Vol. 78 Monday, 

No. 155 August 12, 2013 

Part III 

Department of Health and Human Services 

Center for Medicare & Medicaid Services 

42 CFR Parts 410, 414, 415, et al. 

Medicare Program; Revisions to Payment Policies Under the Physician Fee 

Schedule, DME Face-to-Face Encounters, Elimination of the Requirement 

for Termination of Non-Random Prepayment Complex Medical Review and 

Other Revisions to Part B for CY 2013; Final Rule 


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48996 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 410, 414, 415, 421, 423, 

425, 486, and 495 

[CMS–1590–CN] 

RIN 0938–AR11 

Medicare Program; Revisions to 

Payment Policies Under the Physician 

Fee Schedule, DME Face-to-Face 

Encounters, Elimination of the 

Requirement for Termination of NonRandom Prepayment Complex Medical 

Review and Other Revisions to Part B 

for CY 2013 

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS. 

ACTION: Correction of final rule with 

comment period. 

SUMMARY: This document corrects 

technical errors that appeared in the 

final rule with comment period 

published in the Federal Register on 

November 16, 2012, entitled ‘‘Medicare 

Program; Revisions to Payment Policies 

Under the Physician Fee Schedule, DME 

Face-to-Face Encounters, Elimination of 

the Requirement for Termination of 

Non-Random Prepayment Complex 

Medical Review and Other Revisions to 

Part B for CY 2013.’’ 

DATES: The correcting document is 

effective August 12, 2013 and is 

applicable beginning January 1, 2013. 

FOR FURTHER INFORMATION CONTACT: 

Elliott Isaac, (410) 786–4735. 

SUPPLEMENTARY INFORMATION: 

I. Background 

In FR Doc. 2012–26900 of November 

16, 2012 (77 FR 68892 through 69373), 

there were a number of technical errors 

that are identified and corrected in the 

Correction of Errors section below. 

These corrections are effective January 

1, 2013. We note that the Addenda A 

through H for the CY 2013 PFS final 

rule with comment period as corrected 

in this correction notice are available on 

the CMS Web site at www.cms.gov// 

PhysicianFeeSched/. 

II. Summary of Errors 

A. Summary of Errors in the Preamble 

On pages 68904 through 68906, in 

Table 3: Calculation of PE RVUs under 

Methodology for Selected Codes, the PE 

RVUs listed in the table are incorrect. 

On page 68907, in our discussion of 

the changes to direct PE inputs for 

specific services, we made a 

typographical error in identifying the 

calendar years. 

On page 68957, in our discussion of 

Medicare telehealth services, we 

inadvertently omitted a discussion of 

psychotherapy services. 

On page 68958, in our discussion of 

therapy services, we inadvertently 

omitted language regarding the claimsbased data collection strategy for 

therapy services. 

On page 68965, we inadvertently 

omitted language in our discussion on 

non-payable G-codes on beneficiary 

functional status. 

On page 68966, we inadvertently 

included language. 

On pages 68967 and 68968, we 

inadvertently made errors in the 

descriptors for G-codes in Table 21: GCodes for Claims-Based Functional 

Reporting for CY 2013. 

On page 69033, we inadvertently 

omitted a code-specific direct PE input. 

On pages 69042 and 69043, in our 

discussion of the global period for CPT 

code 22586, we made a typographical 

error in the code descriptor. 

On page 69051, 

a. We inadvertently used the wrong 

descriptor for CPT 36221. 

b. We inadvertently omitted two 

paragraphs regarding our treatment of 

CPT codes 37197 and 37214. 

On pages 69071 through 69073, we 

made clerical errors in table references. 

On page 69074, in our discussion of 

pricing supply and equipment items, we 

inadvertently omitted a paragraph 

detailing the items for which we did not 

receive adequate information and 

therefore could not price them for the 

interim final values in the CY 2013 rule. 

On pages 69077 through 69128, we 

made numerous typographical errors 

and technical errors in Table 74: CPT 

Codes with Refined direct PE 

Recommendations for CY 2013 Interim 

Codes and therefore are correcting the 

table. 

On page 69138, we made 

typographical errors in the CY 2013 PFS 

conversion factor (CF). 

On page 69138, we made 

typographical errors in the CY 2013 PFS 

CF in Table 87: Calculation of the CY 

2013 PFS CF. 

On page 69139, in Table 88: 

Calculation of the CY 2013 Anesthesia 

CF, we inadvertently listed the incorrect 

anesthesia CF. 

On page 69145, we inadvertently 

referred to ‘‘physician’s order’’ instead 

of ‘‘valid prescription.’’ 

On page 69212, due to a typographical 

error, the title of PQRS Measure 190 

referred to in the comment bullet was 

not correct. 

On pages 69215 through 69267, the 

notes after Table 95: Individual Quality 

Measures for the Physician Quality 

Reporting System Proposed to be 

Available for Reporting via Claims, 

Registry, EHR, or GRPO Web Interface 

Beginning in 2013 or 2014* were 

inadvertently omitted. 

On page 69237, in Table 95: 

Individual Quality Measures for the 

Physician Quality Reporting System 

Proposed to be Available for Reporting 

via Claims, Registry, EHR, or GRPO Web 

Interface Beginning in 2013 or 2014*, 

due to a typographical error, Measures 

#189 and 190 were incorrectly listed as 

available for reporting under PQRS. 

On page 69269, in Table 96: PQRS 

Quality Measures Available for 

Reporting for Group Practices Using the 

GPRO Web Interface for 2013 and 

Beyond, due to a typographical error, 

the description of the measure 

‘‘Medication Reconciliation’’ is 

incorrect. 

On page 69277, in Table 108: HIV/ 

AIDS Measures Group, due to a clerical 

error, there are measures listed that have 

lost their NQF endorsement and are 

therefore no longer being maintained by 

the respective measure owner. 

On page 69300, due to a clerical error, 

we stated the deadlines for requesting 

an informal review for the 2012 and 

2013 eRx incentives incorrectly. The 

regulation at § 414.92(g) correctly states 

that eligible professionals and group 

practices must submit an informal 

review request for the 2012 and 2013 

incentives within 90 days of the release 

of the feedback reports. The preamble 

does not reflect this same regulation 

text. Therefore, we are revising the 

preamble to reflect the regulation text at 

§ 414.92(g). 

On pages 69344 through 69345, in 

Table 134: CY 2013 PFS Final Rule with 

Comment Period Estimated Impact on 

Total Allowed Charges by Specialty, 

due to technical errors in the 

calculations of the impacts, there were 

errors in the total estimated impacts and 

the estimated impacts for the following 

specialties: 01—ALLERGY/ 

IMMUNOLOGY, 02— 

ANESTHESIOLOGY, 10—FAMILY 

PRACTICE, 13—GENERAL SURGERY, 

18—INTERNAL MEDICINE, 19— 

INTERVENTIONAL PAIN 

MANAGEMENT, 21— 

MULTISPECIALTY CLINIC/OTHER 

PHY, 34—PLASTIC SURGERY, 41— 

UROLOGY, 49—NURSE ANES/ANES 

ASST. 

On page 69345, at the end of Table 

134: CY 2013 PFS Final Rule with 

Comment Period Estimated Impact on 

Total Allowed Charges by Specialty, we 

made clerical errors in the first footnote. 

On pages 69347 through 69348, in 

Table 135: CY 2013 PFS Final Rule with 


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Comment Period Estimated Impact on 

Total Allowed Charges by Specialty by 

Selected Policy, due to technical errors 

in calculations of the impacts, there 

were errors in the estimates of the total 

impact and on the impact for the 

following specialties: 01—ALLERGY/ 

IMMUNOLOGY, 02— 

ANESTHESIOLOGY, 13—GENERAL 

SURGERY, 18—INTERNAL MEDICINE, 

19—INTERVENTIONAL PAIN 

MANAGEMENT, 21— 

MULTISPECIALTY CLINIC/OTHER 

PHY, 41—UROLOGY, 49—NURSE 

ANES/ANES ASST. 

On page 69348, at the end of Table 

135: CY 2013 PFS Final Rule with 

Comment Period Estimated Impact on 

Total Allowed Charges by Specialty by 

Selected Policy, we made a clerical error 

in the first footnote. 

On page 69350 through 69351, in 

Table 136: Impact of Final Rule with 

Comment Period on CY 2013 Payment 

for Selected Procedures, we made 

technical errors in the calculation of the 

impacts. 

On page 69351, in footnotes 3 and 4 

at the end of Table 136: Impact of Final 

Rule with Comment Period on CY 2013 

Payment for Selected Procedures, we 

inadvertently listed the incorrect 2012 

conversion factor. 

B. Summary and Correction of Errors in 

the Addenda on the CMS Web site 

Technical errors in the creation of the 

direct practice expense database 

resulted in incorrect direct PE inputs for 

CPT codes: 11307, 11313, 13100, 13101, 

13102, 13120, 13121, 13122, 13131, 

13132, 13133, 13150, 13151, 13152, 

31231, 32554, 32555, 32556, 32557, 

35475, 35476, 36221, 36222, 36223, 

36224, 36225, 36226, 37197, 52224, 

64612, 65800, 72040, 72050, 72052, 

72069, 72193, 72194, 74160, 74170, 

74177, 74178, 76872, 77301, 92081, 

92082, 92083, 92235, 92286, 93925, 

93970, 95010, 95015, 95017, 95018, 

95782, 95783, and 97150. As a result of 

these errors, the budget neutrality 

adjustment used in calculating PE RVUs 

was incorrect, resulting in incorrect 

values for other PE RVUs in Addenda B 

and C. These errors are corrected in the 

revised Direct PE Input Database 

available on the CMS Web site at 

www.cms.gov//PhysicianFeeSched/. 

Resulting changes to PE RVUs are 

reflected in the corrected Addenda B 

and C posted on the CMS Web site at 

www.cms.gov//PhysicianFeeSched/. 

Due to a technical error, although the 

physician time records for CPT codes 

22841, 51798, 95990, 96913, and 97602 

were properly removed from the 

physician time file per final policy 

discussed in the CY 2013 final rule with 

comment period (77 FR 68926), these 

time records were inadvertently used in 

the creation of the PE RVUs. This 

technical error is corrected in the 

revised CY 2013 Addendum B posted to 

the CMS Web site at www.cms.gov// 

PhysicianFeeSched/. 

Due a technical error in applying a 

change made in the final rule in 

calculating the impact of the 

ophthalmology MPPR used in the PE 

methodology, as described on page 

68901, the ‘‘CY 2012 Utilization data 

Crosswalk to CY 2013’’ file posted on 

the CMS Web site contained errors. This 

also resulted in errors in Addenda B and 

C files posted on the CMS Web site. 

These addenda have been corrected as 

a result of the changes made in this 

correction notice and the corrected 

Addenda B and C files are posted on the 

CMS Web site. www.cms.gov// 

PhysicianFeeSched/. 

Due to a technical error in calculating 

the anesthesia inputs, the PE RVUs for 

all services reflected in Addenda B and 

C posted on the CMS Web site were 

inaccurate. Resulting changes to the PE 

RVUs are reflected in the corrected 

Addenda B and C. 

Due to a technical error, in 

Addendum B, row 8744 containing 

CPT/HCPC 92287 did not list RVUs for 

use with both the TC and 26 modifiers. 

The corrected Addendum B, which is 

posted on the CMS Web site at 

www.cms.gov//PhysicianFeeSched/, 

includes these services and related 

information. 

Due to a technical error in Addendum 

B, row 9180 containing CPT/HCPC 

93657 did not list a PE RVU. The 

corrected Addendum B, which is posted 

on the CMS Web site at www.cms.gov// 

PhysicianFeeSched/ reflects this change. 

Due to a technical error in the posting 

of Addendum C, the ‘‘NA’’ flags did not 

display for services when either the 

facility or nonfacility setting did not 

contain a value. The corrected 

Addendum C, which is posted on the 

CMS Web site at www.cms.gov// 

PhysicianFeeSched/, reflects the ‘‘NA’’ 

flags for services that are not valued in 

the indicated setting. 

III. Waiver of Proposed Rulemaking 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register to provide a period for public 

comment before the provisions of a rule 

take effect in accordance with section 

553(b) of the Administrative Procedure 

Act (APA) (5 U.S.C. 553(b)). However, 

we can waive this notice and comment 

procedure if the Secretary finds, for 

good cause, that the notice and 

comment process is impracticable, 

unnecessary, or contrary to the public 

interest, and incorporates a statement of 

the finding and the reasons therefore in 

the notice. 

Section 553(d) of the APA ordinarily 

requires a 30-day delay in the effective 

date of final rules after the date of their 

publication in the Federal Register. 

This 30-day delay in effective date can 

be waived, however, if an agency finds 

for good cause that the delay is 

impracticable, unnecessary, or contrary 

to the public interest, and the agency 

incorporates a statement of the findings 

and its reasons in the rule issued. 

This document merely corrects 

typographical and technical errors in 

the preamble and addenda of the CY 

2013 Physician Fee Schedule final rule 

with comment period. The provisions of 

that final rule with comment period 

have been subjected to notice and 

comment procedures. The corrections 

contained in this document are 

consistent with, and do not make 

substantive changes to, the policies and 

payment methodologies that were 

adopted in the CY 2013 PFS final rule 

with comment period. As a result, the 

corrections made through this correcting 

document are intended to ensure that 

the CY 2013 PFS final rule with 

comment period accurately reflects the 

policies adopted in that rule. Therefore, 

we find for good cause that it is 

unnecessary and would be contrary to 

the public interest to undertake further 

notice and comment procedures to 

incorporate the corrections in this 

document into the CY 2013 PFS final 

rule with comment period. For the same 

reasons, we find that there is good cause 

to waive the 30-day delay in the 

effective date for these corrections. 

Further, we believe that it is in the 

public interest to ensure that the CY 

2013 PFS final rule with comment 

period accurately reflects our policies as 

of the date they take effect. Therefore, 

we find that delaying the effective date 

of these corrections beyond the effective 

date of the final rule with comment 

period would be contrary to the public 

interest. In so doing, we find good cause 

to waive the 30-day delay in effective 

date. 

IV. Correction of Errors 

In FR Doc. 2012–26900 of November 

16, 2012 (77 FR 68892), make the 

following corrections: 

A. Correction of Errors in the Preamble 

1. On pages 68904 through 68906, in 

Table 3: Calculation of PE RVUs Under 

Methodology for Selected Codes, the 

table is corrected to read as follows: 


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TABLE 3—CALCULATION OF PE RVUS UNDER

METHODOLOGY FOR

SELECTED

CODES

Step Source Formula 

99213 

Office visit, est 

nonfacility 

33533 

CABG, arterial, 

single 

facility 

71020 

Chest x-ray 

nonfacility 

71020–TC 

Chest x-ray 

nonfacility 

71020–26 

Chest x-ray 

nonfacility 

93000 

ECG, complete 

nonfacility 

93005 

ECG, tracing 

nonfacility 

93010 

ECG, report 

nonfacility 

(1) Labor cost 

(Lab).

Step 1 ............ AMA .............. .......................... 13.32 77.52 5.74 5.74 0.00 6.12 6.12 0.00 

(2) Supply cost 

(Sup).

