 ..... septoplasty tray .............................................. 4.0 $725.76 Deleted through PEAC refinement. ............... .......... .............................. No Details 

shock wave machine ...................................... 5.0 $450,000.00 shock wave system ........................................ 5 $350,000.00 Other Equipment 

E13103 ..... sigmoidoscopic equipment cart ...................... 10.0 $3,340.00 cart, endoscopy imaging equipment .............. 10 $2,793.00 Scope 

simple ear instrument pack ............................ 4.0 .............................. instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment simple ear instrumentation pack .................... 4.0 .............................. instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment Simulator, Varian ............................................ 5.0 $595,000.00 IMRT x-ray-fluoroscopic-based simulator ...... 5 $598,120.00 Radiology 

E51024 ..... Simulator, Ximatron CF w/last Image hold .... 5.0 $450,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E53018 ..... Single Head Anger Scintillation Camera ....... 5.0 $300,000.00 gamma camera system, single-dual head ..... 5 $406,816.80 Radiology E53020 ..... Single Head or Dual Head Camera ............... 5.0 $575,000.00 gamma camera system, single-dual head ..... 5 $406,816.80 Radiology E53032 ..... Single Photon Densitometer/Computer ......... 5.0 $22,500.00 densitometry unit, whole body, SPA .............. 5 $22,500.00 Radiology E71028 ..... Sinusoidal Harmonic Acceleration Chair ....... 7.0 $70,080.00 CDP-computerized dynamic posturography 

system.

7 $86,957.50 Other Equipment 

sleep kit (includes snore sensor & leg kit) ..... 7.0 $630.00 Deleted (less than $500) ................................ .......... .............................. No Details 

E13644 ..... slide dryer oven .............................................. 10.0 $695.00 slide dryer ....................................................... 10 $962.50 Laboratory E13645 ..... slide etcher ..................................................... 7.5 $9,400.00 slide etcher-labeler ......................................... 7 $15,836.67 Laboratory 

47718 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

E13617 ..... slide stainer .................................................... 7.0 $13,000.00 slide stainer, automated, high-volume 

throughput.

7 $14,085.68 Laboratory 

smoke evacuation system .............................. 10.0 .............................. Deleted (part of new system) ......................... .......... .............................. No Details soft tissue procedure pack ............................. 4.0 $539.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment 

E30003 ..... soft tissue tray ................................................ 4.0 $1,559.40 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment E52009 ..... Software (Paceart) ......................................... 5.0 $6,000.00 pacemaker follow-up system (incl software 

and hardware) (Paceart).

7 $23,507.00 Other Equipment 

software, MR/PET/CT fusion ......................... 5.0 $60,000.00 computer software, MR/PET/CT fusion ......... 5 $60,000.00 Documentation software-woodcock johnson test/cognitive 

abilities.

5.0 $728.00 cognitive abilities testing software 

(Woodcock Johnson).

5 $558.00 Other Equipment 

E51046 ..... Solid Water Calibration Phantom ................... 5.0 $2,000.00 phantom, solid water calibration check .......... 10 $2,109.50 Radiology E13646 ..... solvent recycling system ................................ 7.5 $22,000.00 solvent recycling system ................................ 7 $13,995.00 Laboratory E13614 ..... sonicator ......................................................... 7.5 $600.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E52010 ..... Sony Color Video Printer ............................... 5.0 $10,500.00 Deleted (part of new system) ......................... .......... .............................. No Details E52010 ..... Sony Color Video Printer (combine with system). 5.0 $10,500.00 video printer, color (Sony medical grade) ...... 4 $2,295.00 Documentation E71031 ..... sound proof booth- double walled ................. 7.5 $11,900.00 audiometric soundproof booth (exam and 

control rooms).

15 $33,518.00 Other Equipment 

sounds and followers set, leforte, 12-24 

french.

4.0 $508.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment 

sounds, female (set) ...................................... 4.0 $1,736.00 instrument pack, medium ($1500 and up) ..... 4 $1,500.00 Other Equipment sounds, male (set) ......................................... 4.0 $1,104.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment sounds, VanBurden ........................................ 4.0 $1,104.00 instrument pack, basic ($500-$1499) ............ 4 $500.00 Other Equipment source, 10 Ci Ir 192 ....................................... 3.0 $22,000.00 source, 10 Ci Ir 192 ....................................... 5 $22,000.00 Radiology 

E53028 ..... SPECT Three head Camera .......................... 5.0 $565,000.00 gamma camera system, single-dual head ..... 5 $406,816.80 Radiology 

spirometry instrument ..................................... 8.0 $37,974.00 Vmax 29s (spirometry testing equip, computer system). 8 $26,875.00 Other Equipment 

E13610 ..... sputter coater ................................................. 7.5 $6,000.00 Deleted (part of new system) ......................... .......... .............................. No Details 

stainer, automated hematology ...................... 7.0 $8,253.00 slide stainer, automated, standard throughput. 7 $8,265.64 Laboratory stairs, exercise ............................................... 10.0 $870.00 stairs, ambulation training .............................. 15 $793.67 Other Equipment stereotactic frame /tongs ................................ 5.0 .............................. cranial-skull tongs (Gardner-Wells) ................ 5 $542.00 Other Equipment stimulator with probe ...................................... 8.0 .............................. Deleted (less than $500) ................................ .......... .............................. No Details 

E11002 ..... stretcher ......................................................... 5.0 $2,664.00 stretcher ......................................................... 10 $1,915.00 Furniture E11002 ..... stretcher ......................................................... 10.0 $2,664.00 stretcher ......................................................... 10 $1,915.00 Furniture 

strontium-90 applicator ................................... 4.0 $8,599.00 strontium-90 applicator ................................... 5 $8,599.00 Other Equipment suction and pressure cabinet, ENT (SMR) .... 15.0 $3,195.00 suction and pressure cabinet, ENT (SMR) .... 10 $3,495.00 Other Equipment 

E30001 ..... suction machine, Gomco ............................... 10.0 $732.20 suction machine (Gomco) .............................. 10 $743.21 Other Equipment E72009 ..... surgical drill system ........................................ 7.5 $19,800.00 drill system, surgical, large (Stryker) ............. 10 $15,933.00 Other Equipment E30009 ..... surgical lamp .................................................. 10.0 $3,650.00 light, surgical .................................................. 10 $4,489.13 Furniture E30018 ..... surgical loupes ............................................... 10.0 $1,300.00 loupes, surgical, prism, up to 8.0x ................. 7 $1,398.33 Other Equipment E53004 ..... Survey Meter .................................................. 7.5 $650.00 radiation survey meter ................................... 8 $756.25 Radiology 

suspension system for sensory integration 

equipment.

8.0 $2,500.00 sensory integration equipment, suspension 

system.

10 $2,500.00 Other Equipment 

E52012 ..... SVHS video recorder ..................................... 5.0 $599.00 Deleted (part of new system) ......................... .......... .............................. No Details E52012 ..... SVHS video recorder ..................................... 5.0 $599.00 video SVHS VCR (medical grade) ................. 5 $1,250.00 Documentation 

swimming pool for aquatic therapy ................ 10.0 $37,500.00 aquatic therapy pool ....................................... 15 $36,000.00 Other Equipment switch kit ......................................................... 5.0 $1,910.00 augmentative communication - AT switches 

(eg, arm, tongue, pneumatic).

7 $1,910.00 Other Equipment 

table, back, mobile ......................................... 10.0 $709.00 table, instrument, mobile ................................ 15 $634.00 Furniture table, fluoroscopy (Hydra Vision 64kW) ........ 10.0 $281,600.00 table, fluoroscopy ........................................... 15 $281,600.00 Furniture table, OR, tilt .................................................. 10.0 $1,010.00 table, power .................................................... 10 $6,153.63 Furniture table, pedestal for OT .................................... 15.0 $795.00 table, for seated OT therapy .......................... 15 $718.67 Furniture 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47719

table, traction with leg rest ............................. 10.0 $3,770.00 Deleted (part of new system) ......................... .......... .............................. No Details table, treatment/work, adjustable height ........ 10.0 $2,905.00 table, treatment, hi-lo ..................................... 15 $2,361.67 Furniture Tech Speak .................................................... 7.0 $645.00 augmentative communication - Tech Speak 7 $645.00 Other Equipment TEE transducer .............................................. 5.0 $45,000.00 ultrasound, transducer (TEE Omniplane II) ... 5 $45,000.00 Other Equipment test, clerical comprehension (Valpar) ............ 10.0 $2,680.00 work samples, clerical comprehension 

(Valpar 5).

7 $2,680.00 Other Equipment 

test, fine finger dexterity (Valpar) ................... 10.0 $725.00 work samples, fine finger dexterity (Valpar 

204).

