67798 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

DEPARTMENT OF HEALTH AND

HUMAN SERVICES

Health Care Financing Administration

42 CFR Part 419

[HCFA–1005–IFC]

RIN 0938–A156

Medicare Program; Prospective

Payment System for Hospital

Outpatient Services

AGENCY: Health Care Financing

Administration (HCFA), HHS.

ACTION: Interim final rule with comment

period.

SUMMARY: This interim final rule with

comment period provides for the annual

update to the Medicare hospital

outpatient prospective payment system

conversion factor that is used to

calculate the payment amount for each

payment group, effective January 1,

2001. It also updates the wage index

values and incorporates the year 2001

changes in the procedure codes that are

used to make payments under this

system. In this rule, we are also

responding to public comments

received on those portions of the April

7, 2000 final rule with comment period

(which established the hospital

outpatient prospective payment system)

that implemented related provisions of

the Balanced Budget Refinement Act

(BBRA) of 1999. In addition, we are

responding to public comments on the

August 3, 2000 interim final rule with

comment period that modified the April

7, 2000 final rule with comment period

by revising the criteria used to define

new or innovative medical devices,

drugs, and biologicals eligible for

transitional pass-through payments and

correcting the criteria for grandfathering

provider-based Federally Qualified

Health Centers (FQHC) into the

prospective payment system.

DATES:

Effective Date: These regulations are

effective on January 1, 2001.

Comment Period: We will consider

comments if we receive them at the

appropriate address, as provided below,

no later than 5 p.m. on January 12, 2001.

ADDRESSES: Mail written comments (1

original and 3 copies) to the following

address:

Health Care Financing Administration,

Department of Health and Human

Services, Attention: HCFA–1005–IFC,

P.O. Box 8013, Baltimore, MD 21244–

8013.

To ensure that mailed comments are

received in time for us to consider them,

please allow for possible delays in

delivering them.

If you prefer, you may deliver your

written comments (1 original and 3

copies) to one of the following

addresses:

Room 443–G, Hubert H. Humphrey

Building, 200 Independence Avenue,

SW., Washington, DC 20201, or

Room C5–14–03, 7500 Security

Boulevard, Baltimore, MD 21244–

1850.

Comments mailed to the above

addresses may be delayed and received

too late for us to consider them. Because

of staff and resource limitations, we

cannot accept comments by facsimile

(FAX) transmission. In commenting,

please refer to file code HCFA–1005–

IFC. of the received timely will be

available for public inspection as they

are received, generally beginning

approximately 3 weeks after publication

of a document, in Room 443–G of the

Department’s office at 200

Independence Avenue, SW.,

Washington, DC, on Monday through

Friday of each week from 8:30 to 5 p.m.

(phone: (202) 690–7890).

FOR FURTHER INFORMATION CONTACT:

Janet Wellham (410) 786–4510, Chuck

Braver, (410) 786–6719, or Jana Petze

(410) 786–9374, (for general

information).

Kity Ahern, (410) 786–4515 (for

information related to ambulatory

payment classification groups and

transitional pass-through payments

related to drugs and biologicals).

Majorie Baldo, (410) 786–4617 or Barry

Levi, (410) 786–4529 (for information

related to transitional pass-through

payments for medical devices).

George Morey (410) 786–4653 (for

information related to the criteria for

grandfathering provider-based FQHCs

into the prospective payment system).

SUPPLEMENTARY INFORMATION:

Availability of Copies and Electronic

Access

Copies: To order copies of the Federal

Register containing this document, send

your request to: New Orders,

Superintendent of Documents, P.O. Box

371954, Pittsburgh, PA 15250–7954.

Specify the date of the issue requested

and enclose a check or money order

payable to the Superintendent of

Documents, or enclose your Visa or

Master Card number and expiration

date. Credit card orders can also be

placed by calling the order desk at (202)

512–1800 or by faxing to (202) 512–

2250. The cost for each copy is $8. As

an alternative, you can view and

photocopy the Federal Register

document at most libraries designated

as Federal Depository Libraries and at

many other public and academic

libraries throughout the country that

receive the Federal Register.

This Federal Register document is

also available from the Federal Register

online database through GPO Access, a

service of the U.S. Government Printing

Office. The Website address is http://

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

To assist readers in referencing

sections contained in this document, we

are providing the following table of

contents:

Table of Contents

I. Background

A. General Summary of April 7, 2000 Final

Rule With Comment Period that

Implemented Amendments Enacted by

the Balanced Budget Act of 1997 and the

Balanced Budget Refinement Act of 1999

B. June 30, 2000 Notice of Delay of Effective

Date for the April 7, 2000 Final Rule

with Comment Period

C. August 3, 2000 Interim Final Rule with

Comment Period

D. Summary of This Interim Final Rule with

Comment Period

II. Analysis of, and Responses to, Public

Comments on the BBRA 1999 Provisions and

the August 3, 2000 Interim Final Rule with

Comment Period

A. April 7, 2000 BBRA 1999 Provisions

1. Outlier Adjustment

2. Transitional Pass-Through for

Additional Costs of Innovative Medical

Devices, Drugs, and Biologicals

a. Definition of a device

b. Eligibility criteria

c. Investigational device exemption (IDE)

device

d. Removing cost of predicate item

e. Excluded costs

f. Effect on conversion factor

g. Cost significance tests

h. Brand-specific versus categorization

approaches

i. Issues pertaining to specific items

j. Pass-through applications process

k. Payment for pass-through items

l. Focus medical review

3. Budget Neutrality Applied to New

Adjustments

4. Limitation on Judicial Review

5. Inclusion in the Hospital Outpatient

Prospective Payment System of Certain

Implantable Items

6. Payment Weights Based on Median or

Mean Hospital Costs

7. Limitation on Variation of Costs of

Services Classified Within a Group

8. Annual Review of the Components of

the Hospital Outpatient Prospective

Payment System

9. Copayment Amounts Not Affected by

Pass-Throughs

10. Extension of Cost Reductions

11. Clarification of Congressional Intent

Regarding Base Amounts Used in

Determining the Hospital Outpatient

Prospective Payment System

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67799

12. Transitional Corridors for Application

of Outpatient Prospective Payment

System

a. Interim payment versus final settlement

b. Payment-to-cost ratios

c. Cost-to-charge ratios

d. Interim payments limited to 85 percent

of the estimated transitional corridor

payment

e. Providers having more than one 1996

cost report

f. Providers having no 1996 cost report

g. Prospective payment system delay and

transitional corridor payments

h. Rural hold-harmless provision

i. Covered charges

j. Cancer hospitals and transitional corridor

payments

k. Teaching hospitals and transitional

corridor payments

13. Limitation on Coinsurance for a

Procedure

14. Reclassification of Certain Hospitals

B. August 3, 2000 Interim Final Rule With

Comment Period

1. Transitional Pass-Through Provisions

a. ‘‘Not insignificant’’ cost criteria

b. Definition of medical device

2. Revision to Grandfather Provision for

Certain FQHCs and ‘‘Look-Alikes’’

3. Clarification of Notice of Beneficiary

Cost-Sharing Liability

4. Clarification of Protocols for Off-Campus

Departments

5. Typographical Errors in the ProviderBased Regulations

III. Provisions of This Interim Final Rule

With Comment Period

A. Changes Relating to the BBRA 1999 Public

Comments

B. Annual Updates to Components of the

Hospital Outpatient Prospective Payment

System

1. APC Groups

a. New codes

b. Deleted codes

c. Revisions to correct errors or

inconsistencies

d. Device-related codes

e. Inpatient codes moved to the outpatient

setting

f. ‘‘Two-times’’ rule

g. Inpatient codes moved to outpatient and

affected by device

h. Newly covered codes

i. Pass-through requests for drugs

2. Inpatient Procedures List Update

3. Wage Index Adjustment

4. Conversion Factor Update

IV. Waiver of Notice of Proposed Rulemaking

V. Collection of Information Requirements

VI. Regulatory Impact

A. General

B. Analysis for Changes in this Interim

Final Rule with Comment Period

C. Federalism

D. Executive Order 12866 and 5 U.S.C.

804(2) Regulation Text

Addenda

Note to the Addenda

Addendum A—List of Hospital Outpatient

Ambulatory Payment Classifications

with Status Indicators, Relative Weights,

Payment Rates, and Coinsurance

Amounts—Calendar Year 2001

Addendum B—Hospital Outpatient

Department (HOPD) Payment Status by

HCPCS Code and Related Information—

Calendar Year 2001

Addendum C—[Reserved]

Addendum D—Status Indicators: How

Various Services Are Treated under the

Hospital Outpatient Prospective Payment

System

Addendum E—CPT Codes Which Will Be

Paid Only As Inpatient Procedures—

Calendar Year 2001

Addendum F—Wage Index for Urban Areas

Addendum G—Wage Index for Rural Areas

Addendum H—Wage Index for Hospitals

That Are Reclassified

Alphabetical List of Acronyms Appearing in

the Interim Final Rule With Comment Period

APC Ambulatory payment classification

APG Ambulatory patient group

ASC Ambulatory surgical center

AWP Average wholesale price

BBA 1997 Balanced Budget Act of 1997

BBRA 1999 Balanced Budget Refinement

Act of 1999

CAT Computerized axial tomography

CCI [HCFA’s] Correct Coding Initiative

CCR Cost center specific cost-to-charge ratio

CMHC Community mental health center

CORF Comprehensive outpatient

rehabilitation facility

CPI Consumer Price Index

CPT [Physicians’] Current Procedural

Terminology, 4th Edition, 2000,

copyrighted by the American Medical

Association

DME Durable medical equipment

DMEPOS DME, prosthetics (which include

prosthetic devices and implants)

orthotics, and supplies

DRG Diagnosis-related group

FDA Food and Drug Administration

FQHC Federally qualified health center

HCPCS HCFA Common Procedure Coding

System

HHA Home health agency

ICD–9–CM International Classification of

Diseases, Ninth Edition, Clinical

Modification

IME Indirect medical education

JCAHO Joint Commission on Accreditation

of Healthcare Organizations

MRI Magnetic resonance imaging

MSA Metropolitan statistical area

NECMA New England County Metropolitan

Area

PPS Prospective payment system

RFA Regulatory Flexibility Act

RHC Rural health clinic

RRC Rural referral center

SCH Sole community hospital

SNF Skilled nursing facility

I. Background

A. General Summary of April 7, 2000

Final Rule With Comment Period That

Implemented Amendments Enacted by

the Balanced Budget Act of 1997 and

the Balanced Budget Refinement Act of

1999

On April 7, 2000, we published in the

FEDERAL REGISTER (65 FR 18434) a final

rule with comment period to implement

a new prospective payment system for

hospital outpatient services. This new

system establishes prospective payment

rates for covered outpatient hospital

services using ambulatory payment

classification (APC) groups. The April 7,

2000 final rule with comment period

implemented section 4523 of the

Balanced Budget Act of 1997 (the BBA

1997), Public Law 105–33, and related

sections of the Balanced Budget

Refinement Act of 1999 (the BBRA

1999), Public Law 106–113. Section

4523 of the BBA 1997 amended section

1833 of the Social Security Act (the Act)

by adding subsection (t) to provide for

implementation of a prospective

payment system for hospital outpatient

services furnished to Medicare

beneficiaries. Section 1833(t) of the Act,

as added by the BBA 1997—

• Authorizes the Secretary to

designate the hospital outpatient

services that would be paid under the

prospective payment system and

requires that the hospital outpatient

prospective payment system include

hospital inpatient services designated

by the Secretary that are covered under

Medicare Part B for beneficiaries who

are entitled to Part A benefits but who

have exhausted them or are otherwise

entitled to them.

• Sets forth certain requirements for

the hospital outpatient prospective

payment system, including the

requirement that a classification system

for covered outpatient services be

developed that may consist of groups

arranged so that the services within

each group are comparable clinically

and with respect to the use of resources.

• Specifies data requirements for

establishing relative payment weights.

The weights are to be based on the

median hospital costs determined by

1996 claims data and data from the most

recent available cost reports. (This

provision has subsequently been

changed by the BBRA 1999, as

discussed later in this preamble.)

• Requires that the portion of the

Medicare payment and the beneficiary

coinsurance that are attributable to labor

and labor-related costs be adjusted for

geographic wage differences in a budget

neutral manner.

• Authorizes the Secretary under

section 1833(t)(2)(E) of the Act to

establish, in a budget neutral manner,

other adjustments, such as outlier

adjustments or adjustments for certain

classes of hospitals, that the Secretary

determines to be necessary to ensure

equitable payments.

• Requires the Secretary to develop a

method for controlling unnecessary

67800 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

increases in the volume of covered

outpatient services.

• Specifies how beneficiary

deductibles are to be treated when

calculating the Medicare payment and

beneficiary coinsurance amounts and

requires that rules be established

regarding determination of coinsurance

amounts for covered services that were

not furnished in 1996. The statute

freezes beneficiary coinsurance at 20

percent of the national median charges

for covered services (or a group of

covered services) furnished during 1996

and updated to 1999 using the

Secretary’s estimated charge growth

from 1996 to 1999.

• Prescribes the formula for

calculating the initial conversion factor

used to determine 1999 Medicare

payment amounts and the method for

updating the conversion factor in

subsequent years.

• Describes the method for

determining the Medicare payment

amount and the beneficiary coinsurance

amount for services covered under the

outpatient prospective payment system.

(This section was amended by the BBRA

1999, as discussed later in this

preamble.)

• Requires the Secretary to establish a

procedure whereby hospitals may

voluntarily elect to reduce beneficiary

copayment for some or all covered

services to an amount no less than 20

percent of the Medicare payment

amount. Hospitals are further allowed to

disseminate information on any such

reductions of copayment amounts.

Section 4451 of the BBA 1997 added

section 1861(v)(1)(T) to the Act, which

provides that any reduction in

copayment, must not be treated as a bad

debt.

• Authorizes periodic review and

revision of the payment groups, relative

payment weights, wage index, and

conversion factor. (This section was

amended by the BBRA 1999, as

discussed later in this preamble.)

• Describes how payment is to be

made for ambulance services, which are

specifically excluded from the hospital

outpatient prospective payment system

under section 1833(t)(1)(B) of the Act.

• Provides that the Secretary may

establish a separate conversion factor for

services furnished by cancer hospitals

that are excluded from the hospital

inpatient prospective payment system.

• Prohibits administrative or judicial

review of the hospital outpatient

prospective payment system

classification system, the payment

groups, relative payment weights, wage

adjustment factors, other adjustments,

calculation of base amounts, periodic

adjustments, and the establishment of a

separate conversion factor for those

cancer hospitals excluded from hospital

inpatient prospective payment system.

(This section was expanded by the

BBRA 1999, as discussed later in this

preamble.)

Section 4523(d) of the BBA 1997

made a conforming amendment to

section 1833(a)(2)(B) of the Act to

provide for payment under the hospital

outpatient prospective payment system

for some services described in section

1832(a)(2) of the Act that are currently

paid on a cost basis and furnished by

providers of services, such as

comprehensive outpatient rehabilitation

facilities (CORFs), home health agencies

(HHAs), hospices, and community

mental health centers (CMHCs). This

amendment provides that partial

hospitalization services furnished by

CMHCs be paid under the hospital

outpatient prospective payment system.

Before enactment of section 4521(b) of

the BBA 1997, the blended payment

formulas for ambulatory surgery centers

(ASC) procedures, radiology, and other

diagnostic services, the ASC or

physician fee schedule portion were

calculated as if the beneficiary paid 20

percent of the ASC rate or physician fee

schedule amount instead of the actual

amount paid, which was 20 percent of

the hospital’s billed charges. Section

4521(b) of the BBA 1997, which

amended sections 1833(i)(3)(B)(i)(II) and

1833(n)(1)(B)(i) of the Act, corrected this

anomaly by changing the blended

calculations so that all amounts paid by

the beneficiary are subtracted from the

total payment in the calculation to

determine the amount due from the

program. Effective for services furnished

on or after October 1, 1997, payment for

ASC surgery, radiology, and other

diagnostic services calculated by

blended payment methods is now

calculated by subtracting the full

amount of coinsurance due from the

beneficiary (based on 20 percent of the

hospital’s billed charges).

Section 1861(v)(1)(S)(ii) of the Act

was amended by section 4522 of the

BBA 1997 to require that the amounts

otherwise payable for hospital

outpatient operating costs and capital

costs be reduced by 5.8 percent and 10

percent, respectively, through December

31, 1999. (This section was further

amended by the BBRA 1999.)

(Refer to the April 7, 2000 hospital

outpatient prospective payment system

final rule with comment period for a

more in-depth description of how the

changes made by the BBA 1997 and the

BBRA 1999 were implemented.)

On November 29, 1999, after we had

published a proposed rule to implement

section 4253 of the BBA 1997, the BBRA

1999 was enacted. The BBRA 1999

made major changes that affected the

hospital outpatient prospective payment

system that was established by the BBA

1997 and implemented in the April 7,

2000 final rule with comment period.

Therefore, in the April 7, 2000 final rule

with comment period, we also

implemented 14 provisions of the BBRA

1999 that affected the hospital

outpatient prospective payment system

and solicited public comments on those

provisions. The BBRA 1999 provisions

on which we solicited comments

included the following:

1. Outlier Adjustment

Section 201(a) of the BBRA 1999

amended section 1833(t) of the Act by

adding a new paragraph (5) to provide

that the Secretary must make payment

adjustments (that is, an outlier payment)

for covered services whose costs exceed

a threshold determined by the Secretary.

This section describes how the

additional payments are to be calculated

and caps the projected outlier payments

at no more than 2.5 percent of the total

projected payments (sum of both

Medicare and beneficiary payments to

the hospital) made under the hospital

outpatient prospective payment system

for years before 2004 and 3.0 percent of

the total projected payments for 2004

and subsequent years.

2. Transitional Pass-Through for

Additional Costs of Innovative Medical

Devices, Drugs, and Biologicals

Section 201(b) of the BBRA 1999

added new section 1833(t)(6) to the Act,

establishing transitional pass-through

payments for certain medical devices,

drugs, and biologicals. This provision

specifies the types of items for which

additional payments must be made;

describes the amount of the additional

payments; limits these payments to at

least 2, but not more than 3 years; and

caps the projected payment adjustments

annually at 2.5 percent of the total

projected payments for hospital

outpatient services each year before

2004 and no more than 2.0 percent in

subsequent years. Under this provision,

the Secretary must reduce pro rata the

amount of the additional payments if,

before the beginning of a year, he or she

estimates that these payments would

otherwise exceed the caps.

3. Budget Neutrality Applied to New

Adjustments

Section 201(c) of the BBRA 1999

amended section 1833(t)(2)(E) of the Act

to require that the establishment of

outlier and transitional pass-through

payment adjustments be made in a

budget neutral manner.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67801

4. Limitation on Judicial Review

Section 201(d) of the BBRA 1999

amended redesignated section

1833(t)(11) of the Act by extending the

prohibition of administrative or judicial

review to include the factors for

determining outlier payments (that is,

the fixed multiple, or a fixed dollar

cutoff amount, the marginal cost of care,

or applicable total payment percentage),

and the determination of additional

payments for certain medical devices,

drugs, and biologicals, the insignificant

cost determination for these items, the

duration of the additional payment or

portion of the prospective payment

system payment amount associated with

particular devices, drugs, or biologicals,

and any pro rata reduction.

5. Inclusion in the Hospital Outpatient

Prospective Payment System of Certain

Implantable Items

Section 201(e) of the BBRA 1999

amended section 1833(t)(1)(B) of the Act

to include as covered hospital

outpatient services implantable

prosthetics, durable medical equipment

(DME), diagnostic x-ray, laboratory, and

other tests associated with those

implantable items.

6. Payment Weights Based on Median or

Mean Hospital Costs

Section 201(f) of the BBRA 1999

amended section 1833(t)(2)(C) of the

Act, which specifies data requirements

for establishing relative payment

weights, to allow the Secretary the

discretion to base the weights on either

the median or mean hospital costs

determined by data from the most recent

available cost reports.

7. Limitation on Variation of Costs of

Services Classified Within a Group

Section 201(g) of the BBRA 1999

amended section 1833(t)(2) of the Act to

limit the variation of costs of services

within each payment classification

group by providing that the highest

median cost (or mean cost, if elected by

the Secretary) for an item or service

within the group cannot be more than

2 times greater than the lowest median

(or mean) cost for an item or service

within the group. The provision allows

the Secretary to make exceptions in

unusual cases, such as for low volume

items and services.

8. Annual Review of the Hospital

Outpatient Prospective Payment System

Components

Section 201(h) of the BBRA 1999

amended redesignated section 1833(t)(8)

of the Act to require at least an annual

review of the payment groups, relative

payment weights, and the wage and

other adjustments made by the Secretary

to take into account changes in medical

practice, the addition of new services,

new cost data, and other relevant

information and factors. Section

201(h)(2) provides that the first annual

review must be conducted in 2001 for

application in 2002. The section was

further amended to require the Secretary

to consult with an expert outside

advisory panel composed of an

appropriate selection of provider

representatives who will review the

clinical integrity of the groups and

weights and advise the Secretary

accordingly. The panel may use data

other than those collected or developed

by the Department of Health and Human

Services (HHS) for review and advisory

purposes.

9. Coinsurance Not Affected by PassThroughs

Section 201(i) of the BBRA 1999

amended redesignated section 1833(t)(7)

of the Act to provide that the beneficiary

coinsurance amount will be calculated

as if the outlier and transitional passthroughs had not occurred; that is, there

will be no additional coinsurance

collected from beneficiaries for the

additional payments made to hospitals

by Medicare for these adjustments.

10. Extension of Cost Reductions

Section 201(k) of the BBRA 1999

amended section 1861(v)(1)(S)(ii) of the

Act to extend, until the first date that

the hospital outpatient prospective

payment system is implemented, the 5.8

and 10 percent reductions for hospital

operating and capital costs, respectively.

11. Clarification of Congressional Intent

Regarding Base Amounts Used in

Determining the Hospital Outpatient

Prospective Payment System

Section 201(l) of the BBRA 1999

provided that, ‘‘With respect to

determining the amount of copayments

described in paragraph (3)(A)(ii) of

section 1833(t) of the Social Security

Act, as added by section 4523(a) of BBA,

Congress finds that such amount should

be determined without regard to such

section, in a budget neutral manner with

respect to aggregate payments to

hospitals, and that the Secretary of

Health and Human Services has the

authority to determine such amount

without regard to such section.’’

12. Transitional Corridors for

Application of Outpatient Prospective

Payment System

Section 202 of the BBRA 1999

amended section 1833(t) of the Act by

redesignating paragraphs (7) through

(11) as paragraphs (8) through (12),

respectively, and adding a new

paragraph (7), which provides for a

transitional adjustment to limit payment

reductions under the hospital outpatient

prospective payment system. More

specifically, from the date the

prospective payment system is

implemented through 2003, a provider,

including a CMHC, will receive an

adjustment if its prospective payment

system payments for outpatient services

furnished during the year is less than a

set percentage of its ‘‘pre-BBA’’ amount

for that year. The pre-BBA amount is the

product of the reasonable costs the

hospital incurs for prospective payment

system services during the year and the

payment-to-cost ratio for covered

prospective payment system services

furnished during the cost report period

ending during 1996. Two categories of

hospitals, rural hospitals with 100 or

fewer beds and cancer hospitals, will be

held harmless under this provision.

Small rural hospitals will be held

harmless for services furnished before

January 1, 2004. The hold-harmless

provision applies permanently to cancer

centers. Section 202 also requires the

Secretary to make interim payments to

affected hospitals subject to

retrospective adjustments and requires

that the provisions of this section do not

affect beneficiary coinsurance. Finally,

this provision is not subject to budget

neutrality.

13. Limitation on Coinsurance for a

Procedure

Section 204 of the BBRA 1999

amended redesignated section 1833(t)(8)

of the Act to provide that the copayment

amount for a procedure performed in a

year cannot exceed the hospital

inpatient deductible for that year.

14. Reclassification of Certain Hospitals

Section 401 of the BBRA 1999 added

section 1886(d)(8)(E) to the Act to

permit reclassification of certain urban

hospitals as rural hospitals for purposes

of section 1886(d) of the Act. Section

401 added section 1833(t)(13) to the Act

to provide that a hospital being treated

as a rural hospital under section

1886(d)(8)(E) is also to be treated as a

rural hospital under the hospital

outpatient prospective payment system.

A discussion of how each of these

BBRA 1999 provisions was

implemented in the April 7, 2000 final

rule with comment period appears in

section II of this preamble preceding our

summary of the public comments

received and our responses to those

comments.

67802 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

B. June 30, 2000 Notice of Delay of

Effective Date for the April 7, 2000 Final

Rule With Comment Period

On June 30, 2000, we published a

notice in the Federal Register (65 FR

40535) announcing a delay in the

effective date of the April 7, 2000

hospital outpatient prospective payment

system final rule with comment period

from July 1, 2000 to August 1, 2000.

This delay was based on our

determination that the appropriate

claims processing changes could not

feasibly be made to our computer

systems and properly tested in time to

ensure that proper payments would be

made for Medicare hospital outpatient

services under the new prospective

payment system by the original July 1,

2000 effective date.

C. August 3, 2000 Interim Final Rule

With Comment Period

On August 3, 2000, we published an

interim final rule with comment period

in the Federal Register (65 FR 47670)

that changed one criterion and

postponed the effective date for two

other criteria that a new device, drug, or

biological must meet in order for its cost

to be considered ‘‘not insignificant’’ for

purposes of determining its eligibility

for transitional pass-through payments

from the hospital outpatient prospective

payment system. It also changed the

transitional pass-through payment

policy to include new single use

medical devices that come in contact

with human tissue and are surgically

implanted or inserted into patients,

whether or not the devices remain with

the patients following their release.

These policies were a departure from

those presented in the April 7, 2000

final rule with comment period.

The August 3, 2000 rule also

corrected a trigger date for

grandfathering of provider-based FQHCs

to conform with the intent not to disrupt

existing FQHCs with longstanding

provider-based treatment that we

discussed in the April 7, 2000 rule.

Under the criteria in the April 7, 2000

final rule with comment period, FQHCs

would have been treated as departments

of a provider without regard to the

criteria for provider-based status if they

continued to qualify as FQHCs and were

designated as FQHCs before 1995. In

accordance with the August 3, 2000

interim final rule with comment period

and this interim final rule with

comment period, facilities that continue

to qualify as FQHCs and were

designated as FQHCs or ‘‘look-alikes’’

on or before April 7, 2000 would

continue to be treated as provider-based

facilities. In addition, we clarified how

the requirement for prior notices to

beneficiaries is to be applied in

emergency situations. We also clarified

the protocols for off-campus

departments in emergency situations.

D. Summary of This Interim Final Rule

With Comment Period

In section II of this preamble, we—

• Respond to public comments

received timely on the 14 BBRA 1999

provisions that were included in the

April 7, 2000 final rule with comment

period. (We received numerous public

comments on other aspects of the April

7, 2000 final rule with comment period

that were not open for comment. We

will not address those comments in this

rule.)

• Respond to public comments on the

August 3, 2000 interim final rule with

comment period that revised the criteria

for defining new or innovative medical

devices, drugs, and biologicals eligible

for pass-through payments and

corrected the criteria for the

grandfathering provision for certain

FQHCs as provider-based.

In section III of this preamble, we are

updating, for services furnished during

calendar year 2001, the wage index

values and the conversion factor, and

revising the APCs to reflect new codes

for 2001 effective January 1, 2001. As

required under section 1833(t)(8)(A) of

the Act, in 2001, we will begin our

annual review process of the APC

groups, relative weights, and the wage

and other adjustments for the

prospective payment systems payments

that will become effective on January 1,

2002. The statute requires the Secretary

to consult with an expert outside

advisory panel composed of an

appropriate selection of representatives

of providers to review (and advise the

Secretary concerning) the clinical

integrity of the groups and weights. This

provision allows these experts to use

data other than those collected or

developed by us during our review of

the APC groups and weights.

II. Analysis of, and Responses to, Public

Comments on the BBRA 1999

Provisions and the August 3, 2000

Interim Final Rule With Comment

Period

We received a total of 747 pieces of

timely correspondence containing

public comments on the April 7, 2000

final rule with comment period. In

addition to receiving comments from

various organizations throughout the

hospital industry, we also received

comments from beneficiaries and their

families, physicians, health care

workers, individual hospitals,

professional associations and societies,

legal and nonlegal representatives and

spokespersons for beneficiaries and

hospitals, members of the Congress, and

other interested citizens. The majority of

the comments addressed the BBRA 1999

provisions relating to the limitation on

variation of costs of services classified

within a group, the transitional passthrough provision for devices, drugs,

and biologicals, and the inclusion of

implantable items.

We received 13 comments in response

to the August 3, 2000 interim final rule

with comment period. These comments

were submitted by major associations,

drug and device manufacturers,

providers, a private citizen, and a law

firm. More than half of the comments

addressed issues for which we did not

solicit comments in the August 3, 2000

interim final rule with comment period.

Those comments specifically addressed

payment policy and typographical

errors present in the April 7, 2000 final

rule with comment period. The

remaining commenters addressed the

revisions to the criteria to define new or

innovative medical devices, drugs, and

biologicals eligible for pass-through

payments and corrections to the criteria

for the grandfathering provision for

certain FQHCs. These commenters took

issue with some of the provisions and

raised additional concerns regarding our

actions. A summary of the public

comments and our responses to them

appears following the discussion of the

April 7, 2000 final rule with comment

period.

We have carefully reviewed and

considered all comments received

timely. The modifications that we are

making in response to commenters’

suggestions and recommendations are

summarized in section III.A of this

preamble and, as appropriate, reflected

in the regulation text.

A. April 7, 2000 BBRA 1999 Provisions

Below we discuss the implementation

of the BBRA 1999 provisions addressed

in the April 7, 2000 final rule with

comment period and modified in the

August 3, 2000 interim final rule with

comment period, the public comments

received on each provision, and our

response to those comments.

1. Outlier Adjustment

Section 1833(t)(5) of the Act, as added

by section 201(a) of the BBRA 1999,

required that the Secretary make an

additional payment (that is, an outlier

adjustment) for outpatient services for

which a hospital’s charges, adjusted to

cost, exceed a fixed multiple of the sum

of the outpatient prospective payment

system payment and the transitional

pass-through payments. The Secretary is

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authorized to determine the amount of

this fixed multiple and the percent of

costs above the threshold that is to be

paid under this outlier provision. Under

the statute, projected outlier payments

may not exceed an ‘‘applicable

percentage’’ of projected total program

payments. The applicable percentage

means a percentage specified by the

Secretary (projected percentage of

outlier payments relative to total

payments), subject to the following

limits: For years before 2004, the

projected percentage that the Secretary

specifies cannot exceed 2.5 percent; for

2004 and later, the projected percentage

cannot exceed 3.0 percent. Section

1833(t)(2)(E) of the Act requires that

these payments be budget neutral.

Section 1833(t)(5)(D) of the Act grants

the Secretary authority until 2002 to

identify outliers on a bill basis rather

than on a specific service basis and to

use an overall hospital cost-to-charge

ratio (CCR) to calculate costs on the bill

rather than using department-specific

CCRs for each hospital.

In the April 7, 2000 final rule with

comment period, in accordance with the

statute, we presented how the

additional outlier payments are to be

calculated.

To set the threshold or fixed multiple

and the payment percentage of costs

above that multiple for which an outlier

payment would be made, we first had to

determine what specified percentage of

total program payment, up to 2.5

percent, we should select. We decided

to set the outlier target at 2.0 percent. In

order to set the fixed multiple outlier

threshold and payment percentage, we

simulated the prospective payment

system payments. We calibrated the

threshold and the payment percentage

applying an iterative process so that the

simulated outlier payments were 2.5

percent of simulated total payments. For

purposes of the simulation, we set a

‘‘target’’ of 2.5 percent (rather than 2.0

percent), because we believed that a

given set of numerical criteria would

result in a higher percentage of outlier

payments under the simulation using

1996 data than under the prospective

payment system. This is because we

believe that the 1996 data reflects

undercoding of services, which means

simulated total payments would likely

be understated and, in turn, the

percentage of outlier payments would

be overstated. In addition, we were not

able to fully estimate the amount and

distribution of pass-through payments

using the 1996 data. Our inability to

make these estimates further

understated the total payments under

the simulation. We believe that a set of

numerical criteria that results in

simulated outlier payments of 2.5

percent using the 1996 data would

result in outlier payments of 2.0 percent

under the prospective payment system.

The difference arises from the effect of

undercoding in the historical data and

the payment of pass-throughs under

prospective payment system. We set the

outlier threshold at 2.5 times the

prospective payment system payments.

Comment: Several commenters asked

us to clarify how series bills for services

such as chemotherapy that are billed

monthly for multiple sessions are

treated in determining outlier payments.

They also asked that we clarify how

bills for multiple clinic visits on the

same day are treated in calculating the

outlier payment.

Response: In accordance with section

1833(t)(5)(D) of the Act, until 2002,

outliers will be determined on a bill

basis rather than on a specific service

basis. Therefore, the charges (converted

to costs) associated with all services

under the hospital outpatient

prospective payment system reported on

series bills or all payable multiple clinic

visits billed on a single claim would be

used to determine whether the outlier

threshold is exceeded and to calculate

the outlier payment.

Comment: One commenter suggested

that we prospectively adjust the

conversion factor if we determine that

the actual outlier expenditures are less

than estimated in a given year.

Response: Consistent with our outlier

policies in other prospective payment

systems, we will not adjust the

conversion factor for a given year to

account for an underestimation (or

overestimation) of outlier payments in a

previous year. The statute does not

provide for such an adjustment to the

conversion factor. We set outlier

policies prospectively, using the best

available data. Outlier payments, like

many aspects of a prospective payment

system, reflect estimates, and we believe

it would be inappropriate to adjust the

conversion factor (upward or

downward) for a given year simply

because an estimate for a previous year

ultimately turned out to be inaccurate.

If we underestimate or overestimate the

percentage of outlier payments, the

divergence of our estimate from actual

experience might provide information

that might help us improve estimates in

the future, but it would have no direct

effect on the conversion factor for any

following year.

Comment: One commenter urged us

to provide additional information about

the cost-to-charge ratios that will be

used to determine whether a claim

exceeds the outlier threshold for

payment. The commenter stated that the

preamble language on page 18498 of our

April 7, 2000 final rule with comment

period conflicts with statements

contained in Program Memorandum

Transmittal No. A–00–23 regarding

which cost-to-charge ratio would be

used to determine whether a claim

meets the outlier threshold

requirements for payment. According to

the commenter, we stated in the final

rule with comment period that we will

use a hospital’s overall cost-to-charge

ratio to make this determination, but

stated in the program memorandum that

we will use an outpatient cost-to-charge

ratio. The commenter asked us to clarify

the conflicting statements.

Response: On September 8, 2000, we

issued Program Memorandum

Transmittal No. A–00–63, titled ‘‘Costto-Charge Ratios (CCRs) for Calculating

Certain Payments Under the Hospital

Outpatient Prospective Payment

System’’ which describes how we

calculated the cost-to-charge ratios that

are used to determine payments for

outliers, interim transitional corridors,

and device pass-throughs for calendar

year 2000. That program memorandum

defined the cost-to-charge ratio that is

used to calculate these payments as the

overall hospital outpatient cost-tocharge ratio. This is consistent with

what we stated in our April 7, 2000 final

rule with comment period. The

September program memorandum

contains the latest and most complete

information available on cost-to-charge

ratio calculation for the hospital

outpatient prospective payment system.

Comment: One commenter assumed

that we will use department level costto-charge ratios after 2002 to determine

if a particular outpatient service

qualifies for outlier payment. The

commenter asked if we will use a

‘‘national cost-to-charge mapping

procedure’’ to determine the appropriate

department cost-to-charge ratios to use.

The commenter expressed concern

about the appropriateness of that

approach because of the variability

among providers in assigning costs to

departments. For this reason, the

commenter recommended, if we use a

national cost-to-charge mapping

procedure, we permit providers to

request outlier payments if they can

demonstrate that the actual department

cost-to-charge ratio to which they assign

costs for a service results in a cost

calculation that meets the outlier

threshold.

Response: We plan to address this

issue and seek comments on it in the

rulemaking process for the annual

update for 2002.

Comment: One commenter urged us

to publish annually the ‘‘cost reporting

67804 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

year’’ used to determine the cost-tocharge ratios that will be used in

determining outlier payments. The

commenter also asked that we explain

how we computed cost-to-charge ratios

for hospitals that have merged or been

acquired.

Response: On September 8, 2000, we

issued Program Memorandum

Transmittal No. A–00–63 that describes

the specific criteria we used and

provides detailed instructions for

calculating the cost-to-charge ratios for

hospitals that have merged or been

acquired. It also identifies the specific

cost reporting year end that was used to

calculate each provider’s cost-to-charge

ratio.

Comment: One commenter asked that

we lower the outlier threshold from 2.5

to 2.0. The commenter strongly

recommended that we permanently

retain the lowered threshold to ensure

appropriate patient care and adequate

provider reimbursement.

Response: We oppose lowering the

outlier threshold to 2.0. As discussed in

our April 7, 2000 final rule with

comment period, we set the outlier

threshold at 2.5 by simulating total

prospective payment system payments

(using 1996 hospital outpatient data)

and using an iterative process to

calculate a threshold under which

outlier payments are projected to equal

2.0 percent of total payments. If we

lowered the threshold as the commenter

suggests, then the projected percentage

of outlier payments would increase and

we would have to reduce the conversion

factor correspondingly (thus reducing

the payment for all non-outlier cases.)

2. Transitional Pass-Through for

Additional Costs of Innovative Medical

Devices, Drugs, and Biologicals

Section 1833(t)(6) of the Act, as added

by section 201(b) of the BBRA 1999,

requires the Secretary to make

additional payments to hospitals,

outside the hospital outpatient

prospective payment system for a period

of 2 to 3 years for specific items. The

items designated by the law are the

following: Current orphan drugs, as

designated under section 526 of the

Federal Food, Drug, and Cosmetic Act;

current drugs, biologic agents, and

brachytherapy devices used for

treatment of cancer; current

radiopharmaceutical drugs and

biological products; and new medical

devices, drugs, and biologic agents, in

instances where the item was not being

paid as a hospital outpatient service as

of December 31, 1996, and where the

cost of the item is ‘‘not insignificant’’ in

relation to the hospital outpatient

prospective payment system payment

amount. In this context, ‘‘current’’ refers

to those items for which hospital

outpatient payment is being made on

the first date the new prospective

payment system is implemented.

Section 1833(t)(6)(C)(i) of the Act sets

the additional payment amounts for the

drugs and biologicals as the amount by

which the amount determined under

section 1842(o) of the Act (95 percent of

the average wholesale price (AWP))

exceeds the portion of the otherwise

applicable hospital outpatient

department fee schedule amount that

the Secretary determines to be

associated with the drug or biological.

Section 1833(t)(6)(C)(ii) of the Act

provides that the additional payment for

medical devices be the amount by

which the hospital’s charges for the

device, adjusted to cost, exceed the

portion of the otherwise applicable

hospital outpatient department fee

schedule amount determined by the

Secretary to be associated with the

device. Under section 1833(t)(6)(D), the

total amount of pass-through payments

for a given year cannot be projected to

exceed an ‘‘applicable percentage’’ of

total payments. For a year (or a portion

of a year) before 2004, the applicable

percentage is 2.5 percent; for 2004 and

subsequent years, the applicable

percentage is 2.0 percent. If the

Secretary estimates that total passthrough payments would exceed the

caps, the statute requires the Secretary

to reduce the additional payments

uniformly to ensure the ceiling is not

exceeded.

These pass-through payments must be

made in a budget neutral manner. In

addition, these additional payments do

not affect the computation of the

beneficiary coinsurance amount.

In the April 7, 2000 final rule with

comment period, we specified the types

of items for which additional payments

would be made; described the amount

of the additional payments; announced

that these payments would be limited to

at least 2 years but not more than 3

years; and announced a cap of the

projected payment adjustments

annually at 2.5 percent of the total

projected payments for hospital

outpatient services each year before

2004 and no more than 2.0 percent in

subsequent years.

a. Definition of a Device

Comment: Some commenters argued

that we have adopted a very narrow

definition of a device that restricts passthrough payments to prosthetic devices

and excludes valuable new

nonprosthetics from pass-through

consideration. They asserted that the

definition of a device should mirror the

definition set forth in the Federal Food,

Drug, and Cosmetic Act. They agreed

that such a definition should exclude

capital equipment, reusable items, and

incidental supplies. However, they

argued that we should clarify and revise

our definition of devices to those that

are ‘‘implanted or inserted’’ and

‘‘remain with the patient after the

patient is released from the hospital

outpatient department.’’

Response: The definition of a device

under the Food, Drug, and Cosmetic Act

is extremely broad. In summary, it refers

to a device as an instrument, apparatus,

implement, machine, contrivance,

implant, in vitro reagent, or other

similar or related article, including any

component, part, or accessory, which

is—

• Recognized in the official national

formulary, or the U.S. Pharmacopeia, or

any supplement to them;

• Intended for the use of the

diagnosis of conditions other than

diseases such as pregnancy;

• Intended to affect the structure or

any function of the body of man or other

animals; or

• Considered an in vitro diagnostic

product, including those previously

regulated as drugs, and which does not

achieve any of its principal intended

purposes through chemical action

within or on the body of man or other

animals and which is not dependent

upon being metabolized for the

achievement of any of its principal

intended purposes.

This definition is inappropriate for

use in the context of the transitional

pass-through payments for several

reasons: It would include (as the

commenters noted) items that are

treated as supplies, reusable items, or

capital equipment by Medicare payment

systems, including the outpatient

prospective payment system. It has a

number of inappropriate elements,

including reference to pharmaceuticals

and to use in animals. Further, it is

insufficiently specific for Medicare

purposes, as it does not mention

medical necessity or the test of whether

the cost of a device is ‘‘not

insignificant’’ relative to the associated

APC.

We have instead provided a definition

of a device specific to the purposes of

the transitional pass-through provision.

This definition was presented in the

preamble to the April 7, 2000 final rule

with comment period and revised in the

August 3, 2000 interim final rule with

comment period, which added

§ 413.43(e)(4).

In the August 3, 2000 interim final

rule with comment period, we revised

the criteria that we had set forth in the

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67805

April 7, 2000 final rule with comment

period to define a device. Among the

changes included is a revision of the

criterion relating to whether a device

must remain with the patient. The new

criterion (§ 419.43(e)(4)(iv)) includes

devices that are surgically implanted or

inserted in a patient ‘‘whether or not

they remain with the patient when the

patient is released from the hospital

outpatient department.’’ This change

allows pass-through payments for

devices that are surgically implanted or

inserted even temporarily in a patient

providing the devices meet all other

requirements for pass-through

payments. As a result, nonprosthetic

devices, such as cardiac catheters,

guidewires, or stents that commenters

noted would be excluded, may be

eligible for pass-through status.

In § 419.43(e)(4)(iv), we have retained

the limitation to devices that are

surgically implanted or inserted because

we believe this offers the best

interpretation of section 201(e) of the

BBRA 1999, which indicates that

implantable devices are to be included

in the APCs. To further clarify how we

interpret § 419.43(e)(4)(iv), we consider

that a device is surgically implanted or

inserted if it is introduced into the

human body through a surgically

created incision. We do not consider an

item used to cut or otherwise create a

surgical opening to be a device that is

surgically implanted or inserted. We

consider items used to create incisions,

such as scalpels, electrocautery units,

biopsy apparatuses, or other commonly

used operating room instruments, to be

supplies or capital equipment, and

hence, in accordance with

§ 419.43(e)(4)(vi) or (vii), we consider

these items not eligible for transitional

pass-through payments. We believe the

function of these items is different and

distinct from that of devices that are

used for surgical implantation or

insertion. Generally, we would expect

that surgical implantation or insertion of

a device occurs after the surgeon uses

certain primary tools, supplies, or

instruments to create the surgical path

or site for implanting the device.

We have discovered some items that

do not meet the requirement of being

surgically implanted or inserted were

erroneously approved for pass-through

payments. Consequently, we will

eliminate these items from the list of

items eligible for pass-through

payments, effective January 1, 2001.

Comment: One commenter claimed

that it was inappropriate for us to

change the definition of devices through

letters to manufacturers. The commenter

believed that this was done outside the

rulemaking process.

Response: We did not make a change

to our policy through a letter. As we

began to evaluate the hundreds of

applications for approval of numerous

devices, it was apparent that our

definition for new medical devices as

published in our April 7, 2000 final rule

with comment period would have

resulted in denials for items that we

believe might warrant pass-through

payments. Examples of such potential

denials are many types of general and

specialty catheters. Based on our

experience in reviewing these

applications, we decided to change

three of the eight specific criteria that a

new device must meet in order to be

eligible for pass-through payments. We

published these changes in our August

3, 2000 interim final rule with comment

period.

b. Eligibility Criteria

Comment: Some commenters believed

that we should accept and process

applications for items while they are

undergoing the FDA review process.

Response: We have accepted and

begun processing all applications,

including those for which items are

pending FDA approval or clearance.

However, in those instances where the

FDA approval or clearance

documentation is missing, the

application is considered incomplete. In

order for an item to be eligible for

transitional pass-through payments, it

must have been approved or cleared by

the FDA for marketing. We will not

make a final determination on any

applications that are pending FDA

approval or clearance until all the

required documentation is submitted.

Resources permitting, we will

commence preliminary processing of

the applications when received. The

applying party is responsible for

providing us with proper evidence of

FDA approval or clearance for any item,

once approval or clearance has been

obtained. Once we receive

documentation of FDA approval or

clearance and determine the item is

determined to be eligible for transitional

pass-through payments, payment for the

item will commence at the start of the

next quarterly update of pass-through

items.

Comment: Some commenters asked

that we clarify that items must meet

Medicare coverage requirements in

order to qualify for pass-through status.

Response: As stated in both our April

7, 2000 final rule with comment period

and our August 3, 2000 interim final

rule with comment, items that qualify

for pass-through payments must be

covered by Medicare. They must have

been determined to be reasonable and

necessary for the diagnosis or treatment

of an illness or injury or to improve the

functioning of a malformed body part,

as required by section 1862(a)(1)(A) of

the Act. (See § 419.43(e)(4)(iii).)

c. Investigational Device Exemption

(IDE) Devices

Comment: Some commenters

recommended that we automatically

define as ‘‘new’’ any device that

receives an investigational device

exemption (IDE) from the FDA, with a

Category B designation. They believed

that we should pay for IDE devices

through the pass-through payment

methodology rather than limit the

payment to no more than what is

currently paid for an equivalent device.

Response: As stated in our August 3,

2000 interim final rule with comment

period, we have changed the payment

methodology for eligible IDE Category B

devices so that they will be paid using

the transitional pass-through

methodology. Since these

noninvestigational devices are required

to meet the same eligibility criteria as

other devices, we determined that they

should be paid in a similar manner.

However, we do not accept the

commenter’s recommendation that all

IDE Category B devices ‘‘automatically’’

be considered as new. The statute

defines ‘‘new’’ medical device on the

basis of a date certain (that is, payment

for the device was not being made as an

hospital outpatient service as of

December 31, 1996) rather than based

on a class of devices (such as IDEs).

d. Removing Cost of Predicate Item

Comment: Some commenters stated

that we did not have adequate data to

ensure appropriate removal of the costs

for predecessor items (particularly

radiopharmaceuticals and devices) from

their relevant APCs. They advocated

that we reevaluate this provision as

soon as possible after implementation of

our new system and make necessary

changes.

Response: We will be continuously

evaluating our data to remove the costs

of predecessor items from the passthrough payments. As of January 1,

2001, a specific dollar amount will be

deducted from selected devices (see

explanation below). Over time, such

deductions will be made, as we are able

to make appropriate estimates from the

data.

e. Excluded Costs

Comment: A number of commenters

stated that the APC construction

excluded costs for implantable devices

billed with revenue codes 274, 275 and

278. The commenters recommended

67806 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

that implantable devices associated with

these revenue codes be included on the

pass-through list until data is collected

to adequately reflect the cost of such

devices. In addition to claims that

revenue codes 274, 275 and 278 were

not represented in the data, some

commenters alleged that implant

procedures were infrequently performed

on an outpatient basis prior to 1997 and

therefore the costs associated with them

were not represented in the data used to

develop the APC rates. Some

commenters recommended, on that

basis, that all implantable devices be

included for pass-through payment

regardless of FDA approval dates.

Response: Following enactment of the

BBRA of 1999, we did not have

sufficient time to re-run our data to

package the costs of implantable device

revenue centers into the APC weights

and still be able to publish a final rule

in time to implement the prospective

payment system by July 1, 2000.

As of January 1, 2001, the APC rates

will reflect the inclusion of revenue

codes 274, 275 and 278. While the

aggregate amount of these revenue

centers is small (0.3 percent of total

charges in 1996), the costs of certain

procedures such as implantation of

cardiac pacemakers did increase

substantially. As detailed in section

III.B.1 of this interim final rule, some

APC groups were modified because of

the inclusion of these revenue centers,

and rates for some procedures will

increase to reflect these costs. A

reduction in an amount equal to the

increase in the APC rates will be

deducted from the relevant devices that

are either eligible for pass-through

payments or that can be billed for

additional payment through the new

technology APCs.

f. Effect on Conversion Factor

Comment: Some commenters believed

that lowering the outpatient prospective

payment system conversion factor to

reflect the 2.5 percent transitional passthrough adjustment could affect

hospitals’ financial health. They

asserted that any risks to the financial

health of hospitals resulting from

reducing the conversion factor should

be balanced against any benefits that

would be gained from higher payments

for new drugs and devices. Another

commenter advocated that we increase

the conversion factor if we find that the

transitional pass-through payments do

not comprise 2.5 percent of the total

outpatient prospective payment system

payments.

Response: Section 1833(t)(2)(E), as

amended by section 201(c) of the BBRA

1999, requires that transitional passthrough payments be implemented in a

budget neutral manner. We set

prospective payment system rates

prospectively and, consistent with our

policies in other aspects of the

prospective payment system, we will

not adjust (upward or downward) the

conversion factor for a given year to

account for the difference between 2.5

percent and the actual percentage of

pass-through payments in a previous

year.

g. Cost Significance Tests

Comment: Some commenters asserted

that we could preclude some

worthwhile technologies from achieving

pass-through status if we set the ‘‘not

insignificant’’ cost threshold at 25

percent of the APC payment rate for the

relevant procedure with which it is

used. They contend that technologies

associated with higher payment APCs

would be more likely to be disqualified.

Response: We have lowered the cost

threshold from 25 percent to 10 percent

of the applicable fee schedule amount

for the service associated with the item.

This change is effective for services

furnished on or after August 1, 2000.

Comment: A hospital association

asked that we clarify how the ‘‘not

insignificant’’ criteria will be applied

when a new device, drug, or biological

is associated with more than one APC.

The commenter stated that, under the

current provisions of the rule, an item

could be determined to be eligible for

pass-through payment when used in

performing a procedure in one APC, but

not another. The commenter suggested

that an item that meets the criteria for

one APC be treated as a pass-through

item for all APCs in which it is used.

Response: We agree with the stated

approach. This has been the policy that

we have applied in processing

applications.

Comment: One manufacturer stated

that we did not make information

available on the ‘‘not insignificant’’ rule

in sufficient time for applicants to take

the criteria into account in preparing

applications for payment effective

August 1, 2000. The commenter alleged

that the term ‘‘not insignificant’’ can be

interpreted widely and caused

manufacturers not to apply for all

potentially eligible pass-through items.

The commenter recommended that we

review applications submitted for the

following HCPCS codes to be certain

that they meet the published cost

criteria and remove them from the passthrough list if they do not. The

commenter also advocated that we

allow other manufacturers to submit

applications retroactive to July 1, 2000,

to assure that we are not promoting a

competitive disadvantage for some

companies.

HCPCS Codes

C1029

C1034

C1061

C1072

C1073

C1074

C1100

C1101

C1155

Response: In order for a device to be

included on the pass-through list, it

must meet the criteria for transitional

pass-through payments. These criteria

include a test of whether the cost of a

device is ‘‘not insignificant’’ relative to

the payment for the associated APC.

This test was first put forth in the April

7, 2000 final rule with comment period,

and subsequently revised in the August

3, 2000 interim final rule with comment

period. All the devices denoted by the

HCPCS codes listed above were tested

and met the 10-percent ‘‘not

insignificant’’ test as well as the other

applicable criteria. The ‘‘not

insignificant’’ test was applied

uniformly to all applications that had

been received timely. We believe that

permitting retroactive applications is

unwarranted (and would be inconsistent

with principles of prospectivity);

moreover, resource and systems

constraints would make it infeasible to

give retroactive effect to determinations

of eligibility for pass-through payments.

h. Brand-Specific Versus Categorization

Approaches

Comment: Many commenters

criticized us for implementing a brandspecific approach to items on the passthrough list. Device manufacturers in

particular recommended a category

scheme to classify pass-through devices.

Representatives of the device industry

also offered to assist us in creating the

categories. They argued that a category

system would allow devices to be added

immediately upon FDA approval. They

stated that under a category approach

manufacturers would only approach us

to obtain new pass-through categories

and codes when items reflect a

technological advance and are

significantly more costly than existing

payment amounts.

Response: We adopted a trade-name

specific approach for several reasons.

First, such an approach provides better

information. Codes that are largely itemspecific allow us to track what

procedures the items are used with and

costs of the items. When the passthrough payments for an item ends, we

would expect to have good information

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67807

for assigning it to relevant APCs and

ensuring appropriate payment for these

APCs. Adopting a scheme with a

significant degree of categorization

would require use of averages in making

assignments and setting payment rates.

Decisions based on these more limited

data would be likely to lead to

intensified concerns about the

appropriateness of APC assignment and

payment.

Second, this approach permits finer

discrimination in eligibility decisions.

An item-by-item approach allows us to

be sure individual items in fact meet the

criteria for eligibility. Of major concern

in this instance is whether a device is

‘‘new’’ using the standard of the statute.

Section 1833(t)(6)(A) of the Act limits

transitional pass-through payment to

those devices for which ‘‘* * *

payment for the device * * * as an

outpatient hospital service under this

part was not being made as of December

31, 1996.’’ Adopting categories would in

some cases mix ‘‘old’’ and ‘‘new’’

devices. In these instances, either some

old devices would get special treatment

that they would not be eligible for if

they were examined on an item-specific

basis, or an entire category could be

considered old, thus depriving some

new devices from special treatment they

would be eligible for if they were

examined on an item-specific basis.

Third, an item-specific scheme avoids

issues associated with the design of

categories needed for purposes of

transitional pass-through payments. It

largely avoids concerns about what

items should be in what category or

whether new categories should be

created to accommodate items that may

appear to be little different from those

in existing categories.

Fourth, an item-specific approach

allows us to assure that a newly arriving

device can obtain the full period of

pass-through status it is arguably

eligible for under the statute. A

categorization approach would likely

lead to latecomers being eligible for

pass-through payments for a shorter

period. Insofar as revision to APC

payment rates reflected the costs of

items in the category by the time the

category was terminated, the shorter

period would be of little consequence.

However, if the costs of the late-coming

item were significantly higher, this

procedure could appear objectionable. A

solution in this case would be to create

a new code, which could be specific to

that item, thus departing from a

categorization approach.

We recognize that a category approach

would lessen concerns about

competitive disadvantages that may

have been inadvertently created by an

item specific approach and about access

to specific items by hospitals and their

patients. However, we found no

satisfactory way of establishing

categories that would not run into

difficulty regarding the test of whether

a device is ‘‘new’’ as described above.

Consequently, we are making no change

in our approach.