Step 1 ............ AMA .............. .......................... 2.98 0.00 3.39 3.39 0.00 1.19 1.19 0.00 

(3) Equipment 

cost (Eqp).

Step 1 ............ AMA .............. .......................... 0.17 0.58 7.24 7.24 0.00 0.11 0.11 0.00 

(4) Direct cost 

(Dir).

Step 1 ............ ....................... =(1)+(2)+(3) 16.48 78.10 16.38 16.38 0.00 7.42 7.42 0.00 

(5) Direct adjustment 

(Dir. Adj.).

Steps 2–4 ...... See footnote* .......................... 0.5973 0.5973 0.5973 0.5973 0.5973 0.5973 0.5973 0.5973 

(6) Adjusted 

Labor.

Steps 2–4 ...... =Labor * Dir 

Adj.

=(1)*(5) 7.96 46.30 3.43 3.43 0.00 3.66 3.66 0.00 

(7) Adjusted 

Supplies.

Steps 2–4 ...... =Eqp * Dir Adj =(2)*(5) 1.78 0.00 2.03 2.03 0.00 0.71 0.71 0.00 

(8) Adjusted 

Equipment.

Steps 2–4 ...... =Sup * Dir Adj =(3)*(5) 0.10 0.35 4.33 4.33 0.00 0.06 0.06 0.00 

(9) Adjusted 

Direct.

Steps 2–4 ...... ....................... =(6)+(7)+(8) 9.84 46.65 9.78 9.78 0.00 4.43 4.43 0.00 

(10) Conversion Factor 

(CF).

Step 5 ............ PFS ............... .......................... 34.0376 34.0376 34.0376 34.0376 34.0376 34.0376 34.0376 34.0376 

(11) Adj. labor 

cost converted.

Step 5 ............ =(Lab * Dir 

Adj)/CF.

=(6)/(10) 0.23 1.36 0.10 0.10 0.00 0.11 0.11 0.00 

(12) Adj. supply cost converted. Step 5 ............ =(Sup * Dir Adj)/CF. =(7)/(10) 0.05 0.00 0.06 0.06 0.00 0.02 0.02 0.00 (13) Adj. 

equipment cost converted.

Step 5 ............ =(Eqp * Dir 

Adj)/CF.

=(8)/(10) 0.00 0.01 0.13 0.13 0.00 0.00 0.00 0.00 

(14) Adj. direct 

cost converted.

Step 5 ............ ....................... =(11)+(12)+(13) 0.29 1.37 0.29 0.29 0.00 0.13 0.13 0.00 

(15) Work 

RVU.

Setup File ...... PFS ............... .......................... 0.97 33.75 0.22 0.00 0.22 0.17 0.00 0.17 

(16) Dir_pct .... Steps 6,7 ....... Surveys ......... .......................... 0.31 0.18 0.31 0.31 0.31 0.31 0.31 0.31 (17) Ind_pct .... Steps 6,7 ....... Surveys ......... .......................... 0.69 0.82 0.69 0.69 0.69 0.69 0.69 0.69 (18) Ind. Alloc. 

Formula (1st part).

Step 8 ............ See Step 8 .... .......................... ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) ((14)/(16)*(17) 

(19) Ind. 

Alloc.(1st part).

Step 8 ............ ....................... See 18 0.87 6.41 0.7 0.7 0 0.32 0.32 0 

(20) Ind. Alloc. 

Formula (2nd part).

Step 8 ............ See Step 8 .... .......................... (15) (15) (15+11) (11) (15) (15+11) (11) (15) 

(21) Ind. 

Alloc.(2nd part).

Step 8 ............ ....................... See 20 0.97 33.75 0.32 0.10 0.22 0.28 0.11 0.17 

(22) Indirect 

Allocator (1st + 2nd).

Step 8 ............ ....................... =(19)+(21) 1.84 40.16 1.03 0.81 0.22 0.60 0.43 0.17 

(23) Indirect 

Adjustment (Ind. Adj.).

Steps 9–11 .... See 

Footnote**.

.......................... 0.40 0.40 0.40 0.40 0.40 0.40 0.40 0.40 


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(24) Adjusted 

Indirect Allocator.

Steps 9–11 .... =Ind Alloc * 

Ind Adj.

.......................... 0.75 16.25 0.42 0.33 0.09 0.24 0.17 0.07 

(25) Ind. Practice Cost 

Index (IPCI).

Steps 12–16 .. ....................... .......................... 1.08 0.79 0.92 0.92 0.92 0.92 0.92 0.92 

(26) Adjusted 

Indirect.

Step 17 .......... = Adj.Ind Alloc 

* PCI.

=(24)*(25) 0.81 12.76 0.38 0.30 0.08 0.22 0.16 0.06 

(27) PE RVU .. Step 18 .......... =(Adj Dir + 

Adj Ind) * budn.

=((14)+(26)) * 

budn 

1.10 14.15 0.67 0.59 0.08 0.35 0.29 0.06 


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2. On page 68907, first column, first 

paragraph, 

a. Line 6, the phrase ‘‘CY 2012’’ is 

corrected to read ‘‘CY 2013.’’ 

b. Line 8, the phrase ‘‘CY 2012’’ is 

corrected to read ‘‘CY 2013.’’ 

3. On page 68957, second column, 

following Table 18 is corrected by 

adding the following: 

‘‘6. Psychiatry Services 

For CY 2013, the CPT Editorial Panel 

replaced the current psychiatry/ 

psychotherapy CPT codes with a new 

structure that allows for the separate 

reporting of E/M codes, eliminates 

codes based upon the site-of-service, 

establishes CPT codes for crisis, and 

creates a series of psychotherapy add-on 

CPT codes to describe interactive 

complexity and medication 

management. Many of these services are 

included in the list of Medicare 

telehealth services. For CY 2013, we did 

not propose any changes in Medicare 

telehealth payment policies related to 

the existing services described by these 

new codes. Therefore, the new codes 

describing services currently included 

on the CY 2012 list of Medicare 

telehealth services will be included on 

the CY 2013 list of Medicare telehealth 

services. 

In the case of pharmacologic 

management services, currently on the 

CY 2012 list of Medicare telehealth 

services, we note that the CPT Editorial 

Panel deleted CPT code 90862 

(Pharmacologic management, including 

prescription, use, and review of 

medication with no more than minimal 

medical psychotherapy), and that for CY 

2013, psychiatrists will bill the 

appropriate E/M code when furnishing 

pharmacologic management services. In 

order to maintain current telehealth 

policy for these services when furnished 

to inpatients, we are establishing a new 

HCPCS G-code, G0459 (Inpatient 

telehealth, pharmacologic management, 

including prescription use and review 

of medication with no more than 

minimal medical psychotherapy), on an 

interim basis for CY 2013 that will 

describe the pharmacologic 

management service when furnished via 

telehealth to inpatients. 

We will address any other change in 

telehealth policy regarding psychiatry 

services in future rulemaking.’’. 

4. On page 68959, first column, partial 

line 5, before the phrase ‘‘Between 

1998–2008,’’ is corrected to read as 

follows: ‘‘We note that this number does 

not represent a discrete number of 

beneficiaries; rather, it represents the 

total number of beneficiaries receiving 

therapy services under plans of care 

from different disciplines and different 

providers.’’. 

5. On page 68965, third column, third 

paragraph, lines 4 and 5, the phrase ‘‘a 

composite score’’ is corrected to read 

‘‘an overall composite score.’’ 

6. On page 68966, third column, 

second full paragraph, lines 19 through 

21, the phrase ‘‘...functional measures, 

such as is done with the FOTO Patient 

tool, for example.’’ is corrected to read 

‘‘functional measures.’’ 

7. On page 68967 and 68968, in Table 

21: G-Codes for Claims-Based 

Functional Reporting for CY 2013, the 

listed entries are corrected to read as 

follows: 

Other PT/OT Primary Functional Limitation 

G8990 ............... Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting 

intervals. 

G8991 ............... Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting. 

G8992 ............... Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting. 

Other PT/OT Primary Functional Limitation 

G8993 ............... Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals. 

G8994 ............... Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at 

reporting intervals, and at discharge or to end reporting. 

G8995 ............... Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end 

reporting. 

Swallowing 

G8996 ............... Swallowing functional limitation, current status at therapy episode outset and at reporting intervals. 

G8997 ............... Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to 

end reporting. 

G8998 ............... Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting. 

Motor Speech 

G8999 ............... Motor speech functional limitation, current status at therapy episode outset and at reporting intervals. 

G9186 ............... Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge 

from or to end reporting. 

Spoken Language Comprehension 

G9159 ............... Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals. 

G9160 ............... Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, 

and at discharge from or to end reporting. 

G9161 ............... Spoken language comprehension functional limitation, discharge status at discharge from therapy or to end reporting. 

Spoken Language Expression 

G9162 ............... Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals. 

G9163 ............... Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and 

at discharge from or to end reporting. 


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G9164 ............... Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting. 

Attention 

G9165 ............... Attention functional limitation, current status at therapy episode outset and at reporting intervals. 

G9166 ............... Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or 

to end reporting. 

G9167 ............... Attention functional limitation, discharge status at discharge from therapy or to end reporting. 

Memory 

G9168 ............... Memory functional limitation, current status at therapy episode outset and at reporting intervals. 

G9169 ............... Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or 

to end reporting. 

G9170 ............... Memory functional limitation, discharge status at discharge from therapy or to end reporting. 

Voice 

G9171 ............... Voice functional limitation, current status at therapy episode outset and at reporting intervals. 

G9172 ............... Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to 

end reporting. 

G9173 ............... Voice functional limitation, discharge status at discharge from therapy or to end reporting. 

Other SLP Functional Limitation 

G9174 ............... Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals. 

G9175 ............... Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, 

and at discharge from or to end reporting. 

G9176 ............... Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting. 

8. On page 69033, in the third 

column, after second full paragraph, is 

corrected by adding the following: 

‘‘(14) Needle EMG: Electromyography 

(CPT Codes 95886, 95887) 

In establishing interim final direct PE 

inputs for 2012, CMS refined the AMA 

RUC’s recommendation for CPT codes 

95886 (Needle electromyography, each 

extremity, with related paraspinal areas, 

when performed, done with nerve 

conduction, amplitude and latency/ 

velocity study; complete, five or more 

muscles studied, innervated by three or 

more nerves or four or more spinal 

levels (list separately in addition to code 

for primary procedure)) and 95887 

(Needle electromyography, nonextremity (cranial nerve supplied or 

axial) muscle(s) done with nerve 

conduction, amplitude and latency/ 

velocity study (list separately in 

addition to code for primary procedure)) 

by reducing the number of service 

period clinical labor minutes to account 

for preparatory clinical labor tasks 

associated with both the base and addon codes. CMS also refined the 

corresponding equipment minutes. 

Comment: Several commenters 

explained that clinical labor typically 

requires additional time to prepare the 

distinct equipment used in furnishing 

the services described by the add-on 

codes. 

Response: After reviewing the 

information provided by the 

commenters, we agree that it would be 

appropriate to incorporate additional 

minutes for these codes. Therefore, we 

are finalizing the direct PE inputs for 

CPT codes 95886 and 95887 with the 

additional refinement of adding two 

minutes to both the service period 

clinical labor time and the 

corresponding equipment time. The 

direct PE inputs are displayed in the 

final CY 2013 direct PE input database, 

available on the CMS Web site under 

downloads for the CY 2013 PFS final 

rule at www.cms.gov/ 

PhysicianFeeSched/.’’. 

9. On page 69042, bottom half of the 

page, last paragraph, last line, the 

phrase CPT code 99231 visits is 

corrected to read ‘‘99231 (subsequent 

hospital care, per day, for the evaluation 

and management of a patient, which 

requires at least 2 of these 3 key 

components: A problem focused 

interval history; a problem focused 

examination; medical decision making 

that is straightforward or of low 

complexity) visits,’’. 

10. On page 69043, top of page, first 

column, first partial paragraph, lines 1 

and 2, the phrase 99323 visit is 

corrected to read ‘‘99232 (subsequent 

hospital care, per day, for the evaluation 

and management of a patient, which 

requires at least 2 of these 3 key 

components: An expanded problem 

focused interval history; an expanded 

problem focused examination; medical 

decision making of moderate 

complexity) visit, 1 CPT code 99238 

(hospital discharge day management; 30 

minutes or less) visit, and 4 CPT code 

99213 (office or other outpatient visit for 

the evaluation and management of an 

established patient, which requires at 

least 2 of these 3 key components: an 

expanded problem focused history; an 

expanded problem focused 

examination; medical decision making 

of low complexity) visits.’’. 

11. On page 69051, 

a. First column, first full paragraph, 

lines 2 through 10, the parenthetical 

((Non-selective catheter placement, 

thoracic aorta, with angiography of the 

extracranial carotid, vertebral, and/or 

intracranial vessels, unilateral or 

bilateral, and all associated radiological 

supervision and interpretation, includes 

angiography of the cervicocerebral arch, 

when performed).), is corrected to read: 

‘‘((Selective catheter placement, 

common carotid or innominate artery, 

unilateral, any approach, with 

angiography of the ipsilateral 

extracranial carotid circulation and all 

associated radiological supervision and 

interpretation, includes angiography of 

the cervicocerebral arch, when 

performed).)’’. 

b. Third column, after last full 

paragraph, is corrected by adding the 

following: 

‘‘CPT codes 37620, 75940, and 36010 

were identified as potentially misvalued 

through the Codes Reported Together 75 

percent or More screen. In response, the 

CPT Editorial Panel created CPT codes 

37191 through 37193 and 37197 to 

bundle the services together. After 

clinical review of CPT code 37197 

(Transcatheter retrieval, percutaneous, 

of intravascular foreign body (for 

example, fractured venous or arterial 


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49002 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

catheter), includes radiological 

supervision and interpretation, and 

imaging guidance (ultrasound or 

fluoroscopy), when performed), along 

with the other related bundled services, 

we believe a work RVU of 6.29 

accurately reflects the work involved in 

furnishing this service. We believe CPT 

code 37197 involves similar work as 

CPT code 36247 (Selective catheter 

placement, arterial system; initial third 

order or more selective abdominal, 

pelvic, or lower extremity artery branch, 

within a vascular family) and should be 

valued the same. Furthermore, we 

believe a work RVU of 6.29 

appropriately reflects the relative 

difference in work between this service 

and related CPT codes 37191, 37192, 

and 37193. The AMA RUC 

recommended a work RVU of 6.72 for 

CPT code 37197, a direct crosswalk to 

CPT code 36475 (Endovenous ablation 

therapy of incompetent vein, extremity, 

inclusive of all imaging guidance and 

monitoring, percutaneous, 

radiofrequency; first vein treated). On 

an interim final basis for CY 2013, we 

are assigning a work RVU of 6.29 to CPT 

code 37197.’’. 

12. On page 69071, lower half of the 

page, third column, 

a. Lines 3 and 4, the phrase ‘‘Table 

KK6 is corrected to read ‘‘Table 73.’’. 

b. Line 10, the phrase ‘‘Table KK7’’ is 

corrected to read ‘‘Table 74.’’. 