7 $725.00 Other Equipment 

test, physical capacity and mobility (Valpar) 10.0 $725.00 work samples, physical capacity (Valpar 201) 7 $725.00 Other Equipment

E92023 ..... Therapeutic exercise equipment set .............. 15.0 $12,260.00 exercise equipment (treadmill, bike, stepper, 

UBE, pulleys, balance board).

15 $12,710.00 Other Equipment 

E92001 ..... therapeutic ultrasound unit ............................. 7.0 $1,995.00 ultrasound unit, therapeutic ............................ 7 $1,304.33 Other Equipment 

Tilt Table ........................................................ 10.0 $6,995.00 table, tilt (w-trendelenberg) ............................ 15 $7,695.00 Furniture 

E13649 ..... tissue processing fume hood ......................... 7.5 $6,400.00 hood, fume ..................................................... 15 $4,778.46 Laboratory E13650 ..... tissue processor ............................................. 7.0 $39,500.00 tissue processor ............................................. 7 $33,593.00 Laboratory 

TLD oven/annealing furnace .......................... 5.0 $1,960.00 TLD annealing furnace ................................... 7 $2,536.00 Laboratory 

E51048 ..... TLD Reader .................................................... 5.0 $13,000.00 TLD Reader .................................................... 7 $14,390.00 Laboratory 

Tonography Unit ............................................. 5.0 $10,065.00 tonography unit .............................................. 7 $6,195.00 Other Equipment tool set, valpar ................................................ 7.0 $1,765.00 work samples, small tools (Valpar 1) ............. 7 $1,765.00 Other Equipment topcon TRC 50 E ........................................... 5.0 $28,790.00 camera, retinal (TRC 50IX, w-ICG, filters, 

motor drives).

5 $37,000.00 Documentation 

tourniquet device, pneumatic ......................... 7.0 $12,500.00 tourniquet system (Zimmer1200) ................... 7 $10,220.00 Other Equipment Tracher 2000 .................................................. 7.0 $1,895.00 augmentative communication - Tracker 2000 7 $1,795.00 Other Equipment transthoracic echo probe, pediatric, 8 mHz ... 5.0 $15,000.00 Deleted (part of new system) ......................... .......... .............................. No Details treadmill .......................................................... 10.0 $4,700.00 treadmill .......................................................... 8 $4,446.11 Other Equipment 

E55020 ..... Treadmill w/ ECG Monitor .............................. 8.0 $16,000.00 cardiac monitor w-treadmill (12-lead PCbased ECG). 10 $14,271.03 Other Equipment E51050 ..... Treatment Planning Computer-3D (Focus) .... 5.0 $221,500.00 computer workstation, 3D teletherapy treatment planning. 5 $221,500.00 Documentation 

treatment planning system for intensity modulated radiotherapy. 5.0 $350,000.00 treatment planning system, IMRT (Corvus w- Peregrine 3D Monte Carlo). 5 $350,545.00 Documentation Treatment Vault .............................................. 7.0 $550,670.00 radiation treatment vault ................................ 15 $550,670.00 Radiology TUMT device .................................................. 5.0 $60,000.00 TUMT system control unit .............................. 7 $29,995.00 Other Equipment 

E71032 ..... tympanometer with printer ............................. 7.0 $2,700.00 tympanometer with printer ............................. 10 $2,648.53 Other Equipment 

ultrasonic biometry, pachymeter .................... 5.0 $3,945.00 ultrasonic biometry, pachymeter .................... 5 $3,945.00 Other Equipment 

E13663 ..... ultrasonic instrument cleaner ......................... 7.5 $945.00 Deleted (indirect) ............................................ .......... .............................. No Details E52019 ..... Ultrasonic nebulizer ........................................ 10.0 $1,000.00 Deleted (CPT action) ..................................... .......... .............................. No Details E52001 ..... ultrasound color doppler, transducers and 

vaginal probe.

5.0 $155,000.00 ultrasound color doppler, transducers and 

vaginal probe.

5 $155,000.00 Other Equipment 

E52018 ..... Ultrasound Room ........................................... 5.0 $272,000.00 room, ultrasound, general .............................. 5 $369,945.00 Room - Lane 

ultrasound table .............................................. 10.0 $4,495.00 table, ultrasound ............................................. 15 $5,823.33 Furniture Ultrasound Unit .............................................. 5.0 $30,000.00 ultrasound unit, Shimadzu ............................. 5 $29,999.00 Other Equipment 

E52005 ..... ultrasound, shimatsu ...................................... 5.0 $35,000.00 ultrasound unit, Shimadzu ............................. 5 $29,999.00 Other Equipment 

urethotome, otis ............................................. 3.0 $1,735.00 urethrotome, Otis ........................................... 4 $1,697.50 Scope 

E52006 ..... urodynamics machine, 4-channel video ........ 5.0 $15,175.00 urodynamics system, 4-channel .................... 5 $30,733.00 Other Equipment 

urodynamics machine, 6-channel video ........ 5.0 $115,578.00 urodynamics system, 6-channel, w-video ...... 5 $115,578.00 Other Equipment uroflowmeter, digital, w-chair (Microflo) ......... 5.0 $2,758.00 uroflowmeter, digital, w-chair ......................... 7 $2,758.00 Other Equipment uterine thermal balloon ablation system 

(Thermachoice).

5.0 $8,500.00 uterine thermal balloon ablation system 

(Thermachoice).

7 $8,500.00 Other Equipment 

UV monitor/meter ........................................... 5.0 $690.00 phototherapy UVB measuring device ............ 10 $690.00 Other Equipment vacuum cart .................................................... 10.0 .............................. vacuum cart .................................................... 10 Other Equipment.

E13615 ..... vacuum dissector ........................................... 10.0 $635.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E13627 ..... vacuum evaporator ........................................ 7.5 $15,000.00 Deleted (part of new system) ......................... .......... .............................. No Details E13612 ..... vacuum oven .................................................. 10.0 $3,000.00 Deleted (part of new system) ......................... .......... .............................. No Details E13624 ..... vacuum pump ................................................. 10.0 $1,455.00 vacuum pump ................................................. 7 $1,840.00 Laboratory E92015 ..... Vasopneumatic device ................................... 10.0 $795.00 vasopneumatic compression system ............. 10 $632.48 Other Equipment E91003 ..... ventilator hood & blower ................................ 10.0 $602.55 hood, ventilator with blower ........................... 10 $1,612.50 Laboratory 

47720 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM D.

—

PROPOSED

CHANGES TO

PRACTICE

EXPENSE

EQUIPMENT

DESCRIPTION, LIFE, AND

PRICING

—Continued

Equip code 

2004 practice expense equipment details 2005 practice expense supply details (proposed) 

Description Life Price Description Life Price Equipment category 

video add-on camera system w-monitor (endoscopy). 5.0 $9,495.00 video add-on camera system w-monitor (en- doscopy). 5 $9,495.00 Scope 

E13635 ..... video camera .................................................. 5.0 $1,000.00 Deleted (part of new system) ......................... .......... .............................. No Details E13635 ..... video camera (combine with system) ............ 5.0 $1,000.00 video add-on camera system w-monitor (endoscopy). 5 $9,495.00 Scope E13635 ..... video camera (combine with system) ............ 5.0 $1,000.00 video camera .................................................. 5 $1,000.00 Documentation 

video system, capsule endoscopy (software, 

computer, monitor, printer).

.......... $17,000.00 video system, capsule endoscopy (software, 

computer, monitor, printer).

5 $17,000.00 Scope 

video system, capsule endoscopy, booster 

drive w-accessories.

.......... $2,500.00 video system, capsule endoscopy, booster 

drive w-accessories.

5 $2,500.00 Scope 

video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

5.0 $33,233.00 video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

5 $33,232.50 Scope 

video system, FEES (scope, camera, light 

source, image capture, monitor, printer, cart).

5.0 $21,675.00 video system, FEES (scope, camera, light 

source, image capture, monitor, printer, cart).

5 $21,675.00 Scope 

video system, FEESST (scope, sensory 

stimulator, camera, light source, image capture, monitor, printer, cart).

5.0 $29,550.00 video system, FEESST (scope, sensory 

stimulator, camera, light source, image capture, monitor, printer, cart).

5 $29,550.00 Scope 

video system, stroboscopy (strobing platform, camera, digital recorder, monitor, 

printer, cart).

5.0 $25,310.00 video system, stroboscopy (strobing platform, camera, digital recorder, monitor, 

printer, cart).