Comment: Many commenters argued

that competitive advantages have

resulted and will continue to result from

using a brand-specific approach to

implementing transitional pass-through

payments for devices. Some

commenters alleged that our use of the

FDA approval date as a proxy for

determining payment in concert with

the brand-specific approach causes

further competitive disadvantages.

Some hospitals claimed that the brandspecific approach would create winners

and losers if a device that one hospital

uses obtains pass-through status, but

one that another hospital uses does not.

A number of commenters asserted that

a category approach would decrease the

administrative burden on hospitals,

manufacturers, and us that a brandspecific approach for application and

approval of new devices now incurs.

Response: It was never our intent to

competitively disadvantage anyone or

any product. To the maximum extent

possible, given the limitations under the

BBRA 1999 and our resource

constraints, we have worked closely

with the pharmaceutical and medical

device industries to identify and resolve

such issues. By October 1, 2000, we had

determined that more than 700 devices

are eligible for pass-through payments.

Therefore, we believe that hospitals will

receive additional payments for many of

the devices they use.

i. Issues Pertaining to Specific Items

Comment: A medical association

advocated pass-through status for the

following devices: new pacemakers,

implantable cardioverter defibrillators,

insertable loop recorders,

electrophysiology catheters (ablation

and diagnostic), intracardiac

echocardiography ultrasound catheters,

and advanced three-dimensional

mapping system catheters.

Response: All of these items are

already on the pass-through list. For a

complete list of items approved on the

pass-through list, refer to Addendum B

of this rule for short descriptions of the

items. Refer to Program Memoranda

Transmittals Nos. A–00–42, A–00–61

and A–00–72 for the long descriptors for

each of the C-codes listed in Addendum

B. We are developing an additional

program memorandum that we expect to

issue shortly. This additional program

memorandum will contain a list of

additional devices, drugs, and new

technology services that will be effective

January 1, 2001.

Comment: Several device

manufacturers alleged that the following

devices were not included on the passthrough list:

PALMAZ Balloon-Expandable Stent

Corinthian IQ Biliary Stent

SMART Cordis Nitinol Stent

CARTO EP Navigation System Catheters

HYDROLYSER Catheter

Indigo Prostate Seeding Needle

Lioresal Intrathecal

SynchroMed and SynchroMed EL

infusion pumps

Response: All of these devices have

been approved for pass-through

payments and assigned C-codes. They

have been assigned the following codes:

the PALMAZ Balloon-Expandable Stent,

C8522; Corinthian IQ Biliary Stent,

C5004; SMART Cordis Nitinol Stent,

C1372; CARTO EP Navigation System

Catheters, C1047; HYDROLYSER

Catheter, C1054; Indigo Prostate Seeding

Needle, C1706; Lioresal Intrathecal,

C9007, C9008, C9009, and C9010;

SynchroMed and SynchroMed EL

infusion pumps, C8505 and C3800,

respectively.

Comment: Another device

manufacturer claimed that the following

devices were not included on the passthrough list:

Mitek Bone Anchors

Innovasive Bone Anchors

VAPR and VAPR Thermal T Electrode

Gynecare TVT Tension-Free Support for

Incontinence System (TVT)

Gynecare Thermachoice Uterine Balloon

Therapy System

Response: Many of the items above

have been approved for pass-through

status and assigned C-codes. The Mitek

and Innovasive Bone Anchors have been

assigned to C1109; VAPR and VAPR

Thermal T Electrode, to C1323; TVT

Single-Use Tension-Free Vaginal Tape,

to C1370; and the Gynecare

Thermachoice II Catheter, to C1056.

However, some of the items included in

the Gynecare TVT Tension-Free Support

for Incontinence System and the

Gynecare Thermachoice Uterine Balloon

Therapy System did not meet the

criteria for pass-through status and,

therefore, are ineligible for additional

payments. The eligible pass-through

items are listed in Addendum B.

Comment: A device manufacturer

believed that we should have approved

the Targis System, which provides

prostatic microwave thermotherapy, for

pass-through payments.

Response: We assigned the prostatic

microwave thermotherapy procedure to

67808 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

a new technology APC, that is, APC

0980. In making this assignment, we

took into account the costs associated

with performing this procedure,

including the cost of the Targis system.

Therefore, we would not also make a

pass-through payment for the system.

Comment: A number of commenters

contended that only 39 of the more than

70 eligible radiopharmaceuticals have

been given pass-through status. They

recommended that we approve the

following radiopharmaceuticals for

pass-through payments:

Strontium Sr 82 Rubidium Rb 82

Generator

Sodium Chromate Cr-51

Co 57 Cobaltous Chloride

Co 57 Cyanocobalamin

Ferrous Citrate Fe59

Fludeoxyglucose F 18

Intrinsic Factor Concentrate Capsules

In 111 Imciromab (Myoscint)

In 111 Labeled WBCs, Platelets

I 123 and I 131 Hippurate

Iodinated I 131 Albumin (I 131

Albumin)

Iodinated I 125 Albumin (I 125

Albumin)

Iothalamate Sodium I 125 Albumin

(I125 Iothalamate)

Technetium Tc 99m Pertechnetate

Technetium Tc 99m Albumin Colloid

Technetium Tc 99m Lidofenin

Technetium Tc 99m Tebroxime

Technetium Tc 99m Nofetumomab

(Verluma)

Technetium Tc 99m HMPAO labeled

WBCs

Technetium Tc 99m Human Serum

Albumin

Technetium Tc 99m Serum Albumin

(Tc 99m HSA kit)

Xenon XE 127 Gas

Response: While a number of

radiopharmaceuticals are already on the

pass-through list, we are unable to add

some of the ones listed above because

we do not have AWPs for them. The

AWPs are the basis for payment for

these items and without the AWPs we

cannot approve them for pass-through

payments. As soon as the AWPs are

made available to us, we will complete

our review to determine their passthrough status. If eligible, they will be

added to the pass-through list during

the appropriate quarterly update cycle.

Comment: One commenter stated that

our transitional pass-through policy for

devices precludes pass-through

eligibility for capital equipment and

therefore does not provide a mechanism

under our new system for recognizing

the incremental costs associated with

capital equipment. The commenter

recommended that we recognize capitalequipment costs through our new

technology APCs.

Response: Under our new outpatient

prospective payment system, capital

costs are not paid separately. Payment

for these costs are included in the total

APC payment amount for each

procedure or medical visit and will be

updated through our annual updating

process. Therefore, the new technology

APCs will not be used to make separate

payments for capital related costs.

Comment: A number of commenters

claimed that we denied pass-through

status for the contrast agents.

Response: As clarified in our August

3, 2000 interim final rule with

comment, contrast agents other than

radiopharmaceuticals are considered

supplies and are not eligible for passthrough payments. (See

§ 419.43(e)(4)(vii).)

Comment: A medical association

claimed that we denied pass-through

status requests for high dose rate

brachytherapy. Another industry group

alleged that many brachytherapy related

items that manufacturers applied for

were excluded from the pass-through

list.

Response: Since publishing our initial

list of potentially eligible pass-through

items to our website on March 9, 2000,

we have added 38 brachytherapy items

to our pass-through list. High-dose rate

brachytherapy will be eligible for passthrough payment effective for services

furnished on or after January 1, 2001.

j. Pass-Through Applications Process

Comment: Some commenters urged

that we process transitional passthrough applications in a more timely

manner. A few other commenters

believed that we should have chosen a

date later than July 14, 2000 as the

application deadline for the October 1,

2000 quarterly update for pass-through

items.

Response: We have committed

considerable resources to process passthrough applications in a timely

manner. Since publication of our

preliminary list of 149 potentially

eligible pass-through items on our

website on March 9, 2000, we have

approved nearly 1000 additional items

for pass-through payments. We have

instituted a coding strategy that allows

us to assign a temporary HCPCS code

immediately to an eligible pass-through

item if a national HCPCS code has not

been assigned. We have committed to

making quarterly updates to the passthrough list, a commitment that is

unprecedented in Medicare’s history.

We have reviewed all applications

timely submitted for each update cycle.

Unfortunately, however, we have had to

defer items with significantly unclear

applications or for which sufficient

information was not included to

determine that the item meets the

statutory criteria. We have endeavored

to work closely with the applicants to

obtain this information and respond

timely to their questions.

Regarding objections to setting a July

14, 2000 deadline for receipt of passthrough applications for the October 1

update, this deadline was established in

order to evaluate the applications and

make the necessary systems

modifications in time for the October

release to our fiscal intermediaries and

standard systems maintainers.

Comment: One commenter believed

that we should update our transitional

pass-through list more frequently than

quarterly. Some other commenters were

concerned that the quarterly updating

process could potentially create systems

problems for both HCFA and hospitals

that would delay payments. They

believed that such a delay would, in

turn, create cash flow difficulties for

hospitals. They urged that we develop

contingency plans to address cash flow

problems resulting from the transitional

pass-through process.

Response: Because of the complexity

of our new system, we cannot institute

systems changes more frequently than

quarterly for pass-through payments.

While we believe that making quarterly

updates to the pass-through list will

present challenges both for HCFA and

the hospital industry, we have not been

advised that any hospital is

experiencing cash flow problems

attributable to the transitional passthrough process.

Comment: One commenter urged us

to issue guidelines that detail the

planned methodologies, data sources,

and associated timelines for updating

the pass-through list.

Response: Since March 10, 2000, we

have published information on our

website which provides detailed

instructions and deadlines for

submitting transitional pass-through

applications. These instructions have

been revised as needed in order to

clarify and update information and may

be found on the following HCFA

website: http://www.hcfa.gov

/medlearn/refopps.htm.

Comment: One commenter claimed

that our method and timing of assigning

HCPCS codes to eligible transitional

pass-through items would preclude

Medicare beneficiaries from receiving

appropriate treatment. The commenter

also alleged that hospitals will not

always be adequately reimbursed for

their costs for such items and that they

will have an incentive to switch to more

invasive treatment options with higher

costs.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67809

Response: We have expedited the

process of assigning HCPCS codes to

pass-through items. When an item is

determined eligible for pass-through

status, a temporary HCPCS code is

assigned immediately in order that

hospitals may begin billing the item as

soon as it is effective for payment.

In addition, section 1833(t)(6)(C)(i) of

the Act requires that the hospital’s

additional payment for drugs and

biologicals be determined as the

difference between the amount

determined under section 1842(o) of the

Act (95 percent of AWP) and the portion

of the hospital outpatient department

fee schedule amount determined by the

Secretary to be associated with those

items. For devices, the additional

payment is the difference between the

hospitals’ charges adjusted to costs and

the portion of the applicable hospital

outpatient department fee schedule

amount associated with the device. We

believe that this payment method will

appropriately reimburse hospitals for

eligible pass-through items and that

hospitals will act in a prudent manner

and not compromise their patients’

safety and care.

k. Payment for Pass-Through Items

Comment: Several commenters

questioned how payment would be

made when a pass-through item is

included on an outpatient claim.

Another commenter stated that our

April 7, 2000 final rule with comment

period does not state the actual payment

amount that will be made for each passthrough item, or provide a good reason

for not updating drug and biological

average wholesale prices quarterly, or

pledge timely correction of payment

amount errors. The latter commenter

believed that we should make available

the actual APC payment rates for passthrough items and institute quarterly

pricing-updates for drug and biological

APCs.

Response: Transitional pass-through

payments for devices are established by

taking the hospital charges for each

billed item (on an item-by-item basis),

reducing them to cost by use of the

hospital’s cost-to-charge ratio, and

subtracting an amount representing the

device cost contained in the APC

payments for procedures involving that

device. Note that for services furnished

prior to January 1, 2001, we have not

subtracted an amount for the predicate

device that is packaged in the relevant

APC. However, we will implement this

policy beginning with services

furnished on or after January 1, 2001.

These calculations are all done in the

outpatient prospective payment system

pricer. Because there are no

predetermined APC payment rates for

eligible pass-through devices, we cannot

publish them in the same manner as we

publish the APC payment rates for other

services.

For drugs and biologicals, passthrough payments are determined based

on 95 percent of the AWP for the

eligible drug or biological. We described

in our April 7, 2000 final rule (65 FR

18481) the process we used to subtract

the cost of the eligible drug or biological

contained in the APC payments for

procedures involving that drug,

radiopharmaceutical or biological. The

year 2000 AWPs for pass-through drugs

and biologicals on which payments are

currently based will be updated

annually at the beginning of the next

quarter following publication of the

updated values. Due to the complexity

of our new system, we cannot update

AWPs quarterly as requested.

Comment: A number of commenters

stated that the codes for drugs in

Addendum K of our April 2000 final

rule are specific to the dosage amount

dispensed and asked what happens if

the dosage dispensed to a patient is not

equal to the amount associated with the

eligible codes. The commenters

requested additional information about

how providers should account for these

situations. They asked if we would

allow providers to bill for the product

amount associated with the container

opened to treat the patient and round up

to the nearest whole billing unit.

Response: The APC payment amount

for drugs and biologicals is established

at the lowest dosage level for the

specific drug or biological. If the dosage

required in treating the patient exceeds

the lowest level specified in the HCPCS

code descriptor for the drug or

biological, providers may bill the

number of units necessary to treat the

patient and round them up to the

nearest unit. To determine the payment

for the drug or biological, multiply the

number of billed units by the APC

payment amount.

Comment: One commenter stated that

the APC payment amount for

Eptifibatide, a drug on the pass-through

list, does not equal 95 percent of the

average wholesale price ($6.28 per 5-mg.

service unit). The commenter claimed

that the APC payment is 42 percent

lower than 95 percent of the AWP. The

commenter asked that we correct the

payment immediately.

Response: The correct APC payment

amount for Eptifibatide injection, 5 mg.

is $12.57, of which $1.68 is the

minimum unadjusted coinsurance.

Comment: One commenter stated that

the APC payment amount for

Quadramet, a pass-through drug, is

incorrect. The commenter claimed the

AWP for this drug is $2,975 rather than

$2,875, which the commenter believed

is the basis for our APC payment

amount. The commenter stated that the

pass-through payment should be

$942.08 instead of $910.42.

Response: The correct APC payment

amount for Quadramet is $942.09. Of

this amount, $134.87 is the minimum

unadjusted coinsurance.

Comment: A commenter stated that

the APC payment amount for Thyrogen,

a pass-through drug, should be $494.00

rather than $404.18 per vial.

Response: The APC payment amount

of $404.18 is for 0.9 mg. units of

Thyrogen rather than 1.1 mg., which

appears to be the standard vial dosage.

However, because Thyrogen is not

available in a vial dosage less than 1.1

mg., we are eliminating the APC

payment for 0.9 mg. units (HCPCS code

J3240) effective for outpatient

prospective payment system services

furnished on or after January 1, 2001.

We have established a new code, C9108,

for Thyrogen, 1.1 mg. with an APC

payment amount of $494.00. This new

code is effective for outpatient

prospective payment system services

furnished on or after January 1, 2001.

Comment: A medical association

acknowledged our short lead-time for

implementing the transitional passthrough provision and urged that we

hold a series of face-to-face meetings

with physicians and suppliers to clarify

and revise our pass-through policies.

Response: Since publishing our April

7, 2000 final rule with comment period,

we have met on numerous occasions

with physicians and representatives of

hospitals, pharmaceutical companies

and device manufacturers. During these

meetings, we have discussed our

transitional pass-through policies and

clarified information regarding the passthrough applications process.

Comment: One commenter stated that

the April 7, 2000 final rule with

comment period requiring the submittal

of applications for national HCPCS

codes to bill eligible transitional passthrough was published after the

application deadline had passed. The

commenter alleged that some

manufacturers obtained information

about the pass-through provisions prior

to publication of the final rule,

submitted their applications timely, and

thus dominated the hospital outpatient

market.

Response: On March 9, 2000, we

posted information on our website

similar to that contained in the April 7,

2000 final rule with comment period

about applying for national HCPCS

codes for pass-through items. We also

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discussed the coding deadline with

representatives of the pharmaceutical

and device manufacturers associations

as well as with hospital industry

representatives through conference

calls, meetings, and e-mails. We note

that the instructions and deadline for

submitting applications for a national

HCPCS code are well established and

were published on HCFA’s website

(http://www.hcfa.gov /medicare/

hcpcs.htm) more than a year prior to

publication of our April 7, 2000 final

rule with comment period. Subsequent

to these publications, we adopted a new

system for assigning codes exclusively

for pass-through items to expedite their

availability to the hospital industry and

Medicare beneficiaries. Therefore,

interested parties applying for passthrough status for items have not been

required to obtain national HCPCS

codes for these items unless they want

to bill other payment systems in

addition to the hospital outpatient

prospective payment system.

l. Focus Medical Review

Comment: One commenter asked that

we clarify why we intend to conduct

focused medical review of pass-through

eligible drugs, biologicals and medical

devices.

Response: Our goal is to identify

inappropriate billing for these services

and to ensure that payment is not made

for noncovered services.

3. Budget Neutrality Applied to New

Adjustments

In the April 7, 2000 final rule with

comment period, in accordance with

section 1833(t)(2)(E) of the Act, as

amended by section 201(c) of the BBRA

1999, we made the outlier and

transitional pass-through payment

adjustments under section 1833(t)(5)

and section 1833(t)(6) of the Act,

respectively, budget neutral. We did not

receive any public comments on this

provision.

4. Limitation on Judicial Review

In the April 7, 2000 final rule with

comment period (65 FR 18503–18504),

in accordance with section 1833(t)(12)

of the Act (as amended by section

201(d) of the BBRA 1999 and

redesignated by section 202(a) of the

BBRA 1999), we implemented the

extension of the prohibition of

administrative or judicial review to

include the factors for determining

outlier payments (that is, the fixed

multiple, or a fixed dollar cutoff

amount, the marginal cost of care, or

applicable total payment percentage),

and the factors used to determine

additional payments for certain medical

devices, drugs, and biologicals, the

insignificant cost determination for

these items, the duration of the

additional payment or portion of the

prospective payment system payment

amount associated with particular

devices, drugs, or biologicals, and any

pro rata reduction.

We did not receive any public

comments on this provision.

5. Inclusion in the Hospital Outpatient

Prospective Payment System of Certain

Implantable Items

In the April 7, 2000 final rule with

comment period, we specified that

section 1833(t)(1)(B) of the Act, as

amended by section 201(e) of the BBRA

1999, provides that ‘‘covered OPD

services’’ include implantable items

described in section 1861(s)(3), (6), or

(8) of the Act.

The conference report accompanying

the BBRA 1999, H.R. Rept. No. 479,

106th Cong., 1st Sess. at 869–870,

(1999), expresses the belief of the

conferees that the current DMEPOS fee

schedule is not appropriate for certain

implantable medical items such as

pacemakers, defibrillators, cardiac

sensors, venous grafts, drug pumps,

stents, neurostimulators, and orthopedic

implants as well as items that come into

contact with internal human tissue

during invasive medical procedures, but

are not permanently implanted. In the

conference report agreement, the

conferees state their intention that

payment for these items be made

through the hospital outpatient

prospective payment system, regardless

of how they might be classified on

current HCFA fee schedules.

In the April 7, 2000 final rule with

comment period, we included the

following in the list of items and

services whose costs are included in

hospital outpatient prospective payment

rates: Prosthetic implants (other than

dental) that replace all or part of an

internal body organ (including

colostomy bags and supplies directly

related to colostomy care), and

including replacement of these devices;

implantable DME; and implantable

items used in performing diagnostic xrays, diagnostic laboratory tests, and

other diagnostic tests. In accordance

with the BBRA 1999 provision, we

require that an implantable item be

classified to the group that includes the

service to which the item relates. We

indicated that we would continue to

review the impact of packaging

implantables in future updates. For

more detailed information on this

provision, refer to the April 7, 2000 final

rule with comment period (65 FR

18443–18444).

Comment: Two commenters

(hospitals) expressed concern that the

APC for the CyberonicsNeuroCybernetic Prosthesis (NCP)

System, an implantable device used to

treat epilepsy patients with partial-onset

seizures, will not adequately reimburse

hospitals for the cost of the device and

the implantation procedure cost. The

hospitals recommended that HCFA

create a separate APC group for the NCP

System implantation.

Response: The NCP System was

approved for pass-through status

effective for services furnished on or

after August 1, 2000 (see Program

Memorandum Transmittal No. A–00–42

issued on July 26, 2000). The two

components of this system, the

NeuroCybernetic Prosthesis Generator

and the NeuroCybernetic Prosthesis

Lead, will be paid based on the

hospital’s charges that are converted to

cost using the hospital’s assigned costto-charge ratio. These devices have been

assigned to two separate pass-through

APCs (1048 and 1306, respectively) and

should be billed using HCPCS code

C1048 for the generator and C1306 for

each lead.

Comment: Several commenters from

physician practices and a device

manufacturer raised concerns that the

APC payment level for the Contigen

Implant procedure is inadequate to

cover the facility costs and the Contigen

Implant supplies. According to the

commenters, the APC reimbursement

amount only covers the 2–3 Contigen

Implant syringes used per procedure.

The commenters recommended that we

map the Contigen Implant procedure

and the collagen skin test to higher

paying completely new APCs, to more

adequately reflect reasonable costs for

syringes and skin tests used in the

procedure, in addition to appropriate

facility fees.

Other commenters raised concerns

that the separate APC reimbursement for

the pre-Contigen Implant procedure

testing is inadequate to reimburse for

the reasonable cost of the supply. They

recommended that we allow payment of

Contigen Implant syringes according to

the DMEPOS fee schedule.

One commenter recommended that

we create a special ancillary APC to

cover Contigen Implant syringes and the

collagen skin test.

Response: While we understand the

commenters’ concerns, Contigen

Implant syringes do not qualify for

transitional pass-through status because

they do not meet all of the device

criteria set forth in § 419.43(e)(4).

Specifically, they are not items that are

surgically implanted or inserted in a

patient. However, both collagen implant

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67811

material and the collagen skin test are

paid as APCs (that is, APCs 6012

through 6016 and 343, respectively). We

will examine data after the first year of

billing under the prospective payment

system to determine if we are

adequately capturing the cost of

performing these procedures.

As stated in our April 7, 2000 final

rule with comment period, we will

initiate the annual review process for

the various components of our system,

including the APC groupings, in

calendar year 2001 for services

furnished on or after January 1, 2002.

We expect to publish our proposed rule

for 2002 in the spring of 2001.

Comment: A device manufacturer

inquired as to what will happen when

devices are taken off the transitional

pass-through list after 2 to 3 years. The

commenter stated that the additional

expense of these implantable devices

will require that HCFA reassign these

CPT codes to an APC that is comparable

clinically and in terms of resources used

at the close of the transition period. If

this does not occur, the commenter

indicated that hospitals would be

seriously underpaid for the use of these

technologies and other technologies in

similar circumstances.

Response: As stated above, the BBRA

1999 allows for 2 to 3 years of

transitional pass-through payments to

be made for new devices, drugs, and

biologicals. After the temporary

payment period expires for any item, its

cost will be packaged with the relative

procedure code or medical visit and

assigned to the APC group that is

clinically related and comparable in

resources used. Thus, the APC

groupings, weights, and payments will

be updated in a subsequent year to

include costs associated with former

pass-through items.

Comment: A coalition of health care

providers and insurers indicated that

providers should be allowed to report

all DME, orthotics, and prosthetic

devices, both implantable and

nonimplantable, on the UB–92 to the

fiscal intermediary. The fiscal

intermediary should be able to either

pay for the item via the DMEPOS fee

schedule or through the APC. This also

would allow a tracking system for future

ratesetting, and consolidate the billing

into one claim. This would consolidate

all charges on one bill per encounter,

which simplifies processing and is

consistent with other third party payer

claims processing as well as Medicare

inpatient claims processing.

Response: Section 201(e) of the BBRA

1999 amended section 1833(t)(1)(B) of

the Act to require that covered

outpatient prospective payment system

services include implantable medical

items, described in section 1861(s)(3),

(6), or (8) of the Act. These items were

formerly paid under the DMEPOS fee

schedule. The statute is explicit in

defining which DME items are payable

under the hospital outpatient

prospective payment system.

Also, we cannot adopt the suggested

billing changes for DME as the

commenter suggested. All services that

are billed through the fiscal

intermediaries, whether they are paid

under the hospital outpatient

prospective payment system or

DMEPOS, may be submitted on the UB–

92 (or the equivalent electronic

transaction). However, there are

numerous, very exacting, specific

criteria and rules that govern Medicare

coverage and payment for

nonimplantable DME and oxygen. The

DME regional carriers are exclusively

qualified to deal with these issues.

Therefore, claims for nonimplantable

DME and oxygen cannot be billed to the

fiscal intermediaries. Instead, providers

must continue to submit claims for

nonimplantable DME and oxygen to the

DME regional carriers using form

HCFA–1500 (or the equivalent

electronic transaction).

It should be noted that if a health care

provider submits an electronic claim for

these services, the transaction must

comply with the standards adopted by

the Secretary in the August 17, 2000

final rule (65 FR 50312) Standards for

Electronic Transactions. The

compliance date of that rule is October

16, 2002.

Comment: A device manufacturer

expressed concern about how the new

system will change the payment

mechanism for cochlear implants.

Under the DMEPOS fee schedule,

payments were fixed and unrelated to

hospital charges. Now, under the new

system, hospitals must properly

establish charges that, when multiplied

by the ratio of cost to charges, provide

an accurate reflection of cost. This

manufacturer was concerned that they

will have to collect data to determine

the charges hospitals have set for these

devices and the applicable ratio of cost

to charges. They believe the charges

may not have been set appropriately to

be consistent with the ratio of cost to

charges. If not, pass-through payments

might be substantially less than the

actual cost for these medical devices.

This manufacturer indicated that it is

working to obtain the required charge

and cost report data from providers of

cochlear implant procedures and will

report back to us once it has these data.

The manufacturer requested that we

agree to work with them in setting any

future update to the payment allowance

recognizing the short timeframe

available to collect the data.

Response: We appreciate the

commenter’s offer to assist us in

collecting cost and charge data on

cochlear implants billed by hospitals.

However, for purposes of making

transitional pass-through payments for

new medical devices such as cochlear

implants, it is not necessary for

manufacturers to obtain cost report data

from hospitals to assist us in developing

hospital-specific, cost-to-charge ratios to

calculate these payments. We have

already calculated these ratios and

assigned them to providers. Each

provider is responsible for accurately

reporting its charges in order that we

may calculate the appropriate payment

for the pass-through device.

6. Payment Weights Based on Median or

Mean Hospital Costs

Section 1833(t)(2)(C) of the Act

requires the Secretary to establish

relative payment weights for covered

hospital outpatient services. This

section requires that the weights be

developed using data on claims from

1996 and data from the most recent

available hospital cost reports.

As specified in the April 7, 2000 final

rule with comment period (65 FR

18482), section 201(f) of the BBRA 1999

amended section 1833(t)(2)(C) of the Act

to authorize the Secretary to base the

relative payments weights on median or

mean hospital costs. In implementing

the BBRA 1999 provision, we decided to

adopt as final our previously proposed

policy to base the relative payment

weights on median (as opposed to

mean) costs. We had already used

median costs to reconstruct our database

for the outpatient prospective payment

system group weights and conversion

factors in a proposed rule and we

believe that this method is still valid,

especially considering the time

constraints for implementation of the

BBRA 1999 provision. We indicated

that, among other things, reconstructing

our database to evaluate the impact of

using mean costs after the BBRA 1999

was enacted would have delayed

implementation of the hospital

outpatient prospective payment system

rule.

Comment: A group of hospitals urged

us to adopt a mean-based APC relative

weight system to implement section

201(f) of the BBRA 1999, which

authorizes, but does not require, the

Secretary to use mean (rather than

median) costs in determining the APC

payment weights. The commenters

contend that use of the geometric mean

is standard in the industry as the basis

67812 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

for calculating payment weights for

prospective payment systems. They

pointed out that the geometric mean is

used because costs are not distributed

‘‘normally’’ (that is, there are no

negative costs) and that for APCs that

include low volume, high costs

procedures, the geometric mean is

preferable for adequately accounting for

these costs. The commenters believed

that our use of median costs also forced

us to select an arbitrary value for

relative weight 1.0, because finding the

median of medians is meaningless. The

commenters believed that, given the

Congress’ clarification in section 201(f)

of the BBRA 1999, we should at least

evaluate the impact of a mean-based

system in our system review for 2001.

Response: We plan to further evaluate

the feasibility of using mean rather than

median costs for calculating APC

payment weights in future updates. In

order to make a decision about whether

we should change the basis we are using

for determining payment weights, we

have to analyze and rerun claims data

and conduct extensive impact analyses

to assess the impact such a change

would have on different types of

providers and different types of

services.

7. Limitation on Variation of Costs of

Services Classified Within a Group

Section 1833(t)(2) of the Act was

amended by section 201(g) of the BBRA

1999 to limit the variation in resource

use among the procedures or services

within an APC group. Specifically,

section 1833(t)(2) of the Act provides

that the items and services within a

group cannot be considered comparable

with respect to the use of resources if

the highest cost item or service within

a group is more than 2 times greater

than the lowest cost item or service

within the same group. The Secretary is

to use either the mean or median cost

of the item or service.

Section 1833(t)(2) of the Act, as

amended, also allows the Secretary to

make exceptions to this limit on the

variation of costs within each group in

unusual cases such as low volume items

and services, although we may not make

such an exception in the case of a drug

or biological that has been designated as

an orphan drug under section 526 of the

Federal Food, Drug, and Cosmetic Act.

In the April 7, 2000 final rule with

comment period, we elected to use the

median cost because we have continued

to set the relative payment weights for

each APC based on median hospital

costs. We modified the composition of

the APC groups and then made

additional changes to the APC in

response to public comments on

individual or serial APCs.

In determining whether or not to

accept changes recommended by

commenters, we focused on five criteria

that are fundamental to the definition of

a group within the APC system. The

decision to accept or decline a

modification to an APC group was

determined based on whether the

change enhanced, detracted from, or

had no effect on the integrity of an APC

group within the context of the

following five criteria:

• Resource homogeneity;

• Clinical homogeneity;

• Provider concentration;

• Frequency of services; and

• Minimal opportunity for upcoding

and code fragmentation.

For a full explanation of these criteria,

refer to the April 7, 2000 final rule with

comment period (65 FR 18457).

After we modified the composition of

the APC groups based on the

recommendations of commenters, we

applied the median cost variation limit

required by section 201(g) of the BBRA

1999 to the revised APC groups. As a

result of our analysis of the array of

median costs within the revised APC

groups, we had to split some otherwise

clinically homogeneous APC groups

into smaller groups. We listed the APC

groups that we had designated as

exceptions to the ‘‘two times’’

requirement and our reasons for

granting the exception. We based the

exceptions on factors such as low

procedure volume, suspect or

incomplete cost data, concerns about

inaccurate or incorrect coding, or

compelling clinical arguments. We

indicated that we would be examining

the extent to which the APC

reorganization due to the ‘‘two times’’

rule results in upcoding (refer to the

April 7, 2000 final rule with comment

period (65 FR 18458–18475)).

Comment: We received requests to

examine 51 APCs that commenters

alleged violated the ‘‘two times’’ rule.

Response: We reevaluated the APCs

listed below, upon which we received

comments, and found that most of them

did not warrant revision. We received

no new information about these APC

groups that would alter our previous

decision. These APCs are identified

below under numbers 1 and 2.

Our review also revealed that a few

APC groups did warrant revision and

we have reconfigured these APCs

accordingly. We have listed these APCs

under number 3. In addition, our review

identified some APCs that are additional

exceptions to the ‘‘two times’’

requirement. These APC groups and our

reasons for the exception are listed

below under number 4.

In reviewing the APC groups for

conformance to the ‘‘two times’’

requirement, we exempted from the

analysis codes for unlisted services and

procedures and those codes that

represent less than 2 percent of the

claims in the APC (our test for low

volume).

1. Taking into account the exemptions

mentioned above, the following APC

groups that we reviewed based on

comments have not been reconfigured:

0005 Level II Needle Biopsy/

Aspiration Except Bone Marrow

0076 Endoscopy Lower Airway

0088 Thrombectomy

0090 Level II Implantation/Removal/

Revision of Pacemaker, AICD or

Vascular Device

0111 Blood Product Exchange

0112 Extracorporeal Photopheresis

0121 Level I Tube changes and

Repositioning

0143 Lower GI Endoscopy

0146 Level I Sigmoidoscopy

0149 Level II Anal/Rectal Procedure

0150 Level III Anal/Rectal Procedure

0151 Endoscopic Retrograde

Cholangio-Pancreatography (ERCP)

0162 Level III Cystourethroscopy and

other Genitourinary Procedures

0260 Level I Plain Film Except Teeth

0262 Plain Film of Teeth

0265 Level I Diagnostic Ultrasound

Except Vascular

0268 Guidance Under Ultrasound

0269 Echocardiogram Except

Transesophageal

0278 Diagnostic Urography

0280 Level II Diagnostic Angiography

and Venography Except Extremity

0282 Level I Computerized Axial

Tomography

0283 Level II Computerized Axial

Tomography

0284 Magnetic Resonance Imaging

0286 Myocardial Scans

0290 Standard Non-Imaging Nuclear

Medicine

0291 Level I Diagnostic Nuclear

Medicine Excluding Myocardial

Scans

0292 Level II Diagnostic Nuclear

Medicine Excluding Myocardial

Scans

0294 Level I Therapeutic Nuclear

Medicine

0297 Level II Therapeutic Radiologic

Procedures

0301 Level II Radiation Therapy

0303 Treatment Device Construction

0304 Level I Therapeutic Radiation

Treatment Preparation

0305 Level II Therapeutic Radiation

Treatment Preparation

2. The following APC groups were

listed in the April 7, 2000 final rule

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67813

with comment period as exceptions to

the ‘‘two times’’ rule and our review

found no factual basis for modifying our

decision:

0030 Breast Reconstruction/

Mastectomy

0264 Level II Miscellaneous Radiology

Procedures

0274 Myelography

0279 Level I Diagnostic Angiography

and Venography Except Extremity

0311 Radiation Physics Services

0371 Allergy Injections

3. We have reconstructed the four

APCs shown below as a result of adding

the cost of certain devices used in

performing procedures included in

these APCs. We discuss this change in

section III.B. of this preamble.

0080 Diagnostic Cardiac

Catheterization

0081 Non-Coronary Angioplasty or

Atherectomy

0082 Coronary Atherectomy

0083 Athrectomy

4. Following are additional exceptions

to the ‘‘two times’’ rule and our reasons

for the exceptions. We are excepting

these APCs from the ‘‘two times limit’’

on an interim basis, until we can review

data from the first year of billing under

the hospital outpatient prospective

payment system.

0142 Small Intestine Endoscopy:

The codes in APC 0142 are clinically

similar and should show a relative

progression of cost with slight increases

in complexity. This effect does not

occur, presumably due to low volume

(although exceeding our low volume

threshold) or inconsistent coding.

Splitting this APC into two, based on

current data, would be unjustified.

0145 Therapeutic Anoscopy: The

costs of the codes in this APC are

aberrant, with several of them exceeding

the costs of more extensive procedures

such as sigmoidoscopy and

colonoscopy.

0152 Percutaneous Biliary

Endoscopic Procedures: The codes in

this APC have so few occurrences that

we cannot justify splitting the group.

Several of the codes call for the use of

devices such as stents that may be paid

for separately.

0161 Level II Cystourethroscopy and

other Genitourinary Procedures: The

costs of the codes in this APC are

aberrant, with more comprehensive

codes costing less than the base codes.

0195 Level V Female Reproductive

Procedures: This is a low volume APC,

with aberrant cost data. In several

instances, codes that are more

comprehensive cost less than the

related, simpler code.

0296 Level I Therapeutic Radiologic

Procedures: We believe the codes at the

lower end of the median cost in this

APC would be underpaid if we were to

move them to a lower-paying APC.

0300 Level I Radiation Therapy: We

believe we would underpay codes at the

lower end of median cost in this APC if

we were to move them to a lower-paying

APC.

0312 Radioelement Applications:

We believe the costs in this very low

volume APC are aberrant. However, the

group is completely coherent clinically.

The radioactive elements related to

these codes would receive separate

payment.

0313 Brachytherapy: We believe the

costs in this very low volume APC are

aberrant. The group is coherent

clinically. The radioactive elements

related to these codes would receive

separate payment.

0314 Hyperthermic Therapies: This

APC has an extremely low volume, with

aberrant costs.

8. Annual Review of the Components of

the Hospital Outpatient Prospective

Payment System

In the April 7, 2000 final rule with

comment period (65 FR 18501–18502),

we indicated that, in accordance with

section 1833(t)(9) (as redesignated and

revised by sections 201(h) and 202(a) of

the BBRA 1999), we would review and

update annually, for implementation

effective January 1 of each year, the APC

groups, the relative payment weights,

and the wage and other adjustments that

are components of the hospital

outpatient prospective payment system.

In accordance with section 201(h)(2) of

the BBRA 1999, an annual review

process will begin in calendar year 2001

for the hospital outpatient prospective

payments that would take effect for

services furnished on or after January 1,

2002. This review process will involve

consultation with an expert advisory

panel. We will provide notice of the

formation of the expert advisory panel

in the Federal Register. The expert

outside advisory panel will review and

make recommendations to us on the

clinical integrity of the groups and

weights and may use data other than

those collected or developed by us for

their review and advisory functions.

We note that in section III of this

preamble, we are updating the wage

index values and the conversion factor

under the hospital outpatient

prospective payment system effective

for calendar year 2001. We also are

making appropriate changes to the APC

groups to reflect additions and deletions

of CPT codes and changes to a limited

number of APCs to incorporate the cost

of certain devices used in performing

those procedures that were excluded

from our initial ratesetting methodology.

Comment: One commenter stated that

the wage index for the Hattiesburg,

Mississippi Metropolitan Statistical

Area (MSA), .7306, was printed

incorrectly in our April 7, 2000 final

rule with comment period. The

commenter stated that use of this value

would result in an underpayment for

that area. The commenter further stated

that, ‘‘the appropriate wage index for

the Hattiesburg, Mississippi MSA for

the fiscal year 2000 is .7634.’’ The

commenter was concerned that we had

previously acknowledged this error and

promised to correct it via a program

memorandum to fiscal intermediaries

dated April 2000 (Transmittal Number

A–00–17), but had failed to do so in our

April 7, 2000 final rule with comment

period.

Response: We apologize for the

confusion. The fiscal year 2000 hospital

inpatient prospective payment system

wage index value for the Hattiesburg,

Mississippi (MSA) was changed from

.7306 to .7634 in accordance with

section 153 of the BBRA 1999 that

required us to include wage data from

Wesley Medical Center in calculating

the wage index for this MSA. On August

1, 2000, we published in the Federal

Register an interim final rule with

comment period (65 FR 47026) that

included Hattiesburg’s new hospital

inpatient prospective payment system

wage index. For services paid under the

hospital outpatient prospective payment

system, the new wage index value is

effective for services furnished on or

after August 1, 2000.

9. Copayment Amounts Not Affected by

Pass-Throughs

Section 1833(t) of the Act, as

established by the BBA of 1997,

includes a mechanism designed to

achieve a beneficiary coinsurance level

equal to 20 percent of the prospectively

determined payment rate established for

the service. In the April 7, 2000 final

rule with comment period, we specified

how a copayment amount is calculated

annually for each APC group under the

hospital outpatient prospective payment

system.

We also explained that sections 201(a)

and (b) of the BBRA 1999 amended

section 1833(t) of the Act to provide for

additional payments to hospitals for

outlier cases and for certain medical

devices, drugs, and biologicals and that

these additional payments to hospitals

will not affect copayment amounts.

Redesignated section 1833(t)(8)(D) of the

Act, as amended by section 201(i) of the

BBRA 1999, provides that the

copayment amount is to be computed as

67814 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

if outlier adjustments, adjustments for

certain medical devices, drugs, and

biologicals, as well as any other

adjustments we may establish under

section 1833(t)(2)(E) of the Act, had not

occurred.

In addition, we specified that section

202 of the BBRA 1999 added a new

section 1833(t)(7) to the Act to provide

transitional corridor payments to certain

hospitals through calendar year 2003

and indefinitely for certain cancer

centers. Section 1833(t)(7)(H) of the Act

provides that the transitional corridor

payment provisions will have no effect

on determining copayment amounts.

We specified that copayment from

beneficiaries will not be collected for

the additional payments made to

hospitals (outlier and transitional passthroughs) by Medicare. Beneficiary

copayment amounts will be calculated

as if the outlier and transitional passthroughs had not occurred (65 FR

18487–18488).

When a drug or device pass-through

payment is reduced by the otherwise

applicable APC payment amount that is

associated with the drug or device, it is

only the portion of the payment that

represents an additional pass-through

payment that is not subject to

copayment. The portion that does not

represent an additional pass-through

payment will be subject to copayment.

We did not receive any public

comments on this provision.

10. Extension of Cost Reductions

In the April 7, 2000 final rule with

comment period (65 FR 18439), we

announced that, in accordance with

section 1861(v)(1)(S)(ii) of the Act (as

amended by section 201(k) of the BBRA

1999), the 5.8 and 10 percent reductions

for hospital operating and capital costs,

respectively, would extend until the

first date that the hospital outpatient

prospective payment system is

implemented (which was August 1,

2000).

We did not receive any public

comments on this provision.

11. Clarification of Congressional Intent

Regarding Base Amounts Used in

Determining the Hospital Outpatient

Prospective Payment System

Section 201(l) of the BBRA 1999

provided that, ‘‘With respect to

determining the amount of copayments

described in paragraph (3)(A)(ii) of

section 1833(t) of the Act, as added by

section 4523(a) of BBA, Congress finds

that such amount should be determined

without regard to such section, in a

budget neutral manner with respect to

aggregate payments to hospitals, and

that the Secretary of Health and Human

Services has the authority to determine

such amount without regard to such

section.’’ In accordance with this

provision, in the April 7, 2000 final rule

with comment period (65 FR 18482–

18493), we explained how we

determined APC group weights,

calculated an outpatient prospective

payment system conversion factor, and

determined national prospective

payment rates, standardized for area

wage variations, for the APC groups. We

then explained how we calculated the

aggregate hospital outpatient

prospective payment to hospitals in a

budget neutral manner and how we

calculated beneficiary coinsurance

amounts for each APC group.

We did not receive any public

comments on this provision.

12. Transitional Corridors for

Application of Outpatient Prospective

Payment System

Section 1833(t)(7) of the Act, as added

by section 202(a)(3) of the BBRA 1999,

provides for payment adjustments

during a transition period to limit the

decline in payments under the

outpatient prospective payment system

for hospitals. These additional

payments are to be implemented

without regard to budget neutrality and

are in effect through 2003.

In the April 7, 2000 final rule with

comment period (65 FR 18499–18500),

we specified that, from the date the

prospective payment system is

implemented through 2003, a provider,

including a CMHC, will receive an

adjustment if its prospective payment

system payments for outpatient services

furnished during the year is less than a

set percentage of its pre-BBA amount for

that year. The pre-BBA amount is the

product of the reasonable cost the

hospital incurs for prospective payment

system services furnished during the

year and the payment-to-cost ratio for

covered prospective payment system

services furnished during the cost

reporting period ending in calendar year

1996. Additionally, we provided that

small rural hospitals with 100 or fewer

beds and cancer hospitals will be held

harmless under this provision. Small

rural hospitals will be held harmless for

services furnished before January 1,

2004. The hold-harmless provision

applies permanently to cancer centers.

We announced that we will make

interim payments to the affected

hospitals subject to retrospective

adjustments and that these provisions

do not affect beneficiary coinsurance.

Finally, we specified that this provision

is not subject to budget neutrality.

a. Interim Payment Versus Final

Settlement

Comment: One commenter

recommended that we make retroactive

payments to hospitals in those

‘‘situations where underpayments have

been made between the prospective

payment system payments as compared

to the pre-prospective payment system

amounts.’’ Another commenter asked

that we set forth the process that would

be used to determine retroactive

payment adjustments if the hospital’s

interim payments are higher or lower

than its actual experience. The

commenter further asks that we state

whether the interim payments will be

compared to outpatient payments

shown on settled or audited cost

reports.

Response: Final transitional corridor

payments are determined based on a

provider’s settled cost report. At the

time the cost report is settled, the

reasonable costs incurred by the

provider to furnish outpatient

prospective payment system services

during the calendar year are known and

that amount is then multiplied by the

provider’s 1996 payment-to-cost ratio to

calculate the pre-BBA amount. The preBBA amount for a calendar year is

compared to the actual prospective

payment system payments the provider

received to determine whether the

provider may be entitled to a

transitional corridor payment. Although

the final transitional corridor payment

is based on a settled cost report,

beginning in October 2000, we have

been making monthly interim payments

to providers based on estimates of what

their transitional corridor payments

should be based on the monthly bills

the provider submits. The monthly

payments are designed to maintain

some additional cash flow to providers

that may otherwise realize significant

losses on services that are being paid

under the prospective payment system.

b. Payment-to-Cost Ratios

Comment: One commenter argued

that our formula for calculating the base

payment-to-cost ratio for the transitional

corridor payments does not comport

with the statutory requirements. The

commenter stated that we define the

denominator of the base payment-tocost ratio to be ‘‘[the] reasonable cost of

these services for the period, without

applying the cost reductions under

section 1861(v)(1)(S) of the Act.’’ The

commenter contends that the phrase

‘‘without applying the cost reductions

under section 1861(v)(1)(S) of the Act’’

is not included in section

1833(t)(7)(F)(ii)(II) of the Act, as

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67815

amended by section 212 of the BBRA

1999. The commenter claimed that by

defining the denominator in this

manner, the payment-to-cost ratio is

understated and transitional corridors

payments to hospitals would be

reduced. The commenter stated that

such a reduction is contrary to

Congressional intent and urged us to

modify our base payment-to-cost

denominator set forth in

§ 419.70(f)(2)(ii) to exclude the phrase

‘‘without applying the cost reduction

under section 1861(v)(1)(S) of the Act.’’

Response: The phrase ‘‘without

applying the cost reductions under

section 1861(v)(1)(S) of the Act’’ was

intended to make clear that a hospital’s

1996 ‘‘reasonable costs’’ do not include

the effects of the reductions in section

1861(v)(1)(S) of the Act. We did not

mean to suggest that we were taking the

hospital’s 1996 ‘‘reasonable costs’’ and

then adding back the reductions for

purposes of determining the

denominator of the base payment-tocost ratio. We view the hospital’s 1996

reasonable costs as the unreduced

amount; thus, the denominator of the

hospital’s base payment-to-cost ratio

(1996 reasonable costs) does not reflect

the reductions. We believe that our

policy is consistent with the purpose of

the transitional corridor provision.

Under this policy, if a hospital incurs

the same amount of costs during the

transitional corridor as in 1996, then its

pre-BBA amount (the amount that

estimates what the hospital would have

received in the current year if payments

were calculated under the preprospective payment system) would be

the same as the payments the hospital

received in 1996. Under the

methodology suggested by the

commenter, if a hospital incurs the same

amount of costs during the transitional

corridor as in 1996, then its pre-BBA

amount would be higher than the

payments the hospital received in 1996.

The language in § 419.70(f)(2)(ii) as set

forth in the April 7, 2000 final rule with

comment period was intended to clarify,

not revise, the definition of 1996

reasonable costs, but we recognize that

the phrase at issue may have

inadvertently caused confusion to the

extent it is redundant; accordingly, we

are revising that section to remove the

phrase.

Comment: One commenter asked us

to clarify the term ‘‘payment-to-cost

ratio’’ and the data that will be used to

compute the ratio. Several commenters

asked why we did not give the 1996

outpatient prospective payment systemspecific amounts required to compute

the payment-to-cost ratio and the

methodology for calculating it.

Response: The statutory definition of

base ‘‘payment-to-cost ratio’’ is fairly

straightforward. Under section

1833(t)(7)(F) of the Act, the base

payment-to-cost ratio for a given

hospital is the ratio of (1) the hospital’s

Medicare Part B reimbursement for

covered OPD services for the cost

reporting period ending during 1996, to

(2) the hospital’s reasonable costs for

that period. We are in the process of

developing program instructions for

fiscal intermediaries (for notification to

providers) to provide detailed

information on how payment-to-cost

ratios are calculated. These instructions

will be made available as soon as

possible.

Comment: One hospital association

recommended that we revise our

regulations to explicitly state that we

will adjust the provider’s 1996 paymentto-cost ratio ‘‘whenever subsequent

developments occur that affect the data

used in the calculation.’’ The

commenter cited final audit adjustments

and appeal determinations as examples

of adjustments that would warrant

changing the 1996 cost data used to

calculate the provider’s payment-to-cost

ratio. The commenter stated that this

policy is consistent with similar

adjustments made under the prospective

payment systems for both inpatient

operating and capital-related costs.

Response: We agree with the

commenter. In the event final audit

adjustments or appeals result in a

change in outpatient costs or payments

for the provider’s 1996 cost report, the

provider’s payment-to-cost ratio would

be recalculated.

Comment: One commenter asked for

clarification on the treatment of direct

graduate medical education costs and

education costs for nursing and allied

health programs in calculating the

payment-to-cost ratio. The commenter

assumed that such costs are excluded

from the pre-BBA amount because they

will continue to be paid on a cost passthrough basis.

Response: The commenter is correct

that direct graduate medical education

costs and certain costs of nursing and

allied health programs are paid on a cost

pass-through basis and will not be

included in calculating a provider’s preBBA amount.

Comment: One commenter asked that

we explain our reasons for basing the

transitional corridor interim payments

on a 0.8 payment-to-cost ratio. The

commenter suggested that a provider be

allowed to modify its interim

transitional corridor payment if it can

show that its payment-to-cost ratio is

higher or lower than the 0.8 level.

Several commenters questioned why

we chose to use a standard 0.8 paymentto-cost ratio for all providers in

calculating the interim payment if

provider-specific payment-to-cost ratios

were available. They stated that 9 of the

10 cancer centers have payment-to-cost

ratios that exceed 0.8.

Response: The standard payment-tocost ratio of 80 percent is an average

value that we calculated for payment-tocost ratios across all hospitals. We

decided to use 80 percent for all

providers to permit us to make interim

payments as soon as possible following

the implementation of the outpatient

prospective payment system. If we had

attempted to calculate individual

payment-to-cost ratios for all providers,

it would have delayed, perhaps for

several months, the introduction of

interim payments. Final transitional

corridor payments will be calculated

using each provider’s payment-to-cost

ratio for the relevant year at the time of

settlement of the cost report. In the

future, as we gain more experience with

interim payments, we will consider

permitting modification of payment-tocost ratios to reflect particular

circumstances.

c. Cost-to-Charge Ratios

Comment: One commenter stated that

the April 7, 2000 final rule with

comment period did not explain how

the transitional corridor payments

would be implemented for the 10 cancer

hospitals. The commenter noted that

while Program Memorandum

Transmittal No. A–00–23 issued by us

on April 7, 2000, does describe how

these payments are to be calculated it

does not clarify how we derived the

hospital-specific cost-to-charge ratios

used to compute the transitional

corridor payments.

Several commenters representing the

10 cancer centers stated that the cost-tocharge ratios for their centers that will

be used in calculating their transitional

corridor, outlier, and transitional passthrough payments are significantly

lower than their estimates. They

requested that we explain how we

determined their ratios and comment on

the appropriateness of our methodology.

They also asked that we respond to a

number of specific questions to allow

hospitals to determine whether the costto-charge ratios accurately reflect the

hospital’s cost and provide a fair base

for calculating their transitional corridor

payments.

Response: On September 8, 2000, we

issued a Program Memorandum

Transmittal No. A–00–63, which

provides a detailed explanation of how

hospital cost-to-charge ratios were

67816 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

calculated. This program memorandum

is available on HCFA’s internet website

at www.hcfa.gov/Medicare.

d. Interim Payments Limited to 85

Percent of the Estimated Transitional

Corridor Payment

Comment: One commenter asked why

we will only pay 85 percent of the

estimated transitional corridor payment

as an interim payment. Another

commenter recommended that we

reconsider our policy to pay providers

only 85 percent of their transitional

corridor payments on the interim basis.

The commenter stated that our policy to

withhold 15 percent of each provider’s

payment until the fiscal intermediary

finalizes the provider’s cost report is

contrary to Congressional intent to

preserve hospitals’ cash flow and ensure

them of an ability to provide outpatient

services to beneficiaries, especially

those in rural areas. Another commenter

stated that retaining 15 percent of each

provider’s estimated transitional

corridor payments until the provider’s

cost report is settled is contrary to

Congressional intent and defers relief

provided by statute for several years.

Response: We limited the interim

payment to less than 100 percent of the

estimated payment in order to minimize

the risk of overpayment. If interim

payments exceed the final settled

amounts, we would need to initiate

recoupment procedures that place

additional burden both on the agency

and on providers. Eighty-five percent

was chosen as a reasonable percentage

that prudently balances the cash flow

needs of some providers with concerns

regarding possible difficulties in the

recovery of overpayments. We have

used comparable figures in other

situations in which we make interim or

advance payments. One example where

we specified 85 percent for advance

payments is in the contingency plan

that we published to address the

possibility that either our contractors or

individual providers would be unable to

process claims at the initiation of the

outpatient prospective payment system.

In the future, as cost reports are settled

and we are able to determine how well

interim transitional corridor payments

relate to final transitional corridor

payments, we will reevaluate this aspect

of our interim payment policy.

e. Providers Having More Than One

1996 Cost Report

Comment: Several commenters stated

that we did not discuss in our final rule

how we would calculate the 1996

payment-to-cost ratio in cases where a

provider has more than one cost report

that is less than 12 full months during

the fiscal year ending in 1996. The

commenters asked which would be the

appropriate cost report to use in

calculating the transitional corridor

payments. One commenter explained

that this situation may occur if

ownership changed during the

provider’s fiscal year ending in 1996.

Response: The 1996 cost report that

will be used to calculate a payment-tocost ratio is the cost report period that

ends in calendar year 1996. If a provider

has two cost reports that end in 1996,

we will make a decision about which

cost report to use on a case-by-case

basis, depending on which appeared to

be the most representative of the

provider’s experience in 1996. For

example, if one cost report covers a

longer period, we would likely use that

one.

f. Providers Having No 1996 Cost Report

Comment: One commenter expressed

concern about insufficient guidance

from us about how transitional corridor

payments would be determined for

providers that did not file cost reports

during 1996. The commenter believed

that because the statute is silent on this

issue, we have the discretion to develop

such policy. The commenter strongly

opposed any decisions by us to preclude

providers without 1996 cost reports

from being eligible to receive

transitional corridor payments.

Another commenter requested that we

treat new hospitals that did not file a

1996 cost report the same as rural

hospitals. The commenter contended

that the pre-BBA payment level for

these hospitals should be based on the

hospital’s first full cost reporting period,

and would be guaranteed at that level

through December 31, 2003. Another

commenter suggested as an option that

we assign a regional average paymentto-cost ratio for existing providers to

providers without a 1996 cost report.

Response: Under the statute, the

amount of transitional payments to

providers depends on the provider’s

reimbursement for the 1996 cost

reporting period. We intend to monitor

the adequacy of payments to providers

not having a 1996 cost report, but we

believe that a statutory change is

required in order to provide transitional

payments to providers that did not have

a 1996 cost report.

g. Prospective Payment System Delay

and Transitional Corridor Payments

Comment: One commenter expressed

concern about the potential effect of

delaying implementation of the hospital

outpatient prospective payment system

on the duration of the transitional

corridor payments as provided by law.

The commenter stated that our decision

to delay implementation of the

prospective payment system for 1

month, from July 1, 2000 to August 1,

2000, should not result in a 1-month

loss of transitional corridor payments

for providers. The commenter believed

that the 31⁄2 years of corridor payments

required by law for non-cancer hospitals

paid under the outpatient prospective

payment system should not be reduced

due to delayed implementation of the

prospective payment system. The

commenter urged us to seek a legislative

change if we determine the 31⁄2 year

period for transitional corridor

payments must coincide with the first

31⁄2 years of actual prospective payment

system implementation.