13. On page 69072, 

a. First column, first full paragraph, 

line 1, the phrase ‘‘Table KK7’’ is 

corrected to read ‘‘Table 74.’’ 

b. Second column, 

(1) First full paragraph, last line, the 

phrase ‘‘Table 73’’ is corrected to read 

‘‘Table 74.’’. 

(2) Second full paragraph, last line, 

the phrase ‘‘Table 73’’ is corrected to 

read ‘‘Table 74.’’. 

c. Third column, 

(1) First paragraph, last line, the 

phrase ‘‘Table 73’’ is corrected to read 

‘‘Table 74.’’. 

(2) Second paragraph, lines 23 and 24, 

the phrase ‘‘Table 73’’ is corrected to 

read ‘‘Table 74.’’ 

14. On page 69073, second column, 

second full paragraph, last line, the 

phrase ‘‘Table 73’’ is corrected to read, 

‘‘Table 74.’’ 

15. On page 69074, first column, 

following first partial paragraph, is 

corrected to read as follows: 

‘‘We note that we did not receive 

adequate information for pricing the 

following new supply and equipment 

items included in the AMA RUC’s CY 

2013 direct PE input recommendations: 

SD276 (Indicator powder), SK115 

(Reproduced patient worksheet), SL464 

(Atomizer tips, disposable), and ER088 

(Infrared illuminator). Therefore, for CY 

2013, these supply and equipment items 

have no price inputs associated with 

them in the direct PE database. We will 

consider any newly submitted 

information regarding appropriate 

pricing for these supply items as part of 

our annual supply and equipment price 

update process.’’ 

16. On pages 69077 through 69128, in 

Table 74: CPT Codes with Refined 

Direct PE Recommendations for CY 

2013 Interim Codes is corrected to read 

as follows: 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

11300 ..................... Shave skin lesion 

0.5 cm/< 

ED004 camera, digital (6 

mexapixel).

NF .............................. 29 14 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 29 14 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 29 14 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 29 14 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 29 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500- 

$1499).

NF .............................. 29 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke 

Evacuator(tubing, covering, etc.) with 

stand.

NF .............................. 29 14 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 


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TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11301 ..................... Shave skin lesion 

0.6–1.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 32 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 32 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 32 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 32 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 32 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500- 

$1499).

NF .............................. 32 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 32 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11302 ..................... Shave skin lesion 

1.1–2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 37 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 37 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 37 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 37 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 37 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500- 

$1499).

NF .............................. 37 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49004 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 37 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11303 ..................... Shave skin lesion 

>2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 41 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 41 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 41 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 41 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 41 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 41 32 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 41 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11305 ..................... Shave skin lesion 

0.5 cm/< 

ED004 camera, digital (6 

mexapixel).

NF .............................. 29 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 29 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 29 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49005 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EF031 table, power ......... NF .............................. 29 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 29 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 29 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 29 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11306 ..................... Shave skin lesion 

0.6–1.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 31 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 31 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 31 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 31 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 31 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 31 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 31 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Assist physician in 

performing procedure.

10 18 Conforming to 

physician time. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49006 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

11307 ..................... Shave skin lesion 

1.1–2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 37 21 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 37 21 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 37 21 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 37 21 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 37 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 37 31 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 37 21 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11308 ..................... Shave skin lesion 

>2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 42 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 42 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 42 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 42 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 42 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 42 34 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49007 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 42 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11310 ..................... Shave skin lesion 

0.5 cm/< 

ED004 camera, digital (6 

mexapixel).

NF .............................. 34 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 34 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 34 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 34 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 34 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 34 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 34 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11311 ..................... Shave skin lesion 

0.6–1.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 34 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 34 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 34 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49008 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EF031 table, power ......... NF .............................. 34 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 34 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 34 34 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 34 24 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Assist physician in 

performing procedure.

11 17 Conforming to 

physician time. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11312 ..................... Shave skin lesion 

1.1–2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 43 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 43 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 43 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 43 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 43 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 43 37 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 43 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49009 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

11313 ..................... Shave skin lesion 

>2.0 cm.

ED004 camera, digital (6 

mexapixel).

NF .............................. 48 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF014 light, surgical ........ NF .............................. 48 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 48 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 48 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 48 0 CMS clinical review; not described as typical in work vignette. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 48 40 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 48 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.1 10 Standardized time 

input. 

SB003 cover, probe 

(cryosurgery).

NF .............................. 1 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB033 mask, surgical ...... NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

11719 ..................... Trim nail(s) any 

number.

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

3 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Provide pre-service education/ 

obtain consent.

2 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Prepare room, 

equipment, supplies.

2 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean room/equipment by physician staff.3 1 CMS clinical review. 

SJ028 hydrogen peroxide NF .............................. 10 0 CMS clinical review. 

SJ053 swab-pad, alcohol NF .............................. 10 0 CMS clinical review. 

13100 ..................... Cmplx rpr trunk 

1.1–2.5 cm.

EF014 light, surgical ........ NF .............................. 32 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 32 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49010 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EF023 table, exam .......... NF .............................. 32 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 32 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 32 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 32 46 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 32 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13101 ..................... Cmplx rpr trunk 

2.6–7.5 cm.

EF014 light, surgical ........ NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 45 54 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 45 47 CMS clinical review. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49011 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB027 gown, staff, impervious.F .............................. 2 0 CMS clinical review. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SB034 mask, surgical, 

with face shield.

F .............................. 2 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 10 0 Duplicative. 

13102 ..................... Cmplx rpr trunk 

addl 5cm/< 

EF015 mayo stand .......... NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13120 ..................... Cmplx rpr s/a/l 

1.1–2.5 cm.

EF014 light, surgical ........ NF .............................. 86 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 86 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 86 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 86 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 86 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 86 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 86 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49012 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB027 gown, staff, impervious.F .............................. 2 0 CMS clinical review. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SB034 mask, surgical, 

with face shield.

F .............................. 2 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13121 ..................... Cmplx rpr s/a/l 

2.6–7.5 cm.

EF014 light, surgical ........ NF .............................. 129 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 129 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 129 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 129 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 129 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 129 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 129 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.15 10 Standardized time 

input. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 10 0 Duplicative. 

13122 ..................... Cmplx rpr s/a/l 

addl 5 cm/> 

EF015 mayo stand .......... NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49013 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EF031 table, power ......... NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 30 20 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13131 ..................... Cmplx rpr f/c/c/m/ 

n/ax/g/h/f.

EF014 light, surgical ........ NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 45 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 


ehiers on DSK2VPTVN1PROD with RULES_2
49014 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

13132 ..................... Cmplx rpr f/c/c/m/ 

n/ax/g/h/f.

EF014 light, surgical ........ NF .............................. 50 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 50 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 50 58 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 10 0 Duplicative. 

13133 ..................... Cmplx rpr f/c/c/m/ 

n/ax/g/h/f.

EF015 mayo stand .......... NF .............................. 35 23 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 35 23 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 35 23 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 35 23 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 35 23 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49015 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13150 ..................... Cmplx rpr e/n/e/l 

1.0 cm/< 

EF014 light, surgical ........ NF .............................. 30 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 30 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 30 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 30 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 30 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 30 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 30 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Assist physician in 

performing procedure.

20 26 Conforming to 

physician time. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13151 ..................... Cmplx rpr e/n/e/l 

1.1–2.5 cm.

EF014 light, surgical ........ NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 45 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49016 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 45 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 45 48 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

13152 ..................... Cmplx rpr e/n/e/l 

2.6–7.5 cm.

EF014 light, surgical ........ NF .............................. 50 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF015 mayo stand .......... NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF023 table, exam .......... NF .............................. 50 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 50 58 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 50 51 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF .............................. 15 10 Standardized time 

input. 

SB016 drape-cover, sterile, OR light 

handle.

NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 0 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 10 0 Duplicative. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49017 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

13153 ..................... Cmplx rpr e/n/e/l 

addl 5cm/< 

EF015 mayo stand .......... NF .............................. 45 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 45 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ114 electrosurgical 

generator, up to 

120 watts.

NF .............................. 45 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 45 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ351 Smoke Evacuator 

(tubing, covering, etc.) with 

stand.

NF .............................. 45 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SC029 needle, 18–27g .... NF .............................. 2 0 CMS clinical review. 

Electrocautery 

Supply Pack.

NF .............................. 1 0 Non-standard direct practice expense input. 

SJ041 povidone soln 

(Betadine).

NF .............................. 5 0 Duplicative. 

20600 ..................... Drain/inject joint/ 

bursa.

EF023 table, exam .......... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... F Discharge day 

management.

6 0 CMS clinical review. 

L037D RN/LPN/MTA ....... F Conduct phone 

calls/call in prescriptions.

0 3 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 4 2 CMS clinical review. 

SC055 syringe 3ml .......... NF .............................. 2 1 CMS clinical review. 

20605 ..................... Drain/inject joint/ 

bursa.

EF023 table, exam .......... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... F Discharge day 

management.

6 0 CMS clinical review. 

L037D RN/LPN/MTA ....... F Conduct phone 

calls/call in prescriptions.

0 3 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 4 2 CMS clinical review. 

SC055 syringe 3ml .......... NF .............................. 2 1 CMS clinical review. 

20610 ..................... Drain/inject joint/ 

bursa.

EF023 table, exam .......... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49018 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ168 light, exam ........... NF .............................. 19 16 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... F Discharge day 

management.

6 0 CMS clinical review. 

L037D RN/LPN/MTA ....... F Conduct phone 

calls/call in prescriptions.

0 3 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 4 2 CMS clinical review. 

SC057 syringe 5–6ml ...... NF .............................. 2 1 CMS clinical review. 

23472 ..................... Reconstruct shoulder joint.SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

23473 ..................... Revis reconst 

shoulder joint.

SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

23474 ..................... Revis reconst 

shoulder joint.

SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

24363 ..................... Replace elbow 

joint.

SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

24370 ..................... Revise reconst 

elbow joint.

SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

24371 ..................... Revise reconst 

elbow joint.

SA052 pack, post-op incision care (staple).F .............................. 0 1 CMS clinical review. 

SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

31231 ..................... Nasal endoscopy 

dx.

ED032 printer, laser, 

paper.

NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF008 chair with headrest, exam, reclining.NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ138 instrument pack, 

medium ($1500 

and up).

NF .............................. 0 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ167 light source, xenon NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ170 light, fiberoptic 

headlight wsource.

NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49019 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ234 suction and pressure cabinet, 

ENT (SMR).

NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES013 endoscope, rigid, 

sinoscopy.

NF .............................. 63 42 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES013 endoscope, rigid, 

sinoscopy.

NF .............................. 63 0 CMS clinical review. 

ES031 video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

NF .............................. 43 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES036 Nasal Endoscopy 

Instrument 

Package.

NF .............................. 63 0 Non-standard direct practice expense input. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

2 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 1 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean Surgical Instrument Package.10 15 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Review/read Xray, lab, and pathology reports.5 0 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 2 1 Duplicative. 

SB034 mask, surgical, 

with face shield.

NF .............................. 2 1 Duplicative. 

31647 ..................... Bronchial valve init 

insert.

L047C RN/Respiratory 

Therapist.

F Complete preservice diagnostic & referral 

forms.

3 5 CMS clinical review. 

L047C RN/Respiratory 

Therapist.

F Coordinate presurgery services.5 3 CMS clinical review. 

32554 ..................... Aspirate pleura w/ 

o imaging.

EF023 table, exam .......... NF .............................. 56 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 0 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Complete preservice diagnostic & referral 

forms.

5 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Coordinate presurgery services.3 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 10 CMS clinical review. 

SA048 pack, minimum 

multi-specialty 

visit.

NF .............................. 0 1 CMS clinical review. 

SA067 tray, shave prep ... NF .............................. 0 1 CMS clinical review. 

................ kit, thoracentesis .. NF .............................. 1 0 CMS clincial review. 

SA070 tray, thoracentesis NF .............................. 0 1 CMS clincial review. 

SA077 kit, pleural catheter insertion.NF .............................. 0 1 CMS clinical review. 

SB001 cap, surgical ........ NF .............................. 0 2 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49020 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 1 0 CMS clinical review. 

SB024 gloves, sterile ....... NF .............................. 1 2 CMS clinical review. 

SB034 mask, surgical, 

with face shield.

NF .............................. 0 2 CMS clinical review. 

SB039 shoe covers, surgical.NF .............................. 0 2 CMS clinical review. 

SB044 underpad 2ft x 3ft 

(Chux).

NF .............................. 0 1 CMS clinical review. 

SG056 gauze, sterile 4in x 

4in (10 pack 

uou).

NF .............................. 1 0 CMS clinical review. 

32555 ..................... Aspirate pleura w/ 

imaging.

ED024 film processor, 

dry, laser.

NF .............................. 58 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF019 stretcher chair ...... NF .............................. 15 10 CMS clinical review. 

EL015 room, ultrasound, 

general.

NF .............................. 33 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 58 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L041B Radiologic Technologist.NF Complete preservice diagnostic & referral 

forms.

5 0 CMS clinical review. 

L041B Radiologic Technologist.NF Coordinate presurgery services.3 1 CMS clinical review. 

L041B Radiologic Technologist.NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

15 10 CMS clinical review. 

L041B Radiologic Technologist.NF Process images, 

complete data 

sheet, present 

images and data 

to the interpreting physician.

5 2 CMS clinical review. 

kit, thoracentesis .. NF .............................. 1 0 CMS clinical review. 

SA070 tray, thoracentesis NF .............................. 0 1 CMS clinical review. 

SA077 kit, pleural catheter insertion.NF .............................. 0 1 CMS clinical review. 

SB001 cap, surgical ........ NF .............................. 0 3 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 0 1 CMS clinical review. 

SB039 shoe covers, surgical.NF .............................. 0 3 CMS clinical review. 

SB044 underpad 2ft x 3ft 

(Chux).

NF .............................. 0 1 CMS clinical review. 

SG078 tape, surgical occlusive 1in 

(Blenderm).

NF .............................. 0 15 CMS clinical review. 

SM012 disinfectant spray 

(Transeptic).

NF .............................. 10 0 CMS clinical review. 

SM021 sanitizing clothwipe (patient).NF .............................. 2 0 CMS clinical review. 

32556 ..................... Insert cath pleura 

w/o image.

EQ168 light, exam ........... NF .............................. 0 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Complete preservice diagnostic & referral 

forms.

5 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49021 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L037D RN/LPN/MTA ....... NF Coordinate presurgery services.3 1 CMS clinical review. 

SA044 pack, moderate 

sedation.

NF .............................. 0 1 CMS clinical review. 

SA048 pack, minimum 

multi-specialty 

visit.

NF .............................. 0 1 CMS clinical review. 

SA067 tray, shave prep ... NF .............................. 0 1 CMS clinical review. 

SB001 cap, surgical ........ NF .............................. 0 2 CMS clinical review. 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 1 0 CMS clinical review. 

SB034 mask, surgical, 

with face shield.

NF .............................. 0 2 CMS clinical review. 

SB039 shoe covers, surgical.NF .............................. 0 2 CMS clinical review. 

SB044 underpad 2ft x 3ft 

(Chux).

NF .............................. 0 1 CMS clinical review. 