5 $25,310.00 Scope 

E71033 ..... visual response audiometry ........................... 7.0 $700.00 VRA-visual reinforcment audiometry system 5 $1,550.00 Other Equipment E55023 ..... VMax 229 (split/combine systems) ................ 8.0 $56,551.20 Vmax 229 (spirometry testing equip, computer system). 8 $44,681.00 Other Equipment E55023 ..... VMax 229 (split/combine systems) ................ 8.0 $56,551.20 Vmax 29s (spirometry testing equip, computer system). 8 $26,875.00 Other Equipment 

Voice Pal Max ................................................ 7.0 $555.00 augmentative communication - VoicePal Max 7 $555.00 Other Equipment 

E13648 ..... vortex mixer .................................................... 7.5 $500.00 Deleted (less than $500) ................................ .......... .............................. No Details E54002 ..... Voyager acquisition station ............................ 7.0 $46,850.00 sleep screening system, attended (w-resp 

plethysmography).

5 $22,000.00 Other Equipment 

water bath ...................................................... 10.0 $750.00 water bath, general purpose (lab) .................. 7 $726.45 Laboratory Water Bath Phantom with Drivers ................. 5.0 $15,000.00 phantom, water, includes remote motor drive 10 $3,070.00 Radiology water bath, general purpose (lab) .................. 5.0 $726.45 water bath, general purpose (lab) .................. 7 $726.45 Laboratory Water Chiller .................................................. 7.0 $28,000.00 water chiller (radiation treatment) .................. 7 $28,000.00 Radiology 

E51026 ..... Waterbath for Thermoplastic Immobilizer 

System.

5.0 $750.00 water bath, thermoplastic softener (20in x 

12in).

7 $722.36 Radiology 

Waterbath, Medtech ....................................... 5.0 $1,150.00 water bath, thermoplastic softener (20in x 

12in).

7 $722.36 Radiology 

E71008 ..... Weeks dark adaptometer ............................... 5.0 $16,100.00 Weeks dark adaptometer ............................... 7 $2,950.00 Other Equipment E51076 ..... Well Counter .................................................. 5.0 $3,955.00 well counter .................................................... 7 $3,955.00 Radiology E51074 ..... Well Ionization Chamber, Standard Imaging 5.0 $4,641.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E71108 ..... wheatstone trainer .......................................... 7.5 $895.00 stereo trainer (wheatstone) ............................ 7 $550.00 Other Equipment E92005 ..... whirlpool ......................................................... 10.0 $3,700.00 whirlpool, lo-boy tank (whole body) ............... 10 $3,296.40 Furniture 

whitkit evaluation kit ....................................... 5.0 $1,400.00 augmentative communication - WhitKit head 

support.

7 $1,400.00 Other Equipment 

E53030 ..... Whole Body or Dual Head Camera ............... 5.0 $575,000.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

WIT thermotherapy unit ................................. 5.0 $18,500.00 WIT system (AquaTherm) .............................. 7 $16,400.00 Other Equipment work bench, orthotic, mobile .......................... 10.0 $750.00 cart-workbench, orthotic, mobile .................... 10 $752.50 Furniture work station, post processing for CT 

angiography.

10.0 $180,000.00 Deleted (part of new system) ......................... .......... .............................. No Details 

E53022 ..... Xenon Delivery System .................................. 5.0 $5,450.00 Deleted through PEAC refinement. ............... .......... .............................. No Details 

xenon light source - cable for endoscope ..... 3.0 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47721

light source, xenon ......................................... 5 $6,723.33 Other Equipment.

E53024 ..... Xenon Monitor ................................................ 5.0 $2,775.00 Deleted through PEAC refinement. ............... .......... .............................. No Details E51003 ..... X-omat Film processor M35A ........................ 8.0 $10,900.00 film processor, x-omat (Kodak 2000A) .......... 8 $11,500.00 Documentation E51002 ..... X-omat film processor M6B ........................... 8.0 $26,832.00 film processor, x-omat (M6B) ......................... 8 $34,865.00 Documentation E55032 ..... x-ray lift ........................................................... 7.5 $800.00 lift, hydraulic, table assist ............................... 10 $1,111.00 Furniture E51001 ..... X-ray View Box 4 panel ................................. 15.0 $909.49 x-ray view box, 4 panel .................................. 10 $889.17 Radiology E72000 ..... YAG laser ....................................................... 5.0 $40,000.00 laser, YAG ...................................................... 5 $29,975.00 Other Equipment E71009 ..... Zeiss slit lamp camera ................................... 10.0 $7,495.00 slit lamp (Haag-Streit) .................................... 10 $7,435.00 Other Equipment 

zeiss visulas 690 PDT laser .......................... 5.0 $37,900.00 laser, photodynamic therapy .......................... 5 $35,000.00 Other Equipment 

47722 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM E.—REVISED 2005 OFFICE RENTAL INDEX VERSUS CURRENT OFFICE RENTAL INDEX BY 2004 FEE SCHEDULE

AREA

Carrier No. Loc. 

No. Locality name Current rental index 

Revised 2005 

rental index Difference Percentage difference 

00510 ....... 00 ALABAMA ............................................................................ 0.738 0.679 -0.059 -8.0 

00831 ....... 01 ALASKA ............................................................................... 1.249 1.141 -0.108 -8.6 

31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.422 1.586 0.164 11.5 

00832 ....... 00 ARIZONA ............................................................................. 1.000 1.034 0.034 3.4 

00520 ....... 13 ARKANSAS ......................................................................... 0.704 0.666 -0.038 -5.4 

00511 ....... 01 ATLANTA, GA ..................................................................... 1.136 1.271 0.135 11.9 

00900 ....... 31 AUSTIN, TX ......................................................................... 1.111 1.243 0.132 11.9 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.026 1.159 0.133 13.0 

00900 ....... 20 BEAUMONT, TX .................................................................. 0.758 0.700 -0.058 -7.7 

00900 ....... 09 BRAZORIA, TX .................................................................... 1.018 0.991 -0.027 -2.7 

00952 ....... 16 CHICAGO, IL ....................................................................... 1.216 1.274 0.058 4.8 

00824 ....... 01 COLORADO ........................................................................ 1.066 1.100 0.034 3.2 

00591 ....... 00 CONNECTICUT ................................................................... 1.215 1.275 0.060 4.9 

00900 ....... 11 DALLAS, TX ........................................................................ 1.196 1.167 -0.029 -2.4 

00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.341 1.584 0.243 18.1 

00902 ....... 01 DELAWARE ......................................................................... 1.051 0.983 -0.068 -6.5 

00953 ....... 01 DETROIT, MI ....................................................................... 1.045 1.060 0.015 1.4 

00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.792 0.912 0.120 15.2 

00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.090 1.041 -0.049 -4.5 

00900 ....... 28 FORT WORTH, TX .............................................................. 0.977 1.017 0.040 4.1 

00900 ....... 15 GALVESTON, TX ................................................................ 0.924 0.901 -0.023 -2.5 

00833 ....... 01 HAWAII/GUAM .................................................................... 1.389 1.186 -0.203 -14.6 

00900 ....... 18 HOUSTON, TX .................................................................... 0.988 1.024 0.036 3.6 

05130 ....... 00 IDAHO .................................................................................. 0.791 0.730 -0.061 -7.7 

00630 ....... 00 INDIANA .............................................................................. 0.847 0.789 -0.058 -6.8 

00826 ....... 00 IOWA ................................................................................... 0.785 0.737 -0.048 -6.1 

00650 ....... 00 KANSAS* ............................................................................. 0.793 0.765 -0.028 -3.5 

00740 ....... 04 KANSAS* ............................................................................. 0.793 0.765 -0.028 -3.5 

00660 ....... 00 KENTUCKY ......................................................................... 0.721 0.685 -0.036 -5.0 

31146 ....... 18 LOS ANGELES, CA ............................................................ 1.223 1.328 0.105 8.6 

00803 ....... 01 MANHATTAN, NY ............................................................... 1.744 1.676 -0.068 -3.9 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.647 1.886 0.239 14.5 

31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.504 1.809 0.305 20.3 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.916 0.962 0.046 5.0 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.178 1.196 0.018 1.5 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.814 0.949 0.135 16.6 

00590 ....... 04 MIAMI, FL ............................................................................ 1.139 1.117 -0.022 -1.9 

00954 ....... 00 MINNESOTA ........................................................................ 0.940 0.997 0.057 6.1 

00512 ....... 00 MISSISSIPPI ........................................................................ 0.690 0.667 -0.023 -3.3 

00751 ....... 01 MONTANA ........................................................................... 0.794 0.738 -0.056 -7.1 

00655 ....... 00 NEBRASKA ......................................................................... 0.817 0.748 -0.069 -8.4 

00834 ....... 00 NEVADA .............................................................................. 1.117 1.110 -0.007 -0.6 

31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.089 1.123 0.034 3.1 

00521 ....... 05 NEW MEXICO ..................................................................... 0.837 0.788 -0.049 -5.9 