Response: For hospitals that do not

qualify for the permanent hold-harmless

provision applicable to cancer hospitals,

the statute provides for transitional

corridor payments through the end of

calendar year 2003. We will monitor

and evaluate prospective payment

system payments and will consider

whether it would be appropriate to

recommend that Congress legislate an

extension of transitional corridor

payments.

h. Rural Hold-Harmless Provision

Comment: One commenter suggested

that we reevaluate the definition of rural

outpatient hospitals eligible for the

hold-harmless provision and consider

including rural hospitals that have 100

to 200 beds, ‘‘but whose outpatient

volumes are not sufficient to maintain

the facilities’ finances.’’

Response: The bed size for hospitals

to qualify for the rural hospital holdharmless provision is limited by statute,

under section 1833(t)(7)(D)(i) of the Act,

to hospitals that have no more than 100

beds.

Comment: One commenter stated that

on page 18501 of the April 7, 2000 final

rule with comment period, we state that

bed size under the rural hospital holdharmless provision will be determined

in the same manner as it is for the

hospital inpatient prospective payment

system indirect medical education

adjustment. The commenter contended

that we have not provided these

instructions to fiscal intermediaries. The

commenter questioned whether the

fiscal intermediaries are using the

number of beds reported on the hospital

cost reports to determine the bed size.

Still another commenter stated that we

failed to specify how beds are to be

counted under the hospital outpatient

prospective payment system. The

commenter further stated that our

impact analysis published in the April

7, 2000 final rule with comment period

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67817

suggests that available bed counts

shown on the HCFA–2552 cost report

S–3 Worksheet are used to determine if

a hospital has 100 or fewer beds to

qualify for the rural hold-harmless

transitional corridor payment provision.

The commenter urged us to clarify this

issue.

Response: In Program Memorandum

Transmittal No. A–00–23, later revised

in June 2000 as Program Memorandum

Transmittal No. A–00–36, we provided

instructions to fiscal intermediaries

concerning how to calculate interim

transitional corridor payments. As

indicated in the April 7, 2000 final rule

with comment period, the bed size used

for transitional corridor payments will

be the same bed size defined in and

used to calculate indirect medical

education costs and disproportionate

share adjustments under the hospital

inpatient prospective payment system.

Fiscal intermediaries are instructed to

obtain certain provider-specific

information needed to make the

calculation from the outpatient

provider-specific file that they maintain.

Certain items on the outpatient

provider-specific file, including bed

size, are taken directly from the

provider file used in processing

inpatient claims.

Comment: One commenter urged that

we revise policy for determining bed

size for purposes of defining rural

providers eligible for the hold-harmless

provision. The commenter advocated

that we adjust a provider’s count of

acute inpatient days to account for

observation patients occupying acute

inpatient beds.

Response: The commenter did not

provide a rationale for their

recommendation. We believe that it is

appropriate to adopt a policy for

purposes of the outpatient prospective

payment system that is consistent with

the policy for purposes of the inpatient

prospective payment system; therefore,

we are not making a change at this time.

Comment: A commenter specifically

asked that, for purposes of determining

bed size for rural providers, we clarify

what year is used to determine bed size.

The commenter also asked what our

policy is regarding providers that

changed their inpatient capacity prior to

July 1, 2000, and those that may change

this capacity during the 31⁄2 year

transition period. The commenter

suggested that we permit hospitals to

downsize capacity without affecting

their eligibility for hold-harmless status.

Response: Under § 412.105(b), to

determine bed size for the rural holdharmless provision, we calculated bed

size on the basis of the provider’s cost

reporting period. A rural hospital’s bed

size and, therefore, its eligibility for

hold-harmless treatment may change

from one cost reporting period to the

next.

Comment: Several commenters asked

us to clarify whether a hospital’s

reclassification for either the wage index

area or standardized amount affects its

eligibility for the rural hold-harmless

payment. The commenter believed that,

because the BBRA 1999 statutory

provision relevant to the rural holdharmless provision refers to providers

‘‘located in a rural area’’ rather than the

provider’s payment status, a provider’s

geographic reclassification for wages or

standardized amount has no bearing on

its rural hold-harmless status. A few

commenters argued that a geographic

reclassification under inpatient

prospective payment system for the

wage index or the standardized amount

is not relevant for purposes of the holdharmless rural payment provision and

that these reclassified hospitals should

be included in the rural hold-harmless

payment.

Response: If a hospital is located in a

rural area, it will not lose its eligibility

for hold-harmless payments if it obtains

a geographic reclassification under the

inpatient prospective payment system

for purposes of determining its wage

index or standardized amount.

Comment: A number of commenters

expressed concern about the various

aspects of the hold-harmless provision,

referring to sections 1886(d)(8)(E) and

1833(t)(13) under section 401 of the

BBRA 1999, and asked about a

hospital’s eligibility for the rural holdharmless provision.

Response: Under section 1886(d)(8)(E)

of the Act, as added by section 401 of

the BBRA 1999, if a hospital submits an

application and meets certain criteria,

the Secretary treats the hospital as being

located in a rural area for purposes of

section 1886(d) of the Act. Under

section 1833(t)(13) of the Act, as added

by section 401(b) of the BBRA 1999, if

a hospital is treated as being located in

a rural area under section 1886(d)(8)(E)

of the Act, then the Secretary shall treat

the hospital as being located in a rural

area for purposes of the outpatient

prospective payment system. Therefore,

if a hospital is treated as being located

in a rural area under section

1886(d)(8)(E) of the Act, then the

hospital is treated as a rural hospital for

purposes of the hold-harmless

provision.

Comment: One commenter stated that

the 2-month waiting period for interim

transitional payments may adversely

affect a large number of small rural

hospitals. The commenter also believed

these hospitals will require a higher

interim payment than planned. The

commenter asked that we use a hospitalspecific impact analyses to create a

process for interim payments for these

small rural hospitals that would begin

concurrently with the start of the

prospective payment system.

Response: In order to calculate

interim transitional corridor payments

for any hospital, we needed to have

some amount of claims that had been

processed under the prospective

payment system. For this reason, we

were not able to begin transitional

corridor payments concurrently with

the implementation of the prospective

payment system. Because of our

concerns discussed earlier about having

to initiate recoupment procedures in

cases of overpayments, we are not

increasing interim payments at this

time. However, as cost reports are

settled and we are able to determine

how well interim payments predict final

transitional corridor payments, we will

be able to reevaluate this policy.

i. Covered Charges

Comment: Several commenters asked

that we clarify the definition of

‘‘covered charges’’ used to compute the

rural hold-harmless transitional corridor

payment. One commenter stated that

total procedures and thus the holdharmless payment will be understated

should we eliminate from these

calculations the charges for incidental

procedures or procedures that the

Outpatient Code Editor consolidates

into the main procedures.

Response: In the preamble and the

regulation text of the April 7, 2000 final

rule with comment period, we refer to

‘‘covered hospital outpatient services’’

to describe the services that are paid

under the prospective payment system

and, therefore, subject to the transitional

corridor provision. To determine a

provider’s costs for purposes of

calculating the pre-BBA amount for both

interim payments and for final cost

report settlement, we will take into

account all costs encompassed under

the prospective payment system,

including the cost of incidental services

that are packaged into the APC rate.

These services are identified as those

having HCPCS codes with a status

indicator of ‘‘N’’ (as listed in Addendum

B) and incidental services that may not

be billed with HCPCS codes, but which

are billed under revenue codes that

indicate a packaged service such as

observation services, recovery room,

supplies and many drugs.

Comment: One commenter asked us

to clarify how charges for packaged

services, for example observation

services, should be billed when they are

67818 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

the only service provided. The

commenter stated that inclusion of

charges for these packaged services in

the total bill charges are necessary to

calculate the proper transitional

corridor payment.

Response: Packaged services will not

be the only items that appear on a bill.

Packaged services will appear on a bill

with the service to which they are

incidental. For example, observation

services are properly billed with the

clinic visit, emergency room visit,

surgery, etc., that results in the need for

the incidental observation service.

j. Cancer Hospitals and Transitional

Corridor Payments

Comment: Several commenters

believed that the process described in

Program Memorandum Transmittal No.

A–00–23 for calculating the holdharmless transitional corridor payments

should be revised because it does not

reflect Congressional intent and will not

provide the relief to the 10 cancer

centers that the Congress intended.

These commenters contended that the

method described in the program

memorandum for calculating the

transitional corridor payments will

result in a 22 percent loss in outpatient

patient revenues for the cancer centers

compared to those received in 1998. The

commenters further claimed that their

revenue losses under the new outpatient

prospective payment system may

increase an additional 2 percent, or 24

percent in total, because we will not pay

claims for any medical visits that are

billed in conjunction with related

significant procedures.

In addition, these commenters urged

us to:

• Establish an appeal process for

providers with cash flow problems that

would permit fiscal intermediaries to

adjust a provider’s cost-to-charge ratio

‘‘to rectify ongoing OPPS losses prior to

reconciliation.’’

• Reduce interim payments to the 10

cancer centers by only 5 percent rather

than 15 percent. (The commenters

contended that this approach would be

consistent with the method currently

used to determine their inpatient

interim payments under the TEFRA cost

limits system.)

• Pay the 10 cancer centers the

balance of the hold-harmless payments

due at the time the cost report is

subjected to desk review rather than at

the time it is settled. (The commenters

stated that settlement of the centers’ cost

reports is completed within 2 to 4 years

after a completed cost report is filed,

whereas the cost report desk review is

generally completed 90 days after it is

filed.)

Response: Medical visits may be

billed with significant procedures as

long as the medical visit is a separate

and distinct service from the significant

procedure, even though the significant

procedure is related to the medical visit.

For example, as a result of an

examination performed as part of a

clinic or emergency room visit, a patient

is determined to need a CT scan or MRI,

or as a result of a dermatology

examination performed as a clinic visit,

a patient also has a surgical procedure

to remove a mole. In these types of

situations, payment will be made for

both a medical visit and a significant

procedure.

Program Memorandum Transmittal

No. A–00–63 provides for adjustment of

a provider’s cost-to-charge ratio in

certain specific situations. In the future,

in order to reflect changes in hospital

costs and charges, we will allow fiscal

intermediaries to make additional

updates of a provider’s cost-to-charge

ratio to ensure that interim payments

accurately reflect our best estimates of

final transitional corridor payments.

Although we limited the interim

payment to 85 percent of the estimated

payment in order to minimize the risk

of overpayment, in the future, as cost

reports are settled and we are able to

determine how well interim payments

predict final transitional corridor

payments, we will be able to reevaluate

this aspect of our interim payment

policy and we will consider permitting

modification of payment-to-cost ratios

to reflect particular circumstances.

The statute indicates that interim

payments are made subject to

retrospective adjustments based on

settled cost reports. However, it is

current practice that, depending on the

provider’s specific situation, a fiscal

intermediary may make additional

payments as part of a tentative

settlement action prior to final

settlement of the cost report.

k. Teaching Hospitals and Transitional

Corridor Payments

Comment: One commenter urged that

we retain the transitional corridor

payments permanently for major

teaching hospitals.

Response: Section 1833(t)(7) of the

Act provides permanent transitional

corridor payments only for cancer

hospitals described in section

1886(d)(1)(B)(v) of the Act. As indicated

earlier, we will monitor and evaluate

the prospective payment system

payments and will consider whether it

would be appropriate to recommend

that Congress extend transitional

corridor payments.

Comment: One commenter stated that

while the transitional corridor payments

will mitigate some of the losses to

teaching hospitals under the prospective

payment system compared to the former

cost-based payment system, these

payments are temporary. The

commenter believed that we

underestimated the losses that some

teaching hospitals will experience.

Another commenter urged us to monitor

closely the impact of the prospective

payment system on major teaching

hospitals during the 31⁄2 year

transitional corridor payments. The

commenter believed that these hospitals

will require a payment adjustment after

the transitional corridor payment period

expires to mitigate their potential

financial losses under the prospective

payment system.

Response: As we stated in the

preamble of the April 7, 2000 final rule

with comment period, we will perform

further comprehensive analyses of cost

and payment differences between

different classes of hospitals as soon as

there is a sufficient amount of claims

data submitted under the prospective

payment system. We will use data from

the initial years of the prospective

payment system to conduct regression

and simulation analyses. In addition, we

will carefully track and analyze the

additional payments made to hospitals

under the transitional corridor

provision. These analyses will be used

to consider and possibly propose

adjustments in the system, particularly

beginning in 2004 when the transitional

corridor provisions expire.

13. Limitation on Coinsurance for a

Procedure

In the April 7, 2000 final rule with

comment period (65 FR 18488), we

specified that, in accordance with

section 1833(t)(8) of the Act (as

amended by section 204(a) of the BBRA

1999), the coinsurance amount for a

procedure performed in a year cannot

exceed the hospital inpatient deductible

for that year. We specified that we

would apply the limitation to the wageadjusted coinsurance amount (not the

unadjusted coinsurance amount) after

any Part B deductible amounts are taken

into account. Therefore, although the

unadjusted coinsurance amount for any

APC may be higher or lower than the

inpatient hospital deductible, the actual

coinsurance amount for an APC,

determined after any deductible

amounts and adjustments for variations

in geographic areas are taken into

account, will be limited to the Medicare

inpatient hospital deductible. Any

reduction in coinsurance that occurs in

applying the limitation will be paid to

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67819

hospitals as additional program

payments.

Comment: One commenter disagreed

with our interpretation of the BBRA

1999 provision that amended section

1833(t)(8) of the Act to limit the

coinsurance amount for a procedure to

the amount of the inpatient hospital

deductible. The commenter believed

that our interpretation that applies the

limitation to coinsurance on an APC by

the APC basis is too narrow.

The commenter concluded that, at a

minimum, the limitation should be

more broadly interpreted to apply to the

total coinsurance incurred by a

beneficiary in connection with an

outpatient visit, that is, from the time

the beneficiary walks into an outpatient

department until he or she is released.

However, to implement the provision as

envisioned by the Congress, the

commenter suggested that we also

consider developing a service period

unit for outpatient procedures that is

similar to the ‘‘spell of illness’’ concept

used to define the set of services to

which a single inpatient hospital

deductible applies. Therefore, when a

patient comes to an outpatient

department for treatment of a particular

condition, his or her coinsurance

liability for all the services required for

that condition should not exceed the

inpatient hospital deductible. The

commenter recommended that we apply

the limitation regardless of how many or

which APCs are billed or the number of

visits required for such treatment.

Response: APCs are based on CPT

codes. We believe that the most

plausible meaning for ‘‘procedure’’ in

this context is a CPT code or, by

extension, an APC. Thus we interpret

the limitation of coinsurance for a

procedure in section 1833(t)(8)(C) of the

Act as added by section 204 of the

BBRA 1999 to apply in general to APCs.

We do not believe that it was the

intent of the Congress to apply the

coinsurance limitation to the

beneficiary’s aggregate coinsurance

amounts for all outpatient services

received during the entire service period

for a specific condition or even to the

services a beneficiary receives in one

day. During the Congressional

committee deliberations on this

provision before it was enacted, we held

technical discussions with committee

staff. At their request, we identified the

specific 10 APCs in the September 1998

proposed rule that would be likely to

have a coinsurance that exceeded the

inpatient hospital deductible. The

Congressional Budget Office also used

that information to project the cost of

this statutory provision. Therefore, we

believe that our interpretation in the

April 7, 2000 final rule with comment

period of how the coinsurance

limitation is to be applied is consistent

with the intent of Congress.

Comment: Several commenters

pointed out that because APCs for drugs

and biologicals are defined based on

HCPCS codes for the lowest unit of the

drug or biological, if we intend to apply

the inpatient deductible limit at the

APC level, we might disadvantage

beneficiaries who receive multiple

units. For example, the coinsurance for

a specific drug APC may not exceed the

inpatient deductible amount. However,

if multiple units of the same drug are

administered, the coinsurance based on

the multiple APCs may, in fact, exceed

the inpatient deductible. The

commenters believed that the total

coinsurance amount for a drug or

biological based on the amount

administered should be subjected to the

inpatient deductible limit. The

commenters believed that constructing

APCs for drugs based on the lowest unit

of the drug is solely a payment

convention and does not mean that each

dose is a separate ‘‘procedure.’’

Therefore, the commenters contended, a

better reading of the statute is that the

administration of a drug or biological,

regardless of the dose, is one procedure

for purposes of applying the hospital

outpatient prospective payment system

and it would be inappropriate to

compare the inpatient deductible limit

to anything but the total coinsurance

amounts.

Response: In the case of services that

involve the administration of drugs and

biologicals in separate APCs, we have

concluded that we should apply the

limitation on coinsurance to include

both the drug or biological (in whatever

units it is administered) and the service

that leads to its administration. We

constructed separate APCs for drugs and

biologicals, and established pricing on

the basis of the lowest dose, not to

reflect CPT codes, but solely as a matter

of convenience in administering the

payment system. Consequently, we

think that the interpretation with the

most clinical relevance in this instance

is to treat a drug or biological and the

service that leads to its administration

as a single procedure. We had not

proposed separate APCs for drugs and

biologicals in the proposed rule for the

outpatient prospective payment system

and the Congress did not know we

would segment APCs at the time it

passed the BBRA 1997.

Effective for drugs and biologicals

furnished on or after January 1, 2001,

when multiple units of a drug or

biological are furnished to a beneficiary

during one day, resulting in multiple

APC payments for the same drug, we

will aggregate the total coinsurance

applicable to the drug or biological, and

the aggregated amount cannot exceed

the inpatient hospital deductible for the

calendar year. In order to accomplish

this change in our bill processing

systems, we are assigning a new status

indicator designated as ‘‘K’’ to APCs for

nonpass-through drugs and biologicals

(as reflected in Addendum D of this

interim final rule with comment

period). Effective for services furnished

on or after July 1, 2001, in the same

circumstances, we will aggregate the

total coinsurance applicable to the drug

or biological and to the service that

resulted in the administration of the

drug, and the aggregated amount cannot

exceed the inpatient hospital deductible

for the calendar year. We are unable to

make the latter provision effective

earlier because of systems constraints.

Comment: One commenter stated that

the BBRA 1999 requirement that

coinsurance for a procedure cannot

exceed the inpatient hospital deductible

for that year adds confusion to an

already complicated formula for

determining coinsurance. The

commenter stated that the monitoring of

coinsurance needed to ensure the

limitation is being applied on a

procedure basis will add undue burden

and increase a provider’s costs. To make

the hospital outpatient prospective

payment system less complicated, the

commenter believed that we should

consider eliminating the threshold.

Response: The coinsurance limitation

is required by statute. Therefore, a

statutory change would be required to

eliminate this provision.

14. Reclassification of Certain Hospitals

In the August 1, 2000 Federal

Register (65 FR 47029), we

implemented section 401 of the BBRA

1999 for the hospital inpatient

prospective payment system. Section

401(a) of the BBRA 1999, which

amended section 1886(d)(8) of the Act

by adding a new paragraph (E), directs

the Secretary to treat any subsection (d)

hospital located in an urban area as

being located in the rural area of the

State in which the hospital is located if

the hospital files an application (in the

form and manner determined by the

Secretary) and meets certain statutorily

specified criteria. Additionally, section

401(a) of the BBRA 1999 includes

hospitals ‘‘* * * located in an area

designated by any law or regulation of

such State as a rural area (or is

designated by such State as a rural

hospital).’’ A hospital also may seek to

qualify for reclassification premised on

the fact that, had it been located in a

67820 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

rural area, it would have qualified as a

rural referral center or as a sole

community hospital.

Section 401(b) of the BBRA 1999

made a conforming change to section

1833(t) of the Act. Specifically, section

401(b) added section 1833(t)(13) to the

Act which provides that if a hospital is

being treated as being located in a rural

area under section 1886(d)(8)(E) of the

Act (for purposes of section 1886(d) of

the Act), the hospital will also be treated

under section 1833(t)(13) of the Act as

being located in a rural area.

In the April 7, 2000 final rule with

comment period, we explained that we

use the same yearly version of the

hospital inpatient prospective payment

system wage index (which takes effect

each October 1) to adjust the portion of

the outpatient prospective payment

system payment rate and the

coinsurance amount that is attributable

to labor-related costs for relative

differences in labor and labor-related

costs across geographic areas (and that

will be applied effective each January

1). This wage index reflects the effects

of hospital designations under section

1886(d)(8)(B) of the Act and hospital

reclassifications under section

1886(d)(10) of the Act.

We did not receive any comments on

this conforming change.

B. August 3, 2000 Interim Final Rule

With Comment Period

Following are the issues addressed in

the August 3, 2000 interim final rule

with comment period, the public

comments received on each issue, and

our response to those comments. In that

interim final rule, we—

• Revised the regulation at

§ 419.43(e)(1)(iv) to change one criterion

and postpone the effective date for two

other criteria that a new device, drug, or

biological must meet in order for its cost

to be considered ‘‘not insignificant’’ for

purposes of determining its eligibility

for transitional pass-through payments;

• Changed our interpretation for three

of the eight criteria set forth in the April

7, 2000 final rule with comment period

for defining a new medical device that

would be eligible for transitional passthrough payments and amended

§ 419.43 by adding new paragraph (e)(4)

to include all eight criteria;

• Clarified the assignment of ‘‘C’’

codes to eligible pass-through items;

• Corrected a trigger date for

grandfathering of provider-based

FQHCs; and

• Clarified our intent regarding prior

notice of beneficiary cost-sharing

liability in emergency situations.

1. Transitional Pass-Through Provisions

a. ‘‘Not Insignificant’’ Cost Criteria

Section 1833(t)(6) of the Act, as added

by section 201(b) of the BBRA 1999,

requires the Secretary to make

transitional pass-through payments for

post-1996 new drugs, biologicals, and

devices for at least 2 but no more than

3 years when the cost of the item is ‘‘not

insignificant’’ in relation to the hospital

outpatient prospective payment system

payment amount. In the April 7, 2000

final rule with comment period, we

established three criteria that a new

device, drug, or biological must meet to

determine whether its costs are not

insignificant relative to the APC

payment with which the item is

associated (65 FR 18480–81). We stated

that all of the following cost criteria

must be satisfied in order for a new

device, drug, or biological to be eligible

for transitional pass-through payments:

• Its expected reasonable cost exceeds

the applicable fee schedule amount

determined to be associated with the

drug, biological, or device by 25

percent.

• The expected reasonable cost of the

new drug, biological, or device exceeds

the portion of the fee schedule amount

determined to be associated with the

drug, biological, or device by 25

percent.

• The difference between the

expected, reasonable cost of the item

and the portion of the hospital

outpatient department fee schedule

amount determined to be associated

with the item exceeds 10 percent of the

applicable hospital outpatient fee

schedule amount.

After we published the April 7, 2000

final rule with comment period, we

gained considerable experience from

reviewing applications for transitional

pass-through payments. Based on that

experience, we concluded that the 25-

percent limitation was too restrictive

and could result in limiting Medicare

beneficiaries’ access to new products.

Therefore, in the August 3, 2000 interim

final rule with comment period, we

changed that criterion to ensure that

Medicare beneficiaries would continue

to have access to the latest technologies.

We now require that the expected

reasonable cost of a new drug,

biological, or device must exceed 10

percent of the applicable fee schedule

amount for the associated service. In

addition, we also postponed the

effective date of the other two criteria

applying to a new device, biologicals, or

drugs for which a transitional passthrough payment is first made to on or

after January 1, 2003. As stated in the

August 3, 2000 interim final rule with

comment period, the delay in the

effective date for these two criteria is

necessary so that we will have sufficient

time to gather and analyze data needed

to determine the current portion of the

fee schedule amounts associated with a

device, drug, or biological, which is an

essential factor in applying these

criteria.

Comment: Several commenters

commended us for revising the one ‘‘not

insignificant’’ criterion and postponing

the other two criteria until after

December 31, 2002. However, some

argued that we created an uneven

playing field by changing our policies

after we published our April 7, 2000

final rule and announced pass-through

application deadlines. They claimed

that our untimely lowering of the cost

threshold from 25 percent to 10 percent

unfairly disadvantaged companies that

did not submit pass-through

applications by the deadline for our

August 1, 2000 payments because they

believed that their products would not

qualify for payment. One commenter

recommended that we rapidly process

applications submitted for our January

1, 2001 update and change the effective

date of that update to November 1, 2000.

Another commenter advocated that we

apply the 10-percent cost threshold

retroactively to all device pass-through

applications to ensure equitable

treatment for all manufacturers.

Response: Based on our review of

transitional pass-through applications,

we believe that we have not applied our

policy change inconsistently to

applications that we received. The

change to the lower cost threshold is

effective for services furnished on or

after August 1, 2000. If an applicant’s

product was denied pass-through status

because its cost was considered to be

‘‘not insignificant’’ and that applicant

can show that our decision was not

based on the 10-percent criterion, the

applicant may request that we

reevaluate the application. In addition,

we encourage other interested parties

who withheld applications because they

believed that their products would not

qualify for pass-through status to submit

them. Further, we cannot update the

pass-through payments effective

November 1, 2000 as requested. Adding

new pass-through items to our

outpatient prospective payment system

requires changes to our complex

Medicare computerized claims

processing systems that we can make

only at the beginning of a calendar

quarter.

Comment: One commenter believed

that reducing the cost threshold to 10

percent for new devices may be too low.

The commenter stated that the lower

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67821

cost threshold would expose hospitals

to financial risk created by the use of

new and expensive technology

furnished in providing patient care. The

commenter advocated that we consider

as an option ‘‘establishing * * * a

floor—or a variable percentage that is

higher for low-cost cases and lower for

high-cost cases.’’

Response: We believe that this option

will require time to evaluate its merits,

assess its impact on our systems and

determine systems changes that would

be required to implement it. Therefore,

we will consider this request for

possible inclusion in our future

proposed rule for outpatient prospective

payment system updating that we

expect to publish in the spring of 2001.

Comment: One commenter urged that

we grant the public another opportunity

to evaluate and comment on all three

‘‘not insignificant’’ cost criteria before

implementing them.

Response: Before we implement all

three of these criteria, we plan to

provide notice and opportunity for

public comment. Since we do not

expect to implement two of these

criteria before January 1, 2003, we

would not expect to publish a proposed

rulemaking until the spring of 2002.

Comment: One commenter asked how

we would apply the three ‘‘not

insignificant’’ cost criteria in instances

when multiple units of a new device are

used in performing a procedure. The

commenter recommended that we use

the ‘‘weighted average cost of the

product, based on the average number of

unit used in a procedure.’’

Response: We plan to fully describe

our approach to implementing these

three criteria in a future proposed rule.

As previously stated, we will not

implement two of these criteria before

January 1, 2003. Therefore, we do not

expect to publish a proposed

rulemaking until the spring of 2002.

Comment: One commenter asked that

we clarify how transitional pass-through

payments will be incorporated into the

APC payments at the end of the 2- to 3-

year transitional period for a given

device. The commenter also asked how

we would prevent the cost for the passthrough items from being diluted

significantly by the median cost of other

procedures grouped in the same APC.

Response: We plan to use a

methodology similar to that currently

used to construct the APC groups to

incorporate payment for pass-through

items into the APC payments once their

pass-through status expires. That is, we

have assigned a unique HCPCS code to

each eligible pass-through item that will

allow us to track its payments and

utilization over the 2 to 3 years that it

is eligible for pass-through status. The

codes will allow us to match the passthrough items to the specific procedures

or medical visits with which they are

used. After we gain appropriate

information about the actual costs a

hospital incurs to provide a passthrough item, we will package the cost

for the pass-through with that for the

relevant procedure or medical visit with

which it is used and assign the

packaged service to a clinically related

APC group with comparable resources.

We will limit the cost variation within

each group as required by section

1833(t)(2) of the Act, as amended by

section 201(g) of the BBRA 1999. In

accordance with this provision, the

items and services within a group

cannot be considered comparable with

respect to the use of resources if the

highest median cost item or service

within a group is more than two times

greater than the lowest median cost item

or service within the same group. By

law, the Secretary is allowed certain

exceptions to this requirement, that is,

for low volume items and services.

Comment: One commenter asked if

we would provide adequate recognition

for multiple devices used in a procedure

‘‘if multiple procedure discounting is

allowed to cut the pass-through

generated recognition of these costs in

half.’’

Response: Under the hospital

outpatient prospective payment system,

devices eligible for pass-through

payments are paid separately and not

subject to the multiple procedure

discounting policy. This policy applies

only to the actual surgical procedure

that is performed to implant the passthrough device. These procedures are

denoted by a status indicator ‘‘T’’ and

listed in Addendum B of this rule.

Comment: One commenter urged us

to correct erroneous APC groupings

more frequently than during our

scheduled quarterly or annual update

cycles until we stabilize the hospital

outpatient prospective payment system.

Response: We understand the

importance of paying appropriately for

services billed under our new outpatient

system and are committed to resolving

problems that would preclude us from

making appropriate payments in a

timely manner. However, because of the

complexity of our system we cannot

commit to making changes other than

during the scheduled updating cycles.

b. Definition of Medical Device

In the April 7, 2000 final rule with

comment period, we established eight

specific criteria that new or innovative

medical devices must meet to be

considered eligible for pass-through

payments under section 1833(t)(6) of the

Act. We stated in that rule that new or

innovative medical devices must meet

all of the following criteria to be

considered eligible for transitional passthrough payments:

(1) They were not recognized for

payment as a hospital outpatient service

prior to 1997.

(2) They have been approved or

cleared for use by the FDA.

(3) They are determined to be

reasonable and necessary for the

diagnosis or treatment of an illness or

injury or to improve the functioning of

a malformed body part, as required by

section 1862(a)(1)(A) of the Act. We

recognize that some investigational

devices are refinements of existing

technologies or replications of existing

technologies and may be considered

reasonable and necessary. Therefore, we

indicated that we will consider devices

for coverage under the hospital

outpatient prospective payment system

if they have received an FDA

investigational device exemption (IDE)

and are classified by the FDA as

Category B devices. However, in

accordance with regulations at

§ 405.209, payment for a

nonexperimental investigation device is

based on, and may not exceed, the

amount that would have been paid for

a currently used device serving the same

medical purpose that has been approved

or cleared for marketing by the FDA.

(4) They are an integral and

subordinate part of the procedure

performed, are used for one patient

only, are surgically implanted or

inserted, and remain with that patient

after the patient is released from the

hospital outpatient department.

(5) The associated cost is not

insignificant in relation to the APC

payment for the service in which the

innovative medical equipment is

packaged.

(6) They are not equipment,

instruments, apparatuses, implements,

or items for which depreciation and

financing expenses are recovered as

depreciable assets as defined in Chapter

1 of the Medicare Provider

Reimbursement Manual (HCFA Pub.

15–1).

(7) They are not materials and

supplies such as sutures, clips, or

customized surgical kits furnished

incident to a service or procedure.

(8) They are not materials such as

biologicals or synthetics that may be

used to replace human skin.

In the August 3, 2000 rule, we revised

criteria (3), (4), and (7) and amended

§ 419.43(e)(4) to include all eight

criteria. We stated in that rule that our

change in policies reflects experience

67822 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

gained in reviewing and processing

transitional pass-through applications

for devices since publishing our April 7,

2000 final rule with comment period.

With regard to criteria (3), we revised it

by removing the cost limitation

provision for IDE Category B devices

that qualify for transitional pass-through

payments. We explained in the August

3, 2000 interim final rule that on review

of our policy for such new devices, we

believed that it would be more

appropriate to remove the cost

limitation because they are subjected to

the same eligibility requirements as any

other device applying for pass-through

status and because pass-through

payments for a specific device are

temporary.

For criteria (4), we modified our

interpretation of which devices are

eligible for transition pass-through

payments to include new medical

devices that are used for one patient

only, are single use, come in contact

with human tissue, and are surgically

implanted or inserted in a patient

during a procedure but may also be

removed during that procedure so that

the patient leaves the hospital without

the device. Our revised interpretation

also includes clips that are used as

radiological site or tissue markers.

As explained in the August 3, 2000

interim final rule, it became apparent,

based on experience gained in

processing a large number of

applications for new medical device

pass-through status, that our attempt to

distinguish implantable devices using

the criteria we had outlined in our April

7, 2000 final rule with comment period

had some practical limitations. We also

explained that, in some instances, the

new medical device is implanted

temporarily rather than permanently as

indicated in our original policy

published in the April 7, 2000 final rule

with comment period. However, we did

not intend for our policy to exclude new

medical devices that are implanted or

inserted during a procedure but also

may be removed during that procedure

so that the patient leaves the hospital

without the device. Rather, we believed

that these devices should be considered

for pass-through payments because they

also are implantables. We further stated

in the August 3, 2000 interim final rule

with comment period that it had

become apparent that some implantable

clips are expensive and function other

than as tools or supplies necessary for

a surgeon to perform a surgical

procedure. We did not intend to exclude

such clips from consideration for passthrough payments. Therefore, we

revised our interpretation of which

devices are eligible for transitional passthrough status to include also new

single use medical devices that may be

temporarily implanted or inserted in a

patient.

Finally, in criterion (7), we became

aware of the need, based on our review

of pass-through applications, to clarify

that supplies include pharmacological

imaging and stressing agents, including

contrast media but excluding

radiopharmaceuticals (for which

payment under the transitional passthrough provision is established by

section 1833(t)(6)(A) of the Act).

Comment: One commenter urged that

we issue detailed guidelines that clarify

whether an IDE Category B device with

pass-through status will be assigned

only one ‘‘C-code’’ for both its clinical

investigation and commercialization.

Response: Our general policy is to

assign only one code to an eligible passthrough item.

Comment: One commenter asked how

we would reconcile differences in passthrough payment differences (over 2 to

3 years) that are made for an eligible IDE

Category B device during its clinical

investigation phase versus those paid

once the device is commercialized.

Response: Policy decisions regarding

the analytical treatment of costs

associated with specific items that will

be included in our database for

constructing APCs will be made in the

context of the methodology that we use

to derive updated APC weights and

payments. This methodology will be

fully described in a subsequent

proposed rule prior to incorporating the

cost for pass-through devices such as

eligible IDE Category B devices into our

APC payments.

Comment: One commenter asked that

we clarify when the definition of a

device includes or excludes all of a

device’s components. The commenter

also asked whether we assigned separate

codes for the device’s components.

Response: If a device can be separated

into distinct components and such

components are considered integral to

the functioning of that device, we

evaluate the device and all its

component parts to determine whether

any or all would qualify for transitional

pass-through payment. For example, we

have approved several implantable

neurostimulator systems for passthrough payment. These systems

usually include at least two or three

separate components such as a

generator, leads, and receiver/

transmitter. In this case, we have

assigned separate HCPCS codes to each

of the eligible components. However, if

an eligible pass-through item is

considered a component of a noneligible item, such as a piece of capital

equipment, only the eligible item will

receive a HCPCS code to bill for passthrough payments.

Comment: One commenter warned us

about medical devices that we have

approved for pass-through payments

such as electrophysiology catheters that

the commenter alleges are not single use

items. The commenter stated that

hospitals use them more than once. The

commenter advocated that we advise

hospitals not to request additional

payments for any approved passthrough item if they reprocess or reuse

them.

Response: In the August 3, 2000

interim final rule with comment period,

we revised criterion ‘‘d’’ of the eight

medical device eligibility criteria to

explicitly preclude pass-through

payments for new medical devices other

than those that are single use. Therefore,

additional payments will not be made

for devices that are reprocessed or

reused. Hospitals that bill these devices

might be considered to be engaging in

fraudulent billing practices.

Comment: A number of the

commenters urged that we abandon the

use of an individual or brand-specific

approach to approving devices for

transitional pass-through payments and

adopt an approach that distinguishes

devices based on categories. The

commenters argued that a category

approach is more appropriate and more

efficient to implement than an

individual, item-specific approach.

They alleged that the latter approach

creates winners and losers and delays

timely approval of new technologies.

Response: As previously stated, we

adopted a trade-name specific approach

for several reasons. First, such an

approach provides better information.

Codes that are largely item-specific

allow us to track what procedures the

items are used with and costs of the

items. When the pass-through payments

for an item ends, we would expect to

have good information for assigning it to

relevant APCs and ensuring appropriate

payment for these APCs. Adopting a

scheme with a significant degree of

categorization would require use of

averages in making assignments and

setting payment rates. Decisions based

on these more limited data would likely

lead to intensified concerns about the

appropriateness of APC assignment and

payment.

Second, this approach permits finer

discrimination in eligibility decisions.

An item-by-item approach allows us to

be sure individual items in fact meet the

criteria for eligibility. Of major concern

in this instance is whether a device is

‘‘new’’ using the standard of the statute.

Section 1833(t)(6)(A) of the Act limits

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67823

transitional pass-through payment to

those devices for which ‘‘ * * *

payment for the device * * * as an

outpatient hospital service under this

part was not being made as of December

31, 1996.’’ Adopting categories would in

some cases mix ‘‘old’’ and ‘‘new’’

devices. In these instances, either some

old devices would get special treatment

that they would not be eligible for if

they were examined on an item-specific

basis, or an entire category could be

considered old, thus depriving some

new devices from special treatment they

would be eligible for if they were

examined on an item-specific basis.

Third, an item-specific scheme avoids

issues associated with the design of

categories needed for purposes of

transitional pass-through payments. It

largely avoids concerns about what

items should be in what category or

whether new categories should be

created to accommodate items that may

appear to be little different from those

in existing categories.

Fourth, an item-specific approach

allows us to assure that a newly arriving

device can obtain the full period of

pass-through status it is arguably

eligible for under the statute. A

categorization approach would likely

lead to latecomers being eligible for

pass-through payments only for a

shorter period. Insofar as revision to

APC payment rates reflected the costs of

items in the category by the time the

category was terminated, the shorter

period would be of little consequence.

However, if the costs of the late-coming

item were significantly higher, this

procedure could appear objectionable. A

solution in this case would be to create

a new code, which could be specific to

that item, thus departing from a

categorization approach.

We recognize that a category approach

would lessen concerns about

competitive disadvantages that may

have been inadvertently created by an

item specific approach and about access

to specific items by hospitals and their

patients. However, we found no

satisfactory way of establishing

categories that would not run into

difficulty regarding the test of whether

a device is ‘‘new’’ as described above.

Consequently, we are making no change

in our approach in response to

comments.

2. Revision to Grandfather Provision for

Certain FQHCs and ‘‘Look-Alikes’’

In the April 7, 2000 final rule with

comment period, which discussed the

provider-based status criteria and

requirements, we grandfathered FQHCs

or ‘‘look-alikes’’ that were designated as

such before 1995 in order to assure the

continuity of care and access to care for

patients of some of these facilities. To

meet our original policy intent of

helping to ensure that the new criteria

do not disrupt the delivery of services

to patients of these facilities, in the

August 3, 2000 interim final rule with

comment period (65 FR 47674), we

corrected § 413.65(m) to state that a

facility that has since April 7, 1995

furnished only services that were billed

as if they had been furnished by a

department of a provider will continue

to be considered as a department of a

provider, without regard to compliance

with the provider-based criteria, if the

facility—

(1) Received a grant on or before April

7, 2000 under section 330 of the Public

Health Service Act and continues to

receive funding under such a grant, or

is receiving funding from a grant made

on or before April 7, 2000 under section

330 of the Public Health Service Act

under a contract with recipient of such

a grant, and continues to meet the

requirements to receive a grant under

section 330 of the Public Health Service

Act; or

(2) Based on the recommendation of

the Public Health Service, was

determined by HCFA on or before April

7, 2000 to meet the requirements for

receiving a grant under section 330 of

the Public Health Service Act, and

continues to meet such requirements.

We made this change to clarify that

grandfathering under § 413.65 is based

on continued status as a section 330 of

the Public Health Service Act grantee or

a ‘‘look-alike’’ facility. We received no

comments on this change.

3. Clarification of Notice of Beneficiary

Cost-Sharing Liability

In the August 3, 2000 interim final

rule with comment, we also addressed

whether hospitals could reasonably be

expected to furnish an exact statement

of the patient’s financial liability, since

the exact scope of services needed may

not be known at the time notice must be

given. Specifically, we stated that when

the extent of care needed is not known

before the patient is admitted, the

hospital may furnish a written notice to

the patient that explains the general fact

that the beneficiary will incur a

coinsurance liability to the hospital that

he or she would not incur if the facility

were not provider based. Furthermore,

we clarified that the estimate of

‘‘potential financial liability’’ in this

written notice may be based on typical

or average charges for visits to the

facility or organization, while stating

that the patient’s actual liability will

depend upon the actual services

furnished by the hospital.

Comment: One commenter stated that

our clarification regarding the notice of

beneficiary cost sharing liability was

helpful, but recommended that we

amend or modify the regulations at

§ 413.65(g)(7) to reflect such

clarification since the wording of the

existing regulations states twice that the

notice must be given ‘‘prior to the

delivery of services’’ without an

exclusion for emergency medical

conditions. In addition, the regulation

states that the hospital has an obligation

to notify the beneficiary of the

‘‘potential financial liability’’ not just to

provide the beneficiary with ‘‘an

estimate based upon typical or average

charges’’ in the event that the exact type

and extent of care is not known.

The commenter also recommended

that we require hospitals to only notify

the beneficiary of the fact that the

beneficiary will incur a coinsurance

liability for hospital outpatient services

without giving a dollar amount of

beneficiary copayment. Such a notice

could include a statement that the

copayment liability will be determined

by us and the beneficiary will be

notified of the exact amount once the

hospital is notified of the amount

determined by us. The commenter

believes that an estimate based on

charges would ‘‘miss the point’’ of this

provision since beneficiary copayment

amounts are now determined by HCFA

using an APC grouper, not charges.

Response: We appreciate the

commenter’s concerns and agree that a

change in the regulations is needed to

reflect the clarification provided in the

August 3, 2000 interim final rule with

comment period in a future proposed

rule. As we stated in the August 3, 2000

interim final rule with comment period

(65 FR 47675), we are developing a

proposed rule that will further revise

and clarify the notice requirements. We

are doing this to allow the public a full

opportunity to comment on the changes

and to ensure that we have the benefit

of all relevant comments.

We disagree with the commenter’s

statement that an estimate based on

charges would ‘‘miss the point’’ of this

provision since such a notice is required

only to give the beneficiary an idea or

an example of their ‘‘potential financial

liability’’. As stated in the August 3,

2000 interim final rule with comment

period (65 FR 47675), the estimate

should state that the beneficiary’s

‘‘actual liability will depend upon

actual services furnished by the

hospital.’’ Also, with the delay in the

effective date of the provider-based

status regulations until January 10,

2001, hospitals will have at least five

months of experience with APC

67824 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

payments under outpatient prospective

payment system and should be able to

develop an appropriate estimate of a

copayment amount based on APCs

rather than charges.

4. Clarification of Protocols for OffCampus Departments

In the April 7, 2000 final rule, under

new § 489.24(i)(2) we require hospitals

to establish protocols for handling

individuals with potential emergency

conditions who arrive at hospital offcampus departments. Section

489.24(i)(2)(ii) further requires that if

the off-campus department is a physical

therapy, radiology, or other facility not

routinely staffed with physicians, RNs,

or LPNs, the department personnel must

be given protocols that direct them to

contact emergency personnel at the

main hospital campus.

In the August 3, 2000 interim final

rule with comment period, we clarified

that § 489.24(i)(2) does not require a

delay of an appropriate transfer when

the main hospital campus does not have

the specialized capability or facilities

required by the individual or when the

individual’s condition is deteriorating

so rapidly that the time needed to move

the individual to the main hospital

campus would significantly jeopardize

the individual’s life or health. We also

stated that the contact with emergency

personnel at the main hospital campus

should be made either after, or

concurrently with, the actions needed to

arrange an appropriate transfer under

§ 489.24(i)(3)(ii), if doing otherwise

would significantly jeopardize the

individual’s life or health. We noted

that this clarification does not relieve

the off-site department of the

responsibility for making this contact,

but only clarifies that the contact may

be delayed in specific cases when doing

otherwise would endanger a patient

subject to EMTALA protection. We

received no comments on this

clarification.

5. Typographical Errors in the ProviderBased Regulations

Comment: One commenter questioned

whether the provider-based regulations

in §§ 413.65 and 489.24, as they

appeared in the April 7, 2000 final rule

with comment period (65 FR 18538),

contained typographical errors.

Response: We are aware of

typographical errors in the providerbased regulations as published in the

April 7, 2000 final rule with comment

period (65 FR 18538) and will be

publishing a correction notice (HCFA–

1005–CN) to make these corrections.

III. Provisions of This Interim Final

Rule With Comment Period

A. Changes Relating to the BBRA 1999

Public Comments

Except for the changes discussed in

the preamble, we are adopting the BBRA

1999 provisions implemented in the

April 7, 2000 final rule with comment

period and the August 3, 2000 interim

final rule with comment period,

described in section II of this preamble,

as final without modification. We are

making the following changes to the

regulation text as a result of the public

comments received:

We are revising § 419.41(c)(4)(i) to

provide that, effective January 1, 2001,

when multiple APCs for a single drug or

biological are furnished to a beneficiary

on the same day, the inpatient hospital

deductible limitation on coinsurance

will be applied to the aggregate

coinsurance for the drug or biological.

The section is further revised to provide

that, effective July 1, 2001, the

coinsurance amount for the procedure

or service that resulted in the

administration of the drug or biological

will be aggregated with the coinsurance

for the drug or biological in applying the

limit.

We are revising § 419.70(f)(2)(ii) to

remove the phrase ‘‘without applying

the cost reductions under section

1861(v)(1)(S) of the Act’’. We recognize

that the phase may have inadvertently

caused confusion to the extent it is

redundant, as pointed out by a

commenter.

B. Annual Updates to Components of

the Hospital Outpatient Prospective

Payment System

In this interim final rule with

comment period, for calendar year 2001,

we are updating the wage index and the

conversion factor adjustment for

covered hospital outpatient services

furnished beginning January 1, 2001.

We also are updating the existing APC

groups to reflect new codes that have

been assigned. In accordance with

section 1833(t)(9)(A) of the Act and

section 201(h)(2) of the BBRA 1999, we

will undertake a complete system

update in 2001 for hospital outpatient

prospective payments. That update will

take effect on January 1, 2002. We will

consult with an expert outside advisory

panel composed of appropriate

representatives of providers. This panel

will review and advise us concerning

the clinical integrity of the APC groups

and relative weights. The panel will be

allowed to use data other than those we

have collected or developed during our

review of the APC groups and relative

weights.

1. APC Groups

We are updating the existing APC

groups effective January 1, 2001 to

reflect the addition of new CPT and

alpha-numeric codes, the deletion of

invalid codes, changes to the list of

procedures we pay for only in an

inpatient setting (the ‘‘inpatient list’’),

the creation of a new status indicator,

newly covered procedures,

reconfigurations due to the inclusion of

device costs, and revisions to correct

errors and provide consistency in the

placement of codes.

a. New Codes

There are 936 new codes, 645 of

which are ‘‘C’’ codes. ‘‘New’’ in this

context means new since the April 7,

2000 final rule with comment period

was published. Many of the ‘‘C’’ codes

were published in program memoranda

over the intervening months. New codes

are shown in Addendum B with an

asterisk in the column preceding the

code.

b. Deleted Codes

With the exception of ‘‘C’’ codes,

codes deleted effective January 1 of each

year are given a 3-month grace period in

which they will still be recognized. ‘‘C’’

codes are temporary codes used

exclusively to bill pass-through items

and new technology services and items

paid under the hospital prospective

payment system. We will retire these

codes prospectively at the start of a new

calendar quarter based on specific

service dates and are not extending the

same 3-month grace period to them. We

will drop all non ‘‘C’’ codes from APCs

effective April l. Deleted codes are

shown in Addendum B. They are

followed by the letter D. The AMA’s

CPT books also list deleted codes.

c. Revisions to Correct Errors or

Inconsistencies

We are revising the APCs in order to

correct errors and to provide greater

consistency in the placement of codes.

For example, we had assigned various

types of cardiovascular diagnostic tests

to four APCs, with rates based on data

that, on subsequent review, appeared

limited. We are recategorizing these

APCs. This recategorization results in

three APCs with greater clinical

coherence.

Medicare covers influenza,

pneumococcal, and hepatitis B

immunizations routinely, with no

copayment or deductible due for flu and

pneumonia vaccines or their

administration. Other vaccines may be

covered in certain circumstances, but

are, in fact, given so infrequently that

our cost data are limited. We are

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67825

rearranging the preventive vaccines and

assigning the less frequently furnished

vaccines based on their reported costs,

but within a smaller range. We expect

very few immunizations other than

influenza and pneumonia to be billed,

but if they are billed, we will update our

data.

We also are changing the APCs to

which bone density studies are

assigned. The codes used in 1996

captured both central and peripheral

bone density studies. Coding changes

since that time have separated the two

types of studies, but this distinction was

not reflected in the 1996 data. In order

to better reflect these differences, we are

separating the various codes and

assigning central dual energy x-ray

absorptiometry (DEXA) bone density

studies to a new technology APC.

We did not include the codes for

transfusion laboratory services (for

example, typing and crossmatching) in

APCs in the April 7, 2000 final rule with

comment period. We are now creating

three APCs to capture these codes, and

an additional APC to capture fertility

procedures.

d. Device-Related Codes

As described in the April 7, 2000 final

rule with comment period, revenue

centers 274, 275, and 278 were not

included for purposes of calculating the

APC rates because prior to the BBRA

1999, we anticipated paying for durable

medical equipment and prosthetics

(including implantable devices) outside

of the outpatient prospective payment

system and it was unfeasible to revise

our database to reflect the revenue

centers in time to publish a final rule

and implement the prospective payment

system by July 1, 2000. To reflect the

inclusion of implantable devices as

required under the BBRA 1999, we have

recalculated APC rates with these

revenue centers included. As a result,

the median cost for certain procedures

such as inserting pacemakers, replacing

leads, and providing neurostimulators

increased significantly.

In order to recognize these cost

increases, which are attributable to the

devices, and to aid in the assignment of

devices to APCs at the end of the passthrough period, we are reconfiguring

certain APCs. That is, we are creating

APC groups for the insertion of

pacemakers, the replacement of

pacemaker electrodes, the implantation

of a pacemaker and electrodes, and the

removal of a pacemaker. These changes

reflect our basic criteria that procedures

within an APC group be clinically

similar and comparable in terms of

resources, with the highest cost item or

service within a group being no more

than 2 times greater than the lowest cost

item or service within the same group.

e. Inpatient Codes Moved to the

Outpatient Setting

In response to numerous requests, we

reviewed the composition of the

inpatient list. While we continue to

believe that we have the majority of the

codes assigned properly, for the reasons

discussed in section III.B.2. we are

persuaded to move a number of codes

to the outpatient setting. We are able to

place most codes into closely related

APCs.

f. ‘‘Two-times’’ Rule

The BBRA 1999 required us to ensure

that no APC contains codes such that

the highest median cost in the APC

exceed twice the lowest median cost.

We undertook an analysis of APCs in

relation to this requirement as part of

the 2001 update. (Note that the law

provides for exceptions based on low

volume and other reasons. We consider

a code that captures fewer than 2

percent of the services within an APC to

be low volume, and we disregard codes

for unlisted services or procedures,

since we do not know what service or

procedure was billed.) For example,

moving a radical mastectomy code from

the inpatient list to a breast procedure

APC caused the group to fail the twotimes test. In another instance, as

described above, we packaged costs

associated with implantable devices

into the relevant procedure codes. This

change would also cause device-related

APCs to fail the two-times test. For these

situations and others that failed the twotimes test, we are reconfiguring the

APCs appropriately.

g. Inpatient Codes Moved to Outpatient

and Affected by Device

Seven codes related to vascular and

neurological procedures were moved

from the inpatient list into APCs, that

were then split according to device use,

in response to comments.

h. Newly Covered Codes

The updated APCs reflect recent

HCFA decisions to provide Medicare

coverage for an electrical bioimpedance

procedure and three magnetic resonance

angiography services. The codes for

these newly covered services are M0302

and 71555, 73725, and 74185,

respectively.

i. Pass-Through Requests for Drugs

Since publication of the April 7, 2000

final rule with comment period, we

have received additional requests for

pass-through status for a number of

drugs. The codes for the additional

eligible pass-through drugs are shown in

Addendum B.

The following table contains a listing

of the changes in the APC groups

discussed above.

SUMMARY OF CHANGES TO APCS

New Codes

Changes to APC Placement of Existing Codes

Revisions or

corrections of

errors

Device-related

codes

Inpatient moved

to outpatient

‘‘Two-times’’

rule

Inpatient codes

moved to outpatient and affected by device

Newly covered

codes

Pass-through

requests for

drugs

936 codes

added, 645 of

which are ‘‘C’’.

111 codes

changed.

87 codes

changed.

56 codes

changed (12

as of 8/1/

2000).

25 codes

changed.

7 codes

changed.

4 codes

changed.

4 codes

changed

67826 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

SUMMARY OF CHANGES TO APCS—Continued

New Codes

Changes to APC Placement of Existing Codes

Revisions or

corrections of

errors

Device-related

codes

Inpatient moved

to outpatient

‘‘Two-times’’

rule

Inpatient codes

moved to outpatient and affected by device

Newly covered

codes

Pass-through

requests for

drugs

Denoted by asterisk in Addendum B.APCs—0004,

0087, 0099,

0100, 0102,

0123, 0282,

0340, 0342,

0346, 0347,

0348, 0349,

0354, 0356,

0602, 0761,

0970, 0971,

0974, 0976,

1044, 1401,

1402, 1403,

1404, 1405,

1406, 1407,

and 1409.

APCs—0082,

0083, 0089,

0091, 0093,

0103, 0104,

0105, 0106,

0107, 0108,

0109, 0115,

0119, 0124,

0185, 0224,

0225, 0226,

0227, 0228,

0229, 0256,

and 1002.

APCs—0005,

0020, 0021,

0029, 0046,

0050, 0081,

0114, 0115,

0120, 0121,

0162, 0165,

0194, 0195,

0198 , 0216,

0254, 0256,

0263, 0264,

0279, 0280,

0970, 0974,

and 0981..

APCs—0028

and 0029.

HCPCS—

37620,

35011,

36834,

61880,

61888,

33284, 63741.

HCPCS—

71555,

73725,

74185,

M0302.

HCPCS—

J1650,

J2770,

J1810, J7315

Addenda A and B reflect changes to

the APC groups, effective January 1,

2001. Addendum C, entitled ‘‘Hospital

Outpatient Department (HOPD)

Payment for Procedures by APC,

Calendar Year 2001,’’ is not published

in this interim final rule with comment

period, but will be posted on our

website at http://www.hcfa.gov

/medlearn/refopps.htm. Addendum C

will display data similar to those

contained in Addenda A and B, but

sorted by APCs with each procedure

code listed that is assigned to the APC.

2. Inpatient Procedures List Update

In the preamble to the April 7, 2000

final rule with comment period, we

indicated that, as part of our annual

update process, we would update the

procedures on the inpatient list. The

first annual revision of this list is

effective on January 1, 2001. We are

removing 44 procedures from the list

and placing them in APCs. (Several

procedures that were inadvertently left

on the inpatient list in the April 7, 2000

final rule with comment period were

removed from the list and placed in

APCs in August 2000.) The revised list

is included in Addendum E.

We have attempted to limit the

inpatient only list to those procedures

that, in current medical practice as

understood by our clinical staff, require

inpatient care, such as those that are

highly invasive, result in major blood

loss or temporary deficits of organ

systems (such as neurological

impairment or respiratory

insufficiency), or otherwise require

intensive or extensive postoperative

care. Insofar as advances in medical

practice mitigate concerns about these

procedures being performed on an

outpatient basis, we will be prepared to

remove them from the inpatient list and

provide for payment under the hospital

outpatient prospective payment system.