SC010 closed flush system, 

angiography.

NF .............................. 0 1 CMS clinical review. 

SG056 gauze, sterile 4in x 

4in (10 pack 

uou).

NF .............................. 1 0 CMS clinical review. 

SH065 sodium chloride 

0.9% flush syringe.

NF .............................. 0 1 CMS clinical review. 

SH069 sodium chloride 

0.9% irrigation 

(500–1000ml 

uou).

NF .............................. 0 1 CMS clinical review. 

SL157 cup, sterile, 8 oz .. NF .............................. 0 1 CMS clinical review. 

32557 ..................... Insert cath pleura 

w/image.

ED024 film processor, 

dry, laser.

NF .............................. 58 7 CMS clinical review. 

EF019 stretcher chair ...... NF .............................. 15 10 CMS clinical review. 

EL007 room, CT .............. NF .............................. 43 40 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 60 40 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 58 7 CMS clinical review. 

L046A CT Technologist .. NF Complete preservice diagnostic & referral 

forms.

5 0 CMS clinical review. 

L046A CT Technologist .. NF Coordinate presurgery services.3 1 CMS clinical review. 

L046A CT Technologist .. NF Check dressings & 

wound/home 

care instructions/coordinate 

office visits/prescriptions.

3 5 CMS clinical review. 

L046A CT Technologist .. NF Assist physician in 

performing procedure.

28 30 Conforming to 

physician time. 

SA071 kit, AccuStick II Introducer System 

with RO Marker.

NF .............................. 1 0 CMS clinical review. 

SA077 kit, pleural catheter insertion.NF .............................. 0 1 CMS clinical review. 

SB001 cap, surgical ........ NF .............................. 2 3 CMS clinical review. 

SB011 drape, sterile, fenestrated 16in x 

29in.

NF .............................. 1 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49022 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB014 drape, sterile, 

three-quarter 

sheet.

NF .............................. 1 0 CMS clinical review. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 4 0 CMS clinical review. 

SB024 gloves, sterile ....... NF .............................. 2 1 CMS clinical review. 

SB027 gown, staff, impervious.NF .............................. 0 1 CMS clinical review. 

SB039 shoe covers, surgical.NF .............................. 2 3 CMS clinical review. 

SC049 stop cock, 3-way .. NF .............................. 1 0 CMS clinical review. 

SC056 syringe 50–60ml .. NF .............................. 2 0 CMS clinical review. 

SC058 syringe w-needle, 

OSHA compliant 

(SafetyGlide).

NF .............................. 1 0 CMS clinical review. 

SD043 dilator, vessel, 

angiographic.

NF .............................. 1 0 CMS clinical review. 

SD088 guidewire ............. NF .............................. 1 0 CMS clinical review. 

SD146 catheter 

percutaneous 

fastener (PercuStay).

NF .............................. 1 0 CMS clinical review. 

SD161 drainage catheter, 

all purpose.

NF .............................. 1 0 CMS clinical review. 

SD163 drainage pouch, 

nephrostomy-biliary.

NF .............................. 1 0 CMS clinical review. 

SF007 blade, surgical 

(Bard-Parker).

NF .............................. 1 0 CMS clinical review. 

SG009 applicator, 

sponge-tipped.

NF .............................. 4 0 CMS clinical review. 

SG078 tape, surgical occlusive 1in 

(Blenderm).

NF .............................. 0 25 CMS clinical review. 

SH047 lidocaine 1%–2% 

inj (Xylocaine).

NF .............................. 10 0 CMS clinical review. 

SJ041 povidone soln 

(Betadine).

NF .............................. 60 0 CMS clinical review. 

SL036 cup, biopsy-specimen sterile 4oz.NF .............................. 1 0 CMS clinical review. 

SL156 cup, sterile, 12–16 

oz.

NF .............................. 1 0 CMS clinical review. 

33361 ..................... Replace aortic 

valve perq.

L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 

33362 ..................... Replace aortic 

valve open.

L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 

33363 ..................... Replace aortic 

valve open.

L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49023 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

33364 ..................... Replace aortic 

valve open.

L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 

33365 ..................... Replace aortic 

valve open.

L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 

33366 ..................... #N/A ..................... L037D RN/LPN/MTA ....... F Coordinate presurgery services.40 10 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

8 5 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Provide pre-service education/ 

obtain consent.

20 7 Standardized time 

input. 

L037D RN/LPN/MTA ....... F Follow-up phone 

calls & prescriptions.

7 3 Standardized time 

input. 

33405 ..................... Replacement of 

aortic valve.

L051A RN ........................ F Other Clinical Activity—specify: 

for reference 

code 33406 and 

codes 33405 

and 33430: Additional coordination between 

multiple specialties for complex 

procedures 

(tests, meds, 

scheduling, etc) 

prior to patient 

arrival at site of 

service..

15 0 CMS clinical review. 

L051A RN ........................ F Other Clinical Activity—specify: 

for reference 

code 33406 and 

codes 33405 

and 33430: Additional coordination between 

multiple specialties for complex 

procedures 

(tests, meds, 

scheduling, etc) 

prior to patient 

arrival at site of 

service..

15 0 CMS clinical review. 

35475 ..................... Repair arterial 

blockage.

EL011 room, angiography NF .............................. 51 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ011 ECG, 3-channel 

(with SpO2, 

NIBP, temp, 

resp).

NF .............................. 212 285 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49024 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ032 IV infusion pump .. NF .............................. 212 285 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EQ168 light, exam ........... NF .............................. 120 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... F Complete preservice diagnostic & referral 

forms.

5 3 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

4 2 Standardized time 

input. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 4 2 CMS clinical review. 

35476 ..................... Repair venous 

blockage.

Ef027 table, instrument, 

mobile.

NF .............................. 302 277 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EL011 room, angiography NF .............................. 43 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ011 ECG, 3-channel 

(with SpO2, 

NIBP, temp, 

resp).

NF .............................. 137 277 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EQ032 IV infusion pump .. NF .............................. 137 277 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EQ168 light, exam ........... NF .............................. 120 44 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... F Schedule space 

and equipment 

in facility.

3 5 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

4 2 Standardized time 

input. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 4 2 CMS clinical review. 

36221 ..................... Place cath thoracic aorta.EF018 stretcher ............... NF .............................. 272 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 272 CMS Code correction. 

EL011 room, angiography NF .............................. 49 45 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49025 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ088 contrast media 

warmer.

NF .............................. 49 45 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 49 45 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

L041A Angio Technician NF Image Post Processing.5 0 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

2 7 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare and position patient/monitor patient/set 

up IV.

2 7 CMS clinical review. 

SD249 Sterile Radioopaque ruler (le 

Maitre, documentation available).

NF .............................. 1 0 CMS clinical review. 

36222 ..................... Place cath carotid/ 

inom art.

EF018 stretcher ............... NF .............................. 282 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 282 CMS Code correction. 

EL011 room, angiography NF .............................. 59 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ088 contrast media 

warmer.

NF .............................. 59 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 59 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

SD147 catheter, (Glide) ... NF .............................. 1 0 CMS clinical review. 

SD249 Sterile Radioopaque ruler (le 

Maitre, documentation available).

NF .............................. 1 0 CMS clinical review. 

36223 ..................... Place cath carotid/ 

inom art.

EF018 stretcher ............... NF .............................. 287 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 287 CMS Code correction. 

EL011 room, angiography NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49026 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ088 contrast media 

warmer.

NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

SD249 Sterile Radioopaque ruler (le 

Maitre, documentation available).

NF .............................. 1 0 CMS clinical review. 

36224 ..................... Place cath carotd 

art.

EF018 stretcher ............... NF .............................. 292 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 292 CMS Code correction. 

EL011 room, angiography NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ088 contrast media 

warmer.

NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

36225 ..................... Place cath subclavian art.EF018 stretcher ............... NF .............................. 287 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 287 CMS Code correction. 

EL011 room, angiography NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ088 contrast media 

warmer.

NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 64 60 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49027 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

36226 ..................... Place cath 

vertebral art.

EF018 stretcher ............... NF .............................. 292 0 CMS Code correction. 

EF027 table, instrument, 

mobile.

NF .............................. 0 292 CMS Code correction. 

EL011 room, angiography NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ088 contrast media 

warmer.

NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 69 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

36228 ..................... Place cath 

intracranial art.

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

1 0 CMS clinical review. 

L041B Radiologic Technologist.NF Assisting with 

flouroscopy/ 

image acquisition (75%).

23 22 CMS clinical review. 

SC057 syringe 5–6ml ...... NF .............................. 4 0 CMS clinical review. 

37197 ..................... Remove intrvas 

foreign body.

EF027 table, instrument, 

mobile.

NF .............................. 305 302 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EL011 room, angiography NF .............................. 77 72 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ011 ECG, 3-channel 

(with SpO2, 

NIBP, temp, 

resp).

NF .............................. 305 302 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EQ032 IV infusion pump .. NF .............................. 305 302 Moderate Sedation 

equipment— 

Time includes 

administering 

anesthesia, procedure time, 

and monitoring 

patient. 

EQ088 contrast media 

warmer.

NF .............................. 77 0 CMS clinical review. 

EQ250 ultrasound unit, 

portable.

NF .............................. 77 0 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 77 72 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49028 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L037D RN/LPN/MTA ....... NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

5 3 Standardized time 

input. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 5 3 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies (including 

imaging equipment).

7 5 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare and position patient/monitor patient/set 

up IV.

5 2 Standardized time 

input. 

SB005 cover-condom, 

transducer or 

ultrasound 

probe.

NF .............................. 1 0 CMS clinical review. 

SB048 sheath-cover, sterile, 96in x 6in 

(transducer).

NF .............................. 1 0 CMS clinical review. 

SD147 catheter, (Glide) ... NF .............................. 1 0 CMS clinical review. 

SD252 guidewire, Amplatz 

wire 260 cm.

NF .............................. 1 0 CMS clinical review. 

SH065 sodium chloride 

0.9% flush syringe.

NF .............................. 2 0 CMS clinical review. 

47600 ..................... Removal of gallbladder.SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

SA054 pack, post-op incision care (suture).F .............................. 0 1 CMS clinical review. 

47605 ..................... Removal of gallbladder.SA053 pack, post-op incision care (suture & staple).F .............................. 1 0 CMS clinical review. 

SA054 pack, post-op incision care (suture).F .............................. 0 1 CMS clinical review. 

50590 ..................... Fragmenting of 

kidney stone.

EL014 room, radiographicfluoroscopic.NF .............................. 86 0 Consistent with 

the AMA RUC’s 

CY2011 recommendation. 

EQ175 lithotriptor, with Carm (ESWL).NF .............................. 86 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

52214 ..................... Cystoscopy and 

treatment.

EF027 table, instrument, 

mobile.

NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ153 laser (gs, uro, obg, 

ge) (Indigo Optima).

NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ167 light source, xenon NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49029 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

ES006 endoscope forceps, biopsy.NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES007 endoscope forceps, grasping.NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES018 fiberscope, flexible, cystoscopy.NF .............................. 100 92 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES031 video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

NF .............................. 100 65 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Review Chart ....... 3 0 CMS clinical review. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 1 0 Duplicative. 

SB024 gloves, sterile ....... NF .............................. 0 1 CMS clinical review. 

SD270 Penis clamp ......... NF .............................. 1 0 Not a disposable 

according to 

submitted invoice. 

SH047 lidocaine 1%–2% 

inj (Xylocaine).

NF .............................. 50 0 Duplicative. 

52224 ..................... Cystoscopy and 

treatment.

EF027 table, instrument, 

mobile.

NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ153 laser (gs, uro, obg, 

ge) (Indigo Optima).

NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ167 light source, xenon NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES006 endoscope forceps, biopsy.NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES007 endoscope forceps, grasping.NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES018 fiberscope, flexible, cystoscopy.NF .............................. 105 94 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES031 video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

NF .............................. 105 67 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49030 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L037D RN/LPN/MTA ....... NF Review Chart ....... 3 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Prepare biopsy 

Specimen.

5 2 CMS clinical review. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 1 0 Duplicative. 

SB024 gloves, sterile ....... NF .............................. 3 1 CMS clinical review. 

SD270 Penis clamp ......... NF .............................. 1 0 Not a disposable 

according to 

submitted invoice. 

SH047 lidocaine 1%–2% 

inj (Xylocaine).

NF .............................. 50 0 Duplicative. 

SL036 cup, biopsy-specimen sterile 4oz.NF .............................. 6 3 CMS clinical review. 

52287 ..................... Cystoscopy 

chemodenervation.

EF027 table, instrument, 

mobile.

NF .............................. 78 49 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 78 49 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ170 light, fiberoptic 

headlight wsource.

NF .............................. 78 49 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES018 fiberscope, flexible, cystoscopy.NF .............................. 78 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ES031 video system, endoscopy (processor, digital 

capture, monitor, printer, cart).

NF .............................. 78 49 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Assist physician in 

performing procedure.

20 21 Conforming to 

physician time. 

SH048 lidocaine 2% jelly, 

topical 

(Xylocaine).

NF .............................. 10 0 Duplicative. 

53850 ..................... Prostatic microwave thermotx.EF020 stretcher, endoscopy.NF .............................. 99 85 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF027 table, instrument, 

mobile.

NF .............................. 99 85 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 169 152 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... F .............................. 169 152 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ037 TUMT system 

control unit.

NF .............................. 99 85 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 169 152 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49031 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ168 light, exam ........... F .............................. 169 152 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ250 ultrasound unit, 

portable.

NF .............................. 99 85 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Prepare room, 

equipment, supplies.

2 4 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Setup ultrasound 

probe.

5 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Setup TUMT machine.5 0 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean TUMT machine.3 0 CMS clinical review. 

SB022 gloves, non-sterile NF .............................. 3 2 CMS clinical review. 

SB024 gloves, sterile ....... NF .............................. 3 2 CMS clinical review. 

SH047 lidocaine 1%–2% 

inj (Xylocaine).

NF .............................. 3 30 CMS clinical review. 

64612 ..................... Destroy nerve face 

muscle.

EL006 lane, screening 

(oph).

F .............................. 39 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL006 lane, screening 

(oph).

NF .............................. 48 45 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SC031 needle, 30g .......... F .............................. 0 1 CMS clinical review. 

64615 ..................... Chemodenerv 

musc migraine.

EF023 table, exam .......... NF .............................. 24 18 Refined equipment 

time to reflect 

typical use exclusive to patient. 

65800 ..................... Drainage of eye ... EL006 Lane, Screening .. NF .............................. 21 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 21 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

67810 ..................... Biopsy eyelid & lid 

margin.

EF014 light, surgical ........ NF .............................. 20 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF031 table, power ......... NF .............................. 20 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ110 electrocauteryhyfrecator, up to 

45 watts.

NF .............................. 1 22 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ137 instrument pack, 

basic ($500– 

$1499).

NF .............................. 1 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

SB011 drape, sterile, fenestrated 16in x 

29in.

NF .............................. 0 1 CMS clinical review. 

SB019 drape-towel, sterile 

18in x 26in.

NF .............................. 4 1 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49032 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SC029 needle, 18–27g .... NF .............................. 1 0 Standardized time 

input. 