00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.832 0.905 0.073 8.8 

05535 ....... 00 NORTH CAROLINA ............................................................. 0.869 0.826 -0.043 -4.9 

00820 ....... 01 NORTH DAKOTA ................................................................ 0.800 0.751 -0.049 -6.1 

00805 ....... 01 NORTHERN NJ ................................................................... 1.399 1.421 0.022 1.6 

00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.573 1.538 -0.035 -2.2 

31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.470 1.886 0.416 28.3 

00883 ....... 00 OHIO .................................................................................... 0.863 0.838 -0.025 -2.9 

00522 ....... 00 OKLAHOMA ......................................................................... 0.725 0.717 -0.008 -1.1 

00835 ....... 01 PORTLAND, OR .................................................................. 1.120 1.058 -0.062 -5.5 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.254 1.201 -0.053 -4.2 

00973 ....... 20 PUERTO RICO .................................................................... 0.688 0.631 -0.057 -8.3 

14330 ....... 04 QUEENS, NY ....................................................................... 1.414 1.359 -0.055 -3.9 

31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.050 1.110 0.060 5.7 

31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.050 1.110 0.060 5.7 

00590 ....... 99 REST OF FLORIDA ............................................................ 0.951 0.928 -0.023 -2.4 

00511 ....... 99 REST OF GEORGIA ........................................................... 0.771 0.729 -0.042 -5.4 

00952 ....... 99 REST OF ILLINOIS ............................................................. 0.797 0.741 -0.056 -7.0 

00528 ....... 99 REST OF LOUISIANA ......................................................... 0.715 0.672 -0.043 -6.0 

31142 ....... 99 REST OF MAINE ................................................................. 0.801 0.755 -0.046 -5.7 

00901 ....... 99 REST OF MARYLAND ........................................................ 0.995 1.026 0.031 3.1 

31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.308 1.239 -0.069 -5.3 

00953 ....... 99 REST OF MICHIGAN .......................................................... 0.848 0.799 -0.049 -5.8 

00740 ....... 99 REST OF MISSOURI* ......................................................... 0.662 0.613 -0.049 -7.4 

00523 ....... 99 REST OF MISSOURI* ......................................................... 0.662 0.613 -0.049 -7.4 

00805 ....... 99 REST OF NEW JERSEY .................................................... 1.312 1.256 -0.056 -4.3 

00801 ....... 99 REST OF NEW YORK ........................................................ 0.875 0.812 -0.063 -7.2 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47723

ADDENDUM E.—REVISED 2005 OFFICE RENTAL INDEX VERSUS CURRENT OFFICE RENTAL INDEX BY 2004 FEE SCHEDULE

AREA—Continued

Carrier No. Loc. 

No. Locality name Current rental index 

Revised 2005 

rental index Difference Percentage difference 

00835 ....... 99 REST OF OREGON ............................................................ 0.901 0.837 -0.064 -7.1 

00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.844 0.785 -0.059 -7.0 

00900 ....... 99 REST OF TEXAS ................................................................ 0.795 0.759 -0.036 -4.5 

00836 ....... 99 REST OF WASHINGTON ................................................... 0.958 0.915 -0.043 -4.5 

00870 ....... 01 RHODE ISLAND .................................................................. 1.098 0.931 -0.167 -15.2 

31140 ....... 05 SAN FRANCISCO, CA ........................................................ 2.174 2.356 0.182 8.4 

31140 ....... 06 SAN MATEO, CA ................................................................ 2.174 2.356 0.182 8.4 

31140 ....... 09 SANTA CLARA, CA ............................................................. 1.949 2.416 0.467 24.0 

00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.232 1.234 0.002 0.2 

00880 ....... 01 SOUTH CAROLINA ............................................................. 0.825 0.763 -0.062 -7.5 

00820 ....... 02 SOUTH DAKOTA ................................................................ 0.853 0.801 -0.052 -6.1 

31142 ....... 03 SOUTHERN MAINE ............................................................ 1.009 1.098 0.089 8.8 

00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.216 1.274 0.058 4.8 

05440 ....... 35 TENNESSEE ....................................................................... 0.800 0.748 -0.052 -6.5 

00910 ....... 09 UTAH ................................................................................... 0.978 0.950 -0.028 -2.9 

31146 ....... 17 VENTURA, CA ..................................................................... 1.294 1.484 0.190 14.7 

31145 ....... 50 VERMONT ........................................................................... 1.004 0.997 -0.007 -0.7 

00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.260 1.164 -0.096 -7.6 

00904 ....... 00 VIRGINIA ............................................................................. 0.892 0.933 0.041 4.6 

00884 ....... 16 WEST VIRGINIA .................................................................. 0.685 0.634 -0.051 -7.4 

00951 ....... 00 WISCONSIN ........................................................................ 0.866 0.801 -0.065 -7.5 

00825 ....... 21 WYOMING ........................................................................... 0.799 0.751 -0.048 -6.0 

Note: Revised Rental Indices Based Upon 2004 HUD FMR Data. 

ADDENDUM F.—CURRENT GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

00510 ....... 00 ALABAMA ...................................................................................................... 1.000 0.870 0.779 

00831 ....... 01 ALASKA ......................................................................................................... 1.670 1.670 1.670 

00832 ....... 00 ARIZONA ....................................................................................................... 1.000 0.978 1.090 

00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0.847 0.389 

31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.037 1.184 0.955 

31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.056 1.139 0.955 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.015 1.248 0.669 

31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.041 1.235 0.669 

31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.068 1.458 0.669 

31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.048 1.432 0.663 

31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.063 1.380 0.622 

31146 ....... 17 VENTURA, CA ............................................................................................... 1.028 1.125 0.763 

31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.034 0.740

31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.034 0.740

00824 ....... 01 COLORADO .................................................................................................. 1.000 0.992 0.821 

00591 ....... 00 CONNECTICUT ............................................................................................. 1.050 1.156 0.933 

00902 ....... 01 DELAWARE ................................................................................................... 1.019 1.035 0.802 

00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.050 1.166 0.917 

00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 1.018 1.790 

00590 ....... 04 MIAMI, FL ...................................................................................................... 1.015 1.052 2.399 

00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.946 1.268 

00511 ....... 01 ATLANTA, GA ............................................................................................... 1.006 1.059 0.951 

00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.892 0.951 

00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.000 1.124 0.817 

05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.881 0.478 

00952 ....... 16 CHICAGO, IL ................................................................................................. 1.028 1.092 1.832 

00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.924 1.720 

00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.006 1.071 1.648 

00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.889 1.175 

00630 ....... 00 INDIANA ........................................................................................................ 1.000 0.922 0.459 

00826 ....... 00 IOWA ............................................................................................................. 1.000 0.876 0.593 

00650 ....... 00 KANSAS* ....................................................................................................... 1.000 0.895 0.738 

00740 ....... 04 KANSAS* ....................................................................................................... 1.000 0.895 0.738 

00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0.866 0.875 

00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.945 1.240 

00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.870 1.066 

31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 0.999 0.652 

31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.910 0.652 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.021 1.038 0.931 

00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.972 0.767

47724 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM F.—CURRENT GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—Continued

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.041 1.239 0.803 

31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.010 1.129 0.803 

00953 ....... 01 DETROIT, MI ................................................................................................. 1.043 1.038 2.741 

00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.938 1.545 

00954 ....... 00 MINNESOTA .................................................................................................. 1.000 0.974 0.431 

00512 ....... 00 MISSISSIPPI .................................................................................................. 1.000 0.837 0.750 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.967 0.896 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.938 0.893 

00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.825 0.842 

00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.825 0.842 

00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.876 0.815 

00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0.877 0.442 

00834 ....... 00 NEVADA ........................................................................................................ 1.005 1.039 1.138 

31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.030 0.883 

00805 ....... 01 NORTHERN NJ ............................................................................................. 1.058 1.193 0.916 

00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.029 1.110 0.916 

00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.900 0.898 

00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.094 1.351 1.586 

00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.068 1.251 1.869 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.011 1.075 1.221 

14330 ....... 04 QUEENS, NY ................................................................................................. 1.058 1.228 1.791 

00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.944 0.720

05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.931 0.618 

00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.880 0.630 

00883 ....... 00 OHIO .............................................................................................................. 1.000 0.944 0.967 

00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0.876 0.413 

00835 ....... 01 PORTLAND, OR ............................................................................................ 1.000 1.049 0.438 

00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.933 0.438 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.023 1.092 1.400 

00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.929 0.790 

00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.712 0.268 

00870 ....... 01 RHODE ISLAND ............................................................................................ 1.017 1.065 0.896 

00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.904 0.336 

00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.878 0.385 

05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0.900 0.612 

00900 ....... 31 AUSTIN, TX ................................................................................................... 1.000 0.996 0.922 

00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.890 1.318 

00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.000 0.978 1.318 

00900 ....... 11 DALLAS, TX .................................................................................................. 1.010 1.065 0.996 

00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.981 0.996 

00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.969 1.318 

00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.007 1.316 

00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.880 1.047 

00910 ....... 09 UTAH ............................................................................................................. 1.000 0.941 0.653 

31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.986 0.527 

00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 1.023 1.003 

00904 ....... 00 VIRGINIA ....................................................................................................... 1.000 0.938 0.540 

00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.005 1.100 0.803 

00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.972 0.803 

00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.850 1.462 

00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0.929 0.865 

00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.895 0.970 

Note: Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska indices, 

set by MMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021. 