Since the April 7, 2000 final rule with

comment period was published, we

have received requests to move a

number of procedures from the

inpatient list because, based on medical

evidence, the procedures can be

performed safely in a hospital

outpatient setting. These included

breast and other cancer procedures,

repairs of facial trauma, many

orthopedic procedures, several vascular

procedures, and some genito-urinary

procedures.

Among the procedures we are

removing from the inpatient list and

placing in APCs as a result of these

requests are excision of chest wall

tumors, several orthopedic repairs,

vascular procedures, and ureteral

endoscopies. We are moving overnight

pulse oximetry from the inpatient list to

packaged status. We also are moving

several comparable procedures, for

example, related ureteral endoscopies.

At this time, we are not removing

from the inpatient list various spinal

procedures, including osteotomies and

laminectomies. We also are not

removing several open abdominal and

retroperitoneal procedures from the

inpatient list because many of these

procedures involve prolonged invasion

of the thoracic cavity, the peritoneum,

or the retroperitoneal space. Patients

undergoing these procedures typically

require prolonged postoperative

monitoring. Moreover, the information

provided to us by requesters did not

provide convincing evidence that these

procedures are currently being

performed or can be safely performed in

an outpatient setting. However, we are

aware that, with advances in technology

and surgical techniques, many of these

procedures may eventually be

performed safely in a hospital

outpatient setting. We will continue to

review all the procedures on the

inpatient list and will consider

additional requests to move specific

procedures to the outpatient setting. We

ask that these requests contain detailed

rationale along with medical evidence

that the procedure may be performed

safely in an outpatient setting.

We note that, in some instances,

requests for removing a particular

procedure from the inpatient list may

have resulted from a misunderstanding

about appropriate coding. Less invasive

versions of the procedure on the

inpatient list may be in an APC. The

presence of certain thoracoscopies on

the inpatient list, for example, does not

mean that no thoracoscopy will be paid

under the outpatient prospective

payment system.

We also were asked to move several

procedures from APCs to the inpatient

list. Because of the rapid advance in

technology and surgical techniques

mentioned above, we believe that if

procedures have been assigned APCs,

we should not reverse that status unless

it becomes obvious that we have made

an error. Thus, we are moving to the

inpatient setting only one of the codes

for which we received a request (open

treatment of a knee dislocation, which

requires more than outpatient

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67827

postoperative monitoring), and two

other codes (for nephrectomy with total

ureterectomy and for escharotomy) that

had been assigned APCs in error.

Beginning in April 2001, we will, if

warranted, revise the inpatient list at

least quarterly to better reflect changes

in medical practice that permit

procedures that were previously

performed only in an inpatient setting to

be safely and effectively performed in

an outpatient setting. In the April 7,

2000 final rule with comment period,

we discussed our intent to revise the list

as part of the annual update of APCs

and asked that interested parties advise

us of procedures that can be performed

in an outpatient setting. Since we will

be making quarterly updates to the

outpatient prospective payment system

for other purposes, we will also change

the inpatient list quarterly, if warranted.

Generally, because of systems

limitations, 3 months or more are

required after a decision is made before

we can implement a change.

The inpatient list was not a result of

a provision of the BBRA 1999; it was

included in the September 1998

proposed rule and we responded to

comments and made the provision final

in the April 7, 2000 final rule with

comment. Accordingly, we did not

request comments on our policy on the

establishment of the inpatient list at that

time. Nonetheless, we received a

number of comments concerning the

existence of this list, the provisions for

updating it, and its implications for

other Medicare payment systems. We

will consider these comments and

expect to discuss the matter further in

the proposed rule updating the hospital

outpatient prospective payment system

for 2002, which we will publish in the

spring of 2001.

3. Wage Index Adjustment

Under section 1833(t)(2)(D) of the Act,

we are required to determine a wage

adjustment factor to adjust, in a budget

neutral manner, the portion of the

payment rate and the coinsurance

amount that is attributable to laborrelated costs for relative differences in

labor and labor-related costs across

geographic regions under the hospital

outpatient prospective payment system.

In the April 7, 2000 final rule with

comment period, we specified, in

regulations at § 419.43(c), that each year

we use the hospital inpatient

prospective payment system wage index

established in accordance with 42 CFR

Part 412 to make a wage adjustment for

relative differences in labor and laborrelated costs across geographic areas

under the hospital outpatient

prospective payment system. We note

that, by statute, we implement the

annual update of the hospital inpatient

prospective payment system on a fiscal

year basis. However, we update the

hospital outpatient prospective payment

system on a calendar year basis.

Therefore, the hospital inpatient

prospective payment system wage index

values established for urban and rural

areas and for reclassified hospitals

published in the Federal Register on

August 1, 2000 (65 FR 47149 through

47157) are being applied for wage

adjustments under the hospital

outpatient prospective payment system,

effective January 1, 2001. The fiscal year

2001 hospital inpatient wage index

reflects the effects of hospitals

redesignated under section

1886(d)(8)(B) of the Act and hospital

reclassifications under section

1886(d)(10) of the Act. After publication

of the hospital inpatient wage index

values for fiscal year 2001 on August 1,

2000, we discovered several errors in

the values for several geographic areas.

The correct wage index values for all

areas are republished in Addenda F, G,

and H of this interim final rule with

comment period.

In this interim final rule with

comment period, we are establishing the

methodology that we will use in making

adjustments for area wage differences

for services furnished in the Virgin

Islands. We note that a hospital

inpatient prospective payment system

wage index value is not calculated for

the Virgin Islands because there are no

hospitals located in that area that are

paid under the inpatient hospital

prospective payment system. Because

the wage index that we adopted in our

April 7, 2000 final rule with comment

period does not include a value for

adjusting wage differences for the Virgin

Islands, we will use the wage index for

the Virgin Islands as calculated for the

skilled nursing facilities prospective

payment system to make this

adjustment. The skilled nursing

facilities prospective payment system

uses the inpatient hospital wage index

data to adjust its prospective payment

rates for the same fiscal year (that is

effective October 1, 2000) as covered by

the hospital inpatient prospective

payment system wage index values. As

stated in the July 31, 2000 skilled

nursing facilities prospective payment

system final rule (65 FR 46770), ‘‘The

computation of the wage index * * *

incorporate[s] the latest data and

methodology used to construct the

hospital wage index. For these reasons,

the wage index adjustment that we will

apply to the Virgin Islands for services

furnished on or after January 1, 2001 is

0.6306.

Although the wage index for skilled

nursing facilities is based on a fiscal

year beginning October 1, we will apply

the wage index factor for the Virgin

Islands that goes into effect on October

1 of each year to the hospital outpatient

prospective payment system services

furnished during the following calendar

year. This is consistent with how we

apply the hospital inpatient prospective

payment system wage index values to

the hospital outpatient prospective

payment system services.

Consistent with the methodology

applicable for services furnished in

2000 (on or after August 1, 2000), in

making adjustments for area wage

differences for services furnished in

2001, we will recognize 60 percent of

the hospital’s costs as labor-related costs

that are standardized for geographic

wage differences.

4. Conversion Factor Update

Section 1833(t)(3)(C)(ii) of the Act

requires us to update annually the

conversion factor used to determine

APC payment rates. Section

1833(t)(3)(C)(iii) of the Act provides that

the update be equal to the hospital

inpatient market basket percentage

increase applicable to hospital

discharges under section

1886(b)(3)(B)(iii) of the Act, reduced by

one percentage point for the years 2000,

2001, and 2002. Thus, the update to the

outpatient hospital prospective payment

system conversion factor for 2001 is 2.4

percent (3.4 percent minus 1 percent).

In accordance with section

1833(t)(9)(B) of the Act, the conversion

factor for 2001 also has been adjusted to

ensure that the revisions we made to

update the wage index are made on a

budget-neutral basis. A budget

neutrality factor of .9989 was calculated

for wage index changes by comparing

total payments from our simulation

model using the wage index values that

will be effective January 1, 2001.

The market basket increase of 2.4

percent for 2001 and the required

budget neutrality adjustment calculated

to be .9989 result in a conversion factor

for 2001 of $49.596.

IV. Waiver of Notice of Proposed

Rulemaking

We ordinarily publish a notice of

proposed rulemaking in the Federal

Register and invite public comments on

the proposed rule. The notice of

proposed rulemaking includes a

reference to the legal authority under

which the rule is proposed, and the

terms and substance of the proposed

rule or a description of the subjects and

67828 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

issues involved. This procedure can be

waived, however, if an agency finds

good cause that a notice-and-comment

procedure is impracticable,

unnecessary, or contrary to the public

interest, and incorporates a statement of

the finding and its reasons in the rule.

For the reasons set forth below, we find

that the circumstances surrounding this

interim final rule with comment period

make it either unnecessary or

impracticable to pursue a notice-andcomment procedure before the

provisions of this interim final rule with

comment period take effect.

As discussed earlier in this interim

final rule with comment period, we

implemented the hospital outpatient

prospective payment system on August

1, 2000 in accordance with the

methodology that we set forth in the

April 7, 2000 final rule with comment

period (65 FR 18434). In section III.I. of

the April 7, 2000 final rule with

comment period (65 FR 18501), we

discuss how we will update the

outpatient prospective payment system

on an annual basis. We are required

under section 1833(t)(3)(C)(ii) of the Act

to update annually the conversion factor

used to determine the APC payment

rates. Under the regulations, 42 CFR

419.43, the wage adjustment under

outpatient prospective payment system

is based on the hospital inpatient wage

index, and we updated the hospital

inpatient wage index after the

publication of the April 7, 2000 final

rule with comment period. Accordingly,

in this interim final rule with comment

period, we are updating the conversion

factor and the wage index adjustment

for covered hospital outpatient services

furnished beginning January 1, 2001,

using the methodology published in the

April 7, 2000 final rule with comment

period, for which we had previously

received comments. We also are

updating the existing APC groups to

reflect new and deleted CPT codes for

2001 and reconfiguring certain APC

groups using more recent data to ensure

clinical integrity and consideration of

resource use as required by section

1833(t)(8)(A) of the Act and as described

in the April 7, 2000 final rule with

comment period (65 FR 18456 and

18501). Because these various

adjustments are being made in

accordance with existing methodology

as set forth in the April 7, 2000 final

rule with comment period, we believe it

is unnecessary to address them further

through the notice-and-comment

procedure.

In addition, we find good cause to

waive prior notice-and-comment

procedures with respect to the Virgin

Islands wage index methodology

because it would have been

impracticable to undertake and

complete notice-and-comment

procedures on this issue in time for the

Virgin Islands outpatient prospective

payment system wage index value to be

effective at the same time as the updated

outpatient prospective payment system

wage index values for all other areas.

Accordingly, we find good cause to

waive the notice-and-comment

procedure with respect to the annual

update of the wage index values,

conversion factor, and the APC groups.

However, we are providing for a 60-day

comment period as specified in the

‘‘Dates’’ section of this preamble.

II. Collection of Information

Requirements

This document does not impose

information collection and

recordkeeping requirements.

Consequently, it need not be reviewed

by the Office of Management and

Budget under the authority of the

Paperwork Reduction Act of 1995.

VI. Regulatory Impact

A. General

We have examined the impacts of this

interim final with comment period rule

as required by Executive Order 12866,

the Unfunded Mandates Reform Act of

1965, and the Regulatory Flexibility Act

(RFA) (Public Law 96–354). Executive

Order 12866 directs agencies to assess

all costs and benefits of available

regulatory alternatives and, if regulation

is necessary, to select regulatory

approaches that maximize net benefits

(including potential economic,

environmental, public health and safety

effects, distributive impacts, and

equity). A regulatory impact analysis

(RIA) must be prepared for major rules

with economically significant effects

($100 million or more annually).

Section 202 of the Unfunded

Mandates Reform Act of 1995 also

requires that agencies assess anticipated

costs and benefits before issuing any

rule that may result in an expenditure

in any one year by State, local, or tribal

governments, in the aggregate, or by the

private sector, of $100 million. This

final rule does not mandate any

requirements for State, local, or tribal

governments.

The RFA requires agencies to analyze

options for regulatory relief of small

businesses. For purposes of the RFA,

small entities include small businesses,

nonprofit organizations and government

agencies. For purposes of the RFA, we

consider all hospitals to be small

entities. Individuals and States are not

included in the definition of a small

entity.

In addition, section 1102(b) of the Act

requires us to prepare a regulatory

impact analysis if a rule may have a

significant impact on the operations of

a substantial number of small rural

hospitals. This analysis must conform to

the provisions of section 604 of the

RFA. With the exception of hospitals

located in certain New England

counties, for purposes of section 1102(b)

of the Act, we define a small rural

hospital as a hospital that is located

outside of a Metropolitan Statistical

Area (MSA) or New England County

Metropolitan Area (NECMA). Section

601(g) of the Social Security

Amendments of 1983 (Public Law 98–

21) designated hospitals in certain New

England counties as belonging to the

adjacent NECMA. Thus, for purposes of

the hospital outpatient prospective

payment system, we classify these

hospitals as urban hospitals.

B. Analysis for Changes in this Interim

Final Rule with Comment Period

We implemented the outpatient

prospective payment system on August

1, 2000 in accordance with the

methodology published in the April 7,

2000 final rule with comment period. In

section III.I. of the April 7, 2000 final

rule with comment period (65 FR

18501), we discuss how we will update

the outpatient prospective payment

system on an annual basis. We are

required under section 1833(t)(3)(C)(ii)

of the Act to update annually the

conversion factor used to determine the

APC payment rates. We are required

under section 1833(t)(8)(A) of the Act to

revise not less often than annually the

wage and other adjustments.

Accordingly, in this interim final rule

with comment period, we are updating

the conversion factor and the wage

index adjustment for covered hospital

outpatient services furnished beginning

January 1, 2001, using the methodology

published in the April 7, 2000 final rule

with comment period, for which we had

previously received comments.

In section IX.B. of the preamble of the

April 7, 2000 final rule with comment

period, we gave our Office of the

Actuary’s projection of the additional

benefit expenditures from the Medicare

Part B Trust Fund resulting from

implementation of the hospital

outpatient prospective payment system

and the hospital outpatient provisions

enacted by the BBRA 1999. The impact

of implementing the hospital outpatient

prospective payment system on the

Medicare program is reflected in the

table below, which is republished from

the April 7, 2000 final rule with

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67829

comment period (65 FR 18530). The

calendar year 2001 increase in total

payments to hospitals, which results

primarily from the updated conversion

factor, is already included as part of

HCFA’s current law baseline

expenditures for hospital outpatient

services under the outpatient

prospective payment system.

Fiscal year Impact (in

millions)

2001 .......................................... $3,030

2002 .......................................... 3,520

2003 .......................................... 4,230

2004 .......................................... 4,670

We also are updating the existing APC

groups to reflect new and deleted CPT

codes for 2001 and adjusting the groups

to reflect more recent data as we

described in the April 7, 2000 final rule

with comment period. The provisions of

this interim final rule with comment

period do not measurably alter the effect

of the outpatient prospective payment

system on the groups of hospitals or

geographic areas as projected in Table 2

of the April 7, 2000 final rule with

comment period (65 FR 18533–18534).

C. Federalism

We have examined this interim rule

with comment period in accordance

with Executive Order 13132,

Federalism, and have determined that it

will not have any negative impact on

the rights, roles, and responsibilities of

State, local or Tribal governments.

D. Executive Order 12866 and 5 U.S.C.

804(2)

The statutory effects of the provisions

that are being implemented by this

interim final rule with comment period

result in expenditures exceeding $100

million per year. Therefore, this interim

final rule with comment period is an

economically significant rule under

Executive Order 12866, and a major rule

under 5 U.S.C. 804(2).

In accordance with the provisions of

Executive Order 12866, this interim

final rule with comment period was

reviewed by the Office of Management

and Budget.

List of Subjects in 42 CFR Part 419

Health facilities, Hospitals, Medicare.

For the reasons set forth in the

preamble, 42 CFR Part 419 is amended

as set forth below:

PART 419—PROSPECTIVE PAYMENT

SYSTEM FOR HOSPITAL OUTPATIENT

DEPARTMENT SERVICES

1. The authority citation for Part 419

continues to read as follows:

Authority: Secs. 1102, 1833(t), and 187l of

the Social Security Act (42 U.S.C. 1302,

1395l(t), and 1395hh).

2. Section 419.41 is amended by

revising paragraph (c)(4)(i) to read as

follows:

§ 419.41 Calculation of national

beneficiary coinsurance amounts and

national Medicare program payment

amounts.

* * * * *

(c) * * *

(4) * * *

(i) The coinsurance amount for an

APC cannot exceed the amount of the

inpatient hospital deductible,

established in accordance with § 409.82

of this chapter, for that year. For

purposes of this paragraph (c)—

(A) Effective for drugs and biologicals

furnished on or after January 1, 2001,

the coinsurance amount for multiple

APCs for a single drug or biological

furnished on the same day will be

aggregated and treated as the

coinsurance amount for one APC.

(B) Effective for drugs and biologicals

furnished on or after July 1, 2001, the

coinsurance amount for the APC or

APCs for a drug or biological furnished

on the same day will be aggregated with

the coinsurance amount for the APC

that reflects the administration of the

drug or biological furnished on that day

and treated as the coinsurance amount

for one APC.

* * * * *

3. Section 419.70 is amended by

revising paragraph (f)(2)(ii) to read as

follows:

§ 419.70 Transitional adjustment to limit

decline in payment.

* * * * *

(f) * * *

(2) * * *

(ii) The reasonable cost of these

services for this period.

* * * * *

(Catalog of Federal Domestic Assistance

Program No. 93.774,

Medicare’Supplementary Medical Insurance

Program)

Dated: November 1, 2000.

Michael M. Hash,

Acting Administrator, Health Care Financing

Administration.

Approved: November 1, 2000.

Donna E. Shalala,

Secretary.

Note to the Addenda: The following

Addenda A through H will not appear in the

Code of Federal Regulations.

Addenda A through H provide various data

pertaining to the Medicare hospital

outpatient prospective payment system.

Addendum A contains the APCs with title,

status indicators, relative weight, payment

rate, national unadjusted coinsurance, and

minimum unadjusted coinsurance.

Addendum B differs from Addendum A in

that the APC titles are not listed and both

HCPCS codes and descriptions appear.

Addendum C, entitled ‘‘Hospital Outpatient

Department (HOPD) Payment for Procedures

by APC, Calendar Year 2001,’’ is not

published in this interim final rule with

comment period, but will be posted on our

website at (http://www.hcfa.gov /medlearn/

refopps.htm). Addendum C will display data

similar to those contained in Addenda A and

B, but sorted by APCs with each procedure

code listed that is assigned to the APC.

Addendum D lists the status indicators for

how various services are treated under the

hospital outpatient prospective payment

system. Addendum E lists the procedures

that we pay for only in an inpatient setting.

Addendum F lists the wage index for urban

areas, Addendum G lists the wage index for

rural areas, and Addendum H lists the wage

index for hospitals that are reclassified.

Addendum A.—List of Hospital Outpatient

Ambulatory Payment Classification Groups

with Status Indicators, Relative Weights,

Payment Rates, and Coinsurance Amounts

The payment rate (once wage adjusted) is

the total payment to the hospital. The

coinsurance amount is part of the total

payment rate.

Those APCs with status indicators ‘‘G’’ or

‘‘J’’ denote the inclusion of drugs that are

eligible for pass-through payments. The

relative weight column for these drug APCs

is empty since payment for pass-through

drugs/biologicals is calculated using the

average wholesale price for the drug/

biological rather than the relative weight.

Note also that the only coinsurance column

that has been filled is the minimum

unadjusted coinsurance column. The

coinsurance is applied to the nonpassthrough portion of the payment rate for the

drug/biological.

Those APCs with status indicator ‘‘H’’

denote the inclusion of devices that are

eligible for pass-through payments. The

relative weight, payment rate, and

coinsurance columns are not filled for these

APCs. The relative weight and payment rate

columns are empty because payment for

pass-through devices is determined based on

the hospital’s submitted charges adjusted to

cost using the hospital’s cost-to-charge ratio.

This calculation is done in the PRICER. The

coinsurance columns for these APCs are not

filled since the coinsurance is applied to the

APC that contains the procedure with which

the pass-through device is used rather than

to the device APC.

Addendum B.—Hospital Outpatient

Department (HOPD) Payment Status by

HCPCS Code and Related Information

The codes listed in this addendum include

the 2001 CPT codes as published in CPT

2001 by the American Medical Association.

Also listed are the codes that have been

deleted for 2001. These codes are denoted in

the CPT column with the subscript letter

‘‘D’’. These codes are billable through March

31, 2001 for services occurring before January

1, 2001. Deleted codes billed after March 31,

67830 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

2001 will be rejected. CPT codes appearing

for the first time in 2001 are denoted in the

CPT column with bolded print. These codes

are new for 2001 and are billable effective

January 1, 2001.

All CPT codes that are paid only as

inpatient procedures are denoted by the

status indicator ‘‘C’’. A number of procedures

that appeared on the inpatient list in the

April 7, 2000 final rule with comment period

are now payable under the hospital

outpatient prospective payment system. The

status indicators for these codes have been

updated to reflect their current payment

status.

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0001 Photochemotherapy ...................................................................................................... S 0.47 $23.31 $8.49 $4.66

0002 Fine needle Biopsy/Aspiration ...................................................................................... T 0.62 $30.75 $17.66 $6.15

0003 Bone Marrow Biopsy/Aspiration ................................................................................... T 0.98 $48.61 $27.99 $9.72

0004 Level I Needle Biopsy/ Aspiration Except Bone Marrow ............................................. T 1.84 $91.26 $32.57 $18.25

0005 Level II Needle Biopsy /Aspiration Except Bone Marrow ............................................ T 5.41 $268.32 $119.75 $53.66

0006 Level I Incision & Drainage .......................................................................................... T 2.00 $99.19 $33.95 $19.84

0007 Level II Incision & Drainage ......................................................................................... T 3.68 $182.51 $72.03 $36.50

0008 Level III Incision & Drainage ........................................................................................ T 6.15 $305.02 $113.67 $61.00

0009 Nail Procedures ............................................................................................................ T 0.74 $36.70 $9.63 $7.34

0010 Level I Destruction of Lesion ........................................................................................ T 0.55 $27.28 $9.86 $5.46

0011 Level II Destruction of Lesion ....................................................................................... T 2.72 $134.90 $50.01 $26.98

0012 Level I Debridement & Destruction .............................................................................. T 0.53 $26.29 $9.18 $5.26

0013 Level II Debridement & Destruction ............................................................................. T 0.91 $45.13 $17.66 $9.03

0014 Level III Debridement & Destruction ............................................................................ T 1.50 $74.39 $24.55 $14.88

0015 Level IV Debridement & Destruction ............................................................................ T 1.77 $87.78 $31.20 $17.56

0016 Level V Debridement & Destruction ............................................................................. T 3.53 $175.07 $74.67 $35.01

0017 Level VI Debridement & Destruction ............................................................................ T 12.45 $617.47 $289.16 $123.49

0018 Biopsy Skin, Subcutaneous Tissue or Mucous Membrane ......................................... T 0.94 $46.62 $17.66 $9.32

0019 Level I Excision/ Biopsy ............................................................................................... T 4.00 $198.39 $78.91 $39.68

0020 Level II Excision/ Biopsy .............................................................................................. T 6.51 $322.87 $130.53 $64.57

0021 Level III Excision/ Biopsy ............................................................................................. T 10.49 $520.26 $236.51 $104.05

0022 Level IV Excision/ Biopsy ............................................................................................. T 12.49 $619.45 $292.94 $123.89

0023 Exploration Penetrating Wound .................................................................................... T 1.98 $98.20 $40.37 $19.64

0024 Level I Skin Repair ....................................................................................................... T 2.43 $120.51 $44.50 $24.10

0025 Level II Skin Repair ...................................................................................................... T 3.74 $185.49 $70.66 $37.10

0026 Level III Skin Repair ..................................................................................................... T 12.11 $600.61 $277.92 $120.12

0027 Level IV Skin Repair ..................................................................................................... T 15.80 $783.62 $383.10 $156.72

0028 Level I Incision/Excision Breast .................................................................................... T 12.37 $613.52 $303.74 $122.70

0029 Level II Incision/Excision Breast ................................................................................... T 31.39 $1,557.05 $820.79 $311.41

0030 Breast Reconstruction .................................................................................................. T 31.11 $1,543.16 $763.55 $308.63

0032 Placement Transvenous Catheters/Arterial Cutdown .................................................. T 5.40 $267.82 $119.52 $53.56

0033 Partial Hospitalization ................................................................................................... P 4.17 $206.82 $48.17 $41.36

0040 Arthrocentesis & Ligament/Tendon Injection ............................................................... T 2.11 $104.65 $40.60 $20.93

0041 Arthroscopy ................................................................................................................... T 24.57 $1,218.58 $592.08 $243.72

0042 Arthroscopically-Aided Procedures .............................................................................. T 29.22 $1,449.19 $804.74 $289.84

0043 Closed Treatment Fracture Finger/Toe/Trunk .............................................................. T 1.64 $81.34 $25.46 $16.27

0044 Closed Treatment Fracture/Dislocation Except Finger/Toe/Trunk ............................... T 2.17 $107.63 $38.08 $21.53

0045 Bone/Joint Manipulation Under Anesthesia ................................................................. T 11.02 $546.55 $277.12 $109.31

0046 Open/Percutaneous Treatment Fracture or Dislocation .............................................. T 22.29 $1,105.50 $535.76 $221.10

0047 Arthroplasty without Prosthesis .................................................................................... T 22.09 $1,095.58 $537.03 $219.12

0048 Arthroplasty with Prosthesis ......................................................................................... T 29.06 $1,441.26 $725.94 $288.25

0049 Level I Musculoskeletal Procedures Except Hand and Foot ....................................... T 15.04 $745.93 $356.95 $149.19

0050 Level II Musculoskeletal Procedures Except Hand and Foot ...................................... T 21.13 $1,047.96 $513.86 $209.59

0051 Level III Musculoskeletal Procedures Except Hand and Foot ..................................... T 27.76 $1,376.79 $675.24 $275.36

0052 Level IV Musculoskeletal Procedures Except Hand and Foot ..................................... T 36.16 $1,793.39 $930.91 $358.68

0053 Level I Hand Musculoskeletal Procedures ................................................................... T 11.32 $561.42 $253.49 $112.28

0054 Level II Hand Musculoskeletal Procedures .................................................................. T 19.66 $975.06 $472.33 $195.01

0055 Level I Foot Musculoskeletal Procedures .................................................................... T 15.47 $767.26 $355.34 $153.45

0056 Level II Foot Musculoskeletal Procedures ................................................................... T 17.30 $858.02 $405.81 $171.60

0057 Bunion Procedures ....................................................................................................... T 21.00 $1,041.52 $496.65 $208.30

0058 Level I Strapping and Cast Application ........................................................................ S 1.09 $54.06 $19.27 $10.81

0059 Level II Strapping and Cast Application ....................................................................... S 1.74 $86.30 $29.59 $17.26

0060 Manipulation Therapy ................................................................................................... S 0.77 $38.19 $7.80 $7.64

0070 Thoracentesis/Lavage Procedures ............................................................................... T 3.64 $180.53 $79.60 $36.11

0071 Level I Endoscopy Upper Airway ................................................................................. T 0.55 $27.28 $14.22 $5.46

0072 Level II Endoscopy Upper Airway ................................................................................ T 1.26 $62.49 $41.52 $12.50

0073 Level III Endoscopy Upper Airway ............................................................................... T 4.11 $203.84 $91.07 $40.77

0074 Level IV Endoscopy Upper Airway ............................................................................... T 13.61 $675.00 $347.54 $135.00

0075 Level V Endoscopy Upper Airway ................................................................................ T 18.55 $920.01 $467.29 $184.00

0076 Endoscopy Lower Airway ............................................................................................. T 8.06 $399.75 $197.05 $79.95

0077 Level I Pulmonary Treatment ....................................................................................... S 0.43 $21.33 $12.62 $4.27

0078 Level II Pulmonary Treatment ...................................................................................... S 1.34 $66.46 $29.13 $13.29

0079 Ventilation Initiation and Management ......................................................................... S 3.18 $157.72 $107.70 $31.54

0080 Diagnostic Cardiac Catheterization .............................................................................. T 31.55 $1,564.75 $838.92 $312.95

0081 Non-Coronary Angioplasty or Atherectomy .................................................................. T 28.81 $1,428.86 $710.91 $285.77

0082 Coronary Atherectomy .................................................................................................. T 51.01 $2,529.89 $1,351.74 $505.98

0083 Coronary Angioplasty ................................................................................................... T 29.70 $1,473.00 $794.30 $294.60

0084 Level I Electrophysiologic Evaluation ........................................................................... S 10.70 $530.68 $177.79 $106.14

0085 Level II Electrophysiologic Evaluation .......................................................................... S 27.06 $1,342.07 $654.48 $268.41

0086 Ablate Heart Dysrhythm Focus .................................................................................... S 47.62 $2,361.76 $1,265.37 $472.35

0087 Cardiac Electrophysiologic Recording/Mapping ........................................................... S 9.53 $472.65 $214.72 $94.53

0088 Thrombectomy .............................................................................................................. T 26.49 $1,313.80 $678.68 $262.76

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67831

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0089 Insertion/Replacement of Permanent Pacemaker and Electrodes .............................. T 78.45 $3,890.81 $2,275.19 $778.16

0090 Insertion/Replacement of Pacemaker Pulse Generator ............................................... T 78.28 $3,882.37 $2,133.88 $776.47

0091 Level I Vascular Ligation .............................................................................................. T 14.79 $733.52 $348.23 $146.70

0092 Level II Vascular Ligation ............................................................................................. T 20.21 $1,002.34 $505.37 $200.47

0093 Vascular Repair/Fistula Construction ........................................................................... T 12.82 $635.82 $277.34 $127.16

0094 Resuscitation and Cardioversion .................................................................................. S 4.51 $223.68 $105.29 $44.74

0095 Cardiac Rehabilitation .................................................................................................. S 0.64 $31.74 $16.98 $6.35

0096 Non-Invasive Vascular Studies .................................................................................... S 2.06 $102.16 $61.48 $20.43

0097 Cardiac Monitoring for 30 days .................................................................................... X 1.62 $80.35 $62.40 $16.07

0098 Injection of Sclerosing Solution .................................................................................... T 1.19 $59.02 $20.88 $11.80

0099 Electrocardiograms ....................................................................................................... S 0.38 $18.85 $14.68 $3.77

0100 Stress Tests and Continuous ECG .............................................................................. X 1.70 $84.32 $71.57 $16.86

0101 Tilt Table Evaluation ..................................................................................................... S 4.47 $221.70 $128.84 $44.34

0102 Electronic Analysis of Pacemakers/other Devices ....................................................... S 0.45 $22.32 $12.62 $4.46

0103 Miscellaneous Vascular Procedures ............................................................................ T 13.09 $649.21 $295.70 $129.84

0104 Transcatheter Placement of Intracoronary Stents ....................................................... T 14.94 $740.96 $339.51 $148.19

0105 Revision/Removal of Pacemakers, AICD, or Vascular Device .................................... T 15.06 $746.92 $372.32 $149.38

0106 Insertion/Replacement/Repair of Pacemaker Electrodes ............................................ T 18.96 $940.34 $503.07 $188.07

0107 Insertion of Cardioverter-Defibrillator ........................................................................... T 147.51 $7,315.91 $5,086.37 $1,463.18

0108 Insertion/Replacement/Repair of Cardioverter-Defibrillator Leads ............................... T 210.84 $10,456.84 $5,484.72 $2,091.37

0109 Removal of Implanted Devices .................................................................................... T 6.53 $323.86 $133.51 $64.77

0110 Transfusion ................................................................................................................... S 5.83 $289.15 $122.73 $57.83

0111 Blood Product Exchange .............................................................................................. S 14.17 $702.77 $300.74 $140.55

0112 Extracorporeal Photopheresis ...................................................................................... S 39.60 $1,964.01 $663.65 $392.80

0113 Excision Lymphatic System .......................................................................................... T 13.89 $688.89 $326.55 $137.78

0114 Thyroid/Lymphadenectomy Procedures ....................................................................... T 19.56 $970.10 $493.78 $194.02

0115 Cannula/Access Device Procedures ............................................................................ T 19.34 $959.19 $506.74 $191.84

0116 Chemotherapy Administration by Other Technique Except Infusion ........................... S 2.34 $116.06 $23.21 $23.21

0117 Chemotherapy Administration by Infusion Only ........................................................... S 1.84 $91.26 $71.80 $18.25

0118 Chemotherapy Administration by Both Infusion and Other Technique ....................... S 2.90 $143.83 $72.03 $28.77

0119 Implantation of Devices ................................................................................................ T 9.87 $489.59 $161.50 $97.92

0120 Infusion Therapy Except Chemotherapy ...................................................................... T 1.66 $82.33 $42.67 $16.47

0121 Level I Tube changes and Repositioning ..................................................................... T 2.36 $117.05 $52.53 $23.41

0122 Level II Tube changes and Repositioning .................................................................... T 5.04 $249.96 $114.93 $49.99

0123 Bone Marrow Harvesting and Bone Marrow/Stem Cell Transplant ............................. S 4.13 $204.83 $40.97 $40.97

0124 Revision of Implanted Infusion Pump .......................................................................... T 2.55 $126.64 $81.36 $25.33

0130 Level I Laparoscopy ..................................................................................................... T 25.36 $1,257.75 $659.53 $251.55

0131 Level II Laparoscopy .................................................................................................... T 41.81 $2,073.61 $1,089.88 $414.72

0132 Level III Laparoscopy ................................................................................................... T 48.91 $2,425.74 $1,239.22 $485.15

0140 Esophageal Dilation without Endoscopy ...................................................................... T 4.74 $235.09 $107.24 $47.02

0141 Upper GI Procedures ................................................................................................... T 7.15 $354.61 $184.67 $70.92

0142 Small Intestine Endoscopy ........................................................................................... T 7.45 $369.49 $162.42 $73.90

0143 Lower GI Endoscopy .................................................................................................... T 7.98 $395.78 $199.12 $79.16

0144 Diagnostic Anoscopy .................................................................................................... T 2.23 $110.60 $49.32 $22.12

0145 Therapeutic Anoscopy .................................................................................................. T 7.46 $369.98 $179.39 $74.00

0146 Level I Sigmoidoscopy ................................................................................................. T 2.83 $140.36 $65.15 $28.07

0147 Level II Sigmoidoscopy ................................................................................................ T 6.26 $310.47 $149.11 $62.09

0148 Level I Anal/Rectal Procedure ...................................................................................... T 2.34 $116.06 $43.59 $23.21

0149 Level II Anal/Rectal Procedure ..................................................................................... T 12.86 $637.80 $293.06 $127.56

0150 Level III Anal/Rectal Procedure .................................................................................... T 17.68 $876.86 $437.12 $175.37

0151 Endoscopic Retrograde Cholangio-Pancreatography (ERCP) .................................... T 10.53 $522.25 $245.46 $104.45

0152 Percutaneous Biliary Endoscopic Procedures ............................................................. T 8.22 $407.68 $207.38 $81.54

0153 Peritoneal and Abdominal Procedures ......................................................................... T 19.62 $973.08 $496.31 $194.62

0154 Hernia/Hydrocele Procedures ...................................................................................... T 22.43 $1,112.45 $556.98 $222.49

0157 Colorectal Cancer Screening: Barium Enema ............................................................. S 1.79 $88.78 .................... $22.19

0158 Colorectal Cancer Screening: Colonoscopy ................................................................ S 7.98 $395.78 .................... $98.94

0159 Colorectal Cancer Screening: Flexible Sigmoidoscopy ............................................... S 2.83 $140.36 .................... $35.09

0160 Level I Cystourethroscopy and other Genitourinary Procedures ................................. T 5.43 $269.30 $110.11 $53.86

0161 Level II Cystourethroscopy and other Genitourinary Procedures ................................ T 10.94 $542.58 $249.36 $108.52

0162 Level III Cystourethroscopy and other Genitourinary Procedures ............................... T 17.49 $867.44 $427.49 $173.49

0163 Level IV Cystourethroscopy and other Genitourinary Procedures .............................. T 28.98 $1,437.30 $792.58 $287.46

0164 Level I Urinary and Anal Procedures ........................................................................... T 2.17 $107.64 $33.03 $21.53

0165 Level II Urinary and Anal Procedures .......................................................................... T 3.89 $192.92 $91.76 $38.58

0166 Level I Urethral Procedures ......................................................................................... T 10.17 $504.39 $218.73 $100.88

0167 Level II Urethral Procedures ........................................................................................ T 21.06 $1,044.50 $555.84 $208.90

0168 Level III Urethral Procedures ....................................................................................... T 24.94 $1,236.93 $536.11 $247.39

0169 Lithotripsy ..................................................................................................................... T 46.72 $2,317.13 $1,384.20 $463.43

0170 Dialysis for Other Than ESRD Patients ....................................................................... S 6.68 $331.30 $72.26 $66.26

0180 Circumcision ................................................................................................................. T 13.62 $675.49 $304.87 $135.10

0181 Penile Procedures ........................................................................................................ T 32.37 $1,605.43 $906.36 $321.09

0182 Insertion of Penile Prosthesis ....................................................................................... T 52.11 $2,584.45 $1,525.05 $516.89

0183 Testes/Epididymis Procedures ..................................................................................... T 18.26 $905.62 $448.94 $181.12

0184 Prostate Biopsy ............................................................................................................ T 4.94 $245.01 $122.96 $49.00

0185 Removal or Repair of Penile Prosthesis ...................................................................... T 32.37 $1,605.43 $906.36 $321.09

0190 Surgical Hysteroscopy .................................................................................................. T 17.85 $885.29 $443.89 $177.06

0191 Level I Female Reproductive Procedures .................................................................... T 1.19 $59.02 $17.43 $11.80

0192 Level II Female Reproductive Procedures ................................................................... T 2.38 $118.04 $35.33 $23.61

0193 Level III Female Reproductive Procedures .................................................................. T 8.93 $442.89 $171.13 $88.58

67832 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0194 Level IV Female Reproductive Procedures ................................................................. T 16.21 $803.96 $395.94 $160.79

0195 Level V Female Reproductive Procedures .................................................................. T 18.68 $926.46 $483.80 $185.29

0196 Dilatation & Curettage .................................................................................................. T 14.47 $717.66 $357.98 $143.53

0197 Infertility Procedures ..................................................................................................... T 2.40 $119.03 $49.55 $23.81

0198 Pregnancy and Neonatal Care Procedures ................................................................. T 1.34 $66.46 $33.03 $13.29

0199 Vaginal Delivery ............................................................................................................ T 11.20 $555.48 $157.83 $111.10

0200 Therapeutic Abortion .................................................................................................... T 13.89 $688.89 $373.23 $137.78

0201 Spontaneous Abortion .................................................................................................. T 13.00 $644.75 $329.65 $128.95

0210 Spinal Tap .................................................................................................................... T 3.00 $148.79 $62.40 $29.76

0211 Level I Nervous System Injections ............................................................................... T 3.32 $164.66 $74.78 $32.93

0212 Level II Nervous System Injections .............................................................................. T 3.64 $180.53 $88.78 $36.11

0213 Extended EEG Studies and Sleep Studies .................................................................. S 11.15 $553.00 $290.42 $110.60

0214 Electroencephalogram .................................................................................................. S 2.32 $115.06 $58.50 $23.01

0215 Level I Nerve and Muscle Tests .................................................................................. S 1.15 $57.04 $30.05 $11.41

0216 Level II Nerve and Muscle Tests ................................................................................. S 2.87 $142.34 $64.69 $28.47

0217 Level III Nerve and Muscle Tests ................................................................................ S 5.87 $291.13 $156.68 $58.23

0220 Level I Nerve Procedures ............................................................................................. T 13.96 $692.36 $326.21 $138.47

0221 Level II Nerve Procedures ............................................................................................ T 18.36 $910.58 $463.62 $182.12

0222 Implantation of Neurological Device ............................................................................. T 124.43 $6,171.23 $2,955.13 $1,234.25

0223 Implantation of Pain Management Device ................................................................... T 7.05 $349.65 $154.27 $69.93

0224 Implantation of Reservoir/Pump/Shunt ......................................................................... T 17.89 $887.27 $453.41 $177.45

0225 Implantation of Neurostimulator Electrodes ................................................................. T 17.72 $878.84 $408.33 $175.77

0226 Implantation of Drug Infusion Reservoir ....................................................................... T 5.62 $278.73 $109.42 $55.75

0227 Implantation of Drug Infusion Device ........................................................................... T 11.17 $553.99 $330.11 $110.80

0228 Creation of Lumbar Subarachnoid Shunt ..................................................................... T 25.06 $1,242.88 $696.46 $248.58

0229 Transcatherter Placement of Intravascular Shunts ...................................................... T 34.81 $1,726.44 $1,030.12 $345.29

0230 Level I Eye Tests .......................................................................................................... S 0.98 $48.61 $22.48 $9.72

0231 Level II Eye Tests ......................................................................................................... S 2.64 $130.94 $59.87 $26.19

0232 Level I Anterior Segment Eye ...................................................................................... T 6.04 $299.56 $134.66 $59.91

0233 Level II Anterior Segment Eye ..................................................................................... T 13.79 $683.93 $331.60 $136.79

0234 Level III Anterior Segment Eye Procedures ................................................................. T 20.64 $1,023.66 $502.16 $204.73

0235 Level I Posterior Segment Eye Procedures ................................................................. T 2.94 $145.81 $78.91 $29.16

0236 Level II Posterior Segment Eye Procedures ................................................................ T 6.70 $332.29 $147.96 $66.46

0237 Level III Posterior Segment Eye Procedures ............................................................... T 33.96 $1,684.28 $852.68 $336.86

0238 Level I Repair and Plastic Eye Procedures ................................................................. T 2.80 $138.87 $58.96 $27.77

0239 Level II Repair and Plastic Eye Procedures ................................................................ T 6.26 $310.47 $123.42 $62.09

0240 Level III Repair and Plastic Eye Procedures ............................................................... T 13.47 $668.06 $315.31 $133.61

0241 Level IV Repair and Plastic Eye Procedures ............................................................... T 16.60 $823.30 $384.47 $164.66

0242 Level V Repair and Plastic Eye Procedures ................................................................ T 23.70 $1,175.42 $597.36 $235.08

0243 Strabismus/Muscle Procedures .................................................................................... T 17.99 $892.23 $431.39 $178.45

0244 Corneal Transplant ....................................................................................................... T 32.88 $1,630.72 $851.42 $326.14

0245 Cataract Procedures without IOL Insert ....................................................................... T 26.55 $1,316.77 $623.85 $263.35

0246 Cataract Procedures with IOL Insert ............................................................................ T 26.55 $1,316.77 $623.85 $263.35

0247 Laser Eye Procedures Except Retinal ......................................................................... T 4.89 $242.52 $112.86 $48.50

0248 Laser Retinal Procedures ............................................................................................. T 4.19 $207.81 $94.05 $41.56

0250 Nasal Cauterization/Packing ........................................................................................ T 2.21 $109.61 $38.54 $21.92

0251 Level I ENT Procedures ............................................................................................... T 1.68 $83.32 $27.99 $16.66

0252 Level II ENT Procedures .............................................................................................. T 5.18 $256.90 $114.24 $51.38

0253 Level III ENT Procedures ............................................................................................. T 12.02 $596.14 $284.00 $119.23

0254 Level IV ENT Procedures ............................................................................................. T 12.45 $617.47 $272.41 $123.49

0256 Level V ENT Procedures .............................................................................................. T 25.40 $1,259.74 $623.05 $251.95

0258 Tonsil and Adenoid Procedures ................................................................................... T 18.62 $923.48 $462.81 $184.70

0260 Level I Plain Film Except Teeth ................................................................................... X 0.79 $39.18 $22.02 $7.84

0261 Level II Plain Film Except Teeth Including Bone Density Measurement ..................... X 1.38 $68.44 $38.77 $13.69

0262 Plain Film of Teeth ....................................................................................................... X 0.40 $19.83 $10.90 $3.97

0263 Level I Miscellaneous Radiology Procedures .............................................................. X 1.68 $83.32 $45.88 $16.66

0264 Level II Miscellaneous Radiology Procedures ............................................................. X 3.83 $189.96 $108.97 $37.99

0265 Level I Diagnostic Ultrasound Except Vascular ........................................................... S 1.17 $58.03 $38.08 $11.61

0266 Level II Diagnostic Ultrasound Except Vascular .......................................................... S 1.79 $88.78 $57.35 $17.76

0267 Vascular Ultrasound ..................................................................................................... S 2.72 $134.90 $80.06 $26.98

0268 Guidance Under Ultrasound ......................................................................................... X 2.23 $110.60 $69.51 $22.12

0269 Echocardiogram Except Transesophageal .................................................................. S 4.40 $218.22 $114.01 $43.64

0270 Transesophageal Echocardiogram ............................................................................... S 5.55 $275.25 $150.26 $55.05

0271 Mammography .............................................................................................................. S 0.70 $34.72 $19.50 $6.94

0272 Level I Fluoroscopy ...................................................................................................... X 1.40 $69.43 $39.00 $13.89

0273 Level II Fluoroscopy ..................................................................................................... X 2.49 $123.49 $61.02 $24.70

0274 Myelography ................................................................................................................. S 4.83 $239.55 $128.12 $47.91

0275 Arthrography ................................................................................................................. S 2.74 $135.89 $72.26 $27.18

0276 Level I Digestive Radiology .......................................................................................... S 1.79 $88.78 $49.78 $17.76

0277 Level II Digestive Radiology ......................................................................................... S 2.47 $122.50 $69.28 $24.50

0278 Diagnostic Urography ................................................................................................... S 2.85 $141.35 $81.67 $28.27

0279 Level I Angiography and Venography except Extremity .............................................. S 6.30 $312.46 $174.57 $62.49

0280 Level II Angiography and Venography except Extremity ............................................. S 14.98 $742.95 $380.12 $148.59

0281 Venography of Extremity .............................................................................................. S 4.40 $218.22 $115.16 $43.64

0282 Level I Computerized Axial Tomography ..................................................................... S 2.38 $118.04 $94.51 $23.61

0283 Level II Computerized Axial Tomography .................................................................... S 4.89 $242.52 $179.39 $48.50

0284 Magnetic Resonance Imaging ...................................................................................... S 8.02 $397.76 $257.39 $79.55

0285 Positron Emission Tomography (PET) ......................................................................... S 15.06 $746.92 $415.21 $149.38

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67833

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0286 Myocardial Scans ......................................................................................................... S 7.28 $361.06 $200.04 $72.21

0290 Standard Non-Imaging Nuclear Medicine .................................................................... S 1.94 $96.21 $55.51 $19.24

0291 Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans ............................. S 3.15 $156.22 $93.14 $31.24

0292 Level II Diagnostic Nuclear Medicine Excluding Myocardial Scans ............................ S 4.36 $216.24 $126.63 $43.25

0294 Level I Therapeutic Nuclear Medicine .......................................................................... S 5.13 $254.43 $144.06 $50.89

0295 Level II Therapeutic Nuclear Medicine ......................................................................... S 19.85 $984.48 $609.17 $196.90

0296 Level I Therapeutic Radiologic Procedures ................................................................. S 3.57 $177.06 $100.25 $35.41

0297 Level II Therapeutic Radiologic Procedures ................................................................ S 6.13 $304.03 $172.51 $60.81

0300 Level I Radiation Therapy ............................................................................................ S 1.98 $98.20 $47.72 $19.64

0301 Level II Radiation Therapy ........................................................................................... S 2.21 $109.61 $52.53 $21.92

0302 Level III Radiation Therapy .......................................................................................... S 8.21 $407.18 $216.55 $81.44

0303 Treatment Device Construction .................................................................................... X 2.83 $140.36 $69.28 $28.07

0304 Level I Therapeutic Radiation Treatment Preparation ................................................. X 1.49 $73.90 $41.52 $14.78

0305 Level II Therapeutic Radiation Treatment Preparation ................................................ X 4.06 $201.36 $97.50 $40.27

0310 Level III Therapeutic Radiation Treatment Preparation ............................................... X 13.98 $693.35 $339.05 $138.67

0311 Radiation Physics Services .......................................................................................... X 1.32 $65.46 $31.66 $13.09

0312 Radioelement Applications ........................................................................................... S 4.09 $202.85 $109.65 $40.57

0313 Brachytherapy ............................................................................................................... S 7.89 $391.31 $164.02 $78.26

0314 Hyperthermic Therapies ............................................................................................... S 5.88 $291.62 $150.95 $58.32

0320 Electroconvulsive Therapy ........................................................................................... S 3.68 $182.51 $80.06 $36.50

0321 Biofeedback and Other Training .................................................................................. S 1.26 $62.49 $29.25 $12.50

0322 Brief Individual Psychotherapy ..................................................................................... S 1.32 $65.46 $14.22 $13.09

0323 Extended Individual Psychotherapy ............................................................................. S 1.85 $91.75 $22.48 $18.35

0324 Family Psychotherapy .................................................................................................. S 1.87 $92.74 $20.19 $18.55

0325 Group Psychotherapy ................................................................................................... S 1.55 $76.88 $19.96 $15.38

0330 Dental Procedures ........................................................................................................ S 1.51 $74.89 $14.98 $14.98

0340 Minor Ancillary Procedures .......................................................................................... X 1.04 $51.58 $12.85 $10.32

0341 Immunology Tests ........................................................................................................ X 0.13 $6.44 $3.67 $1.29

0342 Level I Pathology .......................................................................................................... X 0.26 $12.90 $8.03 $2.58

0343 Level II Pathology ......................................................................................................... X 0.45 $22.32 $12.16 $4.46

0344 Level III Pathology ........................................................................................................ X 0.79 $39.18 $23.63 $7.84

0345 Transfusion Laboratory Procedures Level I ................................................................. X 0.22 $10.92 $5.37 $2.18

0346 Transfusion Laboratory Procedures Level II ................................................................ X 0.51 $25.49 $12.03 $5.10

0347 Transfusion Laboratory Procedures Level III ............................................................... X 0.84 $41.90 $20.13 $8.38

0348 Fertility Laboratory Procedures .................................................................................... X 0.52 $25.57 $5.11 $5.11

0349 Miscellaneous Laboratory Procedures ......................................................................... X 0.48 $23.65 $4.73 $4.73

0354 Administration of Influenza/Pneumonia Vaccine .......................................................... K 0.13 $6.33 .................... ....................