72040 ..................... X-ray exam neck 

spine 3/<vws.

ED025 film processor, wet NF .............................. 20 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL012 room, basic radiology.NF .............................. 20 13 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 20 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Film jacket or jacket insert.NF .............................. 1 0 Non-standard direct practice expense input. 

72050 ..................... X-ray exam neck 

spine 4/5vws.

ED025 film processor, wet NF .............................. 28 6 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL012 room, basic radiology.NF .............................. 28 19 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 28 6 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Film jacket or jacket insert.NF .............................. 1 0 Non-standard direct practice expense input. 

72052 ..................... X-ray exam neck 

spine 6/>vws.

ED025 film processor, wet NF .............................. 36 8 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL012 room, basic radiology.NF .............................. 36 25 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 36 8 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Film jacket or jacket insert.NF .............................. 1 0 Non-standard direct practice expense input. 

72191 ..................... Ct angiograph pelv 

w/o&w/dye.

EL007 room, CT .............. NF .............................. 101 40 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L041B Radiologic Technologist.NF Retrieve prior appropriate imaging exams and 

hang for MD review, verify orders, review the 

chart to incorporate relevant 

clinical information.

0 5 CMS clinical review. 

L041B Radiologic Technologist.NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

0 3 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49033 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L041B Radiologic Technologist.NF Education/instruction/counseling/ 

obtain consent.

0 2 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

0 2 Standardized time 

input. 

L041B Radiologic Technologist.NF Prepare and position patient/monitor patient/set 

up IV.

0 7 CMS clinical review. 

L041B Radiologic Technologist.NF Aquire images ...... 0 28 CMS clinical review. 

L041B Radiologic Technologist.NF Clean room/equipment by physician staff.0 3 CMS clinical review. 

L046A CT Technologist .. NF Retrieve prior appropriate imaging exams and 

hang for MD review, verify orders, review the 

chart to incorporate relevant 

clinical information.

5 0 CMS clinical review. 

L046A CT Technologist .. NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

3 0 CMS clinical review. 

L046A CT Technologist .. NF Education/instruction/counseling/ 

obtain consent.

2 0 CMS clinical review. 

L046A CT Technologist .. NF Prepare room, 

equipment, supplies.

5 0 CMS clinical review. 

L046A CT Technologist .. NF Prepare and position patient/monitor patient/set 

up IV.

7 0 CMS clinical review. 

L046A CT Technologist .. NF Aquire images ...... 28 0 CMS clinical review. 

L046A CT Technologist .. NF Clean room/equipment by physician staff.3 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 1 0.1 CMS clinical review. 

72192 ..................... Ct pelvis w/o dye ED024 film processor, 

dry, laser.

NF .............................. 5 0 CMS clinical review. 

ED032 printer, laser, 

paper.

NF .............................. 0 5 CMS clinical review. 

EL007 room, CT .............. NF .............................. 45 22 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 6 4 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 4 8 CMS clinical review. 

72193 ..................... Ct pelvis w/dye .... ED024 film processor, 

dry, laser.

NF .............................. 5 0 CMS clinical review. 

ED032 printer, laser, 

paper.

NF .............................. 0 5 CMS clinical review. 

EL007 room, CT .............. NF .............................. 40 32 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 7 4 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 40 43 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49034 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 1 0 CMS clinical review. 

SB014 drape, sterile, 

three-quarter 

sheet.

NF .............................. 0 1 CMS clinical review. 

SC001 angiocatheter 

14g–24g.

NF .............................. 1 0 CMS clinical review. 

SC002 angiocatheter set NF .............................. 0 1 CMS clinical review. 

SC025 needle, 14–20g, 

biopsy.

NF .............................. 0 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

SC059 syringe, 25ml (MRI 

power injector).

NF .............................. 0 1 CMS clinical review. 

SG068 plaster bandage 

(4in x 5yd uou).

NF .............................. 1 0 CMS clinical review. 

SG075 tape, elastic, 1in 

(Elastoplast, 

Elasticon) (5yd 

uou).

NF .............................. 0 6 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 6 0 CMS clinical review. 

SH065 sodium chloride 

0.9% flush syringe.

NF .............................. 0 15 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

72194 ..................... Ct pelvis w/o & w/ 

dye.

ED024 film processor, 

dry, laser.

NF .............................. 10 7 CMS clinical review. 

EL007 room, CT .............. NF .............................. 54 39 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 10 7 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 7 4 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 54 52 CMS clinical review. 

SC025 needle, 14–20g, 

biopsy.

NF .............................. 0 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 0 8 CMS clinical review. 

73221 ..................... Mri joint upr 

extrem w/o dye.

ED024 film processor, 

dry, laser.

NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL008 room, MR ............. NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49035 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L047A MRI Technologist NF Prepare room, 

equipment, supplies.

5 3 CMS clinical review. 

L047A MRI Technologist NF Prepare and position patient/monitor patient/set 

up IV.

3 2 Standardized time 

input. 

L047A MRI Technologist NF Escort patient from 

exam room due 

to magnetic sensitivity.

2 0 Non-standard direct practice expense input. 

Insert folder .......... NF .............................. 1 0 Non-standard direct practice expense input. 

73721 ..................... Mri jnt of lwr extre 

w/o dye.

ED024 film processor, 

dry, laser.

NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL008 room, MR ............. NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 63 33 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L047A MRI Technologist NF Prepare room, 

equipment, supplies.

5 3 CMS clinical review. 

L047A MRI Technologist NF Prepare and position patient/monitor patient/set 

up IV.

3 2 Standardized time 

input. 

L047A MRI Technologist NF Escort patient from 

exam room due 

to magnetic sensitivity.

2 0 Non-standard direct practice expense input. 

Insert folder .......... NF .............................. 1 0 Non-standard direct practice expense input. 

74150 ..................... Ct abdomen w/o 

dye.

ED024 film processor, 

dry, laser.

NF .............................. 5 0 CMS clinical review. 

ED032 printer, laser, 

paper.

NF .............................. 0 5 CMS clinical review. 

EL007 room, CT .............. NF .............................. 32 22 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 6 4 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 4 8 CMS clinical review. 

74160 ..................... Ct abdomen w/dye ED024 film processor, 

dry, laser.

NF .............................. 7 0 CMS clinical review. 

ED032 printer, laser, 

paper.

NF .............................. 0 5 CMS clinical review. 

EL007 room, CT .............. NF .............................. 47 32 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 7 5 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 7 4 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 47 43 CMS clinical review. 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 1 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49036 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SB014 drape, sterile, 

three-quarter 

sheet.

NF .............................. 0 1 CMS clinical review. 

SC001 angiocatheter 

14g–24g.

NF .............................. 1 0 CMS clinical review. 

SC002 angiocatheter set NF .............................. 0 1 CMS clinical review. 

SC025 needle, 14–20g, 

biopsy.

NF .............................. 0 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

SC059 syringe, 25ml (MRI 

power injector).

NF .............................. 0 1 CMS clinical review. 

SG075 tape, elastic, 1in 

(Elastoplast, 

Elasticon) (5yd 

uou).

NF .............................. 0 6 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 6 0 CMS clinical review. 

SH065 sodium chloride 

0.9% flush syringe.

NF .............................. 0 15 CMS clinical review. 

SH068 sodium chloride 

0.9% inj 

bacteriostatic 

(30ml uou).

NF .............................. 1 0 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 6 4 CMS clinical review. 

74170 ..................... Ct abdomen w/o & 

w/dye.

ED024 film processor, 

dry, laser.

NF .............................. 15 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL007 room, CT .............. NF .............................. 65 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 15 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L046A CT Technologist .. NF Retrieve prior appropriate imaging exams and 

hang for MD review, verify orders, review the 

chart to incorporate relevant 

clinical information and confirm 

contrast protocol 

with interpreting 

MD.

7 4 CMS clinical review. 

L046A CT Technologist .. NF Assist physician in 

performing procedure.

32 27 CMS clinical review. 

L046A CT Technologist .. NF Image Post Processing.15 7 CMS clinical review. 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 1 0 CMS clinical review. 

SB014 drape, sterile, 

three-quarter 

sheet.

NF .............................. 0 1 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49037 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SC001 angiocatheter 

14g–24g.

NF .............................. 1 0 CMS clinical review. 

SC002 angiocatheter set NF .............................. 0 1 CMS clinical review. 

SC025 needle, 14–20g, 

biopsy.

NF .............................. 0 1 CMS clinical review. 

SC029 needle, 18–27g .... NF .............................. 1 0 CMS clinical review. 

SC059 syringe, 25ml (MRI 

power injector).

NF .............................. 0 1 CMS clinical review. 

SG050 gauze, non-sterile 

2in x 2in.

NF .............................. 0 1 CMS clinical review. 

SG075 tape, elastic, 1in 

(Elastoplast, 

Elasticon) (5yd 

uou).

NF .............................. 0 6 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 6 0 CMS clinical review. 

SH016 barium suspension 

(Polibar).

NF .............................. 900 0 CMS clinical review. 

SH065 sodium chloride 

0.9% flush syringe.

NF .............................. 0 15 CMS clinical review. 

SH068 sodium chloride 

0.9% inj 

bacteriostatic 

(30ml uou).

NF .............................. 1 0 CMS clinical review. 

SK013 computer media, 

dvd.

NF .............................. 1 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK091 x-ray envelope ..... NF .............................. 1 0 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 14 8 CMS clinical review. 

74175 ..................... Ct angio abdom w/ 

o & w/dye.

EL007 room, CT .............. NF .............................. 101 40 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L041B Radiologic Technologist.NF Retrieve prior appropriate imaging exams and 

hang for MD review, verify orders, review the 

chart to incorporate relevant 

clinical information.

0 5 CMS clinical review. 

L041B Radiologic Technologist.NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

0 3 CMS clinical review. 

L041B Radiologic Technologist.NF Education/instruction/counseling/ 

obtain consent.

0 2 CMS clinical review. 

L041B Radiologic Technologist.NF Prepare room, 

equipment, supplies.

0 2 Standardized time 

input. 

L041B Radiologic Technologist.NF Prepare and position patient/monitor patient/set 

up IV.

0 7 CMS clinical review. 

L041B Radiologic Technologist.NF Aquire images ...... 0 28 CMS clinical review. 

L041B Radiologic Technologist.NF Clean room/equipment by physician staff.0 3 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49038 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L046A CT Technologist .. NF Retrieve prior appropriate imaging exams and 

hang for MD review, verify orders, review the 

chart to incorporate relevant 

clinical information.

5 0 CMS clinical review. 

L046A CT Technologist .. NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

3 0 CMS clinical review. 

L046A CT Technologist .. NF Education/instruction/counseling/ 

obtain consent.

2 0 CMS clinical review. 

L046A CT Technologist .. NF Prepare room, 

equipment, supplies.

5 0 CMS clinical review. 

L046A CT Technologist .. NF Prepare and position patient/monitor patient/set 

up IV.

7 0 CMS clinical review. 

L046A CT Technologist .. NF Aquire images ...... 28 0 CMS clinical review. 

L046A CT Technologist .. NF Clean room/equipment by physician staff.3 0 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 1 0.1 CMS clinical review. 

74176 ..................... Ct abd & pelvis .... ED032 printer, laser, 

paper.

NF .............................. 8 7 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 27 7 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 40 39 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

74177 ..................... Ct abd & pelv w/ 

contrast.

ED032 printer, laser, 

paper.

NF .............................. 10 7 CMS clinical review. 

EL007 room, CT .............. NF .............................. 42 39 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 42 7 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 7 6 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 58 52 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 10 8 CMS clinical review. 

74178 ..................... Ct abd & pelv 1/> 

regns.

ED032 printer, laser, 

paper.

NF .............................. 20 10 CMS clinical review. 

EL007 room, CT .............. NF .............................. 57 48 CMS clinical review. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 57 10 CMS clinical review. 

L046A CT Technologist .. NF Pre-Service Period 7 6 CMS clinical review. 

L046A CT Technologist .. NF Service Period ..... 83 64 CMS clinical review. 

SK016 computer media, 

optical disk 

2.6gb.

NF .............................. 0 0.1 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49039 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SK076 slide sleeve (photo 

slides).

NF .............................. 0 1 CMS clinical review. 

SK098 film, x-ray, laser 

print.

NF .............................. 23 16 CMS clinical review. 

76830 ..................... Transvaginal us 

non-ob.

ED024 film processor, 

dry, laser.

NF .............................. 5 0 CMS clinical review. 

ED032 printer, laser, 

paper.

NF .............................. 1 0 CMS clinical review. 

EF027 table, instrument, 

mobile.

NF .............................. 0 36 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF034 table, ultrasound .. NF .............................. 0 36 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL015 room, ultrasound, 

general.

NF .............................. 37 0 CMS clinical review. 

EQ250 ultrasound unit, 

portable.

NF .............................. 0 36 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 10 0 CMS clinical review. 

ER086 ultrasound probe .. NF .............................. 0 37 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Clean room/equipment by physician staff.3 2 CMS clinical review. 

SB026 gown, patient ....... NF .............................. 0 1 CMS clinical review. 

SJ033 lubricating jelly 

(Surgilube).

NF .............................. 1 0 CMS clinical review. 

76872 ..................... Us transrectal ...... EF027 table, instrument, 

mobile.

NF .............................. 68 34 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EF034 table, ultrasound .. NF .............................. 68 34 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ250 ultrasound unit, 

portable.

NF .............................. 68 34 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER086 ultrasound probe .. NF .............................. 68 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Retrieve prior images for comparison:.0 3 CMS clinical review. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Review Chart ....... 3 0 CMS clinical review. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Obtain vital signs 3 0 CMS clinical review. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Prepare room, 

equipment, supplies.

2 3 CMS clinical review. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Prepare 

ultrasound 

probe.

5 0 CMS clinical review. 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Obtain vital signs 3 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49040 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L051B RN/Diagnostic 

Medical 

Sonographer.

NF Clean room/equipment by physician staff.3 2 CMS clinical review. 

SB012 drape, sterile, for 

Mayo stand.

NF .............................. 1 0 CMS clinical review. 

SC019 iv tubing (extension).NF .............................. 1 0 CMS clinical review. 

SH048 lidocaine 2% jelly, 

topical 

(Xylocaine).

NF .............................. 10 0 CMS clinical review. 

SJ001 alcohol isopropyl 

70%.

NF .............................. 5 0 CMS clinical review. 

SJ032 lubricating jelly (K– 

Y) (5gm uou).

NF .............................. 2 0 CMS clinical review. 

SM018 glutaraldehyde 

3.4% (Cidex, 

Maxicide, 

Wavicide).

NF .............................. 32 0 CMS clinical review. 

SM019 glutaraldehyde test 

strips (Cidex, 

Metrex).

NF .............................. 1 0 CMS clinical review. 

SM022 sanitizing clothwipe (surface, 

instruments, 

equipment).

NF .............................. 2 0 CMS clinical review. 

77003 ..................... Fluoroguide for 

spine inject.

ED025 film processor, wet NF .............................. 3 2 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL014 room, radiographicfluoroscopic.NF .............................. 9 18 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER029 film alternator (motorized film 

viewbox).