ADDENDUM G.—PROPOSED 2005 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

00510 ....... 00 ALABAMA ...................................................................................................... 1.000 0.860 0.779 

00831 ....... 01 ALASKA ......................................................................................................... 1.670 1.670 1.670 

00832 ....... 00 ARIZONA ....................................................................................................... 1.000 0.983 1.090 

00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0.841 0.389 

31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.036 1.203 0.955 

31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.049 1.142 0.955 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.026 1.292 0.669 

31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.049 1.301 0.669 

31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.066 1.498 0.669 

31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.062 1.482 0.663 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47725

ADDENDUM G.—PROPOSED 2005 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—

Continued

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.076 1.457 0.622 

31146 ....... 17 VENTURA, CA ............................................................................................... 1.029 1.146 0.763 

31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.039 0.740

31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.039 0.740

00824 ....... 01 COLORADO .................................................................................................. 1.000 1.004 0.821 

00591 ....... 00 CONNECTICUT ............................................................................................. 1.044 1.161 0.933 

00902 ....... 01 DELAWARE ................................................................................................... 1.016 1.027 0.802 

00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.051 1.202 0.917 

00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 1.005 1.790 

00590 ....... 04 MIAMI, FL ...................................................................................................... 1.007 1.036 2.399 

00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.941 1.268 

00511 ....... 01 ATLANTA, GA ............................................................................................... 1.009 1.076 0.951 

00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.885 0.951 

00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.001 1.113 0.817 

05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.874 0.478 

00952 ....... 16 CHICAGO, IL ................................................................................................. 1.027 1.110 1.832 

00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.934 1.720 

00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.013 1.094 1.648 

00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.883 1.175 

00630 ....... 00 INDIANA ........................................................................................................ 1.000 0.916 0.459 

00826 ....... 00 IOWA ............................................................................................................. 1.000 0.874 0.593 

00650 ....... 00 KANSAS* ....................................................................................................... 1.000 0.889 0.738 

00740 ....... 04 KANSAS* ....................................................................................................... 1.000 0.889 0.738 

00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0.862 0.875 

00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.947 1.240 

00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.860 1.066 

31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 1.006 0.652 

31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.899 0.652 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.017 1.054 0.931 

00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.974 0.767

31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.036 1.277 0.803 

31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.009 1.113 0.803 

00953 ....... 01 DETROIT, MI ................................................................................................. 1.040 1.044 2.741 

00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.930 1.545 

00954 ....... 00 MINNESOTA .................................................................................................. 1.000 0.990 0.431 

00512 ....... 00 MISSISSIPPI .................................................................................................. 1.000 0.840 0.750 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.972 0.896 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.949 0.893 

00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.815 0.842 

00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.815 0.842 

00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.861 0.815 

00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0.878 0.442 

00834 ....... 00 NEVADA ........................................................................................................ 1.004 1.039 1.138 

31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.027 0.883 

00805 ....... 01 NORTHERN NJ ............................................................................................. 1.058 1.204 0.916 

00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.036 1.114 0.916 

00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.895 0.898 

00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.080 1.346 1.586 

00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.059 1.256 1.869 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.012 1.072 1.221 

14330 ....... 04 QUEENS, NY ................................................................................................. 1.045 1.210 1.791 

00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.934 0.720

05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.928 0.618 

00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.871 0.630 

00883 ....... 00 OHIO .............................................................................................................. 1.000 0.940 0.967 

00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0.867 0.413 

00835 ....... 01 PORTLAND, OR ............................................................................................ 1.000 1.052 0.438 

00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.929 0.438 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.020 1.098 1.400 

00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.917 0.790 

00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.708 0.268 

00870 ....... 01 RHODE ISLAND ............................................................................................ 1.030 1.028 0.896 

00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.901 0.336 

00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.878 0.385 

05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0.892 0.612 

00900 ....... 31 AUSTIN, TX ................................................................................................... 1.000 1.025 0.922 

00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.877 1.318 

00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.008 0.971 1.318 

00900 ....... 11 DALLAS, TX .................................................................................................. 1.011 1.064 0.996 

00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.985 0.996 

47726 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM G.—PROPOSED 2005 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—

Continued

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.962 1.318 

00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.012 1.316 

00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.874 1.047 

00910 ....... 09 UTAH ............................................................................................................. 1.000 0.940 0.653 

31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.979 0.527 

00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 1.008 1.003 

00904 ....... 00 VIRGINIA ....................................................................................................... 1.000 0.941 0.540 

00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.011 1.115 0.803 

00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.975 0.803 

00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.836 1.462 

00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0.925 0.865 

00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.875 0.970 

Note: Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska indices, 

set by MMAMMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021. 

ADDENDUM H.—PROPOSED 2006 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

00510 ....... 00 ALABAMA ...................................................................................................... 1.000 0.850 0.752 

00831 ....... 01 ALASKA ......................................................................................................... 1.670 1.670 1.670 

00832 ....... 00 ARIZONA ....................................................................................................... 1.000 0.988 1.069 

00520 ....... 13 ARKANSAS ................................................................................................... 1.000 0.835 0.438 

31146 ....... 26 ANAHEIM/SANTA ANA, CA .......................................................................... 1.036 1.223 0.954 

31146 ....... 18 LOS ANGELES, CA ...................................................................................... 1.043 1.144 0.954 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ......................................................................... 1.037 1.336 0.651 

31140 ....... 07 OAKLAND/BERKELEY, CA ........................................................................... 1.058 1.366 0.651 

31140 ....... 05 SAN FRANCISCO, CA .................................................................................. 1.064 1.539 0.651 

31140 ....... 06 SAN MATEO, CA .......................................................................................... 1.076 1.531 0.639 

31140 ....... 09 SANTA CLARA, CA ....................................................................................... 1.088 1.534 0.604 

31146 ....... 17 VENTURA, CA ............................................................................................... 1.031 1.167 0.744 

31146 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.044 0.733

31140 ....... 99 REST OF CALIFORNIA* ............................................................................... 1.007 1.044 0.733

00824 ....... 01 COLORADO .................................................................................................. 1.000 1.016 0.803 

00591 ....... 00 CONNECTICUT ............................................................................................. 1.039 1.167 0.900 

00902 ....... 01 DELAWARE ................................................................................................... 1.013 1.020 0.892 

00903 ....... 01 DC + MD/VA SUBURBS ............................................................................... 1.052 1.238 0.926 

00590 ....... 03 FORT LAUDERDALE, FL .............................................................................. 1.000 0.992 1.703 

00590 ....... 04 MIAMI, FL ...................................................................................................... 1.000 1.020 2.269 

00590 ....... 99 REST OF FLORIDA ...................................................................................... 1.000 0.936 1.272 

00511 ....... 01 ATLANTA, GA ............................................................................................... 1.012 1.093 0.966 

00511 ....... 99 REST OF GEORGIA ..................................................................................... 1.000 0.877 0.966 

00833 ....... 01 HAWAII/GUAM .............................................................................................. 1.006 1.101 0.800 

05130 ....... 00 IDAHO ............................................................................................................ 1.000 0.868 0.459 

00952 ....... 16 CHICAGO, IL ................................................................................................. 1.027 1.128 1.867 

00952 ....... 12 EAST ST. LOUIS, IL ...................................................................................... 1.000 0.944 1.750 

00952 ....... 15 SUBURBAN CHICAGO, IL ............................................................................ 1.021 1.117 1.652 

00952 ....... 99 REST OF ILLINOIS ....................................................................................... 1.000 0.877 1.193 

00630 ....... 00 INDIANA ........................................................................................................ 1.000 0.910 0.436 

00826 ....... 00 IOWA ............................................................................................................. 1.000 0.872 0.589 

00650 ....... 00 KANSAS* ....................................................................................................... 1.000 0.882 0.721 

00740 ....... 04 KANSAS* ....................................................................................................... 1.000 0.882 0.721 

00660 ....... 00 KENTUCKY ................................................................................................... 1.000 0.858 0.873 

00528 ....... 01 NEW ORLEANS, LA ...................................................................................... 1.000 0.950 1.197 