0355 Level I Immunizations ................................................................................................... K 0.19 $9.42 $5.05 $1.88

0356 Level II Immunizations .................................................................................................. K 0.36 $17.86 $4.82 $3.57

0359 Injections ....................................................................................................................... X 0.96 $47.61 $9.52 $9.52

0360 Level I Alimentary Tests ............................................................................................... X 1.38 $68.44 $34.75 $13.69

0361 Level II Alimentary Tests .............................................................................................. X 3.53 $175.07 $88.09 $35.01

0362 Fitting of Vision Aids ..................................................................................................... X 0.51 $25.30 $9.63 $5.06

0363 Otorhinolaryngologic Function Tests ............................................................................ X 2.83 $140.36 $53.22 $28.07

0364 Level I Audiometry ........................................................................................................ X 0.68 $33.72 $13.31 $6.74

0365 Level II Audiometry ....................................................................................................... X 1.47 $72.91 $22.48 $14.58

0367 Level I Pulmonary Test ................................................................................................ X 0.83 $41.16 $20.65 $8.23

0368 Level II Pulmonary Tests .............................................................................................. X 1.66 $82.33 $42.44 $16.47

0369 Level III Pulmonary Tests ............................................................................................. X 2.34 $116.06 $58.50 $23.21

0370 Allergy Tests ................................................................................................................. X 0.57 $28.27 $11.81 $5.65

0371 Allergy Injections .......................................................................................................... X 0.32 $15.87 $3.67 $3.17

0372 Therapeutic Phlebotomy ............................................................................................... X 0.43 $21.33 $10.09 $4.27

0373 Neuropsychological Testing ......................................................................................... X 3.21 $159.20 $44.96 $31.84

0374 Monitoring Psychiatric Drugs ........................................................................................ X 1.17 $58.03 $13.08 $11.61

0600 Low Level Clinic Visits .................................................................................................. V 0.98 $48.61 $9.72 $9.72

0601 Mid Level Clinic Visits .................................................................................................. V 1.00 $49.60 $9.92 $9.92

0602 High Level Clinic Visits ................................................................................................. V 1.66 $82.33 $16.47 $16.47

0610 Low Level Emergency Visits ........................................................................................ V 1.34 $66.46 $20.65 $13.29

0611 Mid Level Emergency Visits ......................................................................................... V 2.11 $104.65 $36.47 $20.93

0612 High Level Emergency Visits ....................................................................................... V 3.19 $158.21 $54.14 $31.64

0620 Critical Care .................................................................................................................. S 8.60 $426.53 $152.78 $85.31

0701 SR 89 chloride, per mCi ............................................................................................... G .................... $783.75 .................... $95.62

0702 SM 153 lexidronam, 50 mCi ......................................................................................... G .................... $942.09 .................... $134.87

0704 IN 111 Satumomab pendetide per dose ...................................................................... G .................... $712.50 .................... $86.93

0705 TC 99M tetrofosmin, per dose ..................................................................................... G .................... $136.80 .................... $16.69

0725 Leucovorin calcium inj, 50 mg ...................................................................................... G .................... $49.73 .................... $6.66

0726 Dexrazoxane hcl injection, 250 mg .............................................................................. G .................... $161.11 .................... $21.59

0727 Etidronate disodium inj 300 mg .................................................................................... G .................... $63.65 .................... $8.53

0728 Filgrastim 300 mcg injection ......................................................................................... G .................... $171.38 .................... $22.96

0730 Pamidronate disodium, 30 mg ..................................................................................... G .................... $232.51 .................... $31.16

0731 Sargramostim injection 50 mcg .................................................................................... G .................... $27.42 .................... $3.67

0732 Mesna injection 200 mg ............................................................................................... G .................... $36.51 .................... $4.89

0733 Non esrd epoetin alpha inj, 1000 u .............................................................................. G .................... $11.40 .................... $1.53

0750 Dolasetron mesylate, 10 mg ........................................................................................ G .................... $14.81 .................... $1.98

0754 Metoclopramide hcl injection up to 10 mg ................................................................... G .................... $2.00 .................... $0.27

0755 Thiethylperazine maleate inj up to 10 mg .................................................................... G .................... $5.02 .................... $0.67

0761 Unspecified oral anti-emetic ......................................................................................... G .................... $0.60 .................... $0.08

0762 Dronabinol 2.5mg oral .................................................................................................. G .................... $3.20 .................... $0.48

67834 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0763 Dolasetron mesylate oral, 100 mg ............................................................................... G .................... $65.21 .................... $8.74

0764 Granisetron hcl injection 100 mcg ................................................................................ G .................... $1.85 .................... $0.25

0765 Granisetron hcl 1 mg oral ............................................................................................. G .................... $44.70 .................... $5.99

0768 Ondansetron hcl injection 1 mg ................................................................................... G .................... $6.09 .................... $0.82

0769 Ondansetron hcl 8mg oral ............................................................................................ G .................... $25.15 .................... $3.37

0800 Leuprolide acetate, 3.75 mg ......................................................................................... G .................... $492.71 .................... $63.27

0801 Cyclophosphamide oral 25 mg ..................................................................................... G .................... $2.12 .................... $0.28

0802 Etoposide oral 50 mg ................................................................................................... G .................... $45.95 .................... $6.16

0803 Melphalan oral 2 mg ..................................................................................................... G .................... $2.07 .................... $0.28

0807 Aldesleukin/single use vial ........................................................................................... G .................... $569.76 .................... $76.35

0809 Bcg live intravesical vac ............................................................................................... G .................... $159.39 .................... $19.45

0810 Goserelin acetate implant 3.6 mg ................................................................................ G .................... $446.49 .................... $59.83

0811 Carboplatin injection 50 mg .......................................................................................... G .................... $98.90 .................... $13.25

0812 Carmus bischl nitro inj 100 mg .................................................................................... G .................... $103.27 .................... $13.84

0813 Cisplatin 10 mg injection .............................................................................................. G .................... $42.18 .................... $5.65

0814 Asparaginase injection 10,000 u .................................................................................. G .................... $57.41 .................... $7.69

0815 Cyclophosphamide 100 mg inj ..................................................................................... G .................... $6.13 .................... $0.82

0816 Cyclophosphamide lyophilized 100 mg ........................................................................ G .................... $6.13 .................... $0.82

0817 Cytarabine hcl 100 mg inj ............................................................................................ G .................... $5.94 .................... $0.80

0818 Dactinomycin 0.5 mg .................................................................................................... G .................... $12.73 .................... $1.71

0819 Dacarbazine 10 mg inj ................................................................................................. G .................... $1.13 .................... $0.15

0820 Daunorubicin 10 mg ..................................................................................................... G .................... $80.04 .................... $10.73

0821 Daunorubicin citrate liposom 10 mg ............................................................................. G .................... $64.60 .................... $8.66

0822 Diethylstilbestrol injection 250 mg ................................................................................ G .................... $4.20 .................... $0.56

0823 Docetaxel, 20 mg ......................................................................................................... G .................... $283.65 .................... $38.01

0824 Etoposide 10 mg inj ...................................................................................................... G .................... $4.06 .................... $0.54

0826 Methotrexate Oral 2.5 mg ............................................................................................ G .................... $2.92 .................... $0.39

0827 Floxuridine injection 500 mg ........................................................................................ G .................... $129.56 .................... $17.36

0828 Gemcitabine HCL 200 mg ............................................................................................ G .................... $88.46 .................... $11.85

0830 Irinotecan injection 20 mg ............................................................................................ G .................... $117.81 .................... $15.79

0831 Ifosfomide injection 1 gm ............................................................................................. G .................... $141.50 .................... $18.96

0832 Idarubicin hcl injection 5 mg ......................................................................................... G .................... $341.38 .................... $45.75

0833 Interferon alfacon-1, 1 mcg .......................................................................................... G .................... $3.91 .................... $0.52

0834 Interferon alfa-2a inj recombinant 3 million u ............................................................... G .................... $33.22 .................... $4.45

0836 Interferon alfa-2b inj recombinant, 1 million ................................................................. G .................... $11.28 .................... $1.51

0838 Interferon gamma 1-b inj, 3 million u ........................................................................... G .................... $199.50 .................... $26.73

0839 Mechlorethamine hcl inj 10 mg .................................................................................... G .................... $11.01 .................... $1.48

0840 Melphalan hydrochl 50 mg ........................................................................................... G .................... $363.48 .................... $48.71

0841 Methotrexate sodium inj 5 mg ...................................................................................... G .................... $0.45 .................... $0.06

0842 Fludarabine phosphate inj 50 mg ................................................................................. G .................... $237.03 .................... $31.76

0843 Pegaspargase, singl dose vial ..................................................................................... G .................... $1,321.65 .................... $177.10

0844 Pentostatin injection, 10 mg ......................................................................................... G .................... $1,562.75 .................... $209.41

0847 Doxorubicin hcl 10 mg vl chemo .................................................................................. G .................... $15.79 .................... $2.12

0849 Rituximab, 100 mg ....................................................................................................... G .................... $420.29 .................... $56.32

0850 Streptozocin injection, 1 gm ......................................................................................... G .................... $65.79 .................... $8.82

0851 Thiotepa injection, 15 mg ............................................................................................. G .................... $100.30 .................... $13.44

0852 Topotecan, 4 mg .......................................................................................................... G .................... $573.75 .................... $76.88

0853 Vinblastine sulfate inj, 1 mg ......................................................................................... G .................... $4.11 .................... $0.55

0854 Vincristine sulfate 1 mg inj ........................................................................................... G .................... $30.16 .................... $4.04

0855 Vinorelbine tartrate, 10 mg ........................................................................................... G .................... $75.51 .................... $10.12

0856 Porfimer sodium, 75 mg ............................................................................................... G .................... $2,603.67 .................... $348.89

0857 Bleomycin sulfate injection 15 u ................................................................................... G .................... $294.48 .................... $39.46

0858 Cladribine, 1mg ............................................................................................................ G .................... $53.47 .................... $7.16

0859 Fluorouracil injection 500 mg ....................................................................................... G .................... $2.75 .................... $0.37

0860 Plicamycin (mithramycin) inj 2.5 mg ............................................................................ G .................... $93.80 .................... $12.57

0861 Leuprolide acetate injection 1 mg ................................................................................ G .................... $22.90 .................... $3.07

0862 Mitomycin 5 mg inj ....................................................................................................... G .................... $121.65 .................... $16.30

0863 Paclitaxel injection, 30 mg ............................................................................................ G .................... $173.50 .................... $23.25

0864 Mitoxantrone hcl, 5 mg ................................................................................................. G .................... $223.02 .................... $29.88

0865 Interferon alfa-n3 inj, human leukocyte derived, 250,000 iu ........................................ G .................... $7.86 .................... $1.05

0884 Rho d immune globulin inj, 1 dose pkg ....................................................................... G .................... $35.91 .................... $4.38

0886 Azathioprine oral 50mg ................................................................................................ G .................... $1.24 .................... $0.17

0887 Azathioprine parenteral 100 mg ................................................................................... G .................... $67.88 .................... $9.10

0888 Cyclosporine oral 100 mg ............................................................................................ G .................... $5.80 .................... $0.78

0889 Cyclosporin parenteral 250mg ..................................................................................... G .................... $15.81 .................... $2.12

0890 Lymphocyte immune globulin 250 mg ......................................................................... G .................... $249.13 .................... $30.39

0891 Tacrolimus oral per 1 mg ............................................................................................. G .................... $2.66 .................... $0.36

0900 Alglucerase injection, per 10 u ..................................................................................... G .................... $37.53 .................... $5.03

0901 Alpha 1 proteinase inhibitor, 10 mg ............................................................................. G .................... $2.09 .................... $0.28

0902 Botulinum toxin a, per unit ........................................................................................... G .................... $4.39 .................... $0.59

0903 Cytomegalovirus imm IV, vial ....................................................................................... G .................... $370.50 .................... $49.65

0905 Immune globulin 500 mg .............................................................................................. G .................... $27.28 .................... $3.33

0906 RSV-ivig, 50 mg ........................................................................................................... G .................... $427.73 .................... $57.32

0907 Ganciclovir Sodium 500 mg injection ........................................................................... K 0.45 $22.26 .................... $4.45

0908 Tetanus immune globulin inj up to 250 u ..................................................................... G .................... $102.60 .................... $13.75

0909 Interferon beta-1a, 33 mcg ........................................................................................... G .................... $204.73 .................... $27.43

0910 Interferon beta-1b, .25 mg ............................................................................................ G .................... $57.00 .................... $7.64

0911 Streptokinase per 250,000 iu ....................................................................................... K 1.76 $87.25 .................... $17.45

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67835

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

0913 Ganciclovir long act implant 4.5 mg ............................................................................. G .................... $4,750.00 .................... $636.50

0914 Reteplase, per 37.6mg ................................................................................................. G .................... $2,612.50 .................... $350.08

0915 Alteplase inj rec, per 10 mg ......................................................................................... K 3.80 $188.46 .................... $37.69

0916 Imiglucerase, unit ......................................................................................................... G .................... $3.75 .................... $0.50

0917 Pharmacologic stressors .............................................................................................. K 0.36 $17.86 .................... $3.57

0918 Brachytherapy Seeds, Any type, Each ........................................................................ H .................... .................... .................... ....................

0925 Factor viii per iu ............................................................................................................ G .................... $0.88 .................... $0.12

0926 Factor VIII (porcine) per iu ........................................................................................... G .................... $2.09 .................... $0.28

0927 Factor viii recombinant per iu ....................................................................................... G .................... $1.17 .................... $0.16

0928 Factor ix complex per iu ............................................................................................... G .................... $.71 .................... $0.10

0929 Anti-inhibitor per iu ....................................................................................................... G .................... $1.43 .................... $0.19

0930 Antithrombin iii injection per iu ..................................................................................... G .................... $.82 .................... $0.11

0931 Factor IX non-recombinant, per iu ............................................................................... G .................... $0.72 .................... $0.10

0932 Factor IX recombinant, per iu ....................................................................................... G .................... $1.12 .................... $0.10

0949 Plasma, Pooled Multiple Donor, Solvent/Detergent Treated, Frozen .......................... K 2.94 $145.76 .................... $29.15

0950 Blood (Whole) For Transfusion .................................................................................... K 2.08 $103.33 .................... $20.67

0952 Cryoprecipitate .............................................................................................................. K 0.70 $34.70 .................... $6.94

0953 Fibrinogen Unit ............................................................................................................. K 0.48 $23.80 .................... $4.76

0954 RBC Leukocytes Reduced ........................................................................................... K 2.83 $140.35 .................... $28.07

0955 Plasma, Fresh Frozen .................................................................................................. K 2.26 $111.85 .................... $22.37

0956 Plasma Protein Fraction ............................................................................................... K 1.26 $62.49 .................... $12.50

0957 Platelet Concentrate ..................................................................................................... K 0.98 $48.55 .................... $9.71

0958 Platelet Rich Plasma .................................................................................................... K 1.16 $57.54 .................... $11.51

0959 Red Blood Cells ............................................................................................................ K 2.04 $101.31 .................... $20.26

0960 Washed Red Blood Cells ............................................................................................. K 3.81 $188.75 .................... $37.75

0961 Infusion, Albumin (Human) 5%, 500 ml ....................................................................... K 2.77 $137.38 .................... $27.48

0962 Infusion, Albumin (Human) 25%, 50 ml ....................................................................... K 1.38 $68.44 .................... $13.69

0970 New Technology— I ($0–$50) ..................................................................................... T 0.52 $25.79 .................... $5.16

0971 New Technology— II ($50–$100) ................................................................................ S 1.55 $76.88 .................... $15.38

0972 New Technology— III ($100–$200) ............................................................................. T 3.09 $153.26 .................... $30.65

0973 New Technology— IV ($200–$300) ............................................................................. T 5.16 $255.91 .................... $51.18

0974 New Technology— V ($300–$500) .............................................................................. S 8.25 $409.17 .................... $81.83

0975 New Technology— VI ($500–$750) ............................................................................. T 12.90 $639.79 .................... $127.96

0976 New Technology— VII ($750–$1000) .......................................................................... S 18.05 $895.21 .................... $179.04

0977 New Technology— VIII ($1000–$1250) ....................................................................... T 23.20 $1,150.63 .................... $230.13

0978 New Technology— IX ($1250–$1500) ......................................................................... T 28.36 $1,406.54 .................... $281.31

0979 New Technology— X ($1500–$1750) .......................................................................... T 33.51 $1,661.96 .................... $332.39

0980 New Technology— XI ($1750–$2000) ......................................................................... T 38.67 $1,917.89 .................... $383.58

0981 New Technology— XII ($2000–$2500) ........................................................................ S 46.40 $2,301.26 .................... $460.25

0982 New Technology— XIII ($2500–$3500) ....................................................................... T 61.87 $3,068.50 .................... $613.70

0983 New Technology— XIV ($3500–$5000) ....................................................................... T 87.65 $4,347.09 .................... $869.42

0984 New Technology— XV ($5000–$6000) ........................................................................ T 113.43 $5,625.67 .................... $1,125.13

0987 New Device Technology— I ($0-$250) ........................................................................ X .................... $127.86 .................... $25.57

0988 New Device Technology— II ($250-$500) ................................................................... X .................... $383.58 .................... $76.72

0989 New Device Technology— III ($500-$750) .................................................................. X .................... $639.30 .................... $127.86

0990 New Device Technology— IV ($750-$1000) ................................................................ X .................... $895.01 .................... $179.00

0991 New Device Technology— V ($1000-$1500) ............................................................... X .................... $1,278.59 .................... $255.72

0992 New Device Technology— VI ($1500-$2000) .............................................................. X .................... $1,790.03 .................... $358.01

0993 New Device Technology— VII ($2000-$3000) ............................................................. X .................... $2,557.18 .................... $511.44

0994 New Device Technology— VIII ($3000-$4000) ............................................................ X .................... $3,580.05 .................... $716.01

0995 New Device Technology— IX ($4000-$5000) .............................................................. X .................... $4,602.92 .................... $920.58

0996 New Device Technology— X ($5000-$7000) ............................................................... X .................... $6,137.23 .................... $1,227.45

0997 New Device Technology— XI ($7000-$9000) .............................................................. X .................... $8,182.98 .................... $1,636.60

1000 Perclose Closer Prostar Arterial Vascular Closure ...................................................... H .................... .................... .................... ....................

1001 AcuNav-diagnstic ultrsnd ca ......................................................................................... H .................... .................... .................... ....................

1002 Cochlear Implant System ............................................................................................. H .................... .................... .................... ....................

1003 Cath, ablation, Livewire TC .......................................................................................... H .................... .................... .................... ....................

1004 Fast-Cath,Swartz,SAFL,CSTA ..................................................................................... H .................... .................... .................... ....................

1006 ARRAY post chamb IOL .............................................................................................. H .................... .................... .................... ....................

1007 Ams 700 penile prosthesis ........................................................................................... H .................... .................... .................... ....................

1008 Urolume-implt urethral stent ......................................................................................... H .................... .................... .................... ....................

1009 Plasma, cryoprecipitate-reduced, unit .......................................................................... K 0.86 $42.76 .................... $8.55

1010 Blood, L/R, CMV-neg ................................................................................................... K 2.88 $142.84 .................... $28.57

1011 Platelets, L/R, CMV-neg, unit ....................................................................................... K 11.86 $588.15 .................... $117.63

1012 Platelet concentrate, L/R, irradiated, unit ..................................................................... K 1.92 $95.23 .................... $19.05

1013 Platelet concentrate, L/R, unit ...................................................................................... K 1.18 $58.30 .................... $11.66

1014 Platelets, aph/pher, L/R, unit ........................................................................................ K 8.93 $443.11 .................... $88.62

1016 Blood, L/R, froz/deglycerol/washed .............................................................................. K 7.15 $354.68 .................... $70.94

1017 Platelets, aph/pher, L/R, CMV-neg, unit ...................................................................... K 9.33 $462.54 .................... $92.51

1018 Blood, L/R, irradiated .................................................................................................... K 3.13 $155.48 .................... $31.10

1019 Platelets, aph/pher, L/R, irradiated, unit ....................................................................... K 9.64 $478.09 .................... $95.62

1024 Quinupristin 150 mg/dalfopriston 350 mg .................................................................... J .................... $102.05 .................... $13.67

1025 Marinr CS catheter ....................................................................................................... H .................... .................... .................... ....................

1026 RF Perfrmr cath 5F RF Marinr ..................................................................................... H .................... .................... .................... ....................

1027 Magic x/short, Radius14mm ......................................................................................... H .................... .................... .................... ....................

1028 Prcis Twst trnsvg anch sys .......................................................................................... H .................... .................... .................... ....................

1029 CRE guided balloon dil cath ......................................................................................... H .................... .................... .................... ....................

1030 Cthtr:Mrshal,Blu Max Utr Dmnd ................................................................................... H .................... .................... .................... ....................

67836 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

1033 Sonicath mdl 37-410 .................................................................................................... H .................... .................... .................... ....................

1034 SURPASS, Long30 SURPASS-cath ............................................................................ H .................... .................... .................... ....................

1035 Cath, Ultra ICE ............................................................................................................. H .................... .................... .................... ....................

1036 R port/reservoir impl dev .............................................................................................. H .................... .................... .................... ....................

1037 Vaxcelchronic dialysis cath .......................................................................................... H .................... .................... .................... ....................

1038 UltraCross Imaging Cath .............................................................................................. H .................... .................... .................... ....................

1039 Wallstent/RP: Trach ...................................................................................................... H .................... .................... .................... ....................

1040 Wallstent/RP TIPS—20/40/60 ...................................................................................... H .................... .................... .................... ....................

1042 Wallstent, UltraFlex: Bil ................................................................................................ H .................... .................... .................... ....................

1043 Atherectomy sys, coronary ........................................................................................... H .................... .................... .................... ....................

1045 I-131 MIBG (ioben-sulfate) O.5mCi .............................................................................. G .................... $1,140.00 .................... $139.08

1047 Navi-Star, Noga-Star cath ............................................................................................ H .................... .................... .................... ....................

1048 NeuroCyberneticPros: gen ........................................................................................... H .................... .................... .................... ....................

1051 Oasis Thrombectomy Cath ........................................................................................... H .................... .................... .................... ....................

1053 EnSite 3000 catheter .................................................................................................... H .................... .................... .................... ....................

1054 Hydrolyser Thromb Cath 6/7F ...................................................................................... H .................... .................... .................... ....................

1055 Transesoph 210, 210-S Cath ....................................................................................... H .................... .................... .................... ....................

1056 Thermachoice II Cath ................................................................................................... H .................... .................... .................... ....................

1057 Micromark Tissue Marker ............................................................................................. H .................... .................... .................... ....................

1059 Carticel,auto cult-chndr cyte ......................................................................................... G .................... $14,250.00 .................... $2,010.00

1060 ACS multi-link tristor stent ............................................................................................ H .................... .................... .................... ....................

1061 ACS Viking Guiding cath .............................................................................................. H .................... .................... .................... ....................

1063 EndoTak Endurance EZ, RX leads .............................................................................. H .................... .................... .................... ....................

1067 Megalink biliary stent .................................................................................................... H .................... .................... .................... ....................

1068 Pulsar DDD pmkr ......................................................................................................... H .................... .................... .................... ....................

1069 Discovery DR, pmaker ................................................................................................. H .................... .................... .................... ....................

1071 Pulsar Max, Pulsar SR pmkr ........................................................................................ H .................... .................... .................... ....................

1072 Guidant: blln dil cath ..................................................................................................... H .................... .................... .................... ....................

1073 Gynecare Morcellator ................................................................................................... H .................... .................... .................... ....................

1074 RX/OTW Viatrac-peri dil cath ....................................................................................... H .................... .................... .................... ....................

1075 Guidant: lead ................................................................................................................ H .................... .................... .................... ....................

1076 Ventak mini sc defib ..................................................................................................... H .................... .................... .................... ....................

1077 Ventak VR Prizm VR, sc defib ..................................................................................... H .................... .................... .................... ....................

1078 Ventak: Prizm, AVIIIDR defib ....................................................................................... H .................... .................... .................... ....................

1079 CO 57/58 0.5 mCi ........................................................................................................ G .................... $264.10 .................... $32.22

1084 Denileukin diftitox, 300 mcg ......................................................................................... G .................... $942.88 .................... $126.35

1086 Temozolomide, 5 mg .................................................................................................... G .................... $5.70 .................... $0.76

1087 I-123 per uCi capsule ................................................................................................... G .................... $0.84 .................... $0.10

1089 CO 57, 0.5 mCi ............................................................................................................ G .................... $91.20 .................... $11.13

1090 IN 111 Chloride, per mCi ............................................................................................. G .................... $152.00 .................... $18.54

1091 IN 111 Oxyquinoline, per 5 mCi ................................................................................... G .................... $508.25 .................... $62.01

1092 IN 111 Pentetate, per 1.5 mCi ..................................................................................... G .................... $769.50 .................... $93.88

1094 TC 99M Albumin aggr, per vial .................................................................................... J .................... $34.20 .................... $4.17

1095 TC 99M Depreotide, per vial ........................................................................................ G .................... $760.00 .................... $101.84

1096 TC 99M Exametazime, per dose ................................................................................. G .................... $445.31 .................... $63.75

1097 TC 99M Mebrofenin, per vial ........................................................................................ G .................... $46.76 .................... $5.71

1098 TC 99M Pentetate, per vial .......................................................................................... G .................... $22.80 .................... $2.78

1099 TC 99M Pyrophosphate, per vial ................................................................................. J .................... $42.75 .................... $5.22

1100 Medtronic AVE GT1 guidewire ..................................................................................... H .................... .................... .................... ....................

1101 Medtronic AVE, AVE Z2 cath ....................................................................................... H .................... .................... .................... ....................

1102 Synergy Neurostim Genrtr ............................................................................................ H .................... .................... .................... ....................

1103 Micro Jewel Defibrillator ............................................................................................... H .................... .................... .................... ....................

1104 RF Conductor Ablative Cath ........................................................................................ H .................... .................... .................... ....................

1105 Sigma 300VDD pacmker .............................................................................................. H .................... .................... .................... ....................

1106 SynergyEZ Pt Progrmr ................................................................................................. H .................... .................... .................... ....................

1107 Torqr, Solist cath .......................................................................................................... H .................... .................... .................... ....................

1108 Reveal Cardiac Recorder ............................................................................................. H .................... .................... .................... ....................

1109 Implantable anchor: Ethicon ......................................................................................... H .................... .................... .................... ....................

1110 Stable Mapper, cath electrd ......................................................................................... H .................... .................... .................... ....................

1111 AneuRxAort-Uni-Ilicstnt&cath ....................................................................................... H .................... .................... .................... ....................

1112 AneuRx Stent graft/del.cath ......................................................................................... H .................... .................... .................... ....................

1113 Tlnt Endo Sprng Stnt Grft Sys ..................................................................................... H .................... .................... .................... ....................

1114 TalntSprgStnt+Graf endo pros ..................................................................................... H .................... .................... .................... ....................

1115 5038S,5038,5038L pace lead ...................................................................................... H .................... .................... .................... ....................

1116 CapSureSP pacing Lead .............................................................................................. H .................... .................... .................... ....................

1117 Ancure Endograft Del Sys ............................................................................................ H .................... .................... .................... ....................

1118 Sigma300DR LegIIDR,pacemkr ................................................................................... H .................... .................... .................... ....................

1119 Sprint6932,6943 defib lead .......................................................................................... H .................... .................... .................... ....................

1120 Sprint6942,6945 defib lead .......................................................................................... H .................... .................... .................... ....................

1121 Gem defibrillator ........................................................................................................... H .................... .................... .................... ....................

1122 TC 99M arcitumomab per dose ................................................................................... G .................... $926.25 .................... $124.12

1123 Gem II VR defibrillator .................................................................................................. H .................... .................... .................... ....................

1124 InterStim Test Stim Kit ................................................................................................. H .................... .................... .................... ....................

1125 Kappa 400SR,Ttopaz II SR pmkr ................................................................................. H .................... .................... .................... ....................

1126 Kappa 700 DR pacemakr ............................................................................................. H .................... .................... .................... ....................

1127 Kappa 700SR,pmkr sgl chamber ................................................................................. H .................... .................... .................... ....................

1128 Kappa 700D,Ruby IID pmkr ......................................................................................... H .................... .................... .................... ....................

1129 Kappa 700VDD,pacmkr ................................................................................................ H .................... .................... .................... ....................

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67837

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

1130 Sigma 200D,LGCY IID sc pmkr ................................................................................... H .................... .................... .................... ....................

1131 Sigma 200DR, pmker ................................................................................................... H .................... .................... .................... ....................

1132 Sigma 200SR Leg II:sc pac ......................................................................................... H .................... .................... .................... ....................

1133 Sigma SR, Vita SR, pmaker ......................................................................................... H .................... .................... .................... ....................

1134 Sigma 300D pmker ....................................................................................................... H .................... .................... .................... ....................

1135 Entity DR 5326L/R, DC, pmkr ...................................................................................... H .................... .................... .................... ....................

1136 Affinity DR 5330L/R, DC, pmkr .................................................................................... H .................... .................... .................... ....................

1137 CardioSEAL implant syst .............................................................................................. H .................... .................... .................... ....................

1143 AddVent mod 2060BL,VDD .......................................................................................... H .................... .................... .................... ....................

1144 Afnty SP 5130,Integrity SR,pmkr ................................................................................. H .................... .................... .................... ....................

1145 Angio-Seal 6fr, 8fr ........................................................................................................ H .................... .................... .................... ....................

1147 AV Plus DX 1368: lead ................................................................................................ H .................... .................... .................... ....................

1148 Contour MD sc defib .................................................................................................... H .................... .................... .................... ....................

1149 Entity DC 5226R-pmker ............................................................................................... H .................... .................... .................... ....................

1151 Passiveplus DX lead, 10mdls ....................................................................................... H .................... .................... .................... ....................

1152 LifeSite Access System ................................................................................................ H .................... .................... .................... ....................

1153 Regency SC+ 2402L pmker ......................................................................................... H .................... .................... .................... ....................

1154 SPL:SPOI,02,04¥ defib lead ....................................................................................... H .................... .................... .................... ....................

1155 Repliform 8 sq cm ........................................................................................................ H .................... .................... .................... ....................

1156 Tr 1102TrSR+ 2260L,2264L,5131 ............................................................................... H .................... .................... .................... ....................

1157 Trilogy DCT 23/8L pmkr ............................................................................................... H .................... .................... .................... ....................

1158 TVL lead SV01,SV02,SV04 .......................................................................................... H .................... .................... .................... ....................

1159 TVL RV02,RV06,RV07: lead ........................................................................................ H .................... .................... .................... ....................

1160 TVL–ADX 1559: lead .................................................................................................... H .................... .................... .................... ....................

1161 Tendril DX, 1388 pacing lead ....................................................................................... H .................... .................... .................... ....................

1162 TempoDr, TrilogyDR+DC pmkr .................................................................................... H .................... .................... .................... ....................

1163 Tendril SDX, 1488T pacing lead .................................................................................. H .................... .................... .................... ....................

1164 Iodine-125 brachytx seed ............................................................................................. H .................... .................... .................... ....................

1166 Cytarabine liposomal, 10 mg ........................................................................................ G .................... $371.45 .................... $49.77

1167 Epirubicin hcl, 2 mg ...................................................................................................... J .................... $24.94 .................... $3.34

1171 Autosuture site marker stple ........................................................................................ H .................... .................... .................... ....................

1172 Spacemaker dissect ballon .......................................................................................... H .................... .................... .................... ....................

1173 Cor stntS540,S670,o-wire stn ...................................................................................... H .................... .................... .................... ....................

1174 Bard brachytx needle ................................................................................................... H .................... .................... .................... ....................

1178 Busulfan IV, 6 mg ......................................................................................................... G .................... $26.48 .................... $3.55

1180 Vigor SR, SC, pmkr ...................................................................................................... H .................... .................... .................... ....................

1181 Meridian SSI, SC, pmkr ................................................................................................ H .................... .................... .................... ....................

1182 Pulsar SSI, SC, pmkr ................................................................................................... H .................... .................... .................... ....................

1183 Jade IIS, Sigma 300S,SC, pmkr .................................................................................. H .................... .................... .................... ....................

1184 Sigma 200S, SC, pmkr ................................................................................................. H .................... .................... .................... ....................

1188 I 131, per mCi ............................................................................................................... G .................... $5.86 .................... $0.75

1200 TC 99M Sodium Glucoheptonate, per vial ................................................................... G .................... $113.05 .................... $13.79

1201 TC 99M succimer, per vial ........................................................................................... G .................... $135.66 .................... $16.55

1202 TC 99M Sulfur Colloid, per dose .................................................................................. G .................... $38.00 .................... $4.64

1203 Verteporfin for Injection ................................................................................................ G .................... $1,458.25 .................... $195.41

1205 TC 99M Disofenin, per vial ........................................................................................... G .................... $427.50 .................... $57.29

1207 Octreotide acetate depot 1mg ...................................................................................... G .................... $135.10 .................... $16.48

1302 SQ01: lead .................................................................................................................... H .................... .................... .................... ....................

1303 CapSure Fix 6940/4068-110, lead ............................................................................... H .................... .................... .................... ....................

1304 Sonicath mdl 37–416,–418 ........................................................................................... H .................... .................... .................... ....................

1305 Apligraf .......................................................................................................................... G .................... $1,157.81 .................... $163.31

1306 NeuroCyberneticPros: lead .......................................................................................... H .................... .................... .................... ....................

1311 Trilogy DR+/DAO pmkr ................................................................................................ H .................... .................... .................... ....................

1312 Magic WALLSTENT stent-Mini ..................................................................................... H .................... .................... .................... ....................

1313 Magic medium, Radius 31mm ...................................................................................... H .................... .................... .................... ....................

1314 Magic WALLSTENT stent-Long ................................................................................... H .................... .................... .................... ....................

1315 Vigor DR, Meridian DR pmkr ....................................................................................... H .................... .................... .................... ....................

1316 Meridian DDD pmkr ...................................................................................................... H .................... .................... .................... ....................

1317 Discovery SR, pmkr ...................................................................................................... H .................... .................... .................... ....................

1318 Meridian SR pmakr ....................................................................................................... H .................... .................... .................... ....................

1319 Wallstent/RP Enteral--60mm ........................................................................................ H .................... .................... .................... ....................

1320 Wallstent/RP Iliac Del Sys ............................................................................................ H .................... .................... .................... ....................

1325 Pallidium ¥103 seed ................................................................................................... H .................... .................... .................... ....................

1326 Angio-jet rheolytic thromb cath ..................................................................................... H .................... .................... .................... ....................

1328 ANS Renew NS trnsmtr ............................................................................................... H .................... .................... .................... ....................

1333 PALMZA Corinthian bill stent ....................................................................................... H .................... .................... .................... ....................

1334 Crown,Mini-crown,CrossLC .......................................................................................... H .................... .................... .................... ....................

1335 Mesh, Prolene .............................................................................................................. H .................... .................... .................... ....................

1336 Constant Flow Imp Pump ............................................................................................. H .................... .................... .................... ....................

1337 IsoMed 8472-20/35/60 .................................................................................................. H .................... .................... .................... ....................

1348 I 131 per mCi solution .................................................................................................. G .................... $146.57 .................... $17.88

1350 Prosta/OncoSeed, RAPID strand, I-125 ....................................................................... H .................... .................... .................... ....................

1351 CapSure(Fix)pacing lead .............................................................................................. H .................... .................... .................... ....................

1352 Gem II defib .................................................................................................................. H .................... .................... .................... ....................

1353 Itrel Interstm neurostim+ext .......................................................................................... H .................... .................... .................... ....................

1354 Kappa 400DR,Diamond II 820DR ................................................................................ H .................... .................... .................... ....................

1355 Kappa 600DR, Vita DR ................................................................................................ H .................... .................... .................... ....................

1356 Profile MD V–186HV3 sc defib .................................................................................... H .................... .................... .................... ....................

67838 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

1357 Angstrom MD V–190HV3 sc defib ............................................................................... H .................... .................... .................... ....................

1358 Affinity DC 5230R-Pacemaker ..................................................................................... H .................... .................... .................... ....................

1359 Pulsar,Pulsar Max DR,pmkr ......................................................................................... H .................... .................... .................... ....................

1363 Gem DR, DC, defib ...................................................................................................... H .................... .................... .................... ....................

1364 Photon DR V-230HV3 DC defib ................................................................................... H .................... .................... .................... ....................

1365 Guidewire, Hi-Torque14/18/35 ..................................................................................... H .................... .................... .................... ....................

1366 Guidewire,PTCA, Hi-Torque ......................................................................................... H .................... .................... .................... ....................

1367 Guidewire, Hi-Torque CrossIt ....................................................................................... H .................... .................... .................... ....................

1369 ANS Renew Stim Sys recvr ......................................................................................... H .................... .................... .................... ....................

1370 Tension-Free Vaginal Tape .......................................................................................... H .................... .................... .................... ....................

1371 Symp Nitinol Transhep Bil Sys ..................................................................................... H .................... .................... .................... ....................

1372 Cordis Nitinol bil stent .................................................................................................. H .................... .................... .................... ....................

1375 Stent, coronary, NIR ..................................................................................................... H .................... .................... .................... ....................

1376 ANS Renew Stim Sys lead .......................................................................................... H .................... .................... .................... ....................

1377 Specify 3988 neuro lead .............................................................................................. H .................... .................... .................... ....................

1378 InterStim Tx 3080/3886 lead ........................................................................................ H .................... .................... .................... ....................

1379 Pisces-Quad 3887 lead ................................................................................................ H .................... .................... .................... ....................

1400 Diphenhydramine hcl 50mg .......................................................................................... G .................... $1.18 .................... $.16

1401 Prochlorperazine maleate 5mg .................................................................................... G .................... $1.31 .................... $.18

1402 Promethazine hcl 12.5mg oral ..................................................................................... G .................... $.03 .................... $.00

1403 Chlorpromazine hcl 10mg oral ..................................................................................... G .................... $.55 .................... $.07

1404 Trimethobenzamide hcl 250mg .................................................................................... G .................... $.36 .................... $.05

1405 Thiethylperazine maleate10mg .................................................................................... G .................... $.69 .................... $.09

1406 Perphenazine 4mg oral ................................................................................................ G .................... $.71 .................... $.10

1407 Hydroxyzine pamoate 25mg ......................................................................................... G .................... $.20 .................... $.03

1409 Factor viia recombinant, per 1.2 mg ............................................................................ G .................... $1,596.00 .................... $213.86

1410 Prosorba column .......................................................................................................... H .................... .................... .................... ....................

1411 Herculink,OTW SDS bil stent ....................................................................................... H .................... .................... .................... ....................

1420 StapleTac2 Bone w/Dermis .......................................................................................... H .................... .................... .................... ....................

1421 StapleTac2 Bone wo Dermis ........................................................................................ H .................... .................... .................... ....................

1450 Orthosphere Arthroplasty ............................................................................................. H .................... .................... .................... ....................

1451 Orthosphere Arthroplasty Kit ........................................................................................ H .................... .................... .................... ....................

1500 Atherectomy sys, peripheral ......................................................................................... H .................... .................... .................... ....................

1600 TC 99M sestamibi, per syringe .................................................................................... G .................... $109.25 .................... $13.33

1601 TC 99M medronate, per dose ...................................................................................... G .................... $38.38 .................... $4.68

1602 TC 99M apcitide, per vial ............................................................................................. G .................... $47.50 .................... $5.80

1603 TL 201, mCi .................................................................................................................. G .................... $28.50 .................... $3.48

1604 IN 111 capromab pendetide, per dose ........................................................................ G .................... $1,008.90 .................... $135.19

1605 Abciximab injection, 10 mg .......................................................................................... G .................... $513.02 .................... $68.74

1606 Anistreplase, 30 u ......................................................................................................... G .................... $2,693.80 .................... $360.97

1607 Eptifibatide injection, 5 mg ........................................................................................... G .................... $12.57 .................... $1.68

1608 Etanercept injection, 25 mg .......................................................................................... G .................... $134.42 .................... $18.01

1609 Rho(D) immune globulin h, sd, 100 iu ......................................................................... G .................... $20.55 .................... $2.51

1611 Hylan G–F 20 injection, 16 mg .................................................................................... G .................... $204.87 .................... $27.45

1612 Daclizumab, parenteral, 25 mg .................................................................................... G .................... $397.29 .................... $53.24

1613 Trastuzumab, 10 mg .................................................................................................... G .................... $48.85 .................... $6.55

1614 Valrubicin, 200 mg ........................................................................................................ G .................... $423.23 .................... $56.71

1615 Basiliximab, 20 mg ....................................................................................................... G .................... $1,250.01 .................... $167.50

1616 Histrelin Acetate, 0.5 mg .............................................................................................. G .................... $14.91 .................... $2.00

1617 Lepirdin, 50 mg ............................................................................................................. G .................... $124.49 .................... $16.68

1618 Von Willebrand factor, per iu ........................................................................................ G .................... $.95 .................... $.13

1619 Ga 67, per mCi ............................................................................................................. G .................... $25.97 .................... $3.17

1620 TC 99M Bicisate, per vial ............................................................................................. G .................... $417.53 .................... $55.95

1621 Xe 133, per mCi ........................................................................................................... G .................... $28.50 .................... $3.66

1622 TC 99M Mertiatide, per vial .......................................................................................... G .................... $185.82 .................... $24.90

1623 TC 99M Gluceptate ...................................................................................................... G .................... $22.61 .................... $2.76

1624 P32 sodium, per mCi .................................................................................................... G .................... $74.10 .................... $9.04

1625 IN 111 Pentetreotide, per mCi ..................................................................................... G .................... $283.42 .................... $37.98

1626 TC 99M Oxidronate, per vial ........................................................................................ G .................... $38.38 .................... $4.68

1627 TC-99 labeled red blood cell, per test .......................................................................... G .................... $38.95 .................... $4.75

1628 P32 phosphate chromic, per mCi ................................................................................. G .................... $137.12 .................... $16.73

1700 Authen Mick TP brachy needle .................................................................................... H .................... .................... .................... ....................

1701 Medtec MT-BT-5201-25 ndl ......................................................................................... H .................... .................... .................... ....................

1702 WWMT brachytx needle ............................................................................................... H .................... .................... .................... ....................

1703 Mentor Prostate Brachy ................................................................................................ H .................... .................... .................... ....................

1704 MT-BT-5001-25/5051-25 .............................................................................................. H .................... .................... .................... ....................

1705 Best Flexi Brachy Needle ............................................................................................. H .................... .................... .................... ....................

1706 Indigo Prostate Seeding Ndl ........................................................................................ H .................... .................... .................... ....................

1707 Varisource Implt Ndl ..................................................................................................... H .................... .................... .................... ....................

1708 UroMed Prostate Seed Ndl .......................................................................................... H .................... .................... .................... ....................

1709 Remington Brachytx Needle ......................................................................................... H .................... .................... .................... ....................

1710 US Biopsy Prostate Needle .......................................................................................... H .................... .................... .................... ....................

1711 MD Tech brachytx needle ............................................................................................ H .................... .................... .................... ....................

1712 Imagyn brachytx needle ............................................................................................... H .................... .................... .................... ....................

1790 Iridium 192 HDR ........................................................................................................... H .................... .................... .................... ....................

1791 OncoSeed, Rapid Strand I-125 .................................................................................... H .................... .................... .................... ....................

1792 UroMed I-125 Brachy seed .......................................................................................... H .................... .................... .................... ....................

1793 Bard InterSource P-103 seed ....................................................................................... H .................... .................... .................... ....................

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67839

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

1794 Bard IsoSeed P-103 seed ............................................................................................ H .................... .................... .................... ....................

1795 Bard BrachySource I-125 ............................................................................................. H .................... .................... .................... ....................

1796 SourceTech Med I-125 ................................................................................................. H .................... .................... .................... ....................

1797 Draximage I-125 seed .................................................................................................. H .................... .................... .................... ....................

1798 Syncor I-125 PharmaSeed ........................................................................................... H .................... .................... .................... ....................

1799 I-Plant I-125 Brachytx seed .......................................................................................... H .................... .................... .................... ....................

1800 Pd-103 brachytx seed .................................................................................................. H .................... .................... .................... ....................

1801 IoGold I-125 brachytx seed .......................................................................................... H .................... .................... .................... ....................

1802 Iridium 192 brachytx seeds .......................................................................................... H .................... .................... .................... ....................

1803 Best Iodine 125 brachytx sds ....................................................................................... H .................... .................... .................... ....................

1804 Best Palladium 103 seeds ............................................................................................ H .................... .................... .................... ....................

1805 IsoStar Iodine-125 seeds ............................................................................................. H .................... .................... .................... ....................

1806 Gold 198 ....................................................................................................................... H .................... .................... .................... ....................

1810 D114S Dilatation Cath .................................................................................................. H .................... .................... .................... ....................

1811 Surgical Dynamics Anchors ......................................................................................... H .................... .................... .................... ....................

1812 OBL Anchors ................................................................................................................ H .................... .................... .................... ....................

1850 Repliform 14/21 sq cm ................................................................................................. H .................... .................... .................... ....................

1851 Repliform 24/28 sq cm ................................................................................................. H .................... .................... .................... ....................

1852 TransCyte, per 247 sq cm ............................................................................................ H .................... .................... .................... ....................

1853 Suspend, per 8/14 sq cm ............................................................................................. H .................... .................... .................... ....................

1854 Suspend, per 24/28 sq cm ........................................................................................... H .................... .................... .................... ....................

1855 Suspend, per 36 sq cm ................................................................................................ H .................... .................... .................... ....................

1856 Suspend, per 48 sq cm ................................................................................................ H .................... .................... .................... ....................

1857 Suspend, per 84 sq cm ................................................................................................ H .................... .................... .................... ....................

1858 DuraDerm, per 8/14 sq cm ........................................................................................... H .................... .................... .................... ....................

1859 DuraDerm, per 21/24/28 sq cm .................................................................................... H .................... .................... .................... ....................

1860 DuraDerm, per 48 sq cm .............................................................................................. H .................... .................... .................... ....................

1861 DuraDerm, per 36 sq cm .............................................................................................. H .................... .................... .................... ....................

1862 DuraDerm, per 72 sq cm .............................................................................................. H .................... .................... .................... ....................

1863 DuraDerm, per 84 sq cm .............................................................................................. H .................... .................... .................... ....................

1864 SpermaTex, per 13.44 sq cm ....................................................................................... H .................... .................... .................... ....................

1865 FasLata, per 8/14 sq cm .............................................................................................. H .................... .................... .................... ....................

1866 FasLata, per 24/28 sq cm ............................................................................................ H .................... .................... .................... ....................

1867 FasLata, per 36/48 sq cm ............................................................................................ H .................... .................... .................... ....................

1868 FasLata, per 96 sq cm ................................................................................................. H .................... .................... .................... ....................

1869 Gore Thyroplasty Dev .................................................................................................. H .................... .................... .................... ....................

1870 DermMatrix, per 16 sq cm ............................................................................................ H .................... .................... .................... ....................

1871 DermMatrix, 32 or 64 sq cm ........................................................................................ H .................... .................... .................... ....................

1872 Dermagraft, per 37.5 sq cm ......................................................................................... H .................... .................... .................... ....................

1873 Bard 3DMax Mesh ........................................................................................................ H .................... .................... .................... ....................

1929 Maverick PTCA Cath .................................................................................................... H .................... .................... .................... ....................

1930 Coyote Dil Cath, 20/30/40mm ...................................................................................... H .................... .................... .................... ....................

1931 Talon Dil Cath ............................................................................................................... H .................... .................... .................... ....................

1932 Scimed Remedy Dil Cath ............................................................................................. H .................... .................... .................... ....................

1933 Opti-Plast XL/Centurion Cath ....................................................................................... H .................... .................... .................... ....................

1934 Ultraverse 3.5F Bal Dil Cath ........................................................................................ H .................... .................... .................... ....................

1935 Workhorse PTA Bal Cath ............................................................................................. H .................... .................... .................... ....................

1936 Uromax Ultra Bal Dil Cath ............................................................................................ H .................... .................... .................... ....................

1937 Synergy Balloon Dil Cath ............................................................................................. H .................... .................... .................... ....................

1938 UroForce Bal Dil Cath .................................................................................................. H .................... .................... .................... ....................

1939 Raptur, Ninja PTCA Dil Cath ........................................................................................ H .................... .................... .................... ....................

1940 PowerFlex,OPTA 5/LP Bal Cath .................................................................................. H .................... .................... .................... ....................

1941 Jupiter PTA Dil Cath ..................................................................................................... H .................... .................... .................... ....................

1942 Cordis Maxi LD PTA Bal Cath ..................................................................................... H .................... .................... .................... ....................

1943 RXCrossSail OTW OpenSail ........................................................................................ H .................... .................... .................... ....................

1944 Rapid Exchange Bil Dil Cath ........................................................................................ H .................... .................... .................... ....................

1945 Savvy PTA Dil Cath ...................................................................................................... H .................... .................... .................... ....................

1946 R1s Rapid Dil Cath ....................................................................................................... H .................... .................... .................... ....................

1947 Gazelle Bal Dil Cath ..................................................................................................... H .................... .................... .................... ....................

1948 Pursuit Balloon Cath ..................................................................................................... H .................... .................... .................... ....................

1949 Oracle Megasonics Cath .............................................................................................. H .................... .................... .................... ....................

1979 Visions PV/Avanar US Cath ......................................................................................... H .................... .................... .................... ....................

1980 Atlantis SR Coronary Cath ........................................................................................... H .................... .................... .................... ....................

1981 PTCA Catheters ........................................................................................................... H .................... .................... .................... ....................

2000 Orbiter ST Steerable Cath ............................................................................................ H .................... .................... .................... ....................

2001 Constellation Diag Cath ................................................................................................ H .................... .................... .................... ....................

2002 Irvine 5F Inquiry Diag EP Cath .................................................................................... H .................... .................... .................... ....................

2003 Irvine 6F Inquiry Diag EP Cath .................................................................................... H .................... .................... .................... ....................

2004 Biosense EP Cath—Octapolar ..................................................................................... H .................... .................... .................... ....................

2005 Biosense EP Cath—Hexapolar .................................................................................... H .................... .................... .................... ....................

2006 Biosense EP Cath—Decapolar .................................................................................... H .................... .................... .................... ....................

2007 Irvine 6F Luma-Cath EP Cath ...................................................................................... H .................... .................... .................... ....................

2008 7F Luma-Cath EP Cath 81910–15 ............................................................................... H .................... .................... .................... ....................

2009 Irvine 7F Luma-Cath EP Cath ...................................................................................... H .................... .................... .................... ....................

2010 Fixed Curve EP Cath ................................................................................................... H .................... .................... .................... ....................

2011 Deflectable Tip Cath—Quad ........................................................................................ H .................... .................... .................... ....................

2012 Celsius Abln Cath ......................................................................................................... H .................... .................... .................... ....................

2013 Celsius Large Abln Cath .............................................................................................. H .................... .................... .................... ....................

67840 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

2014 Celsius II Asym Abln Cath ........................................................................................... H .................... .................... .................... ....................

2015 Celsius II Sym Abln Cath ............................................................................................. H .................... .................... .................... ....................

2016 Navi-Star DS, Navi-Star Ther ....................................................................................... H .................... .................... .................... ....................

2017 Navi-Star Abln Cath ...................................................................................................... H .................... .................... .................... ....................

2018 Polaris T Ablation Cath ................................................................................................ H .................... .................... .................... ....................

2019 EP Deflectable Cath ..................................................................................................... H .................... .................... .................... ....................

2020 Blazer II XP Abln Cath ................................................................................................. H .................... .................... .................... ....................

2021 SilverFlex EP Cath ....................................................................................................... H .................... .................... .................... ....................

2022 CP Chilli Cooled Abln Cath .......................................................................................... H .................... .................... .................... ....................

2023 Chilli Cld AblnCath-std, lg ............................................................................................ H .................... .................... .................... ....................

2100 CP CS Reference Cath ................................................................................................ H .................... .................... .................... ....................

2101 CP RV Reference Cath ................................................................................................ H .................... .................... .................... ....................

2102 CP Radii 7F EP Cath ................................................................................................... H .................... .................... .................... ....................

2103 CP Radii 7F EP Cath w/Track ..................................................................................... H .................... .................... .................... ....................

2104 Lasso Deflectable Cath ................................................................................................ H .................... .................... .................... ....................

2151 Veripath Guiding Cath .................................................................................................. H .................... .................... .................... ....................

2152 Cordis Vista Brite Tip Cath ........................................................................................... H .................... .................... .................... ....................

2153 Bard Viking Cath .......................................................................................................... H .................... .................... .................... ....................

2200 Arrow-Trerotola PTD Cath ............................................................................................ H .................... .................... .................... ....................

2300 Varisource Stnd Catheters ........................................................................................... H .................... .................... .................... ....................

2597 CliniCath/kit 16/18 sgl/dbl ............................................................................................. H .................... .................... .................... ....................

2598 CliniCath 18/20/24G-single ........................................................................................... H .................... .................... .................... ....................

2599 CliniCath 16/18G-double .............................................................................................. H .................... .................... .................... ....................

2601 Bard DL Ureteral Cath .................................................................................................. H .................... .................... .................... ....................

2602 Vitesse Laser Cath 1.4/1.7mm ..................................................................................... H .................... .................... .................... ....................

2603 Vitesse Laser Cath 2.0mm ........................................................................................... H .................... .................... .................... ....................

2604 Vitesse E Laser Cath 2.0mm ....................................................................................... H .................... .................... .................... ....................

2605 Extreme Laser Catheter ............................................................................................... H .................... .................... .................... ....................

2606 SpineCath XL Catheter ................................................................................................ H .................... .................... .................... ....................

2607 SpineCath Intradiscal Cath ........................................................................................... H .................... .................... .................... ....................

2608 Scimed 6F Wiseguide Cath .......................................................................................... H .................... .................... .................... ....................

2609 Flexima Bil Drainage Cath ........................................................................................... H .................... .................... .................... ....................

2610 FlexTipPlus Intraspinal Cath ........................................................................................ H .................... .................... .................... ....................

2611 AlgoLine Intraspinal Cath ............................................................................................. H .................... .................... .................... ....................

2612 InDura Catheter ............................................................................................................ H .................... .................... .................... ....................

2700 MycroPhylax Plus SC defib .......................................................................................... H .................... .................... .................... ....................

2701 Phylax XM SC defib ..................................................................................................... H .................... .................... .................... ....................

2702 Ventak Prizm 2 VR Defib ............................................................................................. H .................... .................... .................... ....................

2703 Ventak Prizm VR HE Defib .......................................................................................... H .................... .................... .................... ....................

2704 Ventak Mini IV+ Defib .................................................................................................. H .................... .................... .................... ....................

2801 Defender IV DR 612 DC defib ..................................................................................... H .................... .................... .................... ....................

2802 Phylax AV DC defib ...................................................................................................... H .................... .................... .................... ....................

2803 Ventak Prizm DR HE Defib .......................................................................................... H .................... .................... .................... ....................

2804 Ventak Prizm 2 DR Defib ............................................................................................. H .................... .................... .................... ....................

2805 Jewel AF 7250 Defib .................................................................................................... H .................... .................... .................... ....................

2806 GEM VR 7227 Defib ..................................................................................................... H .................... .................... .................... ....................

2807 Contak CD 1823 ........................................................................................................... H .................... .................... .................... ....................

2808 Contak TR 1241 ........................................................................................................... H .................... .................... .................... ....................

3002 EasyTrak Defib Lead .................................................................................................... H .................... .................... .................... ....................

3001 Kainox SL/RV defib lead .............................................................................................. H .................... .................... .................... ....................

3003 Endotak SQ Array XP lead .......................................................................................... H .................... .................... .................... ....................

3004 Intervene Defib Lead .................................................................................................... H .................... .................... .................... ....................

3400 Siltex Spectrum, Contour Prof ...................................................................................... H .................... .................... .................... ....................

3401 Saline-Filled Spectrum ................................................................................................. H .................... .................... .................... ....................

3500 Mentor Alpha I Inf Penile Pros ..................................................................................... H .................... .................... .................... ....................

3510 AMS 800 Urinary Pros ................................................................................................. H .................... .................... .................... ....................

3551 Choice/PT Graphix/Luge/Trooper ................................................................................. H .................... .................... .................... ....................

3552 Hi-Torque Whisper ....................................................................................................... H .................... .................... .................... ....................

3553 Cordis guidewires ......................................................................................................... H .................... .................... .................... ....................

3554 Jindo guidewire ............................................................................................................. H .................... .................... .................... ....................

3555 Wholey Hi-Torque Plus GW ......................................................................................... H .................... .................... .................... ....................

3556 Wave/FlowWire Guidewire ........................................................................................... H .................... .................... .................... ....................

3557 HyTek guidewire ........................................................................................................... H .................... .................... .................... ....................

3800 SynchroMed EL infusion pump .................................................................................... H .................... .................... .................... ....................

3801 Arrow/MicroJect PCA Sys ............................................................................................ H .................... .................... .................... ....................

3851 Elastic UV IOL AA-4203T/TF/TL .................................................................................. H .................... .................... .................... ....................

4000 Opus G 4621, 4624 SC pmkr ...................................................................................... H .................... .................... .................... ....................

4001 Opus S 4121/4124 SC pmkr ........................................................................................ H .................... .................... .................... ....................

4002 Talent 113 SC pmkr ..................................................................................................... H .................... .................... .................... ....................

4003 Kairos SR SC pmkr ...................................................................................................... H .................... .................... .................... ....................

4004 Actros SR, Actros SLR SC pmkr ................................................................................. H .................... .................... .................... ....................

4005 Philos SR/SR-B SC pmkr ............................................................................................. H .................... .................... .................... ....................

4006 Pulsar Max II SR pmkr ................................................................................................. H .................... .................... .................... ....................

4007 Marathon SR pmkr ....................................................................................................... H .................... .................... .................... ....................

4008 Discovery II SSI pmkr ................................................................................................... H .................... .................... .................... ....................

4009 Discovery II SR pmkr ................................................................................................... H .................... .................... .................... ....................

4300 Integrity AFx DR 5342 pmkr ......................................................................................... H .................... .................... .................... ....................

4301 Integrity AFx DR 5346 pmkr ......................................................................................... H .................... .................... .................... ....................

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67841

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

4302 Affinity VDR 5430 pmkr ................................................................................................ H .................... .................... .................... ....................

4303 Brio 112 DC pmkr ......................................................................................................... H .................... .................... .................... ....................

4304 Brio 212, Talent 213/223 DC pmkr .............................................................................. H .................... .................... .................... ....................

4305 Brio 222 DC pmkr ......................................................................................................... H .................... .................... .................... ....................

4306 Brio 220 DC pmkr ......................................................................................................... H .................... .................... .................... ....................

4307 Kairos DR DC pmkr ...................................................................................................... H .................... .................... .................... ....................

4308 Inos2, Inos2+ DC pmkr ................................................................................................ H .................... .................... .................... ....................

4309 Actros DR,D,DR-A,SLR DC pmkr ................................................................................ H .................... .................... .................... ....................

4310 Actros DR-B DC pmkr .................................................................................................. H .................... .................... .................... ....................

4311 Philos DR/DR-B/SLR DC pmkr .................................................................................... H .................... .................... .................... ....................

4312 Pulsar Max II DR pmkr ................................................................................................. H .................... .................... .................... ....................

4313 Marathon DR pmkr ....................................................................................................... H .................... .................... .................... ....................

4314 Momentum DR pmkr .................................................................................................... H .................... .................... .................... ....................

4315 Selection AFm pmkr ..................................................................................................... H .................... .................... .................... ....................

4316 Discovery II DR ............................................................................................................ H .................... .................... .................... ....................

4317 Discovery II DDD .......................................................................................................... H .................... .................... .................... ....................

4600 Snynox,Polyrox,Elox,Retrox ......................................................................................... H .................... .................... .................... ....................

4602 Tendril SDX, 1488K pmkr lead .................................................................................... H .................... .................... .................... ....................

4603 Oscor/Flexion pmkr lead .............................................................................................. H .................... .................... .................... ....................

4604 CrystallineActFix,CapsureFix ........................................................................................ H .................... .................... .................... ....................

4605 CapSure Epi pmkr lead ................................................................................................ H .................... .................... .................... ....................

4606 Flextend pmkr lead ....................................................................................................... H .................... .................... .................... ....................

4607 FinelineII/EZ, ThinlineII/EZ ........................................................................................... H .................... .................... .................... ....................

5000 BX Velocity w/Hepacoat ............................................................................................... H .................... .................... .................... ....................

5001 Memotherm Bil Stent, sm, med .................................................................................... H .................... .................... .................... ....................

5002 Memotherm Bil Stent, large .......................................................................................... H .................... .................... .................... ....................

5003 Memotherm Bil Stent, x-large ....................................................................................... H .................... .................... .................... ....................

5004 PalmazCorinthian IQ Bil Stent ...................................................................................... H .................... .................... .................... ....................

5005 PalmazCorinthian IQ Trans/Bil ..................................................................................... H .................... .................... .................... ....................

5006 PalmazTrans Bil Stent Sys-Med .................................................................................. H .................... .................... .................... ....................