NF .............................. 3 2 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L041B Radiologic Technologist.NF Clean room/equipment by physician staff.2 1 CMS clinical review. 

L041B Radiologic Technologist.NF Process films, 

hang films and 

review study 

with interpreting 

MD prior to patient discharge.

3 2 CMS clinical review. 

77080 ..................... Dxa bone density 

axial.

ER078 phantom, spine, 

DXA calibration 

check.

NF .............................. 1 2 Refined equipment 

time to reflect 

typical use exclusive to patient. 

77301 ..................... Radiotherapy dose 

plan imrt.

ED011 computer system, 

record and 

verify.

NF .............................. 20 0 CMS clinical review. 

ED033 treatment planning 

system, IMRT 

(Corvus w-Peregrine 3D Monte 

Carlo).

NF .............................. 376 330 CMS clinical review. 

ER005 IMRT CT-based 

simulator.

NF .............................. 58 47 CMS clinical review. 

ER014 chamber, Farmertype.NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER028 electrometer, PCbased, dual 

channel.

NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49041 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

ER050 phantom, solid 

water calibration 

check.

NF .............................. 45 47 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER089 IMRT accelerator NF .............................. 45 47 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Obtain vital signs 3 0 CMS clinical review. 

78012 ..................... Thyroid uptake 

measurement.

EF010 chair, thyroid imaging.NF .............................. 40 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER063 thyroid uptake system.NF .............................. 40 30 Refined equipment 

time to reflect 

typical use exclusive to patient. 

78013 ..................... Thyroid imaging w/ 

blood flow.

ER032 gamma camera 

system, singledual head.

NF .............................. 48 38 Refined equipment 

time to reflect 

typical use exclusive to patient. 

78014 ..................... Thyroid imaging w/ 

blood flow.

EF010 chair, thyroid imaging.NF .............................. 65 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER032 gamma camera 

system, singledual head.

NF .............................. 65 50 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER063 thyroid uptake system.NF .............................. 65 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

78070 ..................... Parathyroid planar 

imaging.

ER032 gamma camera 

system, singledual head.

NF .............................. 73 68 Refined equipment 

time to reflect 

typical use exclusive to patient. 

78071 ..................... Parathyrd planar 

w/wo subtrj.

ER032 gamma camera 

system, singledual head.

NF .............................. 86 81 Refined equipment 

time to reflect 

typical use exclusive to patient. 

86153 ..................... Cell enumeration 

phys interp.

EP106 CELLSEARCH 

system.

NF .............................. 16 0 Laboratory physician interpretation code. 

EP107 Laboratory Information System.NF .............................. 4 0 Laboratory physician interpretation code. 

L045A Cytotechnologist .. NF Collate images 

and review with 

Pathologist.

5 0 Laboratory physician interpretation code. 

88120 ..................... Cytp urne 3–5 

probes ea spec.

EP088 ThermoBrite ......... NF .............................. 107 321 CMS clinical review. 

EP092 Olympus BX41 

Fluorescent Microscope (without filters or 

camera ).

NF .............................. 1.33 73.00 CMS clinical review. 

88121 ..................... Cytp urine 3–5 

probes cmptr.

EP088 ThermoBrite ......... NF .............................. 26.75 160.50 CMS clinical review. 

EP090 IkoniLan Software NF .............................. 2.97 29.70 CMS clinical review. 

EP091 IkoniScope ........... NF .............................. 2.97 29.70 CMS clinical review. 

88300 ..................... Surgical path 

gross.

................ courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

Copath System 

with maintenance contract.

NF .............................. 3 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 3 0 Indirect Practice 

Expense. 


ehiers on DSK2VPTVN1PROD with RULES_2
49042 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

88302 ..................... Tissue exam by 

pathologist.

................ specimen, solvent, 

and formalin disposal cost.

NF .............................. 0.18 0 Indirect Practice 

Expense. 

courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

equipment maintenance cost.NF .............................. 0.61 0 Included in equipment cost per 

minute calculation. 

Copath System 

with maintenance contract.

NF .............................. 3 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 3 0 Indirect Practice 

Expense. 

88304 ..................... Tissue exam by 

pathologist.

................ specimen, solvent, 

and formalin disposal cost.

NF .............................. 0.35 0 Indirect Practice 

Expense. 

courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

equipment maintenance cost.NF .............................. 0.61 0 Included in equipment cost per 

minute calculation. 

Copath System 

with maintenance contract.

NF .............................. 5 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 5 0 Indirect Practice 

Expense. 

88305 ..................... Tissue exam by 

pathologist.

................ specimen, solvent, 

and formalin disposal cost.

NF .............................. 0.35 0 Indirect Practice 

Expense. 

courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

equipment maintenance cost.NF .............................. 0.61 0 Included in equipment cost per 

minute calculation. 

Copath System 

with maintenance contract.

NF .............................. 4 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 4 0 Indirect Practice 

Expense. 

88307 ..................... Tissue exam by 

pathologist.

................ specimen, solvent, 

and formalin disposal cost.

NF .............................. 1.85 0 Indirect Practice 

Expense. 

courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

equipment maintenance cost.NF .............................. 0.61 0 Included in equipment cost per 

minute calculation. 

Copath System 

with maintenance contract.

NF .............................. 10 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 10 0 Indirect Practice 

Expense. 

88309 ..................... Tissue exam by 

pathologist.

................ specimen, solvent, 

and formalin disposal cost.

NF .............................. 1.85 0 Indirect Practice 

Expense. 

courier transportation cost.NF .............................. 2.02 0 Indirect Practice 

Expense. 

equipment maintenance cost.NF .............................. 0.61 0 Included in equipment cost per 

minute calculation. 

Copath System 

with maintenance contract.

NF .............................. 12 0 Indirect Practice 

Expense. 

Copath software .. NF .............................. 12 0 Indirect Practice 

Expense. 

90791 ..................... Psych diagnostic 

evaluation.

................ .............................. NF .............................. .......................... .................... 2012 Fully Implemented PE 

RVUs maintained. 

90832 ..................... Psytx pt&/family 

30 minutes.

................ .............................. NF .............................. .......................... .................... 2012 Fully Implemented PE 

RVUs maintained. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49043 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

90834 ..................... Psytx pt&/family 

45 minutes.

................ .............................. NF .............................. .......................... .................... 2012 Fully Implemented PE 

RVUs maintained. 

90836 ..................... Psytx pt&/fam w/ 

e&m 45 min.

................ .............................. NF .............................. .......................... .................... 2012 Fully Implemented PE 

RVUs maintained. 

91112 ..................... Gi wireless capsule measure................. Activation Fixture NF .............................. 5 0 CMS clinical review. 

Docking Station ... NF .............................. 40 0 CMS clinical review. 

MotiliGI software .. NF .............................. 40 0 CMS clinical review. 

EQ352 Data receiver ....... NF .............................. 7,220 2,880 CMS clinical review. 

SA048 pack, minimum 

multi-specialty 

visit.

NF .............................. 1 0 CMS clinical review. 

SmartBar .............. NF .............................. 1 0 CMS clinical review. 

92081 ..................... Visual field examination(s).SA050 pack, ophthalmology visit (no 

dilation).

NF .............................. 1 0 CMS clinical review. 

EL006 lane, screening 

(oph).

NF .............................. 12 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ029 Humphrey field 

analyzer.

NF .............................. 12 17 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ165 lens set, trial, full 

diameter, wframe.

NF .............................. 12 17 CMS clinical review. 

92082 ..................... Visual field examination(s).SA050 pack, ophthalmology visit (no 

dilation).

NF .............................. 1 0 CMS clinical review. 

EL006 lane, screening 

(oph).

NF .............................. 22 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ029 Humphrey field 

analyzer.

NF .............................. 22 27 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ165 lens set, trial, full 

diameter, wframe.

NF .............................. 22 27 CMS clinical review. 

92083 ..................... Visual field examination(s).SA050 pack, ophthalmology visit (no 

dilation).

NF .............................. 1 0 CMS clinical review. 

EL006 lane, screening 

(oph).

NF .............................. 32 37 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ029 Humphrey field 

analyzer.

NF .............................. 32 37 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ165 lens set, trial, full 

diameter, wframe.

NF .............................. 32 37 CMS clinical review. 

92235 ..................... Eye exam with 

photos.

ED008 camera, retinal 

(TRC 50IX, wICG, filters, 

motor drives).

NF .............................. 60 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49044 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EF030 table, motorized 

(for instrumentsequipment).

NF .............................. 60 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EL005 lane, exam (oph) NF .............................. 60 35 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L038A COMT/COT/RN/ 

CST.

NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 2 CMS clinical review. 

L039A Certified Retinal 

Angio.

NF Assist physician in 

performing procedure.

40 20 CMS clinical review. 

93015 ..................... Cardiovascular 

stress test.

EF023 table, exam .......... NF .............................. 58 46 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ078 cardiac monitor wtreadmill (12- 

lead PC-based 

ECG).

NF .............................. 58 46 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L051A RN ........................ NF Assist physician in 

performing procedure.

20 14 CMS clinical review. 

93017 ..................... Cardiovascular 

stress test.

EF023 table, exam .......... NF .............................. 58 46 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ078 cardiac monitor wtreadmill (12- 

lead PC-based 

ECG).

NF .............................. 58 46 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L051A RN ........................ NF Assist physician in 

performing procedure.

20 14 CMS clinical review. 

L051A RN ........................ NF Complete diagnostic forms, lab 

& X-ray requisitions.

0 4 CMS clinical review. 

93925 ..................... Lower extremity 

study.

ED011 computer system, 

record and 

verify.

NF .............................. 10 0 CMS clinical review. 

ED021 computer, desktop, w-monitor.NF .............................. 95 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED025 film processor, wet NF .............................. 10 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED034 video SVHS VCR 

(medical grade).

NF .............................. 95 0 CMS clinical review. 

EL016 room, ultrasound, 

vascular.

NF .............................. 95 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER067 x-ray view box, 4 

panel.

NF .............................. 10 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L054A Vascular Technologist.NF Provide pre-service education/ 

obtain consent.

3 2 CMS clinical review. 

L054A Vascular Technologist.NF Prepare room, 

equipment, supplies.

3 2 Standardized time 

input. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49045 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L054A Vascular Technologist.NF Prepare and position patient.3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Other Clinical Activity: Collate 

preliminary data, 

arrange images, 

archive.

10 7 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: Record 

patient history.

1 0 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: QA documentation.4 0 CMS clinical review. 

SK086 video tape, VHS .. NF .............................. 1 0 CMS clinical review. 

93926 ..................... Lower extremity 

study.

ED011 computer system, 

record and 

verify.

NF .............................. 10 0 CMS clinical review. 

ED021 computer, desktop, w-monitor.NF .............................. 59 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED025 film processor, wet NF .............................. 10 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED034 video SVHS VCR 

(medical grade).

NF .............................. 59 0 CMS clinical review. 

EL016 room, ultrasound, 

vascular.

NF .............................. 59 42 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER067 x-ray view box, 4 

panel.

NF .............................. 10 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L054A Vascular Technologist.NF Provide pre-service education/ 

obtain consent.

3 2 CMS clinical review. 

L054A Vascular Technologist.NF Prepare room, 

equipment, supplies.

3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Prepare and position patient.3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Other Clinical Activity: Collate 

preliminary data, 

arrange images, 

archive.

8 4 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: Record 

patient history.

1 0 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: QA documentation.4 0 CMS clinical review. 

SK086 video tape, VHS .. NF .............................. 1 0 CMS clinical review. 

93970 ..................... Extremity study .... ED011 computer system, 

record and 

verify.

NF .............................. 10 0 CMS clinical review. 

ED021 computer, desktop, w-monitor.NF .............................. 71 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED025 film processor, wet NF .............................. 10 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED034 video SVHS VCR 

(medical grade).

NF .............................. 71 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49046 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EL016 room, ultrasound, 

vascular.

NF .............................. 71 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ER067 x-ray view box, 4 

panel.

NF .............................. 10 7 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L054A Vascular Technologist.NF Provide pre-service education/ 

obtain consent.

3 2 CMS clinical review. 

L054A Vascular Technologist.NF Prepare room, 

equipment, supplies.

3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Prepare and position patient.3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Other Clinical Activity: Collate 

preliminary data, 

arrange images, 

archive.

10 7 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: Record 

patient history.

1 0 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: QA documentation.4 0 CMS clinical review. 

SK086 video tape, VHS .. NF .............................. 1 0 CMS clinical review. 

93971 ..................... Extremity study .... ED011 computer system, 

record and 

verify.

NF .............................. 10 0 CMS clinical review. 

ED021 computer, desktop, w-monitor.NF .............................. 45 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED025 film processor, wet NF .............................. 10 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

ED034 video SVHS VCR 

(medical grade).

NF .............................. 45 0 CMS clinical review. 

EL016 room, ultrasound, 

vascular.

NF .............................. 45 30 CMS clinical review. 

ER067 x-ray view box, 4 

panel.

NF .............................. 10 4 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L054A Vascular Technologist.NF Provide pre-service education/ 

obtain consent.

3 2 CMS clinical review. 

L054A Vascular Technologist.NF Prepare room, 

equipment, supplies.

3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Prepare and position patient.3 2 Standardized time 

input. 

L054A Vascular Technologist.NF Other Clinical Activity: Collate 

preliminary data, 

arrange images, 

archive.

6 4 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: Record 

patient history.

1 0 CMS clinical review. 

L054A Vascular Technologist.NF Other Clinical Activity: QA documentation.4 0 CMS clinical review. 

SB006 drape, non-sterile, 

sheet 40in x 

60in.

NF .............................. 2 1 CMS clinical review. 

SK086 video tape, VHS .. NF .............................. 1 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49047 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

95076 ..................... Ingest challenge 

ini 120 min.

EF023 table, exam .......... NF .............................. 141 133 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 141 133 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037D RN/LPN/MTA ....... NF Prepare testing 

doses.

15 7 CMS clinical review. 

95115 ..................... Immunotherapy 

one injection.

EF040 refrigerator, vaccine, commercial grade, walarm lock.NF .............................. 15 0 CMS clinical review. 

95117 ..................... Immunotherapy injections.EF041 x-ray machine, 

portable.

NF .............................. 17 0 CMS clinical review. 

95782 ..................... Polysom <6 yrs 4/ 

> paramtrs.

EF003 bedroom furniture 

(hospital bed, 

table, reclining 

chair).

NF .............................. 660 602 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Crib ...................... NF .............................. 660 0 CMS clinical review. 

EQ134 impedance meter, 

32-channel.

NF .............................. 660 602 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ272 sleep diagnostic 

system, attended (w-acquisition station, review master, 

computer).

NF .............................. 660 662 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Capnograph ......... NF .............................. 660 0 Duplicative. 

ER088 Infrared illuminator NF .............................. 660 602 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L047B REEGT ................ NF Provide pre-service education/ 

obtain consent.

5 3 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Set up and calibrate all monitoring and recording equipment (initial), including 

capnograph (for 

child).

6 5 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Measure and 

mark head and 

face. Apply and 

secure electrodes to head 

and face. Check 

impedances. 