00528 ....... 99 REST OF LOUISIANA ................................................................................... 1.000 0.849 1.058 

31142 ....... 03 SOUTHERN MAINE ...................................................................................... 1.000 1.013 0.637 

31142 ....... 99 REST OF MAINE ........................................................................................... 1.000 0.888 0.637 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ................................................................. 1.014 1.070 0.947 

00901 ....... 99 REST OF MARYLAND .................................................................................. 1.000 0.977 0.760

31143 ....... 01 METROPOLITAN BOSTON .......................................................................... 1.032 1.314 0.823 

31143 ....... 99 REST OF MASSACHUSETTS ...................................................................... 1.008 1.097 0.823 

00953 ....... 01 DETROIT, MI ................................................................................................. 1.038 1.050 2.744 

00953 ....... 99 REST OF MICHIGAN .................................................................................... 1.000 0.923 1.518 

00954 ....... 00 MINNESOTA .................................................................................................. 1.000 1.005 0.410 

00512 ....... 00 MISSISSIPPI .................................................................................................. 1.000 0.843 0.722 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ......................................................... 1.000 0.978 0.946 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ................................................................ 1.000 0.961 0.941 

00740 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.805 0.892 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47727

ADDENDUM H.—PROPOSED 2006 GEOGRAPHIC PRACTICE COST INDICES BY MEDICARE CARRIER AND LOCALITY—

Continued

Carrier No. Loc. 

No. Locality name Work GPCI PE GPCI MP GPCI 

00523 ....... 99 REST OF MISSOURI* ................................................................................... 1.000 0.805 0.892 

00751 ....... 01 MONTANA ..................................................................................................... 1.000 0.845 0.904 

00655 ....... 00 NEBRASKA ................................................................................................... 1.000 0.879 0.454 

00834 ....... 00 NEVADA ........................................................................................................ 1.003 1.039 1.068 

31144 ....... 40 NEW HAMPSHIRE ........................................................................................ 1.000 1.023 0.942 

00805 ....... 01 NORTHERN NJ ............................................................................................. 1.059 1.215 0.973 

00805 ....... 99 REST OF NEW JERSEY .............................................................................. 1.043 1.117 0.973 

00521 ....... 05 NEW MEXICO ............................................................................................... 1.000 0.890 0.895 

00803 ....... 01 MANHATTAN, NY ......................................................................................... 1.067 1.341 1.504 

00803 ....... 02 NYC SUBURBS/LONG I., NY ....................................................................... 1.051 1.260 1.785 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ......................................................... 1.013 1.070 1.167 

14330 ....... 04 QUEENS, NY ................................................................................................. 1.032 1.192 1.710 

00801 ....... 99 REST OF NEW YORK .................................................................................. 1.000 0.923 0.677

05535 ....... 00 NORTH CAROLINA ....................................................................................... 1.000 0.926 0.640 

00820 ....... 01 NORTH DAKOTA .......................................................................................... 1.000 0.862 0.602 

00883 ....... 00 OHIO .............................................................................................................. 1.000 0.937 0.976 

00522 ....... 00 OKLAHOMA ................................................................................................... 1.000 0.858 0.382 

00835 ....... 01 PORTLAND, OR ............................................................................................ 1.004 1.055 0.441 

00835 ....... 99 REST OF OREGON ...................................................................................... 1.000 0.926 0.441 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ......................................................... 1.018 1.105 1.386 

00865 ....... 99 REST OF PENNSYLVANIA .......................................................................... 1.000 0.906 0.806 

00973 ....... 20 PUERTO RICO .............................................................................................. 1.000 0.705 0.261 

00870 ....... 01 RHODE ISLAND ............................................................................................ 1.044 0.992 0.909 

00880 ....... 01 SOUTH CAROLINA ....................................................................................... 1.000 0.897 0.394 

00820 ....... 02 SOUTH DAKOTA .......................................................................................... 1.000 0.879 0.365 

05440 ....... 35 TENNESSEE ................................................................................................. 1.000 0.884 0.631 

00900 ....... 31 AUSTIN, TX ................................................................................................... 1.000 1.053 0.986 

00900 ....... 20 BEAUMONT, TX ............................................................................................ 1.000 0.864 1.298 

00900 ....... 09 BRAZORIA, TX .............................................................................................. 1.025 0.964 1.298 

00900 ....... 11 DALLAS, TX .................................................................................................. 1.013 1.063 1.061 

00900 ....... 28 FORT WORTH, TX ........................................................................................ 1.000 0.989 1.061 

00900 ....... 15 GALVESTON, TX .......................................................................................... 1.000 0.956 1.298 

00900 ....... 18 HOUSTON, TX .............................................................................................. 1.020 1.017 1.297 

00900 ....... 99 REST OF TEXAS .......................................................................................... 1.000 0.868 1.138 

00910 ....... 09 UTAH ............................................................................................................. 1.000 0.939 0.662 

31145 ....... 50 VERMONT ..................................................................................................... 1.000 0.972 0.514 

00973 ....... 50 VIRGIN ISLANDS .......................................................................................... 1.000 0.993 1.003 

00904 ....... 00 VIRGINIA ....................................................................................................... 1.000 0.944 0.579 

00836 ....... 02 SEATTLE (KING CNTY), WA ........................................................................ 1.018 1.131 0.819 

00836 ....... 99 REST OF WASHINGTON ............................................................................. 1.000 0.979 0.819 

00884 ....... 16 WEST VIRGINIA ............................................................................................ 1.000 0.822 1.547 

00951 ....... 00 WISCONSIN .................................................................................................. 1.000 0.921 0.790 

00825 ....... 21 WYOMING ..................................................................................................... 1.000 0.856 0.935 

Note: Work GPCI is the 1/4 work GPCI required by section 1848(e)(1)(A)(iii) of the Act. 1.0 Floor on Work GPCI, 1.67 for all Alaska indices, 

set by MMA GPCIs are scaled by the following factors: Work= 0.9977, Practice Expense=0.9930, Malpractice Expense=1.0021. 

ADDENDUM I.—COMPARISON OF CURRENT 2004 GAFS TO PROPOSED 2005GAFS

[In descending order of difference] 

Carrier No. Loc. 

No. Locality name Current 2004 GAF 

Proposed 

2005 GAF Difference Percent difference 

31140 ....... 09 SANTA CLARA, CA ............................................................. 1.184 1.225 0.040 3.41 

31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.111 1.144 0.033 2.96 

31140 ....... 06 SAN MATEO, CA ................................................................ 1.201 1.230 0.029 2.44 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.104 1.128 0.025 2.25 

31140 ....... 05 SAN FRANCISCO, CA ........................................................ 1.223 1.239 0.017 1.36 

00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.095 1.112 0.016 1.49 

31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.118 1.132 0.014 1.24 

00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.059 1.073 0.014 1.31 

00900 ....... 31 AUSTIN, TX ......................................................................... 0.995 1.008 0.013 1.26 

00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.038 1.048 0.010 0.96 

31146 ....... 17 VENTURA, CA ..................................................................... 1.060 1.070 0.010 0.91 

00511 ....... 01 ATLANTA, GA ..................................................................... 1.027 1.036 0.009 0.88 

31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.098 1.106 0.008 0.72 

00952 ....... 16 CHICAGO, IL ....................................................................... 1.087 1.094 0.008 0.70 

00954 ....... 00 MINNESOTA ........................................................................ 0.967 0.974 0.007 0.70 

00805 ....... 99 REST OF NEW JERSEY .................................................... 1.060 1.065 0.005 0.50 

00824 ....... 01 COLORADO ........................................................................ 0.990 0.995 0.005 0.51 

47728 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM I.—COMPARISON OF CURRENT 2004 GAFS TO PROPOSED 2005GAFS—Continued

[In descending order of difference] 

Carrier No. Loc. 