5007 PalmazTrans XL Bil Stent--40mm ................................................................................ H .................... .................... .................... ....................

5008 PalmazTrans XL Bil Stent--50mm ................................................................................ H .................... .................... .................... ....................

5009 VistaFlex Biliary Stent .................................................................................................. H .................... .................... .................... ....................

5010 Rapid Exchange Bil Stent Sys ..................................................................................... H .................... .................... .................... ....................

5011 IntraStent, IntraStent LP ............................................................................................... H .................... .................... .................... ....................

5012 IntraStent DoubleStrut LD ............................................................................................ H .................... .................... .................... ....................

5013 IntraStent DoubleStrut, XS ........................................................................................... H .................... .................... .................... ....................

5014 AVE Bridge Stent Sys-10/17/28 ................................................................................... H .................... .................... .................... ....................

5015 AVE/X3 Bridge Sys, 40-100 ......................................................................................... H .................... .................... .................... ....................

5016 Biliary stent single use cov ........................................................................................... H .................... .................... .................... ....................

5017 WallstentRP Bil--20/40/60/68mm ................................................................................. H .................... .................... .................... ....................

5018 WallstentRP Bil--80/94mm ........................................................................................... H .................... .................... .................... ....................

5019 Flexima Bil Stent Sys ................................................................................................... H .................... .................... .................... ....................

5020 Smart Nitinol Stent--20mm ........................................................................................... H .................... .................... .................... ....................

5021 Smart Nitinol Stent--40/60mm ...................................................................................... H .................... .................... .................... ....................

5022 Smart Nitinol Stent--80mm ........................................................................................... H .................... .................... .................... ....................

5023 BX Velocity Stent--8/13mm .......................................................................................... H .................... .................... .................... ....................

5024 BX Velocity Stent--18mm ............................................................................................. H .................... .................... .................... ....................

5025 BX Velocity Stent--23mm ............................................................................................. H .................... .................... .................... ....................

5026 BX Velocity Stent--28/33mm ........................................................................................ H .................... .................... .................... ....................

5027 BX Velocity w/Hep--8/13mm ........................................................................................ H .................... .................... .................... ....................

5028 BX Velocity w/Hep--18mm ........................................................................................... H .................... .................... .................... ....................

5029 BX Velocity w/Hep--23mm ........................................................................................... H .................... .................... .................... ....................

5030 Stent, coronary, S660 9/12mm .................................................................................... H .................... .................... .................... ....................

5031 Stent,coronary, S660 15/18mm .................................................................................... H .................... .................... .................... ....................

5032 Stent,coronary, S660 24/30mm .................................................................................... H .................... .................... .................... ....................

5033 Niroyal Stent Sys, 9mm ................................................................................................ H .................... .................... .................... ....................

5034 Niroyal Stent Sys, 12/15mm ......................................................................................... H .................... .................... .................... ....................

5035 Niroyal Stent Sys, 18mm .............................................................................................. H .................... .................... .................... ....................

5036 Niroyal Stent Sys, 25mm .............................................................................................. H .................... .................... .................... ....................

5037 Niroyal Stent Sys, 31mm .............................................................................................. H .................... .................... .................... ....................

5038 BX Velocity Stent w/Raptor .......................................................................................... H .................... .................... .................... ....................

5039 IntraCoil Periph Stent--40mm ....................................................................................... H .................... .................... .................... ....................

5040 IntraCoil Periph Stent--60mm ....................................................................................... H .................... .................... .................... ....................

5041 BeStent Over-the-Wire 24/30mm ................................................................................. H .................... .................... .................... ....................

5042 BeStent Over-the-Wire 18mm ...................................................................................... H .................... .................... .................... ....................

5043 BeStent Over-the-Wire 15mm ...................................................................................... H .................... .................... .................... ....................

5044 BeStent Over-the-Wire 9/12mm ................................................................................... H .................... .................... .................... ....................

5045 Multilink Tetra Cor Stent Sys ....................................................................................... H .................... .................... .................... ....................

5046 Radius 20mm cor stent ................................................................................................ H .................... .................... .................... ....................

5047 Niroyal Elite Cor Stent Sys ........................................................................................... H .................... .................... .................... ....................

5048 GR II Coronary Stent .................................................................................................... H .................... .................... .................... ....................

5130 Wilson-Cook Colonic Z-Stent ....................................................................................... H .................... .................... .................... ....................

5131 Bard Colorectal Stent-60mm ........................................................................................ H .................... .................... .................... ....................

5132 Bard Colorectal Stent-80mm ........................................................................................ H .................... .................... .................... ....................

5133 Bard Colorectal Stent-100mm ...................................................................................... H .................... .................... .................... ....................

5134 Enteral Wallstent—90mm ............................................................................................. H .................... .................... .................... ....................

5279 Contour/Percuflex Stent ............................................................................................... H .................... .................... .................... ....................

67842 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

5280 Inlay Dbl Ureteral Stent ................................................................................................ H .................... .................... .................... ....................

5281 Wallgraft Trach Sys 70mm ........................................................................................... H .................... .................... .................... ....................

5282 Wallgraft Trach Sys 20/30/50 ....................................................................................... H .................... .................... .................... ....................

5283 Wallstent/RP TIPS—80mm .......................................................................................... H .................... .................... .................... ....................

5284 Wallstent TrachUltraFlex .............................................................................................. H .................... .................... .................... ....................

5600 Closure dev, VasoSeal ES ........................................................................................... H .................... .................... .................... ....................

5601 VasoSeal Model 1000 .................................................................................................. H .................... .................... .................... ....................

6001 Composix Mesh 8/21 in ................................................................................................ H .................... .................... .................... ....................

6002 Composix Mesh 32 in ................................................................................................... H .................... .................... .................... ....................

6003 Composix Mesh 48 in ................................................................................................... H .................... .................... .................... ....................

6004 Composix Mesh 80 in ................................................................................................... H .................... .................... .................... ....................

6005 Composix Mesh 140 in ................................................................................................. H .................... .................... .................... ....................

6006 Composix Mesh 144 in ................................................................................................. H .................... .................... .................... ....................

6012 Pelvicol Collagen 8/14 sq cm ....................................................................................... H .................... .................... .................... ....................

6013 Pelvicol Collagen 21/24/28 sq cm ................................................................................ H .................... .................... .................... ....................

6014 Pelvicol Collagen 36 sq cm .......................................................................................... H .................... .................... .................... ....................

6015 Pelvicol Collagen 48 sq cm .......................................................................................... H .................... .................... .................... ....................

6016 Pelvicol Collagen 96 sq cm .......................................................................................... H .................... .................... .................... ....................

6017 Gore-Tex DualMesh 75/96 sq cm ................................................................................ H .................... .................... .................... ....................

6018 Gore-Tex DualMesh 150 sq cm ................................................................................... H .................... .................... .................... ....................

6019 Gore-Tex DualMesh 285 sq cm ................................................................................... H .................... .................... .................... ....................

6020 Gore-Tex DualMesh 432 sq cm ................................................................................... H .................... .................... .................... ....................

6021 Gore-Tex DualMesh 600 sq cm ................................................................................... H .................... .................... .................... ....................

6022 Gore-Tex DualMesh 884 sq cm ................................................................................... H .................... .................... .................... ....................

6023 Gore-TexPlus 1mm, 75/96sq cm ................................................................................. H .................... .................... .................... ....................

6024 Gore-TexPlus 1mm, 150sq cm .................................................................................... H .................... .................... .................... ....................

6025 Gore-TexPlus 1mm, 285sq cm .................................................................................... H .................... .................... .................... ....................

6026 Gore-TexPlus 1mm, 432sq cm .................................................................................... H .................... .................... .................... ....................

6027 Gore-TexPlus 1mm, 600sq cm .................................................................................... H .................... .................... .................... ....................

6028 Gore-TexPlus 1mm, 884 sq cm ................................................................................... H .................... .................... .................... ....................

6029 Gore-TexPlus 2mm, 150 sq cm ................................................................................... H .................... .................... .................... ....................

6030 Gore-TexPlus 2mm, 285 sq cm ................................................................................... H .................... .................... .................... ....................

6031 Gore-TexPlus 2mm, 432 sq cm ................................................................................... H .................... .................... .................... ....................

6032 Gore-TexPlus 2mm, 600 sq cm ................................................................................... H .................... .................... .................... ....................

6033 Gore-TexPlus 2mm, 884 sq cm ................................................................................... H .................... .................... .................... ....................

6034 Bard ePTFE: 150 sq cm--2mm .................................................................................... H .................... .................... .................... ....................

6035 Bard ePTFE 150 sqcm-1mm,75-2mm ......................................................................... H .................... .................... .................... ....................

6036 Bard ePTFE: 50/75 sqcm-1,2mm ................................................................................. H .................... .................... .................... ....................

6037 Bard ePTFE: 300 sq cm-1,2mm .................................................................................. H .................... .................... .................... ....................

6038 Bard ePTFE: 600 sq cm-1mm ..................................................................................... H .................... .................... .................... ....................

6039 Bard ePTFE: 884 sq cm-1mm ..................................................................................... H .................... .................... .................... ....................

6040 Bard ePTFE: 600 sq cm-2mm ..................................................................................... H .................... .................... .................... ....................

6041 Bard ePTFE: 884 sq cm-2mm ..................................................................................... H .................... .................... .................... ....................

6050 Female Sling Sys w/wo Matrl ....................................................................................... H .................... .................... .................... ....................

6051 Stratasis Sling, 20/40 cm ............................................................................................. H .................... .................... .................... ....................

6052 Stratasis Sling, 60 cm .................................................................................................. H .................... .................... .................... ....................

6053 Surgisis Soft Graft ........................................................................................................ H .................... .................... .................... ....................

6054 Surgisis Enhanced Graft .............................................................................................. H .................... .................... .................... ....................

6055 Surgisis Enhanced Tissue ............................................................................................ H .................... .................... .................... ....................

6056 Surgisis Soft Tissue Graft ............................................................................................ H .................... .................... .................... ....................

6057 Surgisis Hernia Graft .................................................................................................... H .................... .................... .................... ....................

6058 SurgiPro Hernia Plug, med/lg ....................................................................................... H .................... .................... .................... ....................

6080 Male Sling Sys w/wo Matrl ........................................................................................... H .................... .................... .................... ....................

6200 Exxcel Sft ePTFE vas graft .......................................................................................... H .................... .................... .................... ....................

6201 Impra Venaflo--10/20cm ............................................................................................... H .................... .................... .................... ....................

6202 Impra Venaflo-30/40cm ................................................................................................ H .................... .................... .................... ....................

6203 Impra Venaflo-50cm,vt45 ............................................................................................. H .................... .................... .................... ....................

6204 Impra Venaflo-stepped ................................................................................................. H .................... .................... .................... ....................

6205 Impra Carboflo—10cm ................................................................................................. H .................... .................... .................... ....................

6206 Impra Carboflo—20cm ................................................................................................. H .................... .................... .................... ....................

6207 Impra Carboflo—30/35/40cm ....................................................................................... H .................... .................... .................... ....................

6208 Impra Carboflo—40/50cm ............................................................................................ H .................... .................... .................... ....................

6209 Impra Carboflo—ctrflex ................................................................................................. H .................... .................... .................... ....................

6210 Exxcel ePTFE vas graft ................................................................................................ H .................... .................... .................... ....................

6300 Vanguard III Endovas Graft .......................................................................................... H .................... .................... .................... ....................

6500 Preface Guiding Sheath ............................................................................................... H .................... .................... .................... ....................

6501 Soft Tip Sheaths ........................................................................................................... H .................... .................... .................... ....................

6502 Perry Exchange Dilator ................................................................................................ H .................... .................... .................... ....................

6525 Spectranetics Laser Sheath ......................................................................................... H .................... .................... .................... ....................

6600 Micro Litho Flex Probes ............................................................................................... H .................... .................... .................... ....................

6650 Fast-Cath Guiding Introducer ....................................................................................... H .................... .................... .................... ....................

6651 Seal-AwayGuiding Introducer ....................................................................................... H .................... .................... .................... ....................

6652 Bard Excalibur Introducer ............................................................................................. H .................... .................... .................... ....................

6700 Focal Seal-L ................................................................................................................. H .................... .................... .................... ....................

7000 Amifostine, 500 mg ....................................................................................................... G .................... $350.31 .................... $46.94

7001 Amphotericin B lipid complex, 50 mg ........................................................................... G .................... $95.00 .................... $12.73

7003 Epoprostenol injection 0.5 mg ...................................................................................... G .................... $16.53 .................... $2.22

7004 Immune globulin 5 gms ................................................................................................ G .................... $272.80 .................... $33.28

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 67843

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

7005 Gonadorelin hydroch, 100 mcg .................................................................................... G .................... $14.80 .................... $1.98

7007 Milrinone lactate, per 5 ml, inj ...................................................................................... K 0.47 $23.31 .................... $4.66

7010 Morphine sulfate (preservative free) 10 mg ................................................................. G .................... $7.41 .................... $.99

7011 Oprelvekin injection, 5 mg ............................................................................................ G .................... $236.31 .................... $31.67

7014 Fentanyl citrate inj up 2 ml ........................................................................................... G .................... $0.98 .................... $0.13

7015 Busulfan, oral, 2 mg ..................................................................................................... G .................... $1.73 .................... $0.23

7019 Aprotinin, 10,000 kiu ..................................................................................................... G .................... $196.35 .................... $26.31

7022 Elliot’s B solution, per ml .............................................................................................. G .................... $14.25 .................... $1.91

7023 Treatment for bladder calculi, per 500 ml .................................................................... G .................... $23.54 .................... $3.15

7024 Corticorelin ovine triflutate, per 0.1 mg ........................................................................ G .................... $353.88 .................... $45.77

7025 Digoxin immune FAB (Ovine), 40 mg vial .................................................................... G .................... $530.44 .................... $64.71

7026 Ethanolamine oleate, 100 mg ...................................................................................... G .................... $27.21 .................... $3.65

7027 Fomepizole, 1.5 mg ...................................................................................................... G .................... $728.33 .................... $97.60

7028 Fosphenytoin, 50 mg .................................................................................................... G .................... $8.55 .................... $1.15

7029 Glatiramer acetate, 20 mg ............................................................................................ G .................... $27.40 .................... $3.67

7030 Hemin, 1 mg ................................................................................................................. G .................... $0.90 .................... $0.12

7031 Octreotide acetate injection 1mg .................................................................................. G .................... $115.34 .................... $15.46

7032 Sermorelin acetate, 0.5 mg .......................................................................................... G .................... $15.78 .................... $2.11

7033 Somatrem, 5 mg ........................................................................................................... G .................... $199.50 .................... $26.73

7034 Somatropin, 1 mg (any derivation) ............................................................................... G .................... $39.90 .................... $5.35

7035 Teniposide, 50 mg ........................................................................................................ G .................... $195.28 .................... $26.17

7036 Urokinase, inj, IV, 250,000 I.U. .................................................................................... K 6.78 $336.29 .................... $67.26

7037 Urofollitropin, 75 I.U. ..................................................................................................... G .................... $69.73 .................... $9.34

7038 Muromonab-CD3, 5 mg ................................................................................................ G .................... $741.00 .................... $99.29

7039 Pegademase bovine inj 25 I.U ..................................................................................... G .................... $139.33 .................... $18.67

7040 Pentastarch 10% inj, 100 ml ........................................................................................ G .................... $15.11 .................... $2.04

7041 Tirofiban hydrochloride 12.5 mg ................................................................................... G .................... $399.00 .................... $53.47

7042 Capecitabine, oral, 150 mg .......................................................................................... G .................... $1.94 .................... $0.26

7043 Infliximab injection 10 mg ............................................................................................. G .................... $58.08 .................... $7.78

7045 Trimetrexate glucoronate 25 mg .................................................................................. G .................... $69.83 .................... $9.36

7046 Doxorubicin hcl liposome inj 10 mg ............................................................................. G .................... $311.72 .................... $41.77

7047 Droperidol/fentanyl inj ................................................................................................... G .................... $7.02 .................... $0.90

7048 Alteplase, 1 mg ............................................................................................................. K 0.38 $18.70 .................... $3.74

7049 Filgrastim 480 mcg injection ......................................................................................... G .................... $273.03 .................... $35.06

7315 Sodium hyaluronate, 20 mg ......................................................................................... G .................... $125.59 .................... $16.83

8099 Spectranetics Lead Lock Dev ...................................................................................... H .................... .................... .................... ....................

8100 Adhesion barrier, ADCON–L ........................................................................................ H .................... .................... .................... ....................

8102 SurgiVision Esoph Coil ................................................................................................. H .................... .................... .................... ....................

9000 Na chromate Cr51, per 0.25mCi .................................................................................. G .................... $259.36 .................... $34.75

9001 Linezolid inj, 200mg ...................................................................................................... J .................... $34.14 .................... $4.57

9002 Tenecteplase, 50mg/vial ............................................................................................... J .................... $2,612.50 .................... $350.08

9003 Palivizumab, per 50mg ................................................................................................. J .................... $664.49 .................... $89.04

9004 Gemtuzumab ozogamicin inj,5mg ................................................................................ J .................... $1,929.69 .................... $258.58

9005 Reteplase inj, half-kit, 18.8 mg/vial .............................................................................. G .................... $1,306.25 .................... $175.04

9006 Tacrolimus inj, per 5mg (1 amp) .................................................................................. J .................... $109.83 .................... $14.72

9007 Baclofen Intrathecal kit-1amp ....................................................................................... G .................... $79.80 .................... $10.69

9008 Baclofen Refill Kit—500mcg ......................................................................................... G .................... $222.30 .................... $29.79

9009 Baclofen Refill Kit—2000mcg ....................................................................................... G .................... $467.40 .................... $62.63

9010 Baclofen Refill Kit—4000mcg ....................................................................................... G .................... $820.80 .................... $109.99

9011 Caffeine Citrate, inj, 1ml ............................................................................................... G .................... $12.22 .................... $1.57

9100 Iodinated I-131 Albumin ............................................................................................... G .................... $246.05 .................... $30.02

9102 51 Na chromate, 50mCi ............................................................................................... G .................... $216.60 .................... $26.43

9103 Na Iothalamate I-125, 10uCi ........................................................................................ G .................... $12.27 .................... $1.50

9104 Anti-thymocyte globulin,25mg ...................................................................................... G .................... $251.75 .................... $33.73

9105 Hep B imm glob, per 1 ml ............................................................................................ G .................... $152.00 .................... $20.37

9106 Sirolimus 1mg/ml .......................................................................................................... J .................... $6.51 .................... $.87

9107 Tinzaparin sodium, 2ml vial .......................................................................................... J .................... $159.60 .................... $20.50

9108 Thyrotropin Alfa,1.1 mg ................................................................................................ G .................... $494.00 .................... $70.72

9109 Tirofiban hydrochloride 6.25 mg ................................................................................... G .................... $199.50 .................... $28.56

9217 Leuprolide acetate for depot suspension, 7.5 mg ........................................................ G .................... $592.60 .................... $79.40

9500 Platelets, irrad, ea unit ................................................................................................. K 1.77 $87.97 .................... $17.59

9501 Platelets, pheresis, ea unit ........................................................................................... K 9.69 $480.75 .................... $96.15

9502 Platelets, pher/irrad, ea unit ......................................................................................... K 10.52 $521.66 .................... $104.33

9503 Fresh frozen plasma, ea unit ....................................................................................... K 1.65 $81.83 .................... $16.37

9504 RBC, deglycerolized, ea unit ........................................................................................ K 4.35 $215.83 .................... $43.17

67844

ADDENDUM A.—LIST OF HOSPITAL OUTPATIENT AMBULATORY PAYMENT CLASSIFICATIONS WITH STATUS INDICATORS, RELATIVE

WEIGHTS, PAYMENT RATES, AND COINSURANCE AMOUNTS, CALENDAR YEAR 2001—Continued

APC Group title Status

indicator

Relative

weight

Payment

rate

National

unadjusted

coinsurance

Minimum

unadjusted

coinsurance

9505 RBC, irradiated, ea unit ................................................................................................ K 2.58 $127.86 .................... $25.57

9998 Enoxaparin .................................................................................................................... G .................... $5.53 .................... $0.79

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

00100 N Anesth, salivary gland ...................................................................... .................... .................... .................... .................... ....................

00102 N Anesth, repair of cleft lip .................................................................. .................... .................... .................... .................... ....................

00103 N Anesth, blepharoplasty ..................................................................... .................... .................... .................... .................... ....................

00104 N Anesth, electroshock ........................................................................ .................... .................... .................... .................... ....................

00120 N Anesth, ear surgery .......................................................................... .................... .................... .................... .................... ....................

00124 N Anesth, ear exam ............................................................................. .................... .................... .................... .................... ....................

00126 N Anesth, tympanotomy ...................................................................... .................... .................... .................... .................... ....................

00140 N Anesth, procedures on eye .............................................................. .................... .................... .................... .................... ....................

00142 N Anesth, lens surgery ........................................................................ .................... .................... .................... .................... ....................

00144 N Anesth, corneal transplant ............................................................... .................... .................... .................... .................... ....................

00145 N Anesth, vitrectomy ............................................................................ .................... .................... .................... .................... ....................

00147 N Anesth, iridectomy ............................................................................ .................... .................... .................... .................... ....................

00148 N Anesth, eye exam ............................................................................ .................... .................... .................... .................... ....................

00160 N Anesth, nose/sinus surgery .............................................................. .................... .................... .................... .................... ....................

00162 N Anesth, nose/sinus surgery .............................................................. .................... .................... .................... .................... ....................

00164 N Anesth, biopsy of nose .................................................................... .................... .................... .................... .................... ....................

00170 N Anesth, procedure on mouth ........................................................... .................... .................... .................... .................... ....................

00172 N Anesth, cleft palate repair ................................................................ .................... .................... .................... .................... ....................

00174 N Anesth, pharyngeal surgery ............................................................. .................... .................... .................... .................... ....................

00176 N Anesth, pharyngeal surgery ............................................................. .................... .................... .................... .................... ....................

00190 N Anesth, facial bone surgery ............................................................. .................... .................... .................... .................... ....................

00192 N Anesth, facial bone surgery ............................................................. .................... .................... .................... .................... ....................

00210 N Anesth, open head surgery .............................................................. .................... .................... .................... .................... ....................

00212 N Anesth, skull drainage ...................................................................... .................... .................... .................... .................... ....................

00214 N Anesth, skull drainage ...................................................................... .................... .................... .................... .................... ....................

00215 N Anesth, skull fracture ....................................................................... .................... .................... .................... .................... ....................

00216 N Anesth, head vessel surgery ........................................................... .................... .................... .................... .................... ....................

00218 N Anesth, special head surgery .......................................................... .................... .................... .................... .................... ....................

00220 N Anesth, spinal fluid shunt ................................................................. .................... .................... .................... .................... ....................

00222 N Anesth, head nerve surgery ............................................................. .................... .................... .................... .................... ....................

00300 N Anesth, head/neck/ptrunk ................................................................ .................... .................... .................... .................... ....................

00320 N Anesth, neck organ surgery ............................................................. .................... .................... .................... .................... ....................

00322 N Anesth, biopsy of thyroid ................................................................. .................... .................... .................... .................... ....................

00350 N Anesth, neck vessel surgery ............................................................ .................... .................... .................... .................... ....................

00352 N Anesth, neck vessel surgery ............................................................ .................... .................... .................... .................... ....................

00400 N Anesth, skin, ext/per/atrunk ............................................................. .................... .................... .................... .................... ....................

00402 N Anesth, surgery of breast ................................................................. .................... .................... .................... .................... ....................

00404 N Anesth, surgery of breast ................................................................. .................... .................... .................... .................... ....................

00406 N Anesth, surgery of breast ................................................................. .................... .................... .................... .................... ....................

00410 N Anesth, correct heart rhythm ........................................................... .................... .................... .................... .................... ....................

00420 N Anesth, skin surgery, back ............................................................... .................... .................... .................... .................... ....................

00450 N Anesth, surgery of shoulder ............................................................. .................... .................... .................... .................... ....................

00452 N Anesth, surgery of shoulder ............................................................. .................... .................... .................... .................... ....................

00454 N Anesth, collar bone biopsy ............................................................... .................... .................... .................... .................... ....................

00470 N Anesth, removal of rib ...................................................................... .................... .................... .................... .................... ....................

00472 N Anesth, chest wall repair .................................................................. .................... .................... .................... .................... ....................

00474 N Anesth, surgery of rib(s) .................................................................. .................... .................... .................... .................... ....................

00500 N Anesth, esophageal surgery ............................................................ .................... .................... .................... .................... ....................

00520 N Anesth, chest procedure .................................................................. .................... .................... .................... .................... ....................

00522 N Anesth, chest lining biopsy .............................................................. .................... .................... .................... .................... ....................

00524 N Anesth, chest drainage .................................................................... .................... .................... .................... .................... ....................

00528 N Anesth, chest partition view ............................................................. .................... .................... .................... .................... ....................

00530 N Anesth, pacemaker insertion ........................................................... .................... .................... .................... .................... ....................

00532 N Anesth, vascular access .................................................................. .................... .................... .................... .................... ....................

00534 N Anesth, cardioverter/defib ................................................................ .................... .................... .................... .................... ....................

*00537 N Anesth, cardiac electrophys ............................................................. .................... .................... .................... .................... ....................

00540 N Anesth, chest surgery ...................................................................... .................... .................... .................... .................... ....................

00542 N Anesth, release of lung .................................................................... .................... .................... .................... .................... ....................

00544 N Anesth, chest lining removal ............................................................ .................... .................... .................... .................... ....................

00546 N Anesth, lung,chest wall surg ............................................................ .................... .................... .................... .................... ....................

00548 N Anesth, trachea,bronchi surg ........................................................... .................... .................... .................... .................... ....................

*00550 N Anesth, sternal debridement ............................................................ .................... .................... .................... .................... ....................

00560 N Anesth, open heart surgery ............................................................. .................... .................... .................... .................... ....................

00562 N Anesth, open heart surgery ............................................................. .................... .................... .................... .................... ....................

67845

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*00563 N Anesth, openproc w/pump ............................................................... .................... .................... .................... .................... ....................

*00566 N Anesth CABG w/o pump .................................................................. .................... .................... .................... .................... ....................

00580 N Anesth heart/lung transplant ............................................................ .................... .................... .................... .................... ....................

00600 N Anesth, spine, cord surgery ............................................................. .................... .................... .................... .................... ....................

00604 N Anesth, surgery of vertebra ............................................................. .................... .................... .................... .................... ....................

00620 N Anesth, spine, cord surgery ............................................................. .................... .................... .................... .................... ....................

00622 N Anesth, removal of nerves ............................................................... .................... .................... .................... .................... ....................

00630 N Anesth, spine, cord surgery ............................................................. .................... .................... .................... .................... ....................

00632 N Anesth, removal of nerves ............................................................... .................... .................... .................... .................... ....................

00634 N Anesth for chemonucleolysis ........................................................... .................... .................... .................... .................... ....................

*00635 N Anesth, lumbar puncture .................................................................. .................... .................... .................... .................... ....................

00670 N Anesth, spine, cord surgery ............................................................. .................... .................... .................... .................... ....................

00700 N Anesth, abdominal wall surg ............................................................ .................... .................... .................... .................... ....................

00702 N Anesth, for liver biopsy .................................................................... .................... .................... .................... .................... ....................

00730 N Anesth, abdominal wall surg ............................................................ .................... .................... .................... .................... ....................

00740 N Anesth, upper gi visualize ................................................................ .................... .................... .................... .................... ....................

00750 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00752 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00754 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00756 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00770 N Anesth, blood vessel repair ............................................................. .................... .................... .................... .................... ....................

00790 N Anesth, surg upper abdomen .......................................................... .................... .................... .................... .................... ....................

00792 N Anesth, part liver removal ................................................................ .................... .................... .................... .................... ....................

00794 N Anesth, pancreas removal ............................................................... .................... .................... .................... .................... ....................

00796 N Anesth, for liver transplant ............................................................... .................... .................... .................... .................... ....................

00800 N Anesth, abdominal wall surg ............................................................ .................... .................... .................... .................... ....................

00802 N Anesth, fat layer removal ................................................................. .................... .................... .................... .................... ....................

00810 N Anesth, low intestine scope ............................................................. .................... .................... .................... .................... ....................

00820 N Anesth, abdominal wall surg ............................................................ .................... .................... .................... .................... ....................

00830 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00832 N Anesth, repair of hernia ................................................................... .................... .................... .................... .................... ....................

00840 N Anesth, surg lower abdomen ........................................................... .................... .................... .................... .................... ....................

00842 N Anesth, amniocentesis ..................................................................... .................... .................... .................... .................... ....................

00844 N Anesth, pelvis surgery ...................................................................... .................... .................... .................... .................... ....................

00846 N Anesth, hysterectomy ....................................................................... .................... .................... .................... .................... ....................

00848 N Anesth, pelvic organ surg ................................................................ .................... .................... .................... .................... ....................

00850 N Anesth, cesarean section ................................................................. .................... .................... .................... .................... ....................

00855 N Anesth, hysterectomy ....................................................................... .................... .................... .................... .................... ....................

00857 N Analgesia, labor & c-section ............................................................ .................... .................... .................... .................... ....................

00860 N Anesth, surgery of abdomen ............................................................ .................... .................... .................... .................... ....................

00862 N Anesth, kidney/ureter surg ............................................................... .................... .................... .................... .................... ....................

00864 N Anesth, removal of bladder .............................................................. .................... .................... .................... .................... ....................

00865 N Anesth, removal of prostate ............................................................. .................... .................... .................... .................... ....................

00866 N Anesth, removal of adrenal .............................................................. .................... .................... .................... .................... ....................

00868 N Anesth, kidney transplant ................................................................. .................... .................... .................... .................... ....................

00870 N Anesth, bladder stone surg .............................................................. .................... .................... .................... .................... ....................

00872 N Anesth kidney stone destruct ........................................................... .................... .................... .................... .................... ....................

00873 N Anesth kidney stone destruct ........................................................... .................... .................... .................... .................... ....................

00880 N Anesth, abdomen vessel surg ......................................................... .................... .................... .................... .................... ....................

00882 N Anesth, major vein ligation ............................................................... .................... .................... .................... .................... ....................

00884 N Anesth, major vein revision .............................................................. .................... .................... .................... .................... ....................

00900D N Anesth, perineal procedure .............................................................. .................... .................... .................... .................... ....................

00902 N Anesth, anorectal surgery ................................................................ .................... .................... .................... .................... ....................

00904 N Anesth, perineal surgery .................................................................. .................... .................... .................... .................... ....................

00906 N Anesth, removal of vulva ................................................................. .................... .................... .................... .................... ....................

00908 N Anesth, removal of prostate ............................................................. .................... .................... .................... .................... ....................

00910 N Anesth, bladder surgery ................................................................... .................... .................... .................... .................... ....................

00912 N Anesth, bladder tumor surg ............................................................. .................... .................... .................... .................... ....................

00914 N Anesth, removal of prostate ............................................................. .................... .................... .................... .................... ....................

00916 N Anesth, bleeding control .................................................................. .................... .................... .................... .................... ....................

00918 N Anesth, stone removal ..................................................................... .................... .................... .................... .................... ....................

00920 N Anesth, genitalia surgery ................................................................. .................... .................... .................... .................... ....................

00922 N Anesth, sperm duct surgery ............................................................. .................... .................... .................... .................... ....................

27280 C Fusion of sacroiliac joint .................................................................. .................... .................... .................... .................... ....................

27282 C Fusion of pubic bones ...................................................................... .................... .................... .................... .................... ....................

27284 C Fusion of hip joint ............................................................................. .................... .................... .................... .................... ....................

27286 C Fusion of hip joint ............................................................................. .................... .................... .................... .................... ....................

27290 C Amputation of leg at hip ................................................................... .................... .................... .................... .................... ....................

27295 C Amputation of leg at hip ................................................................... .................... .................... .................... .................... ....................

27299 T Pelvis/hip joint surgery ..................................................................... 0043 1.64 $81.34 $25.46 $16.27

27301 T Drain thigh/knee lesion .................................................................... 0008 6.15 $305.02 $113.67 $61.00

27303 C Drainage of bone lesion ................................................................... .................... .................... .................... .................... ....................

27305 T Incise thigh tendon & fascia ............................................................. 0049 15.04 $745.93 $356.95 $149.19

27306 T Incision of thigh tendon .................................................................... 0049 15.04 $745.93 $356.95 $149.19

67846

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27307 T Incision of thigh tendons .................................................................. 0049 15.04 $745.93 $356.95 $149.19

27310 T Exploration of knee joint .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27315 T Partial removal, thigh nerve ............................................................. 0220 13.96 $692.36 $326.21 $138.47

27320 T Partial removal, thigh nerve ............................................................. 0220 13.96 $692.36 $326.21 $138.47

27323 T Biopsy, thigh soft tissues ................................................................. 0021 10.49 $520.26 $236.51 $104.05

27324 T Biopsy, thigh soft tissues ................................................................. 0022 12.49 $619.45 $292.94 $123.89

27327 T Removal of thigh lesion ................................................................... 0022 12.49 $619.45 $292.94 $123.89

27328 T Removal of thigh lesion ................................................................... 0022 12.49 $619.45 $292.94 $123.89

27329 T Remove tumor, thigh/knee ............................................................... 0022 12.49 $619.45 $292.94 $123.89

27330 T Biopsy, knee joint lining ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27331 T Explore/treat knee joint .................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27332 T Removal of knee cartilage ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27333 T Removal of knee cartilage ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27334 T Remove knee joint lining .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27335 T Remove knee joint lining .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27340 T Removal of kneecap bursa .............................................................. 0049 15.04 $745.93 $356.95 $149.19

27345 T Removal of knee cyst ...................................................................... 0049 15.04 $745.93 $356.95 $149.19

27347 T Remove knee cyst ........................................................................... 0049 15.04 $745.93 $356.95 $149.19

27350 T Removal of kneecap ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27355 T Remove femur lesion ....................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27356 T Remove femur lesion/graft ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27357 T Remove femur lesion/graft ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27358 T Remove femur lesion/fixation ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27360 T Partial removal, leg bone(s) ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27365 C Extensive leg surgery ....................................................................... .................... .................... .................... .................... ....................

27370 N Injection for knee x-ray .................................................................... .................... .................... .................... .................... ....................

27372 T Removal of foreign body .................................................................. 0022 12.49 $619.45 $292.94 $123.89

27380 T Repair of kneecap tendon ................................................................ 0049 15.04 $745.93 $356.95 $149.19

27381 T Repair/graft kneecap tendon ............................................................ 0049 15.04 $745.93 $356.95 $149.19

27385 T Repair of thigh muscle ..................................................................... 0049 15.04 $745.93 $356.95 $149.19

27386 T Repair/graft of thigh muscle ............................................................. 0049 15.04 $745.93 $356.95 $149.19

27390 T Incision of thigh tendon .................................................................... 0049 15.04 $745.93 $356.95 $149.19

27391 T Incision of thigh tendons .................................................................. 0049 15.04 $745.93 $356.95 $149.19

27392 T Incision of thigh tendons .................................................................. 0049 15.04 $745.93 $356.95 $149.19

27393 T Lengthening of thigh tendon ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27394 T Lengthening of thigh tendons .......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27395 T Lengthening of thigh tendons .......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27396 T Transplant of thigh tendon ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27397 T Transplants of thigh tendons ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27400 T Revise thigh muscles/tendons ......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27403 T Repair of knee cartilage ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27405 T Repair of knee ligament ................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27407 T Repair of knee ligament ................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27409 T Repair of knee ligaments ................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27418 T Repair degenerated kneecap ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27420 T Revision of unstable kneecap .......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27422 T Revision of unstable kneecap .......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27424 T Revision/removal of kneecap ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27425 T Lateral retinacular release ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27427 T Reconstruction, knee ....................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

27428 T Reconstruction, knee ....................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

27429 T Reconstruction, knee ....................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

27430 T Revision of thigh muscles ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

27435 T Incision of knee joint ........................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

27437 T Revise kneecap ................................................................................ 0047 22.09 $1,095.58 $537.03 $219.12

27438 T Revise kneecap with implant ........................................................... 0048 29.06 $1,441.26 $725.94 $288.25

27440 T Revision of knee joint ....................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27441 T Revision of knee joint ....................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27442 T Revision of knee joint ....................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27443 T Revision of knee joint ....................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27445 C Revision of knee joint ....................................................................... .................... .................... .................... .................... ....................

27446 C Revision of knee joint ....................................................................... .................... .................... .................... .................... ....................

27447 C Total knee replacement ................................................................... .................... .................... .................... .................... ....................

27448 C Incision of thigh ................................................................................ .................... .................... .................... .................... ....................

27450 C Incision of thigh ................................................................................ .................... .................... .................... .................... ....................

27454 C Realignment of thigh bone ............................................................... .................... .................... .................... .................... ....................

27455 C Realignment of knee ........................................................................ .................... .................... .................... .................... ....................

27457 C Realignment of knee ........................................................................ .................... .................... .................... .................... ....................

27465 C Shortening of thigh bone .................................................................. .................... .................... .................... .................... ....................

27466 C Lengthening of thigh bone ............................................................... .................... .................... .................... .................... ....................

27468 C Shorten/lengthen thighs ................................................................... .................... .................... .................... .................... ....................

27470 C Repair of thigh .................................................................................. .................... .................... .................... .................... ....................

27472 C Repair/graft of thigh ......................................................................... .................... .................... .................... .................... ....................

27475 C Surgery to stop leg growth ............................................................... .................... .................... .................... .................... ....................

67847

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27477 C Surgery to stop leg growth ............................................................... .................... .................... .................... .................... ....................

27479 C Surgery to stop leg growth ............................................................... .................... .................... .................... .................... ....................

27485 C Surgery to stop leg growth ............................................................... .................... .................... .................... .................... ....................

27486 C Revise/replace knee joint ................................................................. .................... .................... .................... .................... ....................

27487 C Revise/replace knee joint ................................................................. .................... .................... .................... .................... ....................

27488 C Removal of knee prosthesis ............................................................ .................... .................... .................... .................... ....................

27495 C Reinforce thigh ................................................................................. .................... .................... .................... .................... ....................

27496 T Decompression of thigh/knee .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27497 T Decompression of thigh/knee .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27498 T Decompression of thigh/knee .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27499 T Decompression of thigh/knee .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27500 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27501 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27502 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27503 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27506 C Treatment of thigh fracture .............................................................. .................... .................... .................... .................... ....................

27507 C Treatment of thigh fracture .............................................................. .................... .................... .................... .................... ....................

27508 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27509 T Treatment of thigh fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27510 T Treatment of thigh fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27511 C Treatment of thigh fracture .............................................................. .................... .................... .................... .................... ....................

27513 C Treatment of thigh fracture .............................................................. .................... .................... .................... .................... ....................

27514 C Treatment of thigh fracture .............................................................. .................... .................... .................... .................... ....................

27516 T Treat thigh fx growth plate ............................................................... 0044 2.17 $107.63 $38.08 $21.53

27517 T Treat thigh fx growth plate ............................................................... 0044 2.17 $107.63 $38.08 $21.53

27519 C Treat thigh fx growth plate ............................................................... .................... .................... .................... .................... ....................

27520 T Treat kneecap fracture ..................................................................... 0044 2.17 $107.63 $38.08 $21.53

27524 T Treat kneecap fracture ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27530 T Treat knee fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

27532 T Treat knee fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

27535 C Treat knee fracture ........................................................................... .................... .................... .................... .................... ....................

27536 C Treat knee fracture ........................................................................... .................... .................... .................... .................... ....................

27538 T Treat knee fracture(s) ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

27540 C Treat knee fracture ........................................................................... .................... .................... .................... .................... ....................

27550 T Treat knee dislocation ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

27552 T Treat knee dislocation ...................................................................... 0045 11.02 $546.55 $277.12 $109.31

27556 C Treat knee dislocation ...................................................................... .................... .................... .................... .................... ....................

27557 C Treat knee dislocation ...................................................................... .................... .................... .................... .................... ....................

27558 C Treat knee dislocation ...................................................................... .................... .................... .................... .................... ....................

27560 T Treat kneecap dislocation ................................................................ 0044 2.17 $107.63 $38.08 $21.53

27562 T Treat kneecap dislocation ................................................................ 0045 11.02 $546.55 $277.12 $109.31

27566 T Treat kneecap dislocation ................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

27570 T Fixation of knee joint ........................................................................ 0045 11.02 $546.55 $277.12 $109.31

27580 C Fusion of knee ................................................................................. .................... .................... .................... .................... ....................

27590 C Amputate leg at thigh ....................................................................... .................... .................... .................... .................... ....................

27591 C Amputate leg at thigh ....................................................................... .................... .................... .................... .................... ....................

27592 C Amputate leg at thigh ....................................................................... .................... .................... .................... .................... ....................

27594 T Amputation follow-up surgery .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27596 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

27598 C Amputate lower leg at knee ............................................................. .................... .................... .................... .................... ....................

27599 T Leg surgery procedure ..................................................................... 0044 2.17 $107.63 $38.08 $21.53

27600 T Decompression of lower leg ............................................................ 0049 15.04 $745.93 $356.95 $149.19

27601 T Decompression of lower leg ............................................................ 0049 15.04 $745.93 $356.95 $149.19

27602 T Decompression of lower leg ............................................................ 0049 15.04 $745.93 $356.95 $149.19

27603 T Drain lower leg lesion ...................................................................... 0008 6.15 $305.02 $113.67 $61.00

27604 T Drain lower leg bursa ....................................................................... 0049 15.04 $745.93 $356.95 $149.19

27605 T Incision of achilles tendon ................................................................ 0055 15.47 $767.26 $355.34 $153.45

00924 N Anesth, testis exploration ................................................................. .................... .................... .................... .................... ....................

00926 N Anesth, removal of testis ................................................................. .................... .................... .................... .................... ....................

00928 N Anesth, removal of testis ................................................................. .................... .................... .................... .................... ....................

00930 N Anesth, testis suspension ................................................................ .................... .................... .................... .................... ....................

00932 N Anesth, amputation of penis ............................................................ .................... .................... .................... .................... ....................

00934 N Anesth, penis, nodes removal ......................................................... .................... .................... .................... .................... ....................

00936 N Anesth, penis, nodes removal ......................................................... .................... .................... .................... .................... ....................

00938 N Anesth, insert penis device .............................................................. .................... .................... .................... .................... ....................

00940 N Anesth, vaginal procedures ............................................................. .................... .................... .................... .................... ....................

00942 N Anesth, surgery on vagina ............................................................... .................... .................... .................... .................... ....................

00944 N Anesth, vaginal hysterectomy .......................................................... .................... .................... .................... .................... ....................

00946 N Anesth, vaginal delivery ................................................................... .................... .................... .................... .................... ....................

00948 N Anesth, repair of cervix .................................................................... .................... .................... .................... .................... ....................

00950 N Anesth, vaginal endoscopy .............................................................. .................... .................... .................... .................... ....................

00952 N Anesth, hysteroscope/graph ............................................................ .................... .................... .................... .................... ....................

00955 N Analgesia, vaginal delivery .............................................................. .................... .................... .................... .................... ....................

01000 N Anesth, skin surgery, pelvis ............................................................. .................... .................... .................... .................... ....................

67848

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

01110 N Anesth, skin surgery, pelvis ............................................................. .................... .................... .................... .................... ....................

*01112 N Anesth, bone aspirate/bx ................................................................. .................... .................... .................... .................... ....................

01120 N Anesth, pelvis surgery ...................................................................... .................... .................... .................... .................... ....................

01130 N Anesth, body cast procedure ........................................................... .................... .................... .................... .................... ....................

01140 N Anesth, amputation at pelvis ............................................................ .................... .................... .................... .................... ....................

01150 N Anesth, pelvic tumor surgery ........................................................... .................... .................... .................... .................... ....................

01160 N Anesth, pelvis procedure ................................................................. .................... .................... .................... .................... ....................

01170 N Anesth, pelvis surgery ...................................................................... .................... .................... .................... .................... ....................

01180 N Anesth, pelvis nerve removal ........................................................... .................... .................... .................... .................... ....................

01190 N Anesth, pelvis nerve removal ........................................................... .................... .................... .................... .................... ....................

01200 N Anesth, hip joint procedure .............................................................. .................... .................... .................... .................... ....................

01202 N Anesth, arthroscopy of hip ............................................................... .................... .................... .................... .................... ....................

01210 N Anesth, hip joint surgery .................................................................. .................... .................... .................... .................... ....................

01212 N Anesth, hip disarticulation ................................................................ .................... .................... .................... .................... ....................

01214 N Anesth, replacement of hip .............................................................. .................... .................... .................... .................... ....................

*01215 N Anesth, revise hip repair .................................................................. .................... .................... .................... .................... ....................

01220 N Anesth, procedure on femur ............................................................ .................... .................... .................... .................... ....................

01230 N Anesth, surgery of femur ................................................................. .................... .................... .................... .................... ....................

01232 N Anesth, amputation of femur ............................................................ .................... .................... .................... .................... ....................

01234 N Anesth, radical femur surg ............................................................... .................... .................... .................... .................... ....................

01240 N Anesth, upper leg skin surg ............................................................. .................... .................... .................... .................... ....................

01250 N Anesth, upper leg surgery ................................................................ .................... .................... .................... .................... ....................

01260 N Anesth, upper leg veins surg ........................................................... .................... .................... .................... .................... ....................

01270 N Anesth, thigh arteries surg ............................................................... .................... .................... .................... .................... ....................

01272 N Anesth, femoral artery surg ............................................................. .................... .................... .................... .................... ....................

01274 N Anesth, femoral embolectomy ......................................................... .................... .................... .................... .................... ....................

01300 N Anesth, skin surgery, knee .............................................................. .................... .................... .................... .................... ....................

01320 N Anesth, knee area surgery ............................................................... .................... .................... .................... .................... ....................

01340 N Anesth, knee area procedure .......................................................... .................... .................... .................... .................... ....................

01360 N Anesth, knee area surgery ............................................................... .................... .................... .................... .................... ....................

01380 N Anesth, knee joint procedure ........................................................... .................... .................... .................... .................... ....................

01382 N Anesth, knee arthroscopy ................................................................ .................... .................... .................... .................... ....................

01390 N Anesth, knee area procedure .......................................................... .................... .................... .................... .................... ....................

01392 N Anesth, knee area surgery ............................................................... .................... .................... .................... .................... ....................

01400 N Anesth, knee joint surgery ............................................................... .................... .................... .................... .................... ....................

01402 N Anesth, replacement of knee ........................................................... .................... .................... .................... .................... ....................

01404 N Anesth, amputation at knee ............................................................. .................... .................... .................... .................... ....................

01420 N Anesth, knee joint casting ................................................................ .................... .................... .................... .................... ....................

01430 N Anesth, knee veins surgery ............................................................. .................... .................... .................... .................... ....................

01432 N Anesth, knee vessel surg ................................................................. .................... .................... .................... .................... ....................

01440 N Anesth, knee arteries surg ............................................................... .................... .................... .................... .................... ....................

01442 N Anesth, knee artery surg .................................................................. .................... .................... .................... .................... ....................

01444 N Anesth, knee artery repair ............................................................... .................... .................... .................... .................... ....................

01460 N Anesth, lower leg skin surg .............................................................. .................... .................... .................... .................... ....................

01462 N Anesth, lower leg procedure ............................................................ .................... .................... .................... .................... ....................

01464 N Anesth, ankle arthroscopy ............................................................... .................... .................... .................... .................... ....................

01470 N Anesth, lower leg surgery ................................................................ .................... .................... .................... .................... ....................

01472 N Anesth, achilles tendon surg ............................................................ .................... .................... .................... .................... ....................

01474 N Anesth, lower leg surgery ................................................................ .................... .................... .................... .................... ....................

01480 N Anesth, lower leg bone surg ............................................................ .................... .................... .................... .................... ....................

01482 N Anesth, radical leg surgery .............................................................. .................... .................... .................... .................... ....................

01484 N Anesth, lower leg revision ................................................................ .................... .................... .................... .................... ....................

01486 N Anesth, ankle replacement .............................................................. .................... .................... .................... .................... ....................

01490 N Anesth, lower leg casting ................................................................. .................... .................... .................... .................... ....................

01500 N Anesth, leg arteries surg .................................................................. .................... .................... .................... .................... ....................

01502 N Anesth, lwr leg embolectomy ........................................................... .................... .................... .................... .................... ....................

01520 N Anesth, lower leg vein surg ............................................................. .................... .................... .................... .................... ....................

01522 N Anesth, lower leg vein surg ............................................................. .................... .................... .................... .................... ....................

01600 N Anesth, shoulder skin surg .............................................................. .................... .................... .................... .................... ....................

01610 N Anesth, surgery of shoulder ............................................................. .................... .................... .................... .................... ....................

01620 N Anesth, shoulder procedure ............................................................. .................... .................... .................... .................... ....................

01622 N Anesth, shoulder arthroscopy .......................................................... .................... .................... .................... .................... ....................

01630 N Anesth, surgery of shoulder ............................................................. .................... .................... .................... .................... ....................

01632 N Anesth, surgery of shoulder ............................................................. .................... .................... .................... .................... ....................

01634 N Anesth, shoulder joint amput ........................................................... .................... .................... .................... .................... ....................

01636 N Anesth, forequarter amput ............................................................... .................... .................... .................... .................... ....................

01638 N Anesth, shoulder replacement ......................................................... .................... .................... .................... .................... ....................

01650 N Anesth, shoulder artery surg ............................................................ .................... .................... .................... .................... ....................

01652 N Anesth, shoulder vessel surg ........................................................... .................... .................... .................... .................... ....................

01654 N Anesth, shoulder vessel surg ........................................................... .................... .................... .................... .................... ....................

01656 N Anesth, arm-leg vessel surg ............................................................ .................... .................... .................... .................... ....................

01670 N Anesth, shoulder vein surg .............................................................. .................... .................... .................... .................... ....................

01680 N Anesth, shoulder casting .................................................................. .................... .................... .................... .................... ....................

01682 N Anesth, airplane cast ....................................................................... .................... .................... .................... .................... ....................

67849

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

01700 N Anesth, elbow area skin surg .......................................................... .................... .................... .................... .................... ....................

01710 N Anesth, elbow area surgery ............................................................. .................... .................... .................... .................... ....................

01712 N Anesth, uppr arm tendon surg ......................................................... .................... .................... .................... .................... ....................

01714 N Anesth, uppr arm tendon surg ......................................................... .................... .................... .................... .................... ....................

01716 N Anesth, biceps tendon repair ........................................................... .................... .................... .................... .................... ....................

01730 N Anesth, uppr arm procedure ............................................................ .................... .................... .................... .................... ....................

01732 N Anesth, elbow arthroscopy ............................................................... .................... .................... .................... .................... ....................

01740 N Anesth, upper arm surgery .............................................................. .................... .................... .................... .................... ....................

01742 N Anesth, humerus surgery ................................................................. .................... .................... .................... .................... ....................

01744 N Anesth, humerus repair .................................................................... .................... .................... .................... .................... ....................

01756 N Anesth, radical humerus surg .......................................................... .................... .................... .................... .................... ....................

01758 N Anesth, humeral lesion surg ............................................................ .................... .................... .................... .................... ....................

01760 N Anesth, elbow replacement .............................................................. .................... .................... .................... .................... ....................

01770 N Anesth, uppr arm artery surg ........................................................... .................... .................... .................... .................... ....................

01772 N Anesth, uppr arm embolectomy ....................................................... .................... .................... .................... .................... ....................

01780 N Anesth, upper arm vein surg ........................................................... .................... .................... .................... .................... ....................

01782 N Anesth, uppr arm vein repair ........................................................... .................... .................... .................... .................... ....................

01784D N Anesth, av fistula repair ................................................................... .................... .................... .................... .................... ....................

01800 N Anesth, lower arm skin surg ............................................................ .................... .................... .................... .................... ....................

01810 N Anesth, lower arm surgery ............................................................... .................... .................... .................... .................... ....................

01820 N Anesth, lower arm procedure ........................................................... .................... .................... .................... .................... ....................

01830 N Anesth, lower arm surgery ............................................................... .................... .................... .................... .................... ....................

01832 N Anesth, wrist replacement ................................................................ .................... .................... .................... .................... ....................

01840 N Anesth, lwr arm artery surg ............................................................. .................... .................... .................... .................... ....................

01842 N Anesth, lwr arm embolectomy ......................................................... .................... .................... .................... .................... ....................

01844 N Anesth, vascular shunt surg ............................................................ .................... .................... .................... .................... ....................

01850 N Anesth, lower arm vein surg ............................................................ .................... .................... .................... .................... ....................

01852 N Anesth, lwr arm vein repair .............................................................. .................... .................... .................... .................... ....................

01860 N Anesth, lower arm casting ............................................................... .................... .................... .................... .................... ....................

01900 N Anesth, uterus/tube inject ................................................................ .................... .................... .................... .................... ....................

01902 N Anesth, burr holes, skull .................................................................. .................... .................... .................... .................... ....................

01904 N Anesth, skull x-ray inject .................................................................. .................... .................... .................... .................... ....................

01906 N Anesth, lumbar myelography ........................................................... .................... .................... .................... .................... ....................

01908 N Anesth, cervical myelography .......................................................... .................... .................... .................... .................... ....................

01910 N Anesth, skull myelography ............................................................... .................... .................... .................... .................... ....................

01912 N Anesth, lumbar diskography ............................................................ .................... .................... .................... .................... ....................

01914 N Anesth, cervical diskography ........................................................... .................... .................... .................... .................... ....................

01916 N Anesth, head arteriogram ................................................................ .................... .................... .................... .................... ....................

01918 N Anesth, limb arteriogram .................................................................. .................... .................... .................... .................... ....................

01920 N Anesth, catheterize heart ................................................................. .................... .................... .................... .................... ....................

01921 N Anesth, vessel surgery ..................................................................... .................... .................... .................... .................... ....................

01922 N Anesth, cat or MRI scan .................................................................. .................... .................... .................... .................... ....................

*01951 N Anesth, burn, less 1 percent ............................................................ .................... .................... .................... .................... ....................

*01952 N Anesth, burn, 1-9 percent ................................................................ .................... .................... .................... .................... ....................

*01953 N Anesth, burn, each 9 percent .......................................................... .................... .................... .................... .................... ....................

01990 N Support for organ donor ................................................................... .................... .................... .................... .................... ....................

01995 N Regional anesthesia, limb ................................................................ .................... .................... .................... .................... ....................

01996 N Manage daily drug therapy .............................................................. .................... .................... .................... .................... ....................

01999 N Unlisted anesth procedure ............................................................... .................... .................... .................... .................... ....................