Reapply electrodes as needed. (1.5 min per 

electrode for 

child, 1 min per 

electrode for 

adult).

30 20 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49048 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Apply recording 

devices for 

cardio-respiratory, leg 

movements, 

body positioning 

and snoring.

0 15 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Apply recording 

devices for 

cardio-respiratory, leg 

movements, 

body positioning, snoring 

and 

capnography.

20 0 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Daytime tech reviews and edits 

recording, marks 

artifacts, scores 

sleep stages, 

performs evaluation of physiological changes.

100 97 CMS clinical review. 

95783 ..................... Polysom <6 yrs 

cpap/bilvl.

EF003 bedroom furniture 

(hospital bed, 

table, reclining 

chair).

NF .............................. 660 647 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Crib ...................... NF .............................. 660 0 CMS clinical review. 

EQ134 impedance meter, 

32-channel.

NF .............................. 660 647 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ272 sleep diagnostic 

system, attended (w-acquisition station, review master, 

computer).

NF .............................. 660 707 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Capnograph ......... NF .............................. 660 0 Duplicative. 

ER088 Infrared illuminator NF .............................. 660 647 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L047B REEGT ................ NF Provide pre-service education/ 

obtain consent.

5 3 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Set up and calibrate all monitoring and recording equipment (initial), including 

capnograph (for 

child).

6 5 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49049 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Measure and 

mark head and 

face. Apply and 

secure electrodes to head 

and face. Check 

impedances. 

Reapply electrodes as needed. (1.5 min per 

electrode for 

child, 1 min per 

electrode for 

adult).

30 20 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Apply recording 

devices for 

cardio-respiratory, leg 

movements, 

body positioning 

and snoring.

0 15 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Apply recording 

devices for 

cardio-respiratory, leg 

movements, 

body positioning, snoring 

and 

capnography.

20 0 CMS clinical review. 

L047B REEGT ................ NF Other Clinical Activity—specify: 

Daytime tech reviews and edits 

recording, marks 

artifacts, scores 

sleep stages, 

performs evaluation of physiological changes.

100 97 CMS clinical review. 

95861 ..................... Muscle test 2 

limbs.

EF023 table, exam .......... NF .............................. 44 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ024 EMG–NCV–EP 

system, 8 channel.

NF .............................. 44 41 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037A Electrodiagnostic 

Technologist.

NF Assist physician in 

performing procedure.

19 29 Conforming to 

physician time. 

95863 ..................... Muscle test 3 

limbs.

EF023 table, exam .......... NF .............................. 58 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ024 EMG–NCV–EP 

system, 8 channel.

NF .............................. 58 52 Refined equipment 

time to reflect 

typical use exclusive to patient. 

95864 ..................... Muscle test 4 

limbs.

EF023 table, exam .......... NF .............................. 71 62 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49050 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ024 EMG–NCV–EP 

system, 8 channel.

NF .............................. 71 62 Refined equipment 

time to reflect 

typical use exclusive to patient. 

95868 ..................... Muscle test cran 

nerve bilat.

EF023 table, exam .......... NF .............................. 35 32 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ024 EMG–NCV–EP 

system, 8 channel.

NF .............................. 35 32 Refined equipment 

time to reflect 

typical use exclusive to patient. 

95907 ..................... Motor&/sens 1–2 

nrv cndj tst.

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 4 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 4 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 12 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95908 ..................... Motor&/sens 3–4 

nrv cndj tst.

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 8 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 8 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 24 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95909 ..................... Motor&/sens 5–6 

nrv cndj tst.

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 12 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 12 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 36 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95910 ..................... Motor&sens 7–8 

nrv cndj test.

L037A Electrodiagnostic 

Technologist.

NF .............................. 50 40 Conforming to 

physician time. 

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 16 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 16 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 48 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95911 ..................... Motor&sen 9–10 

nrv cndj test.

L037A Electrodiagnostic 

Technologist.

NF .............................. 64 50 Conforming to 

physician time. 

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 20 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 20 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 60 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95912 ..................... Motor&sen 11–12 

nrv cnd test.

L037A Electrodiagnostic 

Technologist.

NF .............................. 77 60 Conforming to 

physician time. 

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 24 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 24 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 72 0 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49051 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95913 ..................... Motor&sens 13/> 

nrv cnd test.

L037A Electrodiagnostic 

Technologist.

NF .............................. 87 70 Conforming to 

physician time. 

SG051 gauze, non-sterile 

4in x 4in.

NF .............................. 0 26 CMS clinical review. 

SG055 gauze, sterile 4in x 

4in.

NF .............................. 26 0 CMS clinical review. 

SG079 tape, surgical 

paper 1in 

(Micropore).

NF .............................. 78 0 CMS clinical review. 

SJ022 electrode skin 

prep gel 

(NuPrep).

NF .............................. 100 0 CMS clinical review. 

95921 ..................... Autonomic nrv 

parasym inervj.

EF032 table, tilt (wtrendelenberg).NF .............................. 64 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ051 arterial tonometry 

acquisition system (WR 

Testworks).

NF .............................. 64 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ052 arterial tonometry 

monitor (Colin 

Pilot).

NF .............................. 64 55 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037A Electrodiagnostic 

Technologist.

NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

3 0 CMS clinical review. 

L037A Electrodiagnostic 

Technologist.

NF Obtain vital signs 3 0 CMS clinical review. 

L037A Electrodiagnostic 

Technologist.

NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 2 CMS clinical review. 

95922 ..................... Autonomic nrv 

adrenrg inervj.

EF032 table, tilt (wtrendelenberg).NF .............................. 79 70 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ051 arterial tonometry 

acquisition system (WR 

Testworks).

NF .............................. 79 70 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ052 arterial tonometry 

monitor (Colin 

Pilot).

NF .............................. 79 70 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037A Electrodiagnostic 

Technologist.

NF Greet patient, provide gowning, 

assure appropriate medical 

records are 

available.

3 0 CMS clinical review. 

L037A Electrodiagnostic 

Technologist.

NF Obtain vital signs 3 0 CMS clinical review. 

L037A Electrodiagnostic 

Technologist.

NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 2 CMS clinical review. 

95923 ..................... Autonomic nrv 

syst funj test.

EQ035 QSART acquisition 

system (QSweat).

NF .............................. 74 61 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
49052 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ124 stimulator, constant current, wstimulating and 

grounding electrodes (Grass 

Telefactor).

NF .............................. 74 61 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ171 light, infra-red, 

ceiling mount.

NF .............................. 74 61 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037A Electrodiagnostic 

Technologist.

NF Assist physician in 

performing procedure.

55 45 CMS clinical review. 

L037A Electrodiagnostic 

Technologist.

NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 2 CMS clinical review. 

SJ020 electrode conductive gel.NF .............................. 5 0 CMS clinical review. 

95924 ..................... Ans parasymp & 

symp w/tilt.

EF032 table, tilt (wtrendelenberg).NF .............................. 79 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ051 arterial tonometry 

acquisition system (WR 

Testworks).

NF .............................. 79 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ052 arterial tonometry 

monitor (Colin 

Pilot).

NF .............................. 79 76 Refined equipment 

time to reflect 

typical use exclusive to patient. 

L037A Electrodiagnostic 

Technologist.

NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

5 2 CMS clinical review. 

96920 ..................... Laser tx skin < 

250 sq cm.

EF031 table, power ......... NF .............................. 20 26 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ161 laser, excimer ...... NF .............................. 20 26 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 17 26 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Annual Laser 

Service Package.

NF .............................. 1 0 Included in equipment cost per 

minute calculation. 

L037D RN/LPN/MTA ....... NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

3 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean room/equipment by physician staff.3 2 CMS clinical review. 

SF028 laser tip (single 

use).

NF .............................. 1 0 CMS clinical review. 

SJ029 ice pack, instant ... NF .............................. 4 1 CMS Code correction. 

96921 ..................... Laser tx skin 250– 

500 sq cm.

EF031 table, power ......... NF .............................. 23 29 Refined equipment 

time to reflect 

typical use exclusive to patient. 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49053 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

EQ161 laser, excimer ...... NF .............................. 23 29 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 23 29 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Annual Laser 

Service Package.

NF .............................. 1 0 Included in equipment cost per 

minute calculation. 

L037D RN/LPN/MTA ....... NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

3 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean room/equipment by physician staff.3 2 CMS clinical review. 

SF028 laser tip (single 

use).

NF .............................. 1 0 CMS clinical review. 

SJ029 ice pack, instant ... NF .............................. 4 2 CMS Code correction. 

96922 ..................... Laser tx skin >500 

sq cm.

EF031 table, power ......... NF .............................. 33 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ161 laser, excimer ...... NF .............................. 33 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ168 light, exam ........... NF .............................. 30 39 Refined equipment 

time to reflect 

typical use exclusive to patient. 

Annual Laser 

Service Package.

NF .............................. 1 0 Included in equipment cost per 

minute calculation. 

L037D RN/LPN/MTA ....... NF Monitor pt. following service/ 

check tubes, 

monitors, drains.

3 1 CMS clinical review. 

L037D RN/LPN/MTA ....... NF Clean room/equipment by physician staff.3 2 CMS clinical review. 

SF028 laser tip (single 

use).

NF .............................. 1 0 CMS clinical review. 

97150 ..................... Group therapeutic 

procedures.

EQ248 ultrasonic biometry, pachymeter.NF .............................. 10 5 Refined equipment 

time to reflect 

typical use exclusive to patient. 

EQ269 blood pressure 

monitor, ambulatory, w-battery 

charger.

NF .............................. 1 0 CMS clinical review. 

SA007 kit, cooking activity 

ingredients 

(mac-cheese).

NF .............................. 1 0 CMS clinical review. 

99495 ..................... Trans care mgmt 

14 day disch.

L042A RN/LPN ................ F Communication 

(with patient, 

family members, 

guardian or 

caretaker, surrogate decision 

makers, and/or 

other professionals) regarding aspects of 

care, etc..

0 45 CMS clinical review. 


ehiers on DSK2VPTVN1PROD with RULES_2
49054 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 74—CPT CODES WITH REFINED DIRECT PE RECOMMENDATIONS FOR CY 2013 INTERIM CODES—Continued 

CPT 

Code 

CPT Code 

description 

CMS 

Code 

CMS Code 

description NonFac/Fac Labor activity (if applicable) 

RUC recommendation 

or current value 

(min or qty) 

CMS refinement 

(min or qty) 

Comment 

99496 ..................... Trans care mgmt 

7 day disch.

L042A RN/LPN ................ NF Communication 

(with patient, 

family members, 

guardian or 

caretaker, surrogate decision 

makers, and/or 

other professionals) regarding aspects of 

care, etc..

60 70 CMS clinical review. 

L042A RN/LPN ................ F Communication 

(with patient, 

family members, 

guardian or 

caretaker, surrogate decision 

makers, and/or 

other professionals) regarding aspects of 

care, etc..

0 70 CMS clinical review. 

17. On page 69138, 

a. Top two thirds of the page, first 

column, first full paragraph, line 1, the 

phrase ‘‘The CY 2013 PFS CF is 

$25.0008’’ is corrected to read ‘‘The CY 

2013 PFS CF is $25.0070.’’ 

b. Third column, first full paragraph, 

line 19, the phrase CF to be $25.0008’’ 

is corrected to read ‘‘CF to be $25.0070.’’ 

c. Lower half of the page, in Table 87: 

Calculation of the CY 2013 PFS CF, the 

list entry 

CY 2013 Conversion Factor .................................................................................................................................... ........................ $25.0008 

is corrected to read as follows: 

CY 2013 Conversion Factor .................................................................................................................................... ........................ $25.0070 

18. On page 69139, top quarter of the 

page, in Table 88: Calculation of the CY 

2013 Anesthesia CF, the list entry 

CY 2013 Anesthesia Factor .................................................................................................................................... ........................ $15.93 

is corrected to read as follows: 

CY 2013 Anesthesia Factor .................................................................................................................................... ........................ $16.1236 

19. On page 69145, second column, 

first partial paragraph, lines 20 and 21, 

the phrase that reads ‘‘pharmacy for use 

upon a physician’s order’’ is corrected 

to read ‘‘pharmacy for use upon a valid 

prescription.’’ 

20. On page 69212, second column, 

first full paragraph, lines 5–8, the phrase 

‘‘Measure 190: Referral for Otologic 

Evaluation for Patients with Acute or 

Chronic Dizziness’’ is corrected to read 

‘‘Measure 190: Referral for Otologic 

Evaluation for Patients with a History of 

Sudden or Rapidly Progressive Hearing 

Loss.’’ 

21. On page 69237, in Table 95: 

Individual Quality Measures for the 

Physician Quality Reporting System 

Proposed to be Available for Reporting 

via Claims, Registry, EHR, or GRPO Web 

Interface Beginning in 2013 or 2014*, 

Measures #189 and #190 are deleted. 

22. On page 69267, after Table 95: 

Individual Quality Measures for the 

Physician Quality Reporting System 

Proposed to be Available for Reporting 

via Claims, Registry, EHR, or GRPO Web 

Interface Beginning in 2013 or 2014*, 

the following note is added: 

*Measures that can be reported using 

the GPRO web interface. 

†These measures can only be reported 

by participants using the GPRO. They 

are not available for reporting for 

individual Eligible Professionals using 

this reporting method. 

¥ Titles and descriptions in this table 

are aligned with 2013 Physician Quality 

Reporting System Claims and Qualified 

Registry measure titles and descriptions, 

and may differ from existing measures 

in other programs. Please reference the 

National Quality Forum (NQF) and 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49055 

Physician Quality Reporting System 

numbers for clarification. 

◊Measures to be deleted in 2014. 

‡Measures to be added in 2013. 

ÆMeasures to be added in 2014. 

23. On page 69269, in Table 96: PQRS 

Quality Measures Available for 

Reporting for Group Practices Using the 

GPRO Web Interface for 2013 and 

Beyond, in the Measure and Title 

description for NQF/PQRS 0097/46 the 

phrase that reads ‘‘seen within 60 days 

following discharge’’ is corrected to read 

‘‘seen within 30 days following 

discharge.’’ 

24. On page 69277, in Table 108: HIV/ 

AIDS Measures Group, the following 

measures: HIV/AIDS Measures Group: 

PQRS Measure #206 (‘‘HIV/AIDS: 

Screening for High Risk Sexual 

Behaviors’’) and #207 (‘‘HIV/AIDS: 

Screening for Injection Drug Use’’) are 

deleted. 

25. On page 69300, 

a. Third column, line 22–23, the 

phrase ‘‘a deadline of February 28, 2013 

to request an informal review’’ is 

corrected to read ‘‘a deadline of 90 days 

following the receipt of the feedback 

reports to request an informal review.’’ 

b. Lines 27–28, the phrase ‘‘a deadline 

of February 28, 2014 to request an 

informal review’’ is corrected to read ‘‘a 

deadline of 90 days following the 

receipt of the feedback reports to request 

an informal review.’’ 