No. Locality name Current 2004 GAF 

Proposed 

2005 GAF Difference Percent difference 

00805 ....... 01 NORTHERN NJ ................................................................... 1.111 1.116 0.005 0.45 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.025 1.030 0.005 0.48 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.969 0.974 0.005 0.51 

00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.995 0.999 0.004 0.44 

31142 ....... 03 SOUTHERN MAINE ............................................................ 0.986 0.989 0.003 0.31 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.981 0.984 0.002 0.24 

31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.011 0.002 0.22 

31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.011 0.002 0.22 

00900 ....... 18 HOUSTON, TX .................................................................... 1.026 1.028 0.002 0.21 

00832 ....... 00 ARIZONA ............................................................................. 0.994 0.996 0.002 0.20 

00900 ....... 28 FORT WORTH, TX .............................................................. 0.992 0.993 0.002 0.16 

00836 ....... 99 REST OF WASHINGTON ................................................... 0.980 0.981 0.002 0.16 

00512 ....... 00 MISSISSIPPI ........................................................................ 0.919 0.920 0.002 0.16 

00835 ....... 01 PORTLAND, OR .................................................................. 1.000 1.001 0.001 0.13 

00904 ....... 00 VIRGINIA ............................................................................. 0.955 0.956 0.001 0.14 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.067 1.069 0.001 0.12 

00953 ....... 01 DETROIT, MI ....................................................................... 1.106 1.107 0.001 0.10 

00901 ....... 99 REST OF MARYLAND ........................................................ 0.979 0.980 0.001 0.11 

00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.985 0.986 0.001 0.10 

00900 ....... 09 BRAZORIA, TX .................................................................... 1.003 1.004 0.001 0.09 

00655 ....... 00 NEBRASKA ......................................................................... 0.925 0.925 0.000 0.04 

00900 ....... 11 DALLAS, TX ........................................................................ 1.033 1.034 0.000 0.02 

00831 ....... 01 ALASKA ............................................................................... 1.670 1.670 0.000 0.00 

00820 ....... 02 SOUTH DAKOTA ................................................................ 0.923 0.923 0.000 -0.01 

00910 ....... 09 UTAH ................................................................................... 0.961 0.960 0.000 -0.03 

00834 ....... 00 NEVADA .............................................................................. 1.025 1.024 -0.001 -0.05 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.047 1.046 -0.001 -0.06 

00591 ....... 00 CONNECTICUT ................................................................... 1.092 1.091 -0.001 -0.08 

00826 ....... 00 IOWA ................................................................................... 0.930 0.929 -0.001 -0.11 

05535 ....... 00 NORTH CAROLINA ............................................................. 0.955 0.954 -0.001 -0.13 

00880 ....... 01 SOUTH CAROLINA ............................................................. 0.932 0.931 -0.001 -0.14 

31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.009 1.007 -0.001 -0.13 

00883 ....... 00 OHIO .................................................................................... 0.974 0.973 -0.002 -0.17 

00835 ....... 99 REST OF OREGON ............................................................ 0.949 0.947 -0.002 -0.18 

00951 ....... 00 WISCONSIN ........................................................................ 0.964 0.962 -0.002 -0.17 

00973 ....... 20 PUERTO RICO .................................................................... 0.846 0.844 -0.002 -0.21 

00660 ....... 00 KENTUCKY ......................................................................... 0.937 0.935 -0.002 -0.20 

00590 ....... 99 REST OF FLORIDA ............................................................ 0.987 0.985 -0.002 -0.21 

00521 ....... 05 NEW MEXICO ..................................................................... 0.952 0.950 -0.002 -0.23 

31146 ....... 18 LOS ANGELES, CA ............................................................ 1.088 1.086 -0.002 -0.22 

00630 ....... 00 INDIANA .............................................................................. 0.945 0.942 -0.003 -0.27 

00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.179 1.176 -0.003 -0.22 

00650 ....... 00 KANSAS* ............................................................................. 0.944 0.941 -0.003 -0.28 

00740 ....... 04 KANSAS* ............................................................................. 0.944 0.941 -0.003 -0.28 

00952 ....... 99 REST OF ILLINOIS ............................................................. 0.958 0.956 -0.003 -0.28 

00900 ....... 99 REST OF TEXAS ................................................................ 0.950 0.947 -0.003 -0.29 

00520 ....... 13 ARKANSAS ......................................................................... 0.910 0.907 -0.003 -0.31 

00900 ....... 15 GALVESTON, TX ................................................................ 0.999 0.996 -0.003 -0.29 

00511 ....... 99 REST OF GEORGIA ........................................................... 0.951 0.948 -0.003 -0.33 

05130 ....... 00 IDAHO .................................................................................. 0.928 0.925 -0.003 -0.34 

31145 ....... 50 VERMONT ........................................................................... 0.976 0.973 -0.003 -0.33 

00953 ....... 99 REST OF MICHIGAN .......................................................... 0.994 0.990 -0.003 -0.34 

05440 ....... 35 TENNESSEE ....................................................................... 0.941 0.938 -0.004 -0.37 

00820 ....... 01 NORTH DAKOTA ................................................................ 0.933 0.929 -0.004 -0.43 

00522 ....... 00 OKLAHOMA ......................................................................... 0.923 0.919 -0.004 -0.44 

00740 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.913 -0.004 -0.46 

00523 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.913 -0.004 -0.46 

00801 ....... 99 REST OF NEW YORK ........................................................ 0.965 0.960 -0.004 -0.44 

00833 ....... 01 HAWAII/GUAM .................................................................... 1.047 1.043 -0.004 -0.42 

00510 ....... 00 ALABAMA ............................................................................ 0.935 0.930 -0.004 -0.48 

00528 ....... 99 REST OF LOUISIANA ......................................................... 0.946 0.941 -0.004 -0.48 

31142 ....... 99 REST OF MAINE ................................................................. 0.947 0.942 -0.005 -0.51 

00902 ....... 01 DELAWARE ......................................................................... 1.018 1.013 -0.005 -0.49 

00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.961 0.956 -0.005 -0.54 

00900 ....... 20 BEAUMONT, TX .................................................................. 0.964 0.959 -0.006 -0.59 

00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.038 1.033 -0.006 -0.55 

00884 ....... 16 WEST VIRGINIA .................................................................. 0.953 0.946 -0.006 -0.66 

00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.010 1.004 -0.007 -0.65 

00751 ....... 01 MONTANA ........................................................................... 0.939 0.932 -0.007 -0.71 

31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.054 1.046 -0.008 -0.72 

Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 47729

ADDENDUM I.—COMPARISON OF CURRENT 2004 GAFS TO PROPOSED 2005GAFS—Continued

[In descending order of difference] 

Carrier No. Loc. 

No. Locality name Current 2004 GAF 

Proposed 

2005 GAF Difference Percent difference 

00825 ....... 21 WYOMING ........................................................................... 0.953 0.944 -0.009 -0.92 

00803 ....... 01 MANHATTAN, NY ............................................................... 1.225 1.216 -0.009 -0.75 

00870 ....... 01 RHODE ISLAND .................................................................. 1.033 1.024 -0.009 -0.89 

00590 ....... 04 MIAMI, FL ............................................................................ 1.085 1.073 -0.011 -1.02 

14330 ....... 04 QUEENS, NY ....................................................................... 1.161 1.146 -0.015 -1.26 

Note: GAFs based upon revised MEI weights as published in November 7, 2003 final rule; Work GPCI=52.466, Practice Expense 

GPCI=43.669, Malpractice GPCI=3.865 

ADDENDUM J.—COMPARISON OF CURRENT 2004 GAFS TO PROPOSED 2006 GAFS

[in descending order of difference] 

Carrier No. Loc. 

No. Locality name Current 2004 GAF 

Proposed 

2006 GAF Difference Percent difference 

31140 ....... 09 SANTA CLARA, CA ............................................................. 1.184 1.264 0.080 6.72 

31140 ....... 07 OAKLAND/BERKELEY, CA ................................................. 1.111 1.177 0.065 5.87 

31140 ....... 06 SAN MATEO, CA ................................................................ 1.201 1.258 0.057 4.76 

31140 ....... 03 MARIN/NAPA/SOLANO, CA ............................................... 1.104 1.153 0.049 4.45 

00903 ....... 01 DC + MD/VA SUBURBS ..................................................... 1.095 1.128 0.033 3.01 

31140 ....... 05 SAN FRANCISCO, CA ........................................................ 1.223 1.255 0.033 2.68 

31143 ....... 01 METROPOLITAN BOSTON ................................................ 1.118 1.147 0.029 2.56 

00952 ....... 15 SUBURBAN CHICAGO, IL .................................................. 1.059 1.087 0.028 2.67 

00900 ....... 31 AUSTIN, TX ......................................................................... 0.995 1.023 0.027 2.74 

00836 ....... 02 SEATTLE (KING CNTY), WA .............................................. 1.038 1.060 0.021 2.04 

31146 ....... 17 VENTURA, CA ..................................................................... 1.060 1.079 0.019 1.80 

00511 ....... 01 ATLANTA, GA ..................................................................... 1.027 1.046 0.019 1.82 

00952 ....... 16 CHICAGO, IL ....................................................................... 1.087 1.104 0.017 1.54 

31146 ....... 26 ANAHEIM/SANTA ANA, CA ................................................ 1.098 1.114 0.017 1.51 

00805 ....... 01 NORTHERN NJ ................................................................... 1.111 1.124 0.013 1.13 

00954 ....... 00 MINNESOTA ........................................................................ 0.967 0.979 0.013 1.29 