10040 T Acne surgery of skin abscess .......................................................... 0006 2.00 $99.19 $33.95 $19.84

10060 T Drainage of skin abscess ................................................................. 0006 2.00 $99.19 $33.95 $19.84

10061 T Drainage of skin abscess ................................................................. 0006 2.00 $99.19 $33.95 $19.84

10080 T Drainage of pilonidal cyst ................................................................. 0006 2.00 $99.19 $33.95 $19.84

10081 T Drainage of pilonidal cyst ................................................................. 0007 3.68 $182.51 $72.03 $36.50

10120 T Remove foreign body ....................................................................... 0006 2.00 $99.19 $33.95 $19.84

10121 T Remove foreign body ....................................................................... 0020 6.51 $322.87 $130.53 $64.57

10140 T Drainage of hematoma/fluid ............................................................. 0007 3.68 $182.51 $72.03 $36.50

10160 T Puncture drainage of lesion ............................................................. 0006 2.00 $99.19 $33.95 $19.84

10180 T Complex drainage, wound ............................................................... 0007 3.68 $182.51 $72.03 $36.50

11000 T Debride infected skin ....................................................................... 0015 1.77 $87.78 $31.20 $17.56

11001 T Debride infected skin add-on ........................................................... 0015 1.77 $87.78 $31.20 $17.56

11010 T Debride skin, fx ................................................................................ 0022 12.49 $619.45 $292.94 $123.89

11011 T Debride skin/muscle, fx .................................................................... 0022 12.49 $619.45 $292.94 $123.89

11012 T Debride skin/muscle/bone, fx ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11040 T Debride skin, partial ......................................................................... 0015 1.77 $87.78 $31.20 $17.56

11041 T Debride skin, full .............................................................................. 0015 1.77 $87.78 $31.20 $17.56

11042 T Debride skin/tissue ........................................................................... 0016 3.53 $175.07 $74.67 $35.01

11043 T Debride tissue/muscle ...................................................................... 0016 3.53 $175.07 $74.67 $35.01

11044 T Debride tissue/muscle/bone ............................................................. 0017 12.45 $617.47 $289.16 $123.49

11055 T Trim skin lesion ................................................................................ 0015 1.77 $87.78 $31.20 $17.56

11056 T Trim skin lesions, 2 to 4 ................................................................... 0015 1.77 $87.78 $31.20 $17.56

11057 T Trim skin lesions, over 4 .................................................................. 0015 1.77 $87.78 $31.20 $17.56

11100 T Biopsy of skin lesion ........................................................................ 0018 0.94 $46.62 $17.66 $9.32

11101 T Biopsy, skin add-on .......................................................................... 0018 0.94 $46.62 $17.66 $9.32

67850

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

11200 T Removal of skin tags ....................................................................... 0015 1.77 $87.78 $31.20 $17.56

11201 T Remove skin tags add-on ................................................................ 0015 1.77 $87.78 $31.20 $17.56

11300 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11301 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11302 T Shave skin lesion ............................................................................. 0014 1.50 $74.39 $24.55 $14.88

11303 T Shave skin lesion ............................................................................. 0015 1.77 $87.78 $31.20 $17.56

11305 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11306 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11307 T Shave skin lesion ............................................................................. 0014 1.50 $74.39 $24.55 $14.88

11308 T Shave skin lesion ............................................................................. 0015 1.77 $87.78 $31.20 $17.56

11310 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11311 T Shave skin lesion ............................................................................. 0013 0.91 $45.13 $17.66 $9.03

11312 T Shave skin lesion ............................................................................. 0015 1.77 $87.78 $31.20 $17.56

11313 T Shave skin lesion ............................................................................. 0016 3.53 $175.07 $74.67 $35.01

11400 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11401 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11402 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11403 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11404 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11406 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11420 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11421 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11422 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11423 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11424 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11426 T Removal of skin lesion ..................................................................... 0022 12.49 $619.45 $292.94 $123.89

11440 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11441 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11442 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11443 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11444 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11446 T Removal of skin lesion ..................................................................... 0022 12.49 $619.45 $292.94 $123.89

11450 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11451 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11462 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11463 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11470 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11471 T Removal, sweat gland lesion ........................................................... 0022 12.49 $619.45 $292.94 $123.89

11600 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11601 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11602 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11603 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11604 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11606 T Removal of skin lesion ..................................................................... 0021 10.49 $520.26 $236.51 $104.05

11620 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11621 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11622 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11623 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11624 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11626 T Removal of skin lesion ..................................................................... 0022 12.49 $619.45 $292.94 $123.89

11640 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11641 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11642 T Removal of skin lesion ..................................................................... 0019 4.00 $198.39 $78.91 $39.68

11643 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11644 T Removal of skin lesion ..................................................................... 0020 6.51 $322.87 $130.53 $64.57

11646 T Removal of skin lesion ..................................................................... 0022 12.49 $619.45 $292.94 $123.89

11719 T Trim nail(s) ....................................................................................... 0009 0.74 $36.70 $9.63 $7.34

11720 T Debride nail, 1-5 ............................................................................... 0009 0.74 $36.70 $9.63 $7.34

11721 T Debride nail, 6 or more .................................................................... 0009 0.74 $36.70 $9.63 $7.34

11730 T Removal of nail plate ....................................................................... 0013 0.91 $45.13 $17.66 $9.03

11732 T Remove nail plate, add-on ............................................................... 0012 0.53 $26.29 $9.18 $5.26

11740 T Drain blood from under nail ............................................................. 0009 0.74 $36.70 $9.63 $7.34

11750 T Removal of nail bed ......................................................................... 0019 4.00 $198.39 $78.91 $39.68

11752 T Remove nail bed/finger tip ............................................................... 0022 12.49 $619.45 $292.94 $123.89

11755 T Biopsy, nail unit ................................................................................ 0019 4.00 $198.39 $78.91 $39.68

11760 T Repair of nail bed ............................................................................. 0024 2.43 $120.51 $44.50 $24.10

11762 T Reconstruction of nail bed ............................................................... 0024 2.43 $120.51 $44.50 $24.10

11765 T Excision of nail fold, toe ................................................................... 0015 1.77 $87.78 $31.20 $17.56

11770 T Removal of pilonidal lesion .............................................................. 0021 10.49 $520.26 $236.51 $104.05

11771 T Removal of pilonidal lesion .............................................................. 0022 12.49 $619.45 $292.94 $123.89

11772 T Removal of pilonidal lesion .............................................................. 0022 12.49 $619.45 $292.94 $123.89

11900 T Injection into skin lesions ................................................................. 0012 0.53 $26.29 $9.18 $5.26

11901 T Added skin lesions injection ............................................................. 0013 0.91 $45.13 $17.66 $9.03

11920 T Correct skin color defects ................................................................ 0024 2.43 $120.51 $44.50 $24.10

67851

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

11921 T Correct skin color defects ................................................................ 0024 2.43 $120.51 $44.50 $24.10

11922 T Correct skin color defects ................................................................ 0024 2.43 $120.51 $44.50 $24.10

11950 T Therapy for contour defects ............................................................. 0024 2.43 $120.51 $44.50 $24.10

11951 T Therapy for contour defects ............................................................. 0024 2.43 $120.51 $44.50 $24.10

11952 T Therapy for contour defects ............................................................. 0024 2.43 $120.51 $44.50 $24.10

11954 T Therapy for contour defects ............................................................. 0024 2.43 $120.51 $44.50 $24.10

11960 T Insert tissue expander(s) ................................................................. 0026 12.11 $600.61 $277.92 $120.12

11970 T Replace tissue expander ................................................................. 0026 12.11 $600.61 $277.92 $120.12

11971 T Remove tissue expander(s) ............................................................. 0022 12.49 $619.45 $292.94 $123.89

11975 E Insert contraceptive cap ................................................................... .................... .................... .................... .................... ....................

11976 T Removal of contraceptive cap ......................................................... 0019 4.00 $198.39 $78.91 $39.68

11977 E Removal/reinsert contra cap ............................................................ .................... .................... .................... .................... ....................

11980 X Implant hormone pellet(s) ................................................................ 0340 1.04 $51.58 $12.85 $10.32

12001 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12002 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12004 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12005 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12006 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12007 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12011 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12013 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12014 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12015 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12016 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12017 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12018 T Repair superficial wound(s) ............................................................. 0024 2.43 $120.51 $44.50 $24.10

12020 T Closure of split wound ..................................................................... 0024 2.43 $120.51 $44.50 $24.10

12021 T Closure of split wound ..................................................................... 0024 2.43 $120.51 $44.50 $24.10

12031 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12032 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12034 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12035 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12036 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12037 T Layer closure of wound(s) ............................................................... 0026 12.11 $600.61 $277.92 $120.12

12041 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12042 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12044 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12045 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12046 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12047 T Layer closure of wound(s) ............................................................... 0026 12.11 $600.61 $277.92 $120.12

12051 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12052 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12053 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12054 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12055 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12056 T Layer closure of wound(s) ............................................................... 0024 2.43 $120.51 $44.50 $24.10

12057 T Layer closure of wound(s) ............................................................... 0026 12.11 $600.61 $277.92 $120.12

13100 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13101 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13102 T Repair wound/lesion add-on ............................................................ 0025 3.74 $185.49 $70.66 $37.10

13120 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13121 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13122 T Repair wound/lesion add-on ............................................................ 0025 3.74 $185.49 $70.66 $37.10

13131 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13132 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13133 T Repair wound/lesion add-on ............................................................ 0025 3.74 $185.49 $70.66 $37.10

13150 T Repair of wound or lesion ................................................................ 0026 12.11 $600.61 $277.92 $120.12

13151 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13152 T Repair of wound or lesion ................................................................ 0025 3.74 $185.49 $70.66 $37.10

13153 T Repair wound/lesion add-on ............................................................ 0025 3.74 $185.49 $70.66 $37.10

13160 T Late closure of wound ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

14000 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14001 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14020 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14021 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14040 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14041 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14060 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14061 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14300 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

14350 T Skin tissue rearrangement ............................................................... 0026 12.11 $600.61 $277.92 $120.12

15000 T Skin graft .......................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15001 T Skin graft add-on .............................................................................. 0026 12.11 $600.61 $277.92 $120.12

15050 T Skin pinch graft ................................................................................ 0026 12.11 $600.61 $277.92 $120.12

67852

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

15100 T Skin split graft .................................................................................. 0026 12.11 $600.61 $277.92 $120.12

15101 T Skin split graft add-on ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15120 T Skin split graft .................................................................................. 0026 12.11 $600.61 $277.92 $120.12

15121 T Skin split graft add-on ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15200 T Skin full graft .................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15201 T Skin full graft add-on ........................................................................ 0026 12.11 $600.61 $277.92 $120.12

15220 T Skin full graft .................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15221 T Skin full graft add-on ........................................................................ 0026 12.11 $600.61 $277.92 $120.12

15240 T Skin full graft .................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15241 T Skin full graft add-on ........................................................................ 0026 12.11 $600.61 $277.92 $120.12

15260 T Skin full graft .................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15261 T Skin full graft add-on ........................................................................ 0026 12.11 $600.61 $277.92 $120.12

*15342 T Cultured skin graft, 25 cm ................................................................ 0025 3.74 $185.49 $70.66 $37.10

*15343 T Culture skin graft addl 25 cm ........................................................... 0025 3.74 $185.49 $70.66 $37.10

15350 T Skin homograft ................................................................................. 0026 12.11 $600.61 $277.92 $120.12

15351 T Skin homograft add-on ..................................................................... 0026 12.11 $600.61 $277.92 $120.12

15400 T Skin heterograft ................................................................................ 0026 12.11 $600.61 $277.92 $120.12

15401 T Skin heterograft add-on ................................................................... 0026 12.11 $600.61 $277.92 $120.12

15570 T Form skin pedicle flap ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15572 T Form skin pedicle flap ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15574 T Form skin pedicle flap ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15576 T Form skin pedicle flap ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

15600 T Skin graft .......................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15610 T Skin graft .......................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15620 T Skin graft .......................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15630 T Skin graft .......................................................................................... 0026 12.11 $600.61 $277.92 $120.12

15650 T Transfer skin pedicle flap ................................................................. 0026 12.11 $600.61 $277.92 $120.12

15732 T Muscle-skin graft, head/neck ........................................................... 0027 15.80 $783.62 $383.10 $156.72

15734 T Muscle-skin graft, trunk .................................................................... 0027 15.80 $783.62 $383.10 $156.72

15736 T Muscle-skin graft, arm ...................................................................... 0027 15.80 $783.62 $383.10 $156.72

15738 T Muscle-skin graft, leg ....................................................................... 0027 15.80 $783.62 $383.10 $156.72

15740 T Island pedicle flap graft .................................................................... 0027 15.80 $783.62 $383.10 $156.72

15750 T Neurovascular pedicle graft ............................................................. 0027 15.80 $783.62 $383.10 $156.72

15756 C Free muscle flap, microvasc ............................................................ .................... .................... .................... .................... ....................

15757 C Free skin flap, microvasc ................................................................. .................... .................... .................... .................... ....................

15758 C Free fascial flap, microvasc ............................................................. .................... .................... .................... .................... ....................

15760 T Composite skin graft ........................................................................ 0027 15.80 $783.62 $383.10 $156.72

15770 T Derma-fat-fascia graft ...................................................................... 0027 15.80 $783.62 $383.10 $156.72

15775 T Hair transplant punch grafts ............................................................. 0026 12.11 $600.61 $277.92 $120.12

15776 T Hair transplant punch grafts ............................................................. 0026 12.11 $600.61 $277.92 $120.12

15780 T Abrasion treatment of skin ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15781 T Abrasion treatment of skin ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15782 T Abrasion treatment of skin ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15783 T Abrasion treatment of skin ............................................................... 0015 1.77 $87.78 $31.20 $17.56

15786 T Abrasion, lesion, single .................................................................... 0013 0.91 $45.13 $17.66 $9.03

15787 T Abrasion, lesions, add-on ................................................................ 0016 3.53 $175.07 $74.67 $35.01

15788 T Chemical peel, face, epiderm .......................................................... 0013 0.91 $45.13 $17.66 $9.03

15789 T Chemical peel, face, dermal ............................................................ 0015 1.77 $87.78 $31.20 $17.56

15792 T Chemical peel, nonfacial .................................................................. 0016 3.53 $175.07 $74.67 $35.01

15793 T Chemical peel, nonfacial .................................................................. 0016 3.53 $175.07 $74.67 $35.01

15810 T Salabrasion ...................................................................................... 0016 3.53 $175.07 $74.67 $35.01

15811 T Salabrasion ...................................................................................... 0022 12.49 $619.45 $292.94 $123.89

15819 T Plastic surgery, neck ........................................................................ 0026 12.11 $600.61 $277.92 $120.12

15820 T Revision of lower eyelid ................................................................... 0026 12.11 $600.61 $277.92 $120.12

15821 T Revision of lower eyelid ................................................................... 0026 12.11 $600.61 $277.92 $120.12

15822 T Revision of upper eyelid .................................................................. 0026 12.11 $600.61 $277.92 $120.12

15823 T Revision of upper eyelid .................................................................. 0026 12.11 $600.61 $277.92 $120.12

15824 T Removal of forehead wrinkles ......................................................... 0027 15.80 $783.62 $383.10 $156.72

15825 T Removal of neck wrinkles ................................................................ 0026 12.11 $600.61 $277.92 $120.12

15826 T Removal of brow wrinkles ................................................................ 0027 15.80 $783.62 $383.10 $156.72

15828 T Removal of face wrinkles ................................................................. 0027 15.80 $783.62 $383.10 $156.72

15829 T Removal of skin wrinkles ................................................................. 0026 12.11 $600.61 $277.92 $120.12

15831 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15832 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15833 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15834 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15835 T Excise excessive skin tissue ............................................................ 0026 12.11 $600.61 $277.92 $120.12

15836 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15837 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15838 T Excise excessive skin tissue ............................................................ 0022 12.49 $619.45 $292.94 $123.89

15839 T Excise excessive skin tissue ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15840 T Graft for face nerve palsy ................................................................ 0027 15.80 $783.62 $383.10 $156.72

15841 T Graft for face nerve palsy ................................................................ 0027 15.80 $783.62 $383.10 $156.72

15842 T Graft for face nerve palsy ................................................................ 0027 15.80 $783.62 $383.10 $156.72

67853

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

15845 T Skin and muscle repair, face ........................................................... 0027 15.80 $783.62 $383.10 $156.72

15850 T Removal of sutures .......................................................................... 0013 0.91 $45.13 $17.66 $9.03

15851 T Removal of sutures .......................................................................... 0013 0.91 $45.13 $17.66 $9.03

15852 T Dressing change,not for burn .......................................................... 0012 0.53 $26.29 $9.18 $5.26

15860 N Test for blood flow in graft ............................................................... .................... .................... .................... .................... ....................

15876 T Suction assisted lipectomy ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15877 T Suction assisted lipectomy ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15878 T Suction assisted lipectomy ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15879 T Suction assisted lipectomy ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15920 T Removal of tail bone ulcer ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15922 T Removal of tail bone ulcer ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15931 T Remove sacrum pressure sore ........................................................ 0022 12.49 $619.45 $292.94 $123.89

15933 T Remove sacrum pressure sore ........................................................ 0022 12.49 $619.45 $292.94 $123.89

15934 T Remove sacrum pressure sore ........................................................ 0027 15.80 $783.62 $383.10 $156.72

15935 T Remove sacrum pressure sore ........................................................ 0027 15.80 $783.62 $383.10 $156.72

15936 T Remove sacrum pressure sore ........................................................ 0027 15.80 $783.62 $383.10 $156.72

15937 T Remove sacrum pressure sore ........................................................ 0027 15.80 $783.62 $383.10 $156.72

15940 T Remove hip pressure sore ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15941 T Remove hip pressure sore ............................................................... 0022 12.49 $619.45 $292.94 $123.89

15944 T Remove hip pressure sore ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15945 T Remove hip pressure sore ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15946 T Remove hip pressure sore ............................................................... 0027 15.80 $783.62 $383.10 $156.72

15950 T Remove thigh pressure sore ............................................................ 0022 12.49 $619.45 $292.94 $123.89

15951 T Remove thigh pressure sore ............................................................ 0022 12.49 $619.45 $292.94 $123.89

15952 T Remove thigh pressure sore ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15953 T Remove thigh pressure sore ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15956 T Remove thigh pressure sore ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15958 T Remove thigh pressure sore ............................................................ 0027 15.80 $783.62 $383.10 $156.72

15999 T Removal of pressure sore ................................................................ 0022 12.49 $619.45 $292.94 $123.89

16000 T Initial treatment of burn(s) ................................................................ 0015 1.77 $87.78 $31.20 $17.56

16010 T Treatment of burn(s) ........................................................................ 0015 1.77 $87.78 $31.20 $17.56

16015 T Treatment of burn(s) ........................................................................ 0017 12.45 $617.47 $289.16 $123.49

16020 T Treatment of burn(s) ........................................................................ 0015 1.77 $87.78 $31.20 $17.56

16025 T Treatment of burn(s) ........................................................................ 0014 1.50 $74.39 $24.55 $14.88

16030 T Treatment of burn(s) ........................................................................ 0015 1.77 $87.78 $31.20 $17.56

16035 C Incision of burn scab, initl ................................................................ .................... .................... .................... .................... ....................

*16036 C Incise burn scab, addl incis ............................................................. .................... .................... .................... .................... ....................

17000 T Destroy benign/premal lesion .......................................................... 0010 0.55 $27.28 $9.86 $5.46

17003 T Destroy lesions, 2-14 ....................................................................... 0010 0.55 $27.28 $9.86 $5.46

17004 T Destroy lesions, 15 or more ............................................................. 0011 2.72 $134.90 $50.01 $26.98

17106 T Destruction of skin lesions ............................................................... 0011 2.72 $134.90 $50.01 $26.98

17107 T Destruction of skin lesions ............................................................... 0011 2.72 $134.90 $50.01 $26.98

17108 T Destruction of skin lesions ............................................................... 0011 2.72 $134.90 $50.01 $26.98

17110 T Destruct lesion, 1-14 ........................................................................ 0010 0.55 $27.28 $9.86 $5.46

17111 T Destruct lesion, 15 or more ............................................................. 0011 2.72 $134.90 $50.01 $26.98

17250 T Chemical cautery, tissue .................................................................. 0014 1.50 $74.39 $24.55 $14.88

17260 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17261 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17262 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17263 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17264 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17266 T Destruction of skin lesions ............................................................... 0016 3.53 $175.07 $74.67 $35.01

17270 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17271 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17272 T Destruction of skin lesions ............................................................... 0013 0.91 $45.13 $17.66 $9.03

17273 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17274 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17276 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17280 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17281 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17282 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17283 T Destruction of skin lesions ............................................................... 0015 1.77 $87.78 $31.20 $17.56

17284 T Destruction of skin lesions ............................................................... 0016 3.53 $175.07 $74.67 $35.01

17286 T Destruction of skin lesions ............................................................... 0016 3.53 $175.07 $74.67 $35.01

17304 T Chemosurgery of skin lesion ........................................................... 0020 6.51 $322.87 $130.53 $64.57

17305 T 2nd stage chemosurgery ................................................................. 0020 6.51 $322.87 $130.53 $64.57

17306 T 3rd stage chemosurgery .................................................................. 0020 6.51 $322.87 $130.53 $64.57

17307 T Followup skin lesion therapy ............................................................ 0020 6.51 $322.87 $130.53 $64.57

17310 T Extensive skin chemosurgery .......................................................... 0020 6.51 $322.87 $130.53 $64.57

17340 T Cryotherapy of skin .......................................................................... 0012 0.53 $26.29 $9.18 $5.26

17360 T Skin peel therapy ............................................................................. 0016 3.53 $175.07 $74.67 $35.01

17380 T Hair removal by electrolysis ............................................................. 0016 3.53 $175.07 $74.67 $35.01

17999 T Skin tissue procedure ...................................................................... 0004 1.84 $91.26 $32.57 $18.25

19000 T Drainage of breast lesion ................................................................. 0004 1.84 $91.26 $32.57 $18.25

67854

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

19001 T Drain breast lesion add-on ............................................................... 0004 1.84 $91.26 $32.57 $18.25

19020 T Incision of breast lesion ................................................................... 0008 6.15 $305.02 $113.67 $61.00

19030 N Injection for breast x-ray .................................................................. .................... .................... .................... .................... ....................

19100 T Bx breast percut w/o image ............................................................. 0005 5.41 $268.32 $119.75 $53.66

19101 T Biopsy of breast, open ..................................................................... 0028 12.37 $613.52 $303.74 $122.70

*19102 T Bx breast percut w/ image ............................................................... 0005 5.41 $268.32 $119.75 $53.66

*19103 S Bx breast percut w/device ................................................................ 0974 8.25 $409.17 .................... $81.83

19110 T Nipple exploration ............................................................................ 0028 12.37 $613.52 $303.74 $122.70

19112 T Excise breast duct fistula ................................................................. 0028 12.37 $613.52 $303.74 $122.70

19120 T Removal of breast lesion ................................................................. 0028 12.37 $613.52 $303.74 $122.70

19125 T Excision, breast lesion ..................................................................... 0028 12.37 $613.52 $303.74 $122.70

19126 T Excision, addl breast lesion ............................................................. 0028 12.37 $613.52 $303.74 $122.70

19140 T Removal of breast tissue ................................................................. 0028 12.37 $613.52 $303.74 $122.70

19160 T Removal of breast tissue ................................................................. 0028 12.37 $613.52 $303.74 $122.70

19162 T Remove breast tissue, nodes .......................................................... 0029 31.39 $1,557.05 $820.79 $311.41

19180 T Removal of breast ............................................................................ 0029 31.39 $1,557.05 $820.79 $311.41

19182 T Removal of breast ............................................................................ 0028 12.37 $613.52 $303.74 $122.70

19200 C Removal of breast ............................................................................ .................... .................... .................... .................... ....................

19220 C Removal of breast ............................................................................ .................... .................... .................... .................... ....................

19240 T Removal of breast ............................................................................ 0029 31.39 $1,557.05 $820.79 $311.41

19260 T Removal of chest wall lesion ........................................................... 0021 10.49 $520.26 $236.51 $104.05

19271 C Revision of chest wall ...................................................................... .................... .................... .................... .................... ....................

19272 C Extensive chest wall surgery ........................................................... .................... .................... .................... .................... ....................

19290 T Place needle wire, breast ................................................................ 0028 12.37 $613.52 $303.74 $122.70

19291 T Place needle wire, breast ................................................................ 0028 12.37 $613.52 $303.74 $122.70

*19295 S Place breast clip, percut .................................................................. 0971 1.55 $76.88 .................... $15.38

19316 T Suspension of breast ....................................................................... 0029 31.39 $1,557.05 $820.79 $311.41

19318 T Reduction of large breast ................................................................. 0029 31.39 $1,557.05 $820.79 $311.41

19324 T Enlarge breast .................................................................................. 0029 31.39 $1,557.05 $820.79 $311.41

19325 T Enlarge breast with implant ............................................................. 0030 31.11 $1,543.16 $763.55 $308.63

19328 T Removal of breast implant ............................................................... 0028 12.37 $613.52 $303.74 $122.70

19330 T Removal of implant material ............................................................ 0028 12.37 $613.52 $303.74 $122.70

19340 T Immediate breast prosthesis ............................................................ 0030 31.11 $1,543.16 $763.55 $308.63

19342 T Delayed breast prosthesis ............................................................... 0030 31.11 $1,543.16 $763.55 $308.63

19350 T Breast reconstruction ....................................................................... 0028 12.37 $613.52 $303.74 $122.70

19355 T Correct inverted nipple(s) ................................................................. 0028 12.37 $613.52 $303.74 $122.70

19357 T Breast reconstruction ....................................................................... 0030 31.11 $1,543.16 $763.55 $308.63

19361 C Breast reconstruction ....................................................................... .................... .................... .................... .................... ....................

19364 C Breast reconstruction ....................................................................... .................... .................... .................... .................... ....................

19366 T Breast reconstruction ....................................................................... 0029 31.39 $1,557.05 $820.79 $311.41

19367 C Breast reconstruction ....................................................................... .................... .................... .................... .................... ....................

19368 C Breast reconstruction ....................................................................... .................... .................... .................... .................... ....................

19369 C Breast reconstruction ....................................................................... .................... .................... .................... .................... ....................

19370 T Surgery of breast capsule ................................................................ 0028 12.37 $613.52 $303.74 $122.70

19371 T Removal of breast capsule .............................................................. 0029 31.39 $1,557.05 $820.79 $311.41

19380 T Revise breast reconstruction ........................................................... 0029 31.39 $1,557.05 $820.79 $311.41

19396 T Design custom breast implant ......................................................... 0028 12.37 $613.52 $303.74 $122.70

19499 T Breast surgery procedure ................................................................ 0004 1.84 $91.26 $32.57 $18.25

20000 T Incision of abscess ........................................................................... 0006 2.00 $99.19 $33.95 $19.84

20005 T Incision of deep abscess ................................................................. 0049 15.04 $745.93 $356.95 $149.19

20100 T Explore wound, neck ........................................................................ 0023 1.98 $98.20 $40.37 $19.64

20101 T Explore wound, chest ....................................................................... 0026 12.11 $600.61 $277.92 $120.12

20102 T Explore wound, abdomen ................................................................ 0026 12.11 $600.61 $277.92 $120.12

20103 T Explore wound, extremity ................................................................. 0023 1.98 $98.20 $40.37 $19.64

20150 T Excise epiphyseal bar ...................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

20200 T Muscle biopsy .................................................................................. 0020 6.51 $322.87 $130.53 $64.57

20205 T Deep muscle biopsy ......................................................................... 0021 10.49 $520.26 $236.51 $104.05

20206 T Needle biopsy, muscle ..................................................................... 0005 5.41 $268.32 $119.75 $53.66

20220 T Bone biopsy, trocar/needle .............................................................. 0019 4.00 $198.39 $78.91 $39.68

20225 T Bone biopsy, trocar/needle .............................................................. 0020 6.51 $322.87 $130.53 $64.57

20240 T Bone biopsy, excisional ................................................................... 0022 12.49 $619.45 $292.94 $123.89

20245 T Bone biopsy, excisional ................................................................... 0022 12.49 $619.45 $292.94 $123.89

20250 T Open bone biopsy ............................................................................ 0049 15.04 $745.93 $356.95 $149.19

20251 T Open bone biopsy ............................................................................ 0049 15.04 $745.93 $356.95 $149.19

20500 T Injection of sinus tract ...................................................................... 0252 5.18 $256.90 $114.24 $51.38

20501 N Inject sinus tract for x-ray ................................................................ .................... .................... .................... .................... ....................

20520 T Removal of foreign body .................................................................. 0019 4.00 $198.39 $78.91 $39.68

20525 T Removal of foreign body .................................................................. 0022 12.49 $619.45 $292.94 $123.89

20550 T Inject tendon/ligament/cyst ............................................................... 0040 2.11 $104.65 $40.60 $20.93

20600 T Drain/inject, joint/bursa ..................................................................... 0040 2.11 $104.65 $40.60 $20.93

20605 T Drain/inject, joint/bursa ..................................................................... 0040 2.11 $104.65 $40.60 $20.93

20610 T Drain/inject, joint/bursa ..................................................................... 0040 2.11 $104.65 $40.60 $20.93

20615 T Treatment of bone cyst .................................................................... 0004 1.84 $91.26 $32.57 $18.25

20650 T Insert and remove bone pin ............................................................. 0049 15.04 $745.93 $356.95 $149.19

67855

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

20660 C Apply,remove fixation device ........................................................... .................... .................... .................... .................... ....................

20661 C Application of head brace ................................................................ .................... .................... .................... .................... ....................

20662 C Application of pelvis brace ............................................................... .................... .................... .................... .................... ....................

20663 C Application of thigh brace ................................................................ .................... .................... .................... .................... ....................

20664 C Halo brace application ..................................................................... .................... .................... .................... .................... ....................

20665 N Removal of fixation device ............................................................... .................... .................... .................... .................... ....................

20670 T Removal of support implant ............................................................. 0021 10.49 $520.26 $236.51 $104.05

20680 T Removal of support implant ............................................................. 0022 12.49 $619.45 $292.94 $123.89

20690 T Apply bone fixation device ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

20692 T Apply bone fixation device ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

20693 T Adjust bone fixation device .............................................................. 0049 15.04 $745.93 $356.95 $149.19

20694 T Remove bone fixation device ........................................................... 0049 15.04 $745.93 $356.95 $149.19

20802 C Replantation, arm, complete ............................................................ .................... .................... .................... .................... ....................

20805 C Replant, forearm, complete .............................................................. .................... .................... .................... .................... ....................

20808 C Replantation hand, complete ........................................................... .................... .................... .................... .................... ....................

20816 C Replantation digit, complete ............................................................. .................... .................... .................... .................... ....................

20822 C Replantation digit, complete ............................................................. .................... .................... .................... .................... ....................

20824 C Replantation thumb, complete ......................................................... .................... .................... .................... .................... ....................

20827 C Replantation thumb, complete ......................................................... .................... .................... .................... .................... ....................

20838 C Replantation foot, complete ............................................................. .................... .................... .................... .................... ....................

20900 T Removal of bone for graft ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

20902 T Removal of bone for graft ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

20910 T Remove cartilage for graft ............................................................... 0026 12.11 $600.61 $277.92 $120.12

20912 T Remove cartilage for graft ............................................................... 0026 12.11 $600.61 $277.92 $120.12

20920 T Removal of fascia for graft ............................................................... 0026 12.11 $600.61 $277.92 $120.12

20922 T Removal of fascia for graft ............................................................... 0026 12.11 $600.61 $277.92 $120.12

20924 T Removal of tendon for graft ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

20926 T Removal of tissue for graft ............................................................... 0026 12.11 $600.61 $277.92 $120.12

20930 C Spinal bone allograft ........................................................................ .................... .................... .................... .................... ....................

20931 C Spinal bone allograft ........................................................................ .................... .................... .................... .................... ....................

20936 C Spinal bone autograft ....................................................................... .................... .................... .................... .................... ....................

20937 C Spinal bone autograft ....................................................................... .................... .................... .................... .................... ....................

20938 C Spinal bone autograft ....................................................................... .................... .................... .................... .................... ....................

20950 T Fluid pressure, muscle ..................................................................... 0008 6.15 $305.02 $113.67 $61.00

20955 C Fibula bone graft, microvasc ............................................................ .................... .................... .................... .................... ....................

20956 C Iliac bone graft, microvasc ............................................................... .................... .................... .................... .................... ....................

20957 C Mt bone graft, microvasc ................................................................. .................... .................... .................... .................... ....................

20962 C Other bone graft, microvasc ............................................................ .................... .................... .................... .................... ....................

20969 C Bone/skin graft, microvasc ............................................................... .................... .................... .................... .................... ....................

20970 C Bone/skin graft, iliac crest ................................................................ .................... .................... .................... .................... ....................

20972 C Bone/skin graft, metatarsal .............................................................. .................... .................... .................... .................... ....................

20973 C Bone/skin graft, great toe ................................................................. .................... .................... .................... .................... ....................

20974 A Electrical bone stimulation ............................................................... .................... .................... .................... .................... ....................

20975 T Electrical bone stimulation ............................................................... 0049 15.04 $745.93 $356.95 $149.19

20979 E Us bone stimulation ......................................................................... .................... .................... .................... .................... ....................

20999 N Musculoskeletal surgery ................................................................... .................... .................... .................... .................... ....................

21010 T Incision of jaw joint ........................................................................... 0254 12.45 $617.47 $272.41 $123.49

21015 T Resection of facial tumor ................................................................. 0254 12.45 $617.47 $272.41 $123.49

21025 T Excision of bone, lower jaw ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21026 T Excision of facial bone(s) ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21029 T Contour of face bone lesion ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21030 T Removal of face bone lesion ........................................................... 0254 12.45 $617.47 $272.41 $123.49

21031 T Remove exostosis, mandible ........................................................... 0253 12.02 $596.14 $284.00 $119.23

21032 T Remove exostosis, maxilla .............................................................. 0253 12.02 $596.14 $284.00 $119.23

21034 T Removal of face bone lesion ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21040 T Removal of jaw bone lesion ............................................................. 0253 12.02 $596.14 $284.00 $119.23

21041 T Removal of jaw bone lesion ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21044 T Removal of jaw bone lesion ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21045 C Extensive jaw surgery ...................................................................... .................... .................... .................... .................... ....................

21050 T Removal of jaw joint ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21060 T Remove jaw joint cartilage ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21070 T Remove coronoid process ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21076 T Prepare face/oral prosthesis ............................................................ 0254 12.45 $617.47 $272.41 $123.49

21077 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21079 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21080 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21081 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21082 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21083 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21084 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21085 T Prepare face/oral prosthesis ............................................................ 0253 12.02 $596.14 $284.00 $119.23

21086 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21087 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21088 T Prepare face/oral prosthesis ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

67856

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

21089 T Prepare face/oral prosthesis ............................................................ 0253 12.02 $596.14 $284.00 $119.23

21100 T Maxillofacial fixation ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21110 T Interdental fixation ............................................................................ 0254 12.45 $617.47 $272.41 $123.49

21116 N Injection, jaw joint x-ray ................................................................... .................... .................... .................... .................... ....................

21120 T Reconstruction of chin ..................................................................... 0254 12.45 $617.47 $272.41 $123.49

21121 T Reconstruction of chin ..................................................................... 0254 12.45 $617.47 $272.41 $123.49

21122 T Reconstruction of chin ..................................................................... 0254 12.45 $617.47 $272.41 $123.49

21123 T Reconstruction of chin ..................................................................... 0254 12.45 $617.47 $272.41 $123.49

21125 T Augmentation, lower jaw bone ......................................................... 0254 12.45 $617.47 $272.41 $123.49

21127 T Augmentation, lower jaw bone ......................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21137 T Reduction of forehead ...................................................................... 0254 12.45 $617.47 $272.41 $123.49

21138 T Reduction of forehead ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21139 T Reduction of forehead ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21141 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21142 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21143 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21145 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21146 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21147 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21150 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21151 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21154 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21155 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21159 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21160 C Reconstruct midface, lefort .............................................................. .................... .................... .................... .................... ....................

21172 C Reconstruct orbit/forehead ............................................................... .................... .................... .................... .................... ....................

21175 C Reconstruct orbit/forehead ............................................................... .................... .................... .................... .................... ....................

21179 C Reconstruct entire forehead ............................................................. .................... .................... .................... .................... ....................

21180 C Reconstruct entire forehead ............................................................. .................... .................... .................... .................... ....................

21181 T Contour cranial bone lesion ............................................................. 0254 12.45 $617.47 $272.41 $123.49

21182 C Reconstruct cranial bone ................................................................. .................... .................... .................... .................... ....................

21183 C Reconstruct cranial bone ................................................................. .................... .................... .................... .................... ....................

21184 C Reconstruct cranial bone ................................................................. .................... .................... .................... .................... ....................

21188 C Reconstruction of midface ............................................................... .................... .................... .................... .................... ....................

21193 C Reconst lwr jaw w/o graft ................................................................. .................... .................... .................... .................... ....................

21194 C Reconst lwr jaw w/ graft ................................................................... .................... .................... .................... .................... ....................

21195 C Reconst lwr jaw w/o fixation ............................................................ .................... .................... .................... .................... ....................

21196 C Reconst lwr jaw w/fixation ................................................................ .................... .................... .................... .................... ....................

21198 T Reconst lwr jaw segment ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

*21199 T Reconst lwr jaw w/advance ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21206 T Reconstruct upper jaw bone ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21208 T Augmentation of facial bones .......................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21209 T Reduction of facial bones ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21210 T Face bone graft ................................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21215 T Lower jaw bone graft ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21230 T Rib cartilage graft ............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21235 T Ear cartilage graft ............................................................................. 0254 12.45 $617.47 $272.41 $123.49

21240 T Reconstruction of jaw joint ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21242 T Reconstruction of jaw joint ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21243 T Reconstruction of jaw joint ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21244 T Reconstruction of lower jaw ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21245 T Reconstruction of jaw ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21246 T Reconstruction of jaw ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21247 C Reconstruct lower jaw bone ............................................................. .................... .................... .................... .................... ....................

21248 T Reconstruction of jaw ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21249 T Reconstruction of jaw ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21255 C Reconstruct lower jaw bone ............................................................. .................... .................... .................... .................... ....................

21256 C Reconstruction of orbit ..................................................................... .................... .................... .................... .................... ....................

21260 T Revise eye sockets .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21261 T Revise eye sockets .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21263 T Revise eye sockets .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21267 T Revise eye sockets .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21268 C Revise eye sockets .......................................................................... .................... .................... .................... .................... ....................

21270 T Augmentation, cheek bone .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21275 T Revision, orbitofacial bones ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21280 T Revision of eyelid ............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21282 T Revision of eyelid ............................................................................. 0253 12.02 $596.14 $284.00 $119.23

21295 T Revision of jaw muscle/bone ........................................................... 0253 12.02 $596.14 $284.00 $119.23

21296 T Revision of jaw muscle/bone ........................................................... 0254 12.45 $617.47 $272.41 $123.49

21299 T Cranio/maxillofacial surgery ............................................................. 0253 12.02 $596.14 $284.00 $119.23

21300 T Treatment of skull fracture ............................................................... 0253 12.02 $596.14 $284.00 $119.23

21310 T Treatment of nose fracture .............................................................. 0253 12.02 $596.14 $284.00 $119.23

21315 T Treatment of nose fracture .............................................................. 0253 12.02 $596.14 $284.00 $119.23

21320 T Treatment of nose fracture .............................................................. 0253 12.02 $596.14 $284.00 $119.23

67857

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

21325 T Treatment of nose fracture .............................................................. 0253 12.02 $596.14 $284.00 $119.23

21330 T Treatment of nose fracture .............................................................. 0254 12.45 $617.47 $272.41 $123.49

21335 T Treatment of nose fracture .............................................................. 0254 12.45 $617.47 $272.41 $123.49

21336 T Treat nasal septal fracture ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

21337 T Treat nasal septal fracture ............................................................... 0253 12.02 $596.14 $284.00 $119.23

21338 T Treat nasoethmoid fracture .............................................................. 0254 12.45 $617.47 $272.41 $123.49

21339 T Treat nasoethmoid fracture .............................................................. 0254 12.45 $617.47 $272.41 $123.49

21340 T Treatment of nose fracture .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21343 C Treatment of sinus fracture .............................................................. .................... .................... .................... .................... ....................

21344 C Treatment of sinus fracture .............................................................. .................... .................... .................... .................... ....................

21345 T Treat nose/jaw fracture .................................................................... 0254 12.45 $617.47 $272.41 $123.49

21346 C Treat nose/jaw fracture .................................................................... .................... .................... .................... .................... ....................

21347 C Treat nose/jaw fracture .................................................................... .................... .................... .................... .................... ....................

21348 C Treat nose/jaw fracture .................................................................... .................... .................... .................... .................... ....................

21355 T Treat cheek bone fracture ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

21356 C Treat cheek bone fracture ................................................................ .................... .................... .................... .................... ....................

21360 C Treat cheek bone fracture ................................................................ .................... .................... .................... .................... ....................

21365 C Treat cheek bone fracture ................................................................ .................... .................... .................... .................... ....................

21366 C Treat cheek bone fracture ................................................................ .................... .................... .................... .................... ....................

21385 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21386 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21387 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21390 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21395 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21400 T Treat eye socket fracture ................................................................. 0252 5.18 $256.90 $114.24 $51.38

21401 T Treat eye socket fracture ................................................................. 0253 12.02 $596.14 $284.00 $119.23

21406 T Treat eye socket fracture ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21407 T Treat eye socket fracture ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

21408 C Treat eye socket fracture ................................................................. .................... .................... .................... .................... ....................

21421 T Treat mouth roof fracture ................................................................. 0254 12.45 $617.47 $272.41 $123.49

21422 C Treat mouth roof fracture ................................................................. .................... .................... .................... .................... ....................

21423 C Treat mouth roof fracture ................................................................. .................... .................... .................... .................... ....................

21431 C Treat craniofacial fracture ................................................................ .................... .................... .................... .................... ....................

21432 C Treat craniofacial fracture ................................................................ .................... .................... .................... .................... ....................

21433 C Treat craniofacial fracture ................................................................ .................... .................... .................... .................... ....................

21435 C Treat craniofacial fracture ................................................................ .................... .................... .................... .................... ....................

21436 C Treat craniofacial fracture ................................................................ .................... .................... .................... .................... ....................

21440 T Treat dental ridge fracture ............................................................... 0253 12.02 $596.14 $284.00 $119.23

21445 T Treat dental ridge fracture ............................................................... 0254 12.45 $617.47 $272.41 $123.49

21450 T Treat lower jaw fracture ................................................................... 0251 1.68 $83.32 $27.99 $16.66

21451 T Treat lower jaw fracture ................................................................... 0254 12.45 $617.47 $272.41 $123.49

21452 T Treat lower jaw fracture ................................................................... 0253 12.02 $596.14 $284.00 $119.23

21453 T Treat lower jaw fracture ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21454 T Treat lower jaw fracture ................................................................... 0254 12.45 $617.47 $272.41 $123.49

21461 T Treat lower jaw fracture ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21462 T Treat lower jaw fracture ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21465 T Treat lower jaw fracture ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21470 T Treat lower jaw fracture ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21480 T Reset dislocated jaw ........................................................................ 0251 1.68 $83.32 $27.99 $16.66

21485 T Reset dislocated jaw ........................................................................ 0253 12.02 $596.14 $284.00 $119.23

21490 T Repair dislocated jaw ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

21493 T Treat hyoid bone fracture ................................................................. 0252 5.18 $256.90 $114.24 $51.38

21494 T Treat hyoid bone fracture ................................................................. 0252 5.18 $256.90 $114.24 $51.38

21495 C Treat hyoid bone fracture ................................................................. .................... .................... .................... .................... ....................

21497 T Interdental wiring .............................................................................. 0253 12.02 $596.14 $284.00 $119.23

21499 T Head surgery procedure .................................................................. 0253 12.02 $596.14 $284.00 $119.23

21501 T Drain neck/chest lesion .................................................................... 0008 6.15 $305.02 $113.67 $61.00

21502 T Drain chest lesion ............................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

21510 C Drainage of bone lesion ................................................................... .................... .................... .................... .................... ....................

21550 T Biopsy of neck/chest ........................................................................ 0019 4.00 $198.39 $78.91 $39.68

21555 T Remove lesion, neck/chest .............................................................. 0022 12.49 $619.45 $292.94 $123.89

21556 T Remove lesion, neck/chest .............................................................. 0022 12.49 $619.45 $292.94 $123.89

21557 C Remove tumor, neck/chest .............................................................. .................... .................... .................... .................... ....................

21600 T Partial removal of rib ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

21610 T Partial removal of rib ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

21615 C Removal of rib .................................................................................. .................... .................... .................... .................... ....................

21616 C Removal of rib and nerves ............................................................... .................... .................... .................... .................... ....................

21620 C Partial removal of sternum ............................................................... .................... .................... .................... .................... ....................

21627 C Sternal debridement ......................................................................... .................... .................... .................... .................... ....................

21630 C Extensive sternum surgery .............................................................. .................... .................... .................... .................... ....................

21632 C Extensive sternum surgery .............................................................. .................... .................... .................... .................... ....................

21700 T Revision of neck muscle .................................................................. 0008 6.15 $305.02 $113.67 $61.00

21705 C Revision of neck muscle/rib ............................................................. .................... .................... .................... .................... ....................

21720 T Revision of neck muscle .................................................................. 0008 6.15 $305.02 $113.67 $61.00

67858

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

21725 T Revision of neck muscle .................................................................. 0008 6.15 $305.02 $113.67 $61.00

21740 C Reconstruction of sternum ............................................................... .................... .................... .................... .................... ....................

21750 C Repair of sternum separation .......................................................... .................... .................... .................... .................... ....................

21800 T Treatment of rib fracture .................................................................. 0043 1.64 $81.34 $25.46 $16.27

21805 T Treatment of rib fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

21810 C Treatment of rib fracture(s) .............................................................. .................... .................... .................... .................... ....................

21820 T Treat sternum fracture ..................................................................... 0043 1.64 $81.34 $25.46 $16.27

21825 C Treat sternum fracture ..................................................................... .................... .................... .................... .................... ....................

21899 T Neck/chest surgery procedure ......................................................... 0252 5.18 $256.90 $114.24 $51.38

21920 T Biopsy soft tissue of back ................................................................ 0020 6.51 $322.87 $130.53 $64.57

21925 T Biopsy soft tissue of back ................................................................ 0022 12.49 $619.45 $292.94 $123.89

21930 T Remove lesion, back or flank .......................................................... 0022 12.49 $619.45 $292.94 $123.89

21935 T Remove tumor, back ........................................................................ 0022 12.49 $619.45 $292.94 $123.89

22100 C Remove part of neck vertebra ......................................................... .................... .................... .................... .................... ....................

22101 C Remove part, thorax vertebra .......................................................... .................... .................... .................... .................... ....................

22102 C Remove part, lumbar vertebra ......................................................... .................... .................... .................... .................... ....................

22103 C Remove extra spine segment .......................................................... .................... .................... .................... .................... ....................

22110 C Remove part of neck vertebra ......................................................... .................... .................... .................... .................... ....................

22112 C Remove part, thorax vertebra .......................................................... .................... .................... .................... .................... ....................

22114 C Remove part, lumbar vertebra ......................................................... .................... .................... .................... .................... ....................

22116 C Remove extra spine segment .......................................................... .................... .................... .................... .................... ....................

22210 C Revision of neck spine ..................................................................... .................... .................... .................... .................... ....................

22212 C Revision of thorax spine .................................................................. .................... .................... .................... .................... ....................

22214 C Revision of lumbar spine ................................................................. .................... .................... .................... .................... ....................

22216 C Revise, extra spine segment ........................................................... .................... .................... .................... .................... ....................

22220 C Revision of neck spine ..................................................................... .................... .................... .................... .................... ....................

22222 C Revision of thorax spine .................................................................. .................... .................... .................... .................... ....................

22224 C Revision of lumbar spine ................................................................. .................... .................... .................... .................... ....................

22226 C Revise, extra spine segment ........................................................... .................... .................... .................... .................... ....................

22305 T Treat spine process fracture ............................................................ 0043 1.64 $81.34 $25.46 $16.27

22310 T Treat spine fracture .......................................................................... 0043 1.64 $81.34 $25.46 $16.27

22315 T Treat spine fracture .......................................................................... 0043 1.64 $81.34 $25.46 $16.27

22318 C Treat odontoid fx w/o graft ............................................................... .................... .................... .................... .................... ....................

22319 C Treat odontoid fx w/graft .................................................................. .................... .................... .................... .................... ....................

22325 C Treat spine fracture .......................................................................... .................... .................... .................... .................... ....................

22326 C Treat neck spine fracture ................................................................. .................... .................... .................... .................... ....................

22327 C Treat thorax spine fracture ............................................................... .................... .................... .................... .................... ....................

22328 C Treat each add spine fx ................................................................... .................... .................... .................... .................... ....................

22505 T Manipulation of spine ....................................................................... 0045 11.02 $546.55 $277.12 $109.31

*22520 T Percut vertebroplasty thor ................................................................ 0049 15.04 $745.93 $356.95 $149.19

*22521 T Percut vertebroplasty lumb .............................................................. 0049 15.04 $745.93 $356.95 $149.19

*22522 T Percut vertebroplasty addl ............................................................... 0049 15.04 $745.93 $356.95 $149.19

22548 C Neck spine fusion ............................................................................. .................... .................... .................... .................... ....................

22554 C Neck spine fusion ............................................................................. .................... .................... .................... .................... ....................

22556 C Thorax spine fusion .......................................................................... .................... .................... .................... .................... ....................

22558 C Lumbar spine fusion ......................................................................... .................... .................... .................... .................... ....................

22585 C Additional spinal fusion .................................................................... .................... .................... .................... .................... ....................

22590 C Spine & skull spinal fusion ............................................................... .................... .................... .................... .................... ....................

22595 C Neck spinal fusion ............................................................................ .................... .................... .................... .................... ....................

22600 C Neck spine fusion ............................................................................. .................... .................... .................... .................... ....................

22610 C Thorax spine fusion .......................................................................... .................... .................... .................... .................... ....................

22612 C Lumbar spine fusion ......................................................................... .................... .................... .................... .................... ....................

22614 C Spine fusion, extra segment ............................................................ .................... .................... .................... .................... ....................

22630 C Lumbar spine fusion ......................................................................... .................... .................... .................... .................... ....................

22632 C Spine fusion, extra segment ............................................................ .................... .................... .................... .................... ....................

22800 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22802 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22804 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22808 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22810 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22812 C Fusion of spine ................................................................................. .................... .................... .................... .................... ....................

22818 C Kyphectomy, 1-2 segments ............................................................. .................... .................... .................... .................... ....................

22819 C Kyphectomy, 3 or more .................................................................... .................... .................... .................... .................... ....................

22830 C Exploration of spinal fusion .............................................................. .................... .................... .................... .................... ....................

22840 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22841 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22842 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22843 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22844 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22845 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22846 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22847 C Insert spine fixation device .............................................................. .................... .................... .................... .................... ....................

22848 C Insert pelv fixation device ................................................................ .................... .................... .................... .................... ....................

22849 C Reinsert spinal fixation ..................................................................... .................... .................... .................... .................... ....................

67859

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

22850 C Remove spine fixation device .......................................................... .................... .................... .................... .................... ....................

22851 C Apply spine prosth device ................................................................ .................... .................... .................... .................... ....................

22852 C Remove spine fixation device .......................................................... .................... .................... .................... .................... ....................

22855 C Remove spine fixation device .......................................................... .................... .................... .................... .................... ....................

22899 T Spine surgery procedure .................................................................. 0043 1.64 $81.34 $25.46 $16.27

22900 T Remove abdominal wall lesion ........................................................ 0022 12.49 $619.45 $292.94 $123.89

22999 T Abdomen surgery procedure ........................................................... 0022 12.49 $619.45 $292.94 $123.89

23000 T Removal of calcium deposits ........................................................... 0021 10.49 $520.26 $236.51 $104.05

23020 T Release shoulder joint ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23030 T Drain shoulder lesion ....................................................................... 0008 6.15 $305.02 $113.67 $61.00

23031 T Drain shoulder bursa ........................................................................ 0008 6.15 $305.02 $113.67 $61.00

23035 C Drain shoulder bone lesion .............................................................. .................... .................... .................... .................... ....................

23040 T Exploratory shoulder surgery ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23044 T Exploratory shoulder surgery ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23065 T Biopsy shoulder tissues ................................................................... 0021 10.49 $520.26 $236.51 $104.05

23066 T Biopsy shoulder tissues ................................................................... 0022 12.49 $619.45 $292.94 $123.89

23075 T Removal of shoulder lesion ............................................................. 0021 10.49 $520.26 $236.51 $104.05

23076 T Removal of shoulder lesion ............................................................. 0022 12.49 $619.45 $292.94 $123.89

23077 T Remove tumor of shoulder .............................................................. 0022 12.49 $619.45 $292.94 $123.89

23100 T Biopsy of shoulder joint .................................................................... 0049 15.04 $745.93 $356.95 $149.19

23101 T Shoulder joint surgery ...................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23105 T Remove shoulder joint lining ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

23106 T Incision of collarbone joint ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23107 T Explore treat shoulder joint .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23120 T Partial removal, collar bone ............................................................. 0051 27.76 $1,376.79 $675.24 $275.36

23125 C Removal of collar bone .................................................................... .................... .................... .................... .................... ....................

23130 T Remove shoulder bone, part ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23140 T Removal of bone lesion ................................................................... 0049 15.04 $745.93 $356.95 $149.19

23145 T Removal of bone lesion ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23146 T Removal of bone lesion ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23150 T Removal of humerus lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23155 T Removal of humerus lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23156 T Removal of humerus lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23170 T Remove collar bone lesion .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23172 T Remove shoulder blade lesion ........................................................ 0050 21.13 $1,047.96 $513.86 $209.59

23174 T Remove humerus lesion .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23180 T Remove collar bone lesion .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23182 T Remove shoulder blade lesion ........................................................ 0050 21.13 $1,047.96 $513.86 $209.59

23184 T Remove humerus lesion .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23190 T Partial removal of scapula ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23195 C Removal of head of humerus .......................................................... .................... .................... .................... .................... ....................

23200 C Removal of collar bone .................................................................... .................... .................... .................... .................... ....................

23210 C Removal of shoulder blade .............................................................. .................... .................... .................... .................... ....................

23220 C Partial removal of humerus .............................................................. .................... .................... .................... .................... ....................

23221 C Partial removal of humerus .............................................................. .................... .................... .................... .................... ....................

23222 C Partial removal of humerus .............................................................. .................... .................... .................... .................... ....................

23330 T Remove shoulder foreign body ........................................................ 0019 4.00 $198.39 $78.91 $39.68

23331 T Remove shoulder foreign body ........................................................ 0022 12.49 $619.45 $292.94 $123.89

23332 C Remove shoulder foreign body ........................................................ .................... .................... .................... .................... ....................

23350 N Injection for shoulder x-ray .............................................................. .................... .................... .................... .................... ....................

23395 C Muscle transfer,shoulder/arm ........................................................... .................... .................... .................... .................... ....................

23397 C Muscle transfers ............................................................................... .................... .................... .................... .................... ....................

23400 C Fixation of shoulder blade ................................................................ .................... .................... .................... .................... ....................

23405 T Incision of tendon & muscle ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

23406 T Incise tendon(s) & muscle(s) ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

23410 T Repair of tendon(s) .......................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

23412 T Repair of tendon(s) .......................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

23415 T Release of shoulder ligament .......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23420 T Repair of shoulder ............................................................................ 0052 36.16 $1,793.39 $930.91 $358.68

23430 T Repair biceps tendon ....................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

23440 C Remove/transplant tendon ............................................................... .................... .................... .................... .................... ....................

23450 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23455 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23460 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23462 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23465 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23466 T Repair shoulder capsule .................................................................. 0052 36.16 $1,793.39 $930.91 $358.68

23470 C Reconstruct shoulder joint ............................................................... .................... .................... .................... .................... ....................

23472 C Reconstruct shoulder joint ............................................................... .................... .................... .................... .................... ....................

23480 T Revision of collar bone .................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23485 T Revision of collar bone .................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23490 T Reinforce clavicle ............................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

23491 T Reinforce shoulder bones ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

23500 T Treat clavicle fracture ....................................................................... 0043 1.64 $81.34 $25.46 $16.27

67860

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

23505 T Treat clavicle fracture ....................................................................... 0043 1.64 $81.34 $25.46 $16.27

23515 T Treat clavicle fracture ....................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

23520 T Treat clavicle dislocation .................................................................. 0043 1.64 $81.34 $25.46 $16.27

23525 T Treat clavicle dislocation .................................................................. 0043 1.64 $81.34 $25.46 $16.27

23530 T Treat clavicle dislocation .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23532 T Treat clavicle dislocation .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23540 T Treat clavicle dislocation .................................................................. 0043 1.64 $81.34 $25.46 $16.27

23545 T Treat clavicle dislocation .................................................................. 0043 1.64 $81.34 $25.46 $16.27

23550 T Treat clavicle dislocation .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23552 T Treat clavicle dislocation .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23570 T Treat shoulder blade fx .................................................................... 0043 1.64 $81.34 $25.46 $16.27

23575 T Treat shoulder blade fx .................................................................... 0043 1.64 $81.34 $25.46 $16.27

23585 T Treat scapula fracture ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

23600 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

23605 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

23615 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

23616 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

23620 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

23625 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

23630 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

23650 T Treat shoulder dislocation ................................................................ 0043 1.64 $81.34 $25.46 $16.27

23655 T Treat shoulder dislocation ................................................................ 0045 11.02 $546.55 $277.12 $109.31

23660 T Treat shoulder dislocation ................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

23665 T Treat dislocation/fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

23670 T Treat dislocation/fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23675 T Treat dislocation/fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

23680 T Treat dislocation/fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

23700 T Fixation of shoulder .......................................................................... 0045 11.02 $546.55 $277.12 $109.31

23800 T Fusion of shoulder joint .................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23802 T Fusion of shoulder joint .................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

23900 C Amputation of arm & girdle .............................................................. .................... .................... .................... .................... ....................

23920 C Amputation at shoulder joint ............................................................ .................... .................... .................... .................... ....................

23921 T Amputation follow-up surgery .......................................................... 0026 12.11 $600.61 $277.92 $120.12

23929 T Shoulder surgery procedure ............................................................ 0043 1.64 $81.34 $25.46 $16.27

23930 T Drainage of arm lesion ..................................................................... 0008 6.15 $305.02 $113.67 $61.00

23931 T Drainage of arm bursa ..................................................................... 0008 6.15 $305.02 $113.67 $61.00

23935 T Drain arm/elbow bone lesion ........................................................... 0049 15.04 $745.93 $356.95 $149.19

24000 T Exploratory elbow surgery ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24006 T Release elbow joint .......................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24065 T Biopsy arm/elbow soft tissue ........................................................... 0020 6.51 $322.87 $130.53 $64.57

24066 T Biopsy arm/elbow soft tissue ........................................................... 0020 6.51 $322.87 $130.53 $64.57

24075 T Remove arm/elbow lesion ................................................................ 0021 10.49 $520.26 $236.51 $104.05

24076 T Remove arm/elbow lesion ................................................................ 0022 12.49 $619.45 $292.94 $123.89

24077 T Remove tumor of arm/elbow ............................................................ 0022 12.49 $619.45 $292.94 $123.89

24100 T Biopsy elbow joint lining ................................................................... 0049 15.04 $745.93 $356.95 $149.19

24101 T Explore/treat elbow joint ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24102 T Remove elbow joint lining ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24105 T Removal of elbow bursa .................................................................. 0049 15.04 $745.93 $356.95 $149.19

24110 T Remove humerus lesion .................................................................. 0049 15.04 $745.93 $356.95 $149.19

24115 T Remove/graft bone lesion ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24116 T Remove/graft bone lesion ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24120 T Remove elbow lesion ....................................................................... 0049 15.04 $745.93 $356.95 $149.19

24125 T Remove/graft bone lesion ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24126 T Remove/graft bone lesion ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24130 T Removal of head of radius ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24134 T Removal of arm bone lesion ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24136 T Remove radius bone lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24138 T Remove elbow bone lesion .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24140 T Partial removal of arm bone ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24145 T Partial removal of radius .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24147 T Partial removal of elbow .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24149 C Radical resection of elbow ............................................................... .................... .................... .................... .................... ....................

24150 C Extensive humerus surgery ............................................................. .................... .................... .................... .................... ....................

24151 C Extensive humerus surgery ............................................................. .................... .................... .................... .................... ....................

24152 C Extensive radius surgery .................................................................. .................... .................... .................... .................... ....................

24153 C Extensive radius surgery .................................................................. .................... .................... .................... .................... ....................

24155 T Removal of elbow joint ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24160 T Remove elbow joint implant ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24164 T Remove radius head implant ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24200 T Removal of arm foreign body .......................................................... 0019 4.00 $198.39 $78.91 $39.68

24201 T Removal of arm foreign body .......................................................... 0021 10.49 $520.26 $236.51 $104.05

24220 N Injection for elbow x-ray ................................................................... .................... .................... .................... .................... ....................

24301 T Muscle/tendon transfer ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24305 T Arm tendon lengthening ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

67861

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

24310 T Revision of arm tendon .................................................................... 0049 15.04 $745.93 $356.95 $149.19

24320 T Repair of arm tendon ....................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24330 T Revision of arm muscles .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

24331 T Revision of arm muscles .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

24340 T Repair of biceps tendon ................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24341 T Repair arm tendon/muscle ............................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24342 T Repair of ruptured tendon ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

24350 T Repair of tennis elbow ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24351 T Repair of tennis elbow ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24352 T Repair of tennis elbow ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24354 T Repair of tennis elbow ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24356 T Revision of tennis elbow .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

24360 T Reconstruct elbow joint .................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

24361 T Reconstruct elbow joint .................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

24362 T Reconstruct elbow joint .................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

24363 T Replace elbow joint .......................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

24365 T Reconstruct head of radius .............................................................. 0047 22.09 $1,095.58 $537.03 $219.12

24366 T Reconstruct head of radius .............................................................. 0048 29.06 $1,441.26 $725.94 $288.25

24400 T Revision of humerus ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24410 T Revision of humerus ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

24420 T Revision of humerus ........................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

24430 T Repair of humerus ........................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24435 T Repair humerus with graft ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

24470 T Revision of elbow joint ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24495 T Decompression of forearm ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

24498 T Reinforce humerus ........................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

24500 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24505 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24515 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24516 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24530 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24535 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24538 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24545 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24546 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24560 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24565 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24566 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24575 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24576 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24577 T Treat humerus fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24579 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24582 T Treat humerus fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24586 T Treat elbow fracture ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24587 T Treat elbow fracture ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24600 T Treat elbow dislocation .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24605 T Treat elbow dislocation .................................................................... 0045 11.02 $546.55 $277.12 $109.31

24615 T Treat elbow dislocation .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24620 T Treat elbow fracture ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

24635 T Treat elbow fracture ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24640 T Treat elbow dislocation .................................................................... 0044 2.17 $107.63 $38.08 $21.53

24650 T Treat radius fracture ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

24655 T Treat radius fracture ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

24665 T Treat radius fracture ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24666 T Treat radius fracture ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24670 T Treat ulnar fracture .......................................................................... 0044 2.17 $107.63 $38.08 $21.53

24675 T Treat ulnar fracture .......................................................................... 0044 2.17 $107.63 $38.08 $21.53

24685 T Treat ulnar fracture .......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

24800 T Fusion of elbow joint ........................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

24802 T Fusion/graft of elbow joint ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

24900 C Amputation of upper arm ................................................................. .................... .................... .................... .................... ....................

24920 C Amputation of upper arm ................................................................. .................... .................... .................... .................... ....................

24925 T Amputation follow-up surgery .......................................................... 0049 15.04 $745.93 $356.95 $149.19

24930 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

24931 C Amputate upper arm & implant ........................................................ .................... .................... .................... .................... ....................

24935 T Revision of amputation .................................................................... 0052 36.16 $1,793.39 $930.91 $358.68

24940 C Revision of upper arm ...................................................................... .................... .................... .................... .................... ....................

24999 T Upper arm/elbow surgery ................................................................. 0044 2.17 $107.63 $38.08 $21.53

25000 T Incision of tendon sheath ................................................................. 0049 15.04 $745.93 $356.95 $149.19

25020 T Decompression of forearm ............................................................... 0049 15.04 $745.93 $356.95 $149.19

25023 T Decompression of forearm ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25028 T Drainage of forearm lesion .............................................................. 0049 15.04 $745.93 $356.95 $149.19

25031 T Drainage of forearm bursa ............................................................... 0049 15.04 $745.93 $356.95 $149.19

25035 T Treat forearm bone lesion ................................................................ 0049 15.04 $745.93 $356.95 $149.19

67862

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

25040 T Explore/treat wrist joint ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25065 T Biopsy forearm soft tissues .............................................................. 0020 6.51 $322.87 $130.53 $64.57

25066 T Biopsy forearm soft tissues .............................................................. 0022 12.49 $619.45 $292.94 $123.89

25075 T Removal of forearm lesion ............................................................... 0020 6.51 $322.87 $130.53 $64.57

25076 T Removal of forearm lesion ............................................................... 0022 12.49 $619.45 $292.94 $123.89

25077 T Remove tumor, forearm/wrist ........................................................... 0022 12.49 $619.45 $292.94 $123.89

25085 T Incision of wrist capsule ................................................................... 0049 15.04 $745.93 $356.95 $149.19

25100 T Biopsy of wrist joint .......................................................................... 0049 15.04 $745.93 $356.95 $149.19

25101 T Explore/treat wrist joint ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25105 T Remove wrist joint lining .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25107 T Remove wrist joint cartilage ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25110 T Remove wrist tendon lesion ............................................................. 0049 15.04 $745.93 $356.95 $149.19

25111 T Remove wrist tendon lesion ............................................................. 0053 11.32 $561.42 $253.49 $112.28

25112 T Reremove wrist tendon lesion ......................................................... 0053 11.32 $561.42 $253.49 $112.28

25115 T Remove wrist/forearm lesion ........................................................... 0049 15.04 $745.93 $356.95 $149.19

25116 T Remove wrist/forearm lesion ........................................................... 0049 15.04 $745.93 $356.95 $149.19

25118 T Excise wrist tendon sheath .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25119 T Partial removal of ulna ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25120 T Removal of forearm lesion ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25125 T Remove/graft forearm lesion ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25126 T Remove/graft forearm lesion ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25130 T Removal of wrist lesion .................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25135 T Remove & graft wrist lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25136 T Remove & graft wrist lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25145 T Remove forearm bone lesion ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25150 T Partial removal of ulna ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25151 T Partial removal of radius .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25170 C Extensive forearm surgery ............................................................... .................... .................... .................... .................... ....................

25210 T Removal of wrist bone ..................................................................... 0054 19.66 $975.06 $472.33 $195.01

25215 T Removal of wrist bones ................................................................... 0054 19.66 $975.06 $472.33 $195.01

25230 T Partial removal of radius .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25240 T Partial removal of ulna ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25246 N Injection for wrist x-ray ..................................................................... .................... .................... .................... .................... ....................

25248 T Remove forearm foreign body ......................................................... 0049 15.04 $745.93 $356.95 $149.19

25250 T Removal of wrist prosthesis ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25251 T Removal of wrist prosthesis ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25260 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25263 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25265 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25270 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25272 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25274 T Repair forearm tendon/muscle ......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25280 T Revise wrist/forearm tendon ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25290 T Incise wrist/forearm tendon .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

25295 T Release wrist/forearm tendon .......................................................... 0049 15.04 $745.93 $356.95 $149.19

25300 T Fusion of tendons at wrist ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25301 T Fusion of tendons at wrist ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27606 T Incision of achilles tendon ................................................................ 0049 15.04 $745.93 $356.95 $149.19

27607 T Treat lower leg bone lesion ............................................................. 0049 15.04 $745.93 $356.95 $149.19

27610 T Explore/treat ankle joint ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27612 T Exploration of ankle joint .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27613 T Biopsy lower leg soft tissue ............................................................. 0020 6.51 $322.87 $130.53 $64.57

27614 T Biopsy lower leg soft tissue ............................................................. 0022 12.49 $619.45 $292.94 $123.89

27615 T Remove tumor, lower leg ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27618 T Remove lower leg lesion .................................................................. 0021 10.49 $520.26 $236.51 $104.05

27619 T Remove lower leg lesion .................................................................. 0022 12.49 $619.45 $292.94 $123.89

27620 T Explore/treat ankle joint ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27625 T Remove ankle joint lining ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27626 T Remove ankle joint lining ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27630 T Removal of tendon lesion ................................................................ 0049 15.04 $745.93 $356.95 $149.19

27635 T Remove lower leg bone lesion ........................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27637 T Remove/graft leg bone lesion .......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27638 T Remove/graft leg bone lesion .......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27640 T Partial removal of tibia ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27641 T Partial removal of fibula ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27645 C Extensive lower leg surgery ............................................................. .................... .................... .................... .................... ....................

27646 C Extensive lower leg surgery ............................................................. .................... .................... .................... .................... ....................

27647 T Extensive ankle/heel surgery ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27648 N Injection for ankle x-ray .................................................................... .................... .................... .................... .................... ....................

27650 T Repair achilles tendon ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27652 T Repair/graft achilles tendon ............................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27654 T Repair of achilles tendon ................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27656 T Repair leg fascia defect ................................................................... 0049 15.04 $745.93 $356.95 $149.19

27658 T Repair of leg tendon, each .............................................................. 0049 15.04 $745.93 $356.95 $149.19

67863

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27659 T Repair of leg tendon, each .............................................................. 0049 15.04 $745.93 $356.95 $149.19

27664 T Repair of leg tendon, each .............................................................. 0049 15.04 $745.93 $356.95 $149.19

27665 T Repair of leg tendon, each .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27675 T Repair lower leg tendons ................................................................. 0049 15.04 $745.93 $356.95 $149.19

27676 T Repair lower leg tendons ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27680 T Release of lower leg tendon ............................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27681 T Release of lower leg tendons .......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27685 T Revision of lower leg tendon ........................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27686 T Revise lower leg tendons ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27687 T Revision of calf tendon .................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27690 T Revise lower leg tendon .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27691 T Revise lower leg tendon .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27692 T Revise additional leg tendon ............................................................ 0051 27.76 $1,376.79 $675.24 $275.36

27695 T Repair of ankle ligament .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27696 T Repair of ankle ligaments ................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27698 T Repair of ankle ligament .................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27700 T Revision of ankle joint ...................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27702 C Reconstruct ankle joint ..................................................................... .................... .................... .................... .................... ....................

27703 C Reconstruction, ankle joint ............................................................... .................... .................... .................... .................... ....................

27704 T Removal of ankle implant ................................................................ 0049 15.04 $745.93 $356.95 $149.19

27705 T Incision of tibia ................................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27707 T Incision of fibula ............................................................................... 0049 15.04 $745.93 $356.95 $149.19

27709 T Incision of tibia & fibula .................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27712 C Realignment of lower leg ................................................................. .................... .................... .................... .................... ....................

27715 C Revision of lower leg ........................................................................ .................... .................... .................... .................... ....................

27720 C Repair of tibia ................................................................................... .................... .................... .................... .................... ....................

27722 C Repair/graft of tibia ........................................................................... .................... .................... .................... .................... ....................

27724 C Repair/graft of tibia ........................................................................... .................... .................... .................... .................... ....................

27725 C Repair of lower leg ........................................................................... .................... .................... .................... .................... ....................

27727 C Repair of lower leg ........................................................................... .................... .................... .................... .................... ....................

27730 T Repair of tibia epiphysis ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27732 T Repair of fibula epiphysis ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27734 T Repair lower leg epiphyses .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27740 T Repair of leg epiphyses ................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27742 T Repair of leg epiphyses ................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27745 T Reinforce tibia .................................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27750 T Treatment of tibia fracture ................................................................ 0044 2.17 $107.63 $38.08 $21.53

27752 T Treatment of tibia fracture ................................................................ 0044 2.17 $107.63 $38.08 $21.53

27756 T Treatment of tibia fracture ................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

27758 T Treatment of tibia fracture ................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

27759 T Treatment of tibia fracture ................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

27760 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27762 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27766 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27780 T Treatment of fibula fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27781 T Treatment of fibula fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27784 T Treatment of fibula fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27786 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27788 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27792 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27808 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27810 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27814 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27816 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27818 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

27822 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27823 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

27824 T Treat lower leg fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

27825 T Treat lower leg fracture .................................................................... 0044 2.17 $107.63 $38.08 $21.53

27826 T Treat lower leg fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27827 T Treat lower leg fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27828 T Treat lower leg fracture .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27829 T Treat lower leg joint ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27830 T Treat lower leg dislocation ............................................................... 0044 2.17 $107.63 $38.08 $21.53

27831 T Treat lower leg dislocation ............................................................... 0045 11.02 $546.55 $277.12 $109.31

27832 T Treat lower leg dislocation ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27840 T Treat ankle dislocation ..................................................................... 0044 2.17 $107.63 $38.08 $21.53

27842 T Treat ankle dislocation ..................................................................... 0045 11.02 $546.55 $277.12 $109.31

27846 T Treat ankle dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27848 T Treat ankle dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27860 T Fixation of ankle joint ....................................................................... 0045 11.02 $546.55 $277.12 $109.31

27870 T Fusion of ankle joint ......................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27871 T Fusion of tibiofibular joint ................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27880 C Amputation of lower leg ................................................................... .................... .................... .................... .................... ....................

67864

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27881 C Amputation of lower leg ................................................................... .................... .................... .................... .................... ....................

27882 C Amputation of lower leg ................................................................... .................... .................... .................... .................... ....................

27884 T Amputation follow-up surgery .......................................................... 0049 15.04 $745.93 $356.95 $149.19

27886 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

27888 C Amputation of foot at ankle .............................................................. .................... .................... .................... .................... ....................

27889 T Amputation of foot at ankle .............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27892 T Decompression of leg ...................................................................... 0049 15.04 $745.93 $356.95 $149.19

27893 T Decompression of leg ...................................................................... 0049 15.04 $745.93 $356.95 $149.19

27894 T Decompression of leg ...................................................................... 0049 15.04 $745.93 $356.95 $149.19

27899 T Leg/ankle surgery procedure ........................................................... 0044 2.17 $107.63 $38.08 $21.53

28001 T Drainage of bursa of foot ................................................................. 0008 6.15 $305.02 $113.67 $61.00

28002 T Treatment of foot infection ............................................................... 0049 15.04 $745.93 $356.95 $149.19

28003 T Treatment of foot infection ............................................................... 0049 15.04 $745.93 $356.95 $149.19

28005 T Treat foot bone lesion ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28008 T Incision of foot fascia ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28010 T Incision of toe tendon ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28011 T Incision of toe tendons ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28020 T Exploration of foot joint .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28022 T Exploration of foot joint .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28024 T Exploration of toe joint ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28030 T Removal of foot nerve ...................................................................... 0220 13.96 $692.36 $326.21 $138.47

28035 T Decompression of tibia nerve .......................................................... 0220 13.96 $692.36 $326.21 $138.47

28043 T Excision of foot lesion ...................................................................... 0021 10.49 $520.26 $236.51 $104.05

28045 T Excision of foot lesion ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28046 T Resection of tumor, foot ................................................................... 0055 15.47 $767.26 $355.34 $153.45

28050 T Biopsy of foot joint lining .................................................................. 0055 15.47 $767.26 $355.34 $153.45

28052 T Biopsy of foot joint lining .................................................................. 0055 15.47 $767.26 $355.34 $153.45

28054 T Biopsy of toe joint lining ................................................................... 0055 15.47 $767.26 $355.34 $153.45

28060 T Partial removal, foot fascia .............................................................. 0056 17.30 $858.02 $405.81 $171.60

28062 T Removal of foot fascia ..................................................................... 0056 17.30 $858.02 $405.81 $171.60

28070 T Removal of foot joint lining .............................................................. 0056 17.30 $858.02 $405.81 $171.60

28072 T Removal of foot joint lining .............................................................. 0056 17.30 $858.02 $405.81 $171.60

28080 T Removal of foot lesion ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28086 T Excise foot tendon sheath ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28088 T Excise foot tendon sheath ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28090 T Removal of foot lesion ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28092 T Removal of toe lesions .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28100 T Removal of ankle/heel lesion ........................................................... 0055 15.47 $767.26 $355.34 $153.45

28102 T Remove/graft foot lesion .................................................................. 0056 17.30 $858.02 $405.81 $171.60

28103 T Remove/graft foot lesion .................................................................. 0056 17.30 $858.02 $405.81 $171.60

28104 T Removal of foot lesion ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28106 T Remove/graft foot lesion .................................................................. 0056 17.30 $858.02 $405.81 $171.60

28107 T Remove/graft foot lesion .................................................................. 0056 17.30 $858.02 $405.81 $171.60

28108 T Removal of toe lesions .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28110 T Part removal of metatarsal ............................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28111 T Part removal of metatarsal ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28112 T Part removal of metatarsal ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28113 T Part removal of metatarsal ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28114 T Removal of metatarsal heads .......................................................... 0055 15.47 $767.26 $355.34 $153.45

28116 T Revision of foot ................................................................................ 0055 15.47 $767.26 $355.34 $153.45

28118 T Removal of heel bone ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28119 T Removal of heel spur ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28120 T Part removal of ankle/heel ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28122 T Partial removal of foot bone ............................................................. 0055 15.47 $767.26 $355.34 $153.45

28124 T Partial removal of toe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28126 T Partial removal of toe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28130 T Removal of ankle bone .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28140 T Removal of metatarsal ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28150 T Removal of toe ................................................................................. 0055 15.47 $767.26 $355.34 $153.45

28153 T Partial removal of toe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28160 T Partial removal of toe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28171 T Extensive foot surgery ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28173 T Extensive foot surgery ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28175 T Extensive foot surgery ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28190 T Removal of foot foreign body ........................................................... 0019 4.00 $198.39 $78.91 $39.68

28192 T Removal of foot foreign body ........................................................... 0021 10.49 $520.26 $236.51 $104.05

28193 T Removal of foot foreign body ........................................................... 0020 6.51 $322.87 $130.53 $64.57

28200 T Repair of foot tendon ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28202 T Repair/graft of foot tendon ............................................................... 0056 17.30 $858.02 $405.81 $171.60

28208 T Repair of foot tendon ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28210 T Repair/graft of foot tendon ............................................................... 0055 15.47 $767.26 $355.34 $153.45

28220 T Release of foot tendon ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28222 T Release of foot tendons ................................................................... 0055 15.47 $767.26 $355.34 $153.45

28225 T Release of foot tendon ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

67865

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

28226 T Release of foot tendons ................................................................... 0055 15.47 $767.26 $355.34 $153.45

28230 T Incision of foot tendon(s) ................................................................. 0055 15.47 $767.26 $355.34 $153.45

28232 T Incision of toe tendon ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28234 T Incision of foot tendon ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28238 T Revision of foot tendon .................................................................... 0056 17.30 $858.02 $405.81 $171.60

28240 T Release of big toe ............................................................................ 0055 15.47 $767.26 $355.34 $153.45

28250 T Revision of foot fascia ...................................................................... 0056 17.30 $858.02 $405.81 $171.60

28260 T Release of midfoot joint ................................................................... 0056 17.30 $858.02 $405.81 $171.60

28261 T Revision of foot tendon .................................................................... 0056 17.30 $858.02 $405.81 $171.60

28262 T Revision of foot and ankle ............................................................... 0056 17.30 $858.02 $405.81 $171.60

28264 T Release of midfoot joint ................................................................... 0056 17.30 $858.02 $405.81 $171.60

28270 T Release of foot contracture .............................................................. 0055 15.47 $767.26 $355.34 $153.45

28272 T Release of toe joint, each ................................................................ 0055 15.47 $767.26 $355.34 $153.45

28280 T Fusion of toes .................................................................................. 0055 15.47 $767.26 $355.34 $153.45

28285 T Repair of hammertoe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28286 T Repair of hammertoe ....................................................................... 0055 15.47 $767.26 $355.34 $153.45

28288 T Partial removal of foot bone ............................................................. 0056 17.30 $858.02 $405.81 $171.60

28289 T Repair hallux rigidus ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28290 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28292 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28293 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28294 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28296 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28297 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28298 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28299 T Correction of bunion ......................................................................... 0057 21.00 $1,041.52 $496.65 $208.30

28300 T Incision of heel bone ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28302 T Incision of ankle bone ...................................................................... 0056 17.30 $858.02 $405.81 $171.60

28304 T Incision of midfoot bones ................................................................. 0056 17.30 $858.02 $405.81 $171.60

28305 T Incise/graft midfoot bones ................................................................ 0056 17.30 $858.02 $405.81 $171.60

28306 T Incision of metatarsal ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28307 T Incision of metatarsal ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28308 T Incision of metatarsal ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28309 T Incision of metatarsals ..................................................................... 0056 17.30 $858.02 $405.81 $171.60

28310 T Revision of big toe ........................................................................... 0055 15.47 $767.26 $355.34 $153.45

28312 T Revision of toe ................................................................................. 0055 15.47 $767.26 $355.34 $153.45

28313 T Repair deformity of toe .................................................................... 0055 15.47 $767.26 $355.34 $153.45

28315 T Removal of sesamoid bone ............................................................. 0055 15.47 $767.26 $355.34 $153.45

28320 T Repair of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28322 T Repair of metatarsals ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28340 T Resect enlarged toe tissue .............................................................. 0055 15.47 $767.26 $355.34 $153.45

28341 T Resect enlarged toe ......................................................................... 0055 15.47 $767.26 $355.34 $153.45

28344 T Repair extra toe(s) ........................................................................... 0056 17.30 $858.02 $405.81 $171.60

28345 T Repair webbed toe(s) ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28360 T Reconstruct cleft foot ....................................................................... 0056 17.30 $858.02 $405.81 $171.60

28400 T Treatment of heel fracture ............................................................... 0044 2.17 $107.63 $38.08 $21.53

28405 T Treatment of heel fracture ............................................................... 0044 2.17 $107.63 $38.08 $21.53

28406 T Treatment of heel fracture ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28415 T Treat heel fracture ............................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

28420 T Treat/graft heel fracture ................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28430 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

28435 T Treatment of ankle fracture .............................................................. 0044 2.17 $107.63 $38.08 $21.53

28436 T Treatment of ankle fracture .............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28445 T Treat ankle fracture .......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28450 T Treat midfoot fracture, each ............................................................. 0044 2.17 $107.63 $38.08 $21.53

28455 T Treat midfoot fracture, each ............................................................. 0044 2.17 $107.63 $38.08 $21.53

28456 T Treat midfoot fracture ....................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28465 T Treat midfoot fracture, each ............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28470 T Treat metatarsal fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

28475 T Treat metatarsal fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

28476 T Treat metatarsal fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28485 T Treat metatarsal fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28490 T Treat big toe fracture ....................................................................... 0043 1.64 $81.34 $25.46 $16.27

28495 T Treat big toe fracture ....................................................................... 0043 1.64 $81.34 $25.46 $16.27

28496 T Treat big toe fracture ....................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28505 T Treat big toe fracture ....................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28510 T Treatment of toe fracture ................................................................. 0043 1.64 $81.34 $25.46 $16.27

28515 T Treatment of toe fracture ................................................................. 0043 1.64 $81.34 $25.46 $16.27

28525 T Treat toe fracture ............................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28530 T Treat sesamoid bone fracture .......................................................... 0044 2.17 $107.63 $38.08 $21.53

28531 T Treat sesamoid bone fracture .......................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28540 T Treat foot dislocation ........................................................................ 0044 2.17 $107.63 $38.08 $21.53

28545 T Treat foot dislocation ........................................................................ 0045 11.02 $546.55 $277.12 $109.31

28546 T Treat foot dislocation ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

67866

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

28555 T Repair foot dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28570 T Treat foot dislocation ........................................................................ 0044 2.17 $107.63 $38.08 $21.53

28575 T Treat foot dislocation ........................................................................ 0045 11.02 $546.55 $277.12 $109.31

28576 T Treat foot dislocation ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

28585 T Repair foot dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28600 T Treat foot dislocation ........................................................................ 0044 2.17 $107.63 $38.08 $21.53

28605 T Treat foot dislocation ........................................................................ 0045 11.02 $546.55 $277.12 $109.31

28606 T Treat foot dislocation ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

28615 T Repair foot dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28630 T Treat toe dislocation ......................................................................... 0043 1.64 $81.34 $25.46 $16.27

28635 T Treat toe dislocation ......................................................................... 0045 11.02 $546.55 $277.12 $109.31

28636 T Treat toe dislocation ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28645 T Repair toe dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28660 T Treat toe dislocation ......................................................................... 0043 1.64 $81.34 $25.46 $16.27

28665 T Treat toe dislocation ......................................................................... 0045 11.02 $546.55 $277.12 $109.31

28666 T Treat toe dislocation ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

28675 T Repair of toe dislocation .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

28705 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28715 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28725 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28730 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28735 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28737 T Revision of foot bones ..................................................................... 0055 15.47 $767.26 $355.34 $153.45

28740 T Fusion of foot bones ........................................................................ 0056 17.30 $858.02 $405.81 $171.60

28750 T Fusion of big toe joint ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28755 T Fusion of big toe joint ...................................................................... 0055 15.47 $767.26 $355.34 $153.45

28760 T Fusion of big toe joint ...................................................................... 0056 17.30 $858.02 $405.81 $171.60

28800 C Amputation of midfoot ...................................................................... .................... .................... .................... .................... ....................

28805 C Amputation thru metatarsal .............................................................. .................... .................... .................... .................... ....................

28810 T Amputation toe & metatarsal ........................................................... 0055 15.47 $767.26 $355.34 $153.45

28820 T Amputation of toe ............................................................................. 0055 15.47 $767.26 $355.34 $153.45

28825 T Partial amputation of toe .................................................................. 0055 15.47 $767.26 $355.34 $153.45

28899 T Foot/toes surgery procedure ............................................................ 0043 1.64 $81.34 $25.46 $16.27

29000 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29010 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29015 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29020 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29025 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29035 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29040 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29044 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29046 S Application of body cast ................................................................... 0059 1.74 $86.30 $29.59 $17.26

29049 S Application of figure eight ................................................................ 0059 1.74 $86.30 $29.59 $17.26

29055 S Application of shoulder cast ............................................................. 0059 1.74 $86.30 $29.59 $17.26

29058 S Application of shoulder cast ............................................................. 0059 1.74 $86.30 $29.59 $17.26

29065 S Application of long arm cast ............................................................ 0059 1.74 $86.30 $29.59 $17.26

29075 S Application of forearm cast .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29085 S Apply hand/wrist cast ....................................................................... 0059 1.74 $86.30 $29.59 $17.26

29105 S Apply long arm splint ....................................................................... 0059 1.74 $86.30 $29.59 $17.26

29125 S Apply forearm splint ......................................................................... 0059 1.74 $86.30 $29.59 $17.26

29126 S Apply forearm splint ......................................................................... 0059 1.74 $86.30 $29.59 $17.26

29130 S Application of finger splint ................................................................ 0059 1.74 $86.30 $29.59 $17.26

29131 S Application of finger splint ................................................................ 0059 1.74 $86.30 $29.59 $17.26

29200 S Strapping of chest ............................................................................ 0059 1.74 $86.30 $29.59 $17.26

29220 S Strapping of low back ...................................................................... 0059 1.74 $86.30 $29.59 $17.26

29240 S Strapping of shoulder ....................................................................... 0059 1.74 $86.30 $29.59 $17.26

29260 S Strapping of elbow or wrist .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29280 S Strapping of hand or finger .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29305 S Application of hip cast ...................................................................... 0059 1.74 $86.30 $29.59 $17.26

29325 S Application of hip casts .................................................................... 0059 1.74 $86.30 $29.59 $17.26

29345 S Application of long leg cast .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29355 S Application of long leg cast .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29358 S Apply long leg cast brace ................................................................ 0059 1.74 $86.30 $29.59 $17.26

29365 S Application of long leg cast .............................................................. 0059 1.74 $86.30 $29.59 $17.26

29405 S Apply short leg cast ......................................................................... 0059 1.74 $86.30 $29.59 $17.26

29425 S Apply short leg cast ......................................................................... 0059 1.74 $86.30 $29.59 $17.26

29435 S Apply short leg cast ......................................................................... 0059 1.74 $86.30 $29.59 $17.26

29440 S Addition of walker to cast ................................................................. 0059 1.74 $86.30 $29.59 $17.26

29445 S Apply rigid leg cast ........................................................................... 0059 1.74 $86.30 $29.59 $17.26

29450 S Application of leg cast ...................................................................... 0059 1.74 $86.30 $29.59 $17.26

29505 S Application, long leg splint ............................................................... 0058 1.09 $54.06 $19.27 $10.81

29515 S Application lower leg splint .............................................................. 0058 1.09 $54.06 $19.27 $10.81

29520 S Strapping of hip ................................................................................ 0058 1.09 $54.06 $19.27 $10.81

29530 S Strapping of knee ............................................................................. 0058 1.09 $54.06 $19.27 $10.81

67867

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

29540 S Strapping of ankle ............................................................................ 0058 1.09 $54.06 $19.27 $10.81

29550 S Strapping of toes .............................................................................. 0058 1.09 $54.06 $19.27 $10.81

29580 S Application of paste boot ................................................................. 0058 1.09 $54.06 $19.27 $10.81

29590 S Application of foot splint ................................................................... 0058 1.09 $54.06 $19.27 $10.81

29700 S Removal/revision of cast .................................................................. 0058 1.09 $54.06 $19.27 $10.81

29705 S Removal/revision of cast .................................................................. 0058 1.09 $54.06 $19.27 $10.81

29710 S Removal/revision of cast .................................................................. 0058 1.09 $54.06 $19.27 $10.81

29715 S Removal/revision of cast .................................................................. 0058 1.09 $54.06 $19.27 $10.81

29720 S Repair of body cast .......................................................................... 0058 1.09 $54.06 $19.27 $10.81

29730 S Windowing of cast ............................................................................ 0058 1.09 $54.06 $19.27 $10.81

29740 S Wedging of cast ............................................................................... 0058 1.09 $54.06 $19.27 $10.81

29750 S Wedging of clubfoot cast ................................................................. 0058 1.09 $54.06 $19.27 $10.81

29799 S Casting/strapping procedure ............................................................ 0058 1.09 $54.06 $19.27 $10.81

29800 T Jaw arthroscopy/surgery .................................................................. 0041 24.57 $1,218.58 $592.08 $243.72

29804 T Jaw arthroscopy/surgery .................................................................. 0041 24.57 $1,218.58 $592.08 $243.72

29815 T Shoulder arthroscopy ....................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29819 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29820 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29821 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29822 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29823 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29825 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29826 T Shoulder arthroscopy/surgery .......................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29830 T Elbow arthroscopy ............................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29834 T Elbow arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29835 T Elbow arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29836 T Elbow arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29837 T Elbow arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29838 T Elbow arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29840 T Wrist arthroscopy ............................................................................. 0041 24.57 $1,218.58 $592.08 $243.72

29843 T Wrist arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29844 T Wrist arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29845 T Wrist arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29846 T Wrist arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29847 T Wrist arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29848 T Wrist endoscopy/surgery .................................................................. 0041 24.57 $1,218.58 $592.08 $243.72

29850 T Knee arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29851 T Knee arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29855 T Tibial arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29856 T Tibial arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29860 T Hip arthroscopy, dx .......................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29861 T Hip arthroscopy/surgery ................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29862 T Hip arthroscopy/surgery ................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29863 T Hip arthroscopy/surgery ................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29870 T Knee arthroscopy, dx ....................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29871 T Knee arthroscopy/drainage .............................................................. 0041 24.57 $1,218.58 $592.08 $243.72

29874 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29875 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29876 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29877 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29879 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29880 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29881 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29882 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29883 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29884 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29885 T Knee arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29886 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29887 T Knee arthroscopy/surgery ................................................................ 0041 24.57 $1,218.58 $592.08 $243.72

29888 T Knee arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29889 T Knee arthroscopy/surgery ................................................................ 0042 29.22 $1,449.19 $804.74 $289.84

29891 T Ankle arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29892 T Ankle arthroscopy/surgery ............................................................... 0042 29.22 $1,449.19 $804.74 $289.84

29893 T Scope, plantar fasciotomy ................................................................ 0055 15.47 $767.26 $355.34 $153.45

29894 T Ankle arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29895 T Ankle arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29897 T Ankle arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29898 T Ankle arthroscopy/surgery ............................................................... 0041 24.57 $1,218.58 $592.08 $243.72

29909 T Arthroscopy of joint .......................................................................... 0041 24.57 $1,218.58 $592.08 $243.72

30000 T Drainage of nose lesion ................................................................... 0251 1.68 $83.32 $27.99 $16.66

30020 T Drainage of nose lesion ................................................................... 0251 1.68 $83.32 $27.99 $16.66

30100 T Intranasal biopsy .............................................................................. 0252 5.18 $256.90 $114.24 $51.38

30110 T Removal of nose polyp(s) ................................................................ 0253 12.02 $596.14 $284.00 $119.23

30115 T Removal of nose polyp(s) ................................................................ 0253 12.02 $596.14 $284.00 $119.23

67868

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

30117 T Removal of intranasal lesion ............................................................ 0253 12.02 $596.14 $284.00 $119.23

30118 T Removal of intranasal lesion ............................................................ 0254 12.45 $617.47 $272.41 $123.49

30120 T Revision of nose .............................................................................. 0253 12.02 $596.14 $284.00 $119.23

30124 T Removal of nose lesion ................................................................... 0252 5.18 $256.90 $114.24 $51.38

30125 T Removal of nose lesion ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30130 T Removal of turbinate bones ............................................................. 0253 12.02 $596.14 $284.00 $119.23

30140 T Removal of turbinate bones ............................................................. 0253 12.02 $596.14 $284.00 $119.23

30150 T Partial removal of nose .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30160 T Removal of nose .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

30200 T Injection treatment of nose .............................................................. 0253 12.02 $596.14 $284.00 $119.23

30210 T Nasal sinus therapy ......................................................................... 0252 5.18 $256.90 $114.24 $51.38

30220 T Insert nasal septal button ................................................................. 0252 5.18 $256.90 $114.24 $51.38

30300 T Remove nasal foreign body ............................................................. 0251 1.68 $83.32 $27.99 $16.66

30310 T Remove nasal foreign body ............................................................. 0253 12.02 $596.14 $284.00 $119.23

30320 T Remove nasal foreign body ............................................................. 0253 12.02 $596.14 $284.00 $119.23

30400 T Reconstruction of nose .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30410 T Reconstruction of nose .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30420 T Reconstruction of nose .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30430 T Revision of nose .............................................................................. 0254 12.45 $617.47 $272.41 $123.49

30435 T Revision of nose .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

30450 T Revision of nose .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

30460 T Revision of nose .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

30462 T Revision of nose .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

*30465 T Repair nasal stenosis ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30520 T Repair of nasal septum .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30540 T Repair nasal defect .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30545 T Repair nasal defect .......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30560 T Release of nasal adhesions ............................................................. 0251 1.68 $83.32 $27.99 $16.66

30580 T Repair upper jaw fistula ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

30600 T Repair mouth/nose fistula ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

30620 T Intranasal reconstruction .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

30630 T Repair nasal septum defect ............................................................. 0254 12.45 $617.47 $272.41 $123.49

30801 T Cauterization, inner nose ................................................................. 0252 5.18 $256.90 $114.24 $51.38

30802 T Cauterization, inner nose ................................................................. 0253 12.02 $596.14 $284.00 $119.23

30901 T Control of nosebleed ........................................................................ 0250 2.21 $109.61 $38.54 $21.92

30903 T Control of nosebleed ........................................................................ 0250 2.21 $109.61 $38.54 $21.92

30905 T Control of nosebleed ........................................................................ 0250 2.21 $109.61 $38.54 $21.92

30906 T Repeat control of nosebleed ............................................................ 0250 2.21 $109.61 $38.54 $21.92

30915 T Ligation, nasal sinus artery .............................................................. 0091 14.79 $733.52 $348.23 $146.70

30920 T Ligation, upper jaw artery ................................................................ 0092 20.21 $1,002.34 $505.37 $200.47

30930 T Therapy, fracture of nose ................................................................. 0253 12.02 $596.14 $284.00 $119.23

30999 T Nasal surgery procedure .................................................................. 0251 1.68 $83.32 $27.99 $16.66

31000 T Irrigation, maxillary sinus ................................................................. 0251 1.68 $83.32 $27.99 $16.66

31002 T Irrigation, sphenoid sinus ................................................................. 0252 5.18 $256.90 $114.24 $51.38

31020 T Exploration, maxillary sinus ............................................................. 0253 12.02 $596.14 $284.00 $119.23

31030 T Exploration, maxillary sinus ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31032 T Explore sinus,remove polyps ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31040 T Exploration behind upper jaw .......................................................... 0254 12.45 $617.47 $272.41 $123.49

31050 T Exploration, sphenoid sinus ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31051 T Sphenoid sinus surgery ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31070 T Exploration of frontal sinus .............................................................. 0254 12.45 $617.47 $272.41 $123.49

31075 T Exploration of frontal sinus .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31080 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31081 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31084 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31085 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31086 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31087 T Removal of frontal sinus .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31090 T Exploration of sinuses ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31200 T Removal of ethmoid sinus ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31201 T Removal of ethmoid sinus ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31205 T Removal of ethmoid sinus ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31225 C Removal of upper jaw ...................................................................... .................... .................... .................... .................... ....................

31230 C Removal of upper jaw ...................................................................... .................... .................... .................... .................... ....................

31231 T Nasal endoscopy, dx ........................................................................ 0071 0.55 $27.28 $14.22 $5.46

31233 T Nasal/sinus endoscopy, dx .............................................................. 0072 1.26 $62.49 $41.52 $12.50

31235 T Nasal/sinus endoscopy, dx .............................................................. 0074 13.61 $675.00 $347.54 $135.00

31237 T Nasal/sinus endoscopy, surg ........................................................... 0074 13.61 $675.00 $347.54 $135.00

31238 T Nasal/sinus endoscopy, surg ........................................................... 0074 13.61 $675.00 $347.54 $135.00

31239 T Nasal/sinus endoscopy, surg ........................................................... 0075 18.55 $920.01 $467.29 $184.00

31240 T Nasal/sinus endoscopy, surg ........................................................... 0074 13.61 $675.00 $347.54 $135.00

31254 T Revision of ethmoid sinus ................................................................ 0075 18.55 $920.01 $467.29 $184.00

31255 T Removal of ethmoid sinus ............................................................... 0075 18.55 $920.01 $467.29 $184.00

31256 T Exploration maxillary sinus .............................................................. 0075 18.55 $920.01 $467.29 $184.00

67869

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

31267 T Endoscopy, maxillary sinus .............................................................. 0075 18.55 $920.01 $467.29 $184.00

31276 T Sinus endoscopy, surgical ............................................................... 0075 18.55 $920.01 $467.29 $184.00

31287 T Nasal/sinus endoscopy, surg ........................................................... 0075 18.55 $920.01 $467.29 $184.00

31288 T Nasal/sinus endoscopy, surg ........................................................... 0075 18.55 $920.01 $467.29 $184.00

31290 C Nasal/sinus endoscopy, surg ........................................................... .................... .................... .................... .................... ....................

31291 C Nasal/sinus endoscopy, surg ........................................................... .................... .................... .................... .................... ....................

31292 C Nasal/sinus endoscopy, surg ........................................................... .................... .................... .................... .................... ....................

31293 C Nasal/sinus endoscopy, surg ........................................................... .................... .................... .................... .................... ....................

31294 C Nasal/sinus endoscopy, surg ........................................................... .................... .................... .................... .................... ....................

31299 T Sinus surgery procedure .................................................................. 0252 5.18 $256.90 $114.24 $51.38

31300 T Removal of larynx lesion .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31320 T Diagnostic incision, larynx ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

31360 C Removal of larynx ............................................................................ .................... .................... .................... .................... ....................

31365 C Removal of larynx ............................................................................ .................... .................... .................... .................... ....................

31367 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31368 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31370 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31375 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31380 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31382 C Partial removal of larynx .................................................................. .................... .................... .................... .................... ....................

31390 C Removal of larynx & pharynx ........................................................... .................... .................... .................... .................... ....................

31395 C Reconstruct larynx & pharynx .......................................................... .................... .................... .................... .................... ....................

31400 T Revision of larynx ............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31420 T Removal of epiglottis ........................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

31500 S Insert emergency airway .................................................................. 0094 4.51 $223.68 $105.29 $44.74

31502 T Change of windpipe airway .............................................................. 0121 2.36 $117.05 $52.53 $23.41

31505 T Diagnostic laryngoscopy .................................................................. 0072 1.26 $62.49 $41.52 $12.50

31510 T Laryngoscopy with biopsy ................................................................ 0074 13.61 $675.00 $347.54 $135.00

31511 T Remove foreign body, larynx ........................................................... 0072 1.26 $62.49 $41.52 $12.50

31512 T Removal of larynx lesion .................................................................. 0074 13.61 $675.00 $347.54 $135.00

31513 T Injection into vocal cord ................................................................... 0073 4.11 $203.84 $91.07 $40.77

31515 T Laryngoscopy for aspiration ............................................................. 0074 13.61 $675.00 $347.54 $135.00

31520 T Diagnostic laryngoscopy .................................................................. 0072 1.26 $62.49 $41.52 $12.50

31525 T Diagnostic laryngoscopy .................................................................. 0074 13.61 $675.00 $347.54 $135.00

31526 T Diagnostic laryngoscopy .................................................................. 0074 13.61 $675.00 $347.54 $135.00

31527 T Laryngoscopy for treatment ............................................................. 0075 18.55 $920.01 $467.29 $184.00

31528 T Laryngoscopy and dilatation ............................................................ 0074 13.61 $675.00 $347.54 $135.00

31529 T Laryngoscopy and dilatation ............................................................ 0074 13.61 $675.00 $347.54 $135.00

31530 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31531 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31535 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31536 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31540 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31541 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31560 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31561 T Operative laryngoscopy ................................................................... 0075 18.55 $920.01 $467.29 $184.00

31570 T Laryngoscopy with injection ............................................................. 0075 18.55 $920.01 $467.29 $184.00

31571 T Laryngoscopy with injection ............................................................. 0075 18.55 $920.01 $467.29 $184.00

31575 T Diagnostic laryngoscopy .................................................................. 0071 0.55 $27.28 $14.22 $5.46

31576 T Laryngoscopy with biopsy ................................................................ 0074 13.61 $675.00 $347.54 $135.00

31577 T Remove foreign body, larynx ........................................................... 0073 4.11 $203.84 $91.07 $40.77

31578 T Removal of larynx lesion .................................................................. 0074 13.61 $675.00 $347.54 $135.00

31579 T Diagnostic laryngoscopy .................................................................. 0073 4.11 $203.84 $91.07 $40.77

31580 T Revision of larynx ............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31582 C Revision of larynx ............................................................................. .................... .................... .................... .................... ....................

31584 C Treat larynx fracture ......................................................................... .................... .................... .................... .................... ....................

31585 T Treat larynx fracture ......................................................................... 0253 12.02 $596.14 $284.00 $119.23

31586 T Treat larynx fracture ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31587 C Revision of larynx ............................................................................. .................... .................... .................... .................... ....................

31588 T Revision of larynx ............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31590 T Reinnervate larynx ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31595 T Larynx nerve surgery ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31599 T Larynx surgery procedure ................................................................ 0253 12.02 $596.14 $284.00 $119.23

31600 T Incision of windpipe .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

31601 T Incision of windpipe .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

31603 T Incision of windpipe .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

31605 T Incision of windpipe .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

31610 T Incision of windpipe .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

31611 T Surgery/speech prosthesis ............................................................... 0254 12.45 $617.47 $272.41 $123.49

31612 T Puncture/clear windpipe ................................................................... 0253 12.02 $596.14 $284.00 $119.23

31613 T Repair windpipe opening ................................................................. 0254 12.45 $617.47 $272.41 $123.49

31614 T Repair windpipe opening ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

31615 T Visualization of windpipe .................................................................. 0076 8.06 $399.75 $197.05 $79.95

31622 T Dx bronchoscope/wash .................................................................... 0076 8.06 $399.75 $197.05 $79.95

67870

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

31623 T Dx bronchoscope/brush ................................................................... 0076 8.06 $399.75 $197.05 $79.95

31624 T Dx bronchoscope/lavage .................................................................. 0076 8.06 $399.75 $197.05 $79.95

31625 T Bronchoscopy with biopsy ............................................................... 0076 8.06 $399.75 $197.05 $79.95

31628 T Bronchoscopy with biopsy ............................................................... 0076 8.06 $399.75 $197.05 $79.95

31629 T Bronchoscopy with biopsy ............................................................... 0076 8.06 $399.75 $197.05 $79.95

31630 T Bronchoscopy with repair ................................................................. 0076 8.06 $399.75 $197.05 $79.95

31631 T Bronchoscopy with dilation .............................................................. 0076 8.06 $399.75 $197.05 $79.95

31635 T Remove foreign body, airway .......................................................... 0076 8.06 $399.75 $197.05 $79.95

31640 T Bronchoscopy & remove lesion ....................................................... 0076 8.06 $399.75 $197.05 $79.95

31641 T Bronchoscopy, treat blockage .......................................................... 0076 8.06 $399.75 $197.05 $79.95

31643 T Diag bronchoscope/catheter ............................................................ 0076 8.06 $399.75 $197.05 $79.95

31645 T Bronchoscopy, clear airways ........................................................... 0076 8.06 $399.75 $197.05 $79.95

31646 T Bronchoscopy, reclear airway .......................................................... 0076 8.06 $399.75 $197.05 $79.95

31656 T Bronchoscopy, inj for xray ............................................................... 0076 8.06 $399.75 $197.05 $79.95

31700 T Insertion of airway catheter .............................................................. 0072 1.26 $62.49 $41.52 $12.50

31708 N Instill airway contrast dye ................................................................. .................... .................... .................... .................... ....................

31710 N Insertion of airway catheter .............................................................. .................... .................... .................... .................... ....................

31715 N Injection for bronchus x-ray ............................................................. .................... .................... .................... .................... ....................

31717 T Bronchial brush biopsy ..................................................................... 0073 4.11 $203.84 $91.07 $40.77

31720 T Clearance of airways ....................................................................... 0072 1.26 $62.49 $41.52 $12.50

31725 C Clearance of airways ....................................................................... .................... .................... .................... .................... ....................

31730 T Intro, windpipe wire/tube .................................................................. 0073 4.11 $203.84 $91.07 $40.77

31750 T Repair of windpipe ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31755 T Repair of windpipe ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

31760 C Repair of windpipe ........................................................................... .................... .................... .................... .................... ....................

31766 C Reconstruction of windpipe .............................................................. .................... .................... .................... .................... ....................

31770 C Repair/graft of bronchus .................................................................. .................... .................... .................... .................... ....................

31775 C Reconstruct bronchus ...................................................................... .................... .................... .................... .................... ....................

31780 C Reconstruct windpipe ....................................................................... .................... .................... .................... .................... ....................

31781 C Reconstruct windpipe ....................................................................... .................... .................... .................... .................... ....................

31785 C Remove windpipe lesion .................................................................. .................... .................... .................... .................... ....................

31786 C Remove windpipe lesion .................................................................. .................... .................... .................... .................... ....................

31800 C Repair of windpipe injury ................................................................. .................... .................... .................... .................... ....................

31805 C Repair of windpipe injury ................................................................. .................... .................... .................... .................... ....................

31820 T Closure of windpipe lesion ............................................................... 0253 12.02 $596.14 $284.00 $119.23

31825 T Repair of windpipe defect ................................................................ 0254 12.45 $617.47 $272.41 $123.49

31830 T Revise windpipe scar ....................................................................... 0254 12.45 $617.47 $272.41 $123.49

31899 T Airways surgical procedure .............................................................. 0076 8.06 $399.75 $197.05 $79.95

32000 T Drainage of chest ............................................................................. 0070 3.64 $180.53 $79.60 $36.11

32002 T Treatment of collapsed lung ............................................................ 0070 3.64 $180.53 $79.60 $36.11

32005 T Treat lung lining chemically ............................................................. 0070 3.64 $180.53 $79.60 $36.11

32020 T Insertion of chest tube ..................................................................... 0070 3.64 $180.53 $79.60 $36.11

32035 C Exploration of chest ......................................................................... .................... .................... .................... .................... ....................

32036 C Exploration of chest ......................................................................... .................... .................... .................... .................... ....................

32095 C Biopsy through chest wall ................................................................ .................... .................... .................... .................... ....................

32100 C Exploration/biopsy of chest .............................................................. .................... .................... .................... .................... ....................

32110 C Explore/repair chest ......................................................................... .................... .................... .................... .................... ....................

32120 C Re-exploration of chest .................................................................... .................... .................... .................... .................... ....................

32124 C Explore chest free adhesions .......................................................... .................... .................... .................... .................... ....................

32140 C Removal of lung lesion(s) ................................................................ .................... .................... .................... .................... ....................

32141 C Remove/treat lung lesions ............................................................... .................... .................... .................... .................... ....................

32150 C Removal of lung lesion(s) ................................................................ .................... .................... .................... .................... ....................

32151 C Remove lung foreign body ............................................................... .................... .................... .................... .................... ....................

32160 C Open chest heart massage .............................................................. .................... .................... .................... .................... ....................

32200 C Drain, open, lung lesion ................................................................... .................... .................... .................... .................... ....................

32201 C Drain, percut, lung lesion ................................................................. .................... .................... .................... .................... ....................

32215 C Treat chest lining .............................................................................. .................... .................... .................... .................... ....................

32220 C Release of lung ................................................................................ .................... .................... .................... .................... ....................

32225 C Partial release of lung ...................................................................... .................... .................... .................... .................... ....................

32310 C Removal of chest lining .................................................................... .................... .................... .................... .................... ....................

32320 C Free/remove chest lining .................................................................. .................... .................... .................... .................... ....................

32400 T Needle biopsy chest lining ............................................................... 0005 5.41 $268.32 $119.75 $53.66

32402 C Open biopsy chest lining .................................................................. .................... .................... .................... .................... ....................

32405 T Biopsy, lung or mediastinum ............................................................ 0005 5.41 $268.32 $119.75 $53.66

32420 T Puncture/clear lung .......................................................................... 0070 3.64 $180.53 $79.60 $36.11

32440 C Removal of lung ............................................................................... .................... .................... .................... .................... ....................

32442 C Sleeve pneumonectomy ................................................................... .................... .................... .................... .................... ....................

32445 C Removal of lung ............................................................................... .................... .................... .................... .................... ....................

32480 C Partial removal of lung ..................................................................... .................... .................... .................... .................... ....................

32482 C Bilobectomy ...................................................................................... .................... .................... .................... .................... ....................

32484 C Segmentectomy ............................................................................... .................... .................... .................... .................... ....................

32486 C Sleeve lobectomy ............................................................................. .................... .................... .................... .................... ....................

32488 C Completion pneumonectomy ........................................................... .................... .................... .................... .................... ....................

32491 C Lung volume reduction ..................................................................... .................... .................... .................... .................... ....................

67871

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

32500 C Partial removal of lung ..................................................................... .................... .................... .................... .................... ....................

32501 C Repair bronchus add-on .................................................................. .................... .................... .................... .................... ....................

32520 C Remove lung & revise chest ............................................................ .................... .................... .................... .................... ....................

32522 C Remove lung & revise chest ............................................................ .................... .................... .................... .................... ....................

32525 C Remove lung & revise chest ............................................................ .................... .................... .................... .................... ....................

32540 C Removal of lung lesion .................................................................... .................... .................... .................... .................... ....................

32601 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32602 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32603 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32604 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32605 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32606 T Thoracoscopy, diagnostic ................................................................ 0076 8.06 $399.75 $197.05 $79.95

32650 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32651 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32652 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32653 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32654 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32655 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32656 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32657 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32658 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32659 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32660 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32661 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32662 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32663 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32664 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32665 C Thoracoscopy, surgical .................................................................... .................... .................... .................... .................... ....................

32800 C Repair lung hernia ............................