26. On pages 69344 through 69345, 

we are correcting Table 134: CY 2013 

PFS Final Rule with Comment Period 

Estimated Impact on Total Allowed 

Charges by Specialty* and the first 

footnote (*) that reads: *Table 83 shows 

only the final payment policy impact on 

PFS services. We note that these 

impacts do not include the effects of the 

negative January 2013 conversion factor 

change under current law.’’ to read as 

follows: 

TABLE 134—CY 2013 FINAL RULE WITH COMMENT PERIOD ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY

SPECIALTY * 

[Estimated impact for RVU changes *] 

Specialty 

Allowed 

charges 

(mil) 

Impact of work 

and MP RVU 

changes 

% 

Impact of PE 

RVU changes 

% 

Combined 

impact 

% 

(A) (B) (C) (D) (E) 

TOTAL ............................................................................................................. $86,384 0 0 0

01–ALLERGY/IMMUNOLOGY ........................................................................ 200 0 2 2 

02–ANESTHESIOLOGY .................................................................................. 1,817 0 2 2 

03–CARDIAC SURGERY ................................................................................ 369 0 ¥1 ¥1 

04–CARDIOLOGY ........................................................................................... 6,733 ¥1 ¥2 ¥2 

05–COLON AND RECTAL SURGERY ........................................................... 153 0 2 2 

06–CRITICAL CARE ....................................................................................... 263 0 1 1 

07–DERMATOLOGY ....................................................................................... 3,024 0 0 0 

08–EMERGENCY MEDICINE ......................................................................... 2,839 0 0 0 

09–ENDOCRINOLOGY ................................................................................... 437 0 1 1 

10–FAMILY PRACTICE ................................................................................... 5,943 2 5 7 

11–GASTROENTEROLOGY ........................................................................... 1,896 0 0 0 

12–GENERAL PRACTICE .............................................................................. 587 0 1 1 

13–GENERAL SURGERY ............................................................................... 2,283 0 1 1 

14–GERIATRICS ............................................................................................. 220 1 3 5 

15–HAND SURGERY ...................................................................................... 135 0 1 1 

16–HEMATOLOGY/ONCOLOGY .................................................................... 1,909 0 2 2 

17–INFECTIOUS DISEASE ............................................................................ 629 0 1 1 

18–INTERNAL MEDICINE .............................................................................. 11,163 1 3 5 

19–INTERVENTIONAL PAIN MGMT .............................................................. 538 0 1 1 

20–INTERVENTIONAL RADIOLOGY ............................................................. 204 0 ¥2 ¥3 

21–MULTISPECIALTY CLINIC/OTHER PHY ................................................. 81 0 0 0 

22–NEPHROLOGY .......................................................................................... 2,080 0 0 0 

23–NEUROLOGY ............................................................................................ 1,604 ¥2 ¥5 ¥7 

24–NEUROSURGERY .................................................................................... 687 0 0 0 

25–NUCLEAR MEDICINE ............................................................................... 49 0 ¥2 ¥3 

27–OBSTETRICS/GYNECOLOGY .................................................................. 704 0 0 0 

28–OPHTHALMOLOGY .................................................................................. 5,645 ¥3 0 ¥3 

29–ORTHOPEDIC SURGERY ........................................................................ 3,643 0 0 0 

30–OTOLARNGOLOGY .................................................................................. 1,076 0 2 2 

31–PATHOLOGY ............................................................................................. 1,210 0 ¥6 ¥6 

32–PEDIATRICS ............................................................................................. 65 1 3 3 

33–PHYSICAL MEDICINE .............................................................................. 999 ¥1 ¥3 ¥4 

34–PLASTIC SURGERY ................................................................................. 356 0 1 1 

35–PSYCHIATRY ............................................................................................ 1,170 ¥1 3 2 

36–PULMONARY DISEASE ........................................................................... 1,703 0 1 1 

37–RADIATION ONCOLOGY ......................................................................... 1,988 0 ¥7 ¥7 

38–RADIOLOGY .............................................................................................. 4,818 0 ¥3 ¥3 

39–RHEUMATOLOGY .................................................................................... 548 0 0 0 

40–THORACIC SURGERY ............................................................................. 343 0 ¥1 ¥1 

41–UROLOGY ................................................................................................. 1,918 0 ¥1 ¥2 

42–VASCULAR SURGERY ............................................................................. 888 0 ¥2 ¥2 

43–AUDIOLOGIST .......................................................................................... 57 0 ¥4 ¥4 

44–CHIROPRACTOR ...................................................................................... 746 0 1 1 

45–CLINICAL PSYCHOLOGIST ..................................................................... 575 1 ¥3 ¥2 

46–CLINICAL SOCIAL WORKER ................................................................... 406 1 ¥3 ¥2 


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49056 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 

TABLE 134—CY 2013 FINAL RULE WITH COMMENT PERIOD ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY

SPECIALTY *—Continued 

[Estimated impact for RVU changes *] 

Specialty 

Allowed 

charges 

(mil) 

Impact of work 

and MP RVU 

changes 

% 

Impact of PE 

RVU changes 

% 

Combined 

impact 

% 

(A) (B) (C) (D) (E) 

47–DIAGNOSTIC TESTING FACILITY ........................................................... 888 0 ¥7 ¥7 

48–INDEPENDENT LABORATORY ................................................................ 1,073 0 ¥14 ¥14 

49–NURSE ANES/ANES ASST ...................................................................... 1,008 0 2 2 

50–NURSE PRACTITIONER ........................................................................... 1,623 1 3 4 

51–OPTOMETRY ............................................................................................ 1,061 ¥1 1 1 

52–ORAL/MAXILLOFACIAL SURGERY ......................................................... 45 0 1 1 

53–PHYSICAL/OCCUPATIONAL THERAPY .................................................. 2,636 0 4 4 

54–PHYSICIAN ASSISTANT .......................................................................... 1,229 1 2 3 

55–PODIATRY ................................................................................................. 1,925 0 2 2 

56–PORTABLE X–RAY SUPPLIER ................................................................ 106 0 5 5 

57–RADIATION THERAPY CENTERS ........................................................... 72 0 ¥9 ¥9 

98–OTHER ...................................................................................................... 19 0 1 1 

* Table 134 shows only the final payment policy impact on PFS services. We note that these impacts do not include the effects of the negative 

January 2013 conversion factor change under current law. 

27. On pages 69347 through 69348, 

we are correcting Table 135: CY 2013 

PFS Final Rule with Comment Period 

Estimated Impact on Total Allowed 

Charges by Specialty by Selected 

Policy* and the text in the first footnote 

(*) for Table 135 that reads ‘‘*Table 135 

shows only the proposed payment 

policy impact on PFS services. We note 

that these impacts do not include the 

effects of the negative January 2013 

conversion factor change under current 

law.’’ to read as follows: 

TABLE 135—CY 2013 PFS FINAL RULE WITH COMMENT PERIOD ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY

SPECIALTY BY SELECTED POLICY* ESTIMATED IMPACT FOR RVU CHANGES* 

Specialty 

Allowed 

charges 

(mil) 

Impact of end 

of PPIS 

transition 

% 

New, 

revised, 

potentially 

misvalued 

codes, MPPR, 

new utilization 

and other 

factors 

% 

Updated 

equipment 

interest rate 

assumption 

% 

Transitional 

care 

management 

% 

Input changes 

for certain 

radiation 

therapy 

procedures 

% 

Total 

(cumulative 

impact) 

% 

(A) (B) (C) (D) (E) (F) (G) (H) 

TOTAL ........................................................... 86,384 0 0 0 0 0 0 

01–ALLERGY/IMMUNOLOGY ...................... 200 0 0 2 0 0 2 

02–ANESTHESIOLOGY ............................... 1,817 1 1 0 0 0 2 

03–CARDIAC SURGERY ............................. 369 ¥1 0 0 0 0 ¥1 

04–CARDIOLOGY ........................................ 6,733 ¥2 0 0 ¥1 0 ¥2 

05–COLON AND RECTAL SURGERY ........ 153 1 0 0 0 0 2 

06–CRITICAL CARE ..................................... 263 0 0 0 0 0 1 

07–DERMATOLOGY .................................... 3,024 0 0 1 ¥1 0 0 

08–EMERGENCY MEDICINE ...................... 2,839 0 0 0 0 0 0 

09–ENDOCRINOLOGY ................................ 437 1 1 0 ¥1 0 1 

10–FAMILY PRACTICE ................................ 5,943 1 1 0 4 0 7 

11–GASTROENTEROLOGY ........................ 1,896 0 0 0 0 0 0 

12–GENERAL PRACTICE ............................ 587 1 0 0 ¥1 0 1 

13–GENERAL SURGERY ............................ 2,283 1 0 0 0 0 1 

14–GERIATRICS .......................................... 220 1 1 0 2 0 5 

15–HAND SURGERY ................................... 135 1 0 0 ¥1 0 1 

16–HEMATOLOGY/ONCOLOGY ................. 1,909 ¥1 3 1 ¥1 0 2 

17–INFECTIOUS DISEASE .......................... 629 1 1 0 0 0 1 

18–INTERNAL MEDICINE ............................ 11,163 1 1 0 3 0 5 

19–INTERVENTIONAL PAIN MGMT ........... 538 1 0 0 ¥1 0 1 

20–INTERVENTIONAL RADIOLOGY ........... 204 ¥2 0 0 0 0 ¥3 

21–MULTISPECIALTY CLINIC/OTHER PHY 81 0 0 0 0 0 0 

22–NEPHROLOGY ....................................... 2,080 0 0 0 0 0 0 

23–NEUROLOGY ......................................... 1,604 1 ¥8 0 0 0 ¥7 

24–NEUROSURGERY .................................. 687 0 0 0 0 0 0 

25–NUCLEAR MEDICINE ............................ 49 ¥2 0 ¥1 0 0 ¥3 

27–OBSTETRICS/GYNECOLOGY ............... 704 0 0 0 ¥1 0 0 

28–OPHTHALMOLOGY ................................ 5,645 2 ¥4 0 0 0 ¥3 

29–ORTHOPEDIC SURGERY ..................... 3,643 1 0 0 0 0 0 

30–OTOLARNGOLOGY ............................... 1,076 1 1 1 ¥1 0 2 

31–PATHOLOGY .......................................... 1,210 ¥1 ¥5 0 0 0 ¥6 

32–PEDIATRICS ........................................... 65 1 0 0 3 0 3 

33–PHYSICAL MEDICINE ............................ 999 1 ¥5 0 ¥1 0 ¥4 


ehiers on DSK2VPTVN1PROD with RULES_2
Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49057 

TABLE 135—CY 2013 PFS FINAL RULE WITH COMMENT PERIOD ESTIMATED IMPACT ON TOTAL ALLOWED CHARGES BY

SPECIALTY BY SELECTED POLICY* ESTIMATED IMPACT FOR RVU CHANGES*—Continued 

Specialty 

Allowed 

charges 

(mil) 

Impact of end 

of PPIS 

transition 

% 

New, 

revised, 

potentially 

misvalued 

codes, MPPR, 

new utilization 

and other 

factors 

% 

Updated 

equipment 

interest rate 

assumption 

% 

Transitional care management 

% 

Input changes 

for certain 

radiation 

therapy 

procedures 

% 

Total 

(cumulative 

impact) 

% 

(A) (B) (C) (D) (E) (F) (G) (H) 

34–PLASTIC SURGERY .............................. $356 1 0 0 0 0 1 

35–PSYCHIATRY ......................................... 1,170 0 2 0 ¥1 0 2 

36–PULMONARY DISEASE ......................... 1,703 0 1 0 ¥1 0 1 

37–RADIATION ONCOLOGY ....................... 1,988 ¥4 2 ¥3 ¥1 ¥1 ¥7 

38–RADIOLOGY ........................................... 4,818 ¥2 0 ¥1 0 0 ¥3 

39–RHEUMATOLOGY .................................. 548 0 1 0 ¥1 0 0 

40–THORACIC SURGERY ........................... 343 ¥1 0 0 0 0 ¥1 

41–UROLOGY .............................................. 1,918 ¥2 0 0 ¥1 0 ¥2 

42–VASCULAR SURGERY .......................... 888 ¥1 ¥1 0 0 0 ¥2 

43–AUDIOLOGIST ........................................ 57 ¥3 0 0 0 0 ¥4 

44–CHIROPRACTOR ................................... 746 1 0 0 0 0 1 

45–CLINICAL PSYCHOLOGIST ................... 575 ¥2 1 0 0 0 ¥2 

46–CLINICAL SOCIAL WORKER ................ 406 ¥2 0 0 0 0 ¥2 

47–DIAGNOSTIC TESTING FACILITY ........ 888 ¥5 0 ¥2 ¥1 0 ¥7 

48–INDEPENDENT LABORATORY ............. 1,073 ¥2 ¥12 1 ¥1 0 ¥14 

49–NURSE ANES/ANES ASST ................... 1,008 2 0 0 0 0 2 

50–NURSE PRACTITIONER ........................ 1,623 1 1 0 2 0 4 

51–OPTOMETRY .......................................... 1,061 2 ¥1 0 0 0 1 

52–ORAL/MAXILLOFACIAL SURGERY ...... 45 1 0 1 ¥1 0 1 

53–PHYSICAL/OCCUPATIONAL THERAPY 2,636 2 2 0 0 0 4 

54–PHYSICIAN ASSISTANT ........................ 1,229 1 0 0 2 0 3 

55–PODIATRY .............................................. 1,925 2 0 1 ¥1 0 2 

56–PORTABLE X–RAY SUPPLIER ............. 106 1 4 1 ¥1 0 5 

57–RADIATION THERAPY CENTERS ........ 72 ¥5 4 ¥5 ¥1 ¥1 ¥9 

98–OTHER .................................................... 19 1 0 0 0 0 1 

‘‘*Table 135 shows only the final payment policy impact on PFS services. We note that these impacts do not include the effects of the negative January 2013 conversion factor change under current law.’’ 

28. On pages 69350 through 69351, 

we are correcting Table 136 Impact of 

Final Rule with Comment Period on CY 

2013 Payment for Selected Procedures* 

to read as follows: 


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49058 Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 


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Federal Register / Vol. 78, No. 155 / Monday, August 12, 2013 / Rules and Regulations 49059 

29. On page 69351, 

a. Footnote 3 ‘‘Payments based on the 

2012 conversion factor of 34.0376, 

adjusted to 34.0066 to include the 

budget neutrality adjustment’’ is 

corrected to read ‘‘Payments based on 

the 2012 conversion factor of 34.0376, 

adjusted to 34.0230 to include the 

budget neutrality adjustment.’’ 

b. Footnote 4 for Table 136 ‘‘Payments 

based on the 2013 conversion factor of 

25.0008, which includes the budget 

neutrality adjustment’’ is corrected to 

read ‘‘Payments based on the 2013 

conversion factor of 25.0070, which 

includes the budget neutrality 

adjustment.’’ 

(Catalog of Federal Domestic Assistance 

Program No. 93.773, Medicare—Hospital 

Insurance; and Program No. 93.774, 

Medicare—Supplementary Medical 

Insurance Program) 

Dated: August 2, 2013. 

Jennifer M. Cannistra, 

Executive Secretary to the Department, 

Department of Health and Human Services. 

[FR Doc. 2013–19378 Filed 8–9–13; 8:45 am] 

BILLING CODE 4120–01–P 


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