00805 ....... 99 REST OF NEW JERSEY .................................................... 1.060 1.073 0.012 1.18 

00523 ....... 01 METROPOLITAN ST. LOUIS, MO ...................................... 0.969 0.981 0.012 1.24 

00901 ....... 01 BALTIMORE/SURR. CNTYS, MD ....................................... 1.025 1.036 0.011 1.07 

00952 ....... 12 EAST ST. LOUIS, IL ............................................................ 0.995 1.005 0.010 1.00 

00824 ....... 01 COLORADO ........................................................................ 0.990 0.999 0.010 0.97 

00740 ....... 02 METROPOLITAN KANSAS CITY, MO ............................... 0.981 0.988 0.007 0.71 

00900 ....... 09 BRAZORIA, TX .................................................................... 1.003 1.009 0.006 0.60 

00900 ....... 28 FORT WORTH, TX .............................................................. 0.992 0.998 0.006 0.59 

31142 ....... 03 SOUTHERN MAINE ............................................................ 0.986 0.992 0.006 0.56 

00835 ....... 01 PORTLAND, OR .................................................................. 1.000 1.005 0.005 0.49 

00904 ....... 00 VIRGINIA ............................................................................. 0.955 0.959 0.004 0.43 

31146 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.013 0.004 0.41 

31140 ....... 99 REST OF CALIFORNIA* ..................................................... 1.008 1.013 0.004 0.41 

00836 ....... 99 REST OF WASHINGTON ................................................... 0.980 0.984 0.004 0.40 

00900 ....... 18 HOUSTON, TX .................................................................... 1.026 1.029 0.004 0.35 

00832 ....... 00 ARIZONA ............................................................................. 0.994 0.997 0.003 0.34 

00900 ....... 11 DALLAS, TX ........................................................................ 1.033 1.037 0.003 0.32 

00953 ....... 01 DETROIT, MI ....................................................................... 1.106 1.109 0.003 0.25 

00865 ....... 01 METROPOLITAN PHILADELPHIA, PA ............................... 1.067 1.070 0.003 0.26 

00901 ....... 99 REST OF MARYLAND ........................................................ 0.979 0.981 0.002 0.22 

00512 ....... 00 MISSISSIPPI ........................................................................ 0.919 0.921 0.002 0.19 

00655 ....... 00 NEBRASKA ......................................................................... 0.925 0.926 0.001 0.13 

00528 ....... 01 NEW ORLEANS, LA ............................................................ 0.985 0.986 0.001 0.07 

00831 ....... 01 ALASKA ............................................................................... 1.670 1.670 0.000 0.00 

00910 ....... 09 UTAH ................................................................................... 0.961 0.960 0.000 -0.04 

00820 ....... 02 SOUTH DAKOTA ................................................................ 0.923 0.923 0.000 -0.05 

31144 ....... 40 NEW HAMPSHIRE .............................................................. 1.009 1.008 -0.001 -0.08 

00880 ....... 01 SOUTH CAROLINA ............................................................. 0.932 0.932 -0.001 -0.09 

05535 ....... 00 NORTH CAROLINA ............................................................. 0.955 0.954 -0.001 -0.13 

00900 ....... 99 REST OF TEXAS ................................................................ 0.950 0.948 -0.002 -0.19 

00826 ....... 00 IOWA ................................................................................... 0.930 0.928 -0.002 -0.22 

00591 ....... 00 CONNECTICUT ................................................................... 1.092 1.090 -0.002 -0.20 

00883 ....... 00 OHIO .................................................................................... 0.974 0.972 -0.003 -0.27 

00835 ....... 99 REST OF OREGON ............................................................ 0.949 0.946 -0.003 -0.30 

00803 ....... 03 POUGHKPSIE/N NYC SUBURBS, NY ............................... 1.047 1.044 -0.003 -0.29 

00973 ....... 20 PUERTO RICO .................................................................... 0.846 0.843 -0.003 -0.39 

00520 ....... 13 ARKANSAS ......................................................................... 0.910 0.906 -0.004 -0.39 

00660 ....... 00 KENTUCKY ......................................................................... 0.937 0.933 -0.004 -0.40 

00834 ....... 00 NEVADA .............................................................................. 1.025 1.021 -0.004 -0.36 

47730 Federal Register / Vol. 69, No. 150 / Thursday, August 5, 2004 / Proposed Rules 

ADDENDUM J.—COMPARISON OF CURRENT 2004 GAFS TO PROPOSED 2006 GAFS—Continued 

[in descending order of difference] 

Carrier No. Loc. 

No. Locality name Current 2004 GAF 

Proposed 

2006 GAF Difference Percent difference 

00590 ....... 99 REST OF FLORIDA ............................................................ 0.987 0.983 -0.004 -0.41 

00521 ....... 05 NEW MEXICO ..................................................................... 0.952 0.948 -0.005 -0.47 

00952 ....... 99 REST OF ILLINOIS ............................................................. 0.958 0.954 -0.005 -0.48 

31146 ....... 18 LOS ANGELES, CA ............................................................ 1.088 1.084 -0.005 -0.43 

00511 ....... 99 REST OF GEORGIA ........................................................... 0.951 0.945 -0.006 -0.63 

00630 ....... 00 INDIANA .............................................................................. 0.945 0.939 -0.006 -0.64 

00902 ....... 01 DELAWARE ......................................................................... 1.018 1.011 -0.006 -0.61 

00900 ....... 15 GALVESTON, TX ................................................................ 0.999 0.992 -0.006 -0.63 

05440 ....... 35 TENNESSEE ....................................................................... 0.941 0.935 -0.006 -0.67 

00951 ....... 00 WISCONSIN ........................................................................ 0.964 0.957 -0.006 -0.66 

00650 ....... 00 KANSAS* ............................................................................. 0.944 0.938 -0.006 -0.68 

00740 ....... 04 KANSAS* ............................................................................. 0.944 0.938 -0.006 -0.68 

05130 ....... 00 IDAHO .................................................................................. 0.928 0.921 -0.007 -0.70 

00740 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.911 -0.007 -0.72 

00523 ....... 99 REST OF MISSOURI* ......................................................... 0.917 0.911 -0.007 -0.72 

31145 ....... 50 VERMONT ........................................................................... 0.976 0.969 -0.007 -0.70 

00953 ....... 99 REST OF MICHIGAN .......................................................... 0.994 0.986 -0.007 -0.75 

00833 ....... 01 HAWAII/GUAM .................................................................... 1.047 1.040 -0.008 -0.74 

00803 ....... 02 NYC SUBURBS/LONG I., NY ............................................. 1.179 1.171 -0.008 -0.70 

00820 ....... 01 NORTH DAKOTA ................................................................ 0.933 0.924 -0.009 -0.97 

00884 ....... 16 WEST VIRGINIA .................................................................. 0.953 0.943 -0.009 -0.96 

00522 ....... 00 OKLAHOMA ......................................................................... 0.923 0.914 -0.009 -0.99 

00865 ....... 99 REST OF PENNSYLVANIA ................................................ 0.961 0.951 -0.009 -0.97 

00528 ....... 99 REST OF LOUISIANA ......................................................... 0.946 0.936 -0.010 -1.02 

00510 ....... 00 ALABAMA ............................................................................ 0.935 0.925 -0.010 -1.06 

31142 ....... 99 REST OF MAINE ................................................................. 0.947 0.937 -0.010 -1.07 

00751 ....... 01 MONTANA ........................................................................... 0.939 0.929 -0.010 -1.09 

00801 ....... 99 REST OF NEW YORK ........................................................ 0.965 0.954 -0.011 -1.11 

00900 ....... 20 BEAUMONT, TX .................................................................. 0.964 0.952 -0.012 -1.26 

00973 ....... 50 VIRGIN ISLANDS ................................................................ 1.010 0.997 -0.013 -1.30 

31143 ....... 99 REST OF MASSACHUSETTS ............................................ 1.054 1.040 -0.014 -1.36 

00590 ....... 03 FORT LAUDERDALE, FL .................................................... 1.038 1.024 -0.015 -1.42 

00870 ....... 01 RHODE ISLAND .................................................................. 1.033 1.016 -0.017 -1.65 

00825 ....... 21 WYOMING ........................................................................... 0.953 0.935 -0.018 -1.93 

00803 ....... 01 MANHATTAN, NY ............................................................... 1.225 1.204 -0.021 -1.74 

00590 ....... 04 MIAMI, FL ............................................................................ 1.085 1.058 -0.027 -2.47 

14330 ....... 04 QUEENS, NY ....................................................................... 1.161 1.128 -0.032 -2.80 

Note: GAFs based upon revised MEI weights as published in November 7, 2003 final rule; Work GPCI=52.466, Practice Expense 

GPCI=43.669, Malpractice GPCI=3.865 

[FR Doc. 04–17312 Filed 7–27–04; 8:45 am] 

BILLING CODE 4120–01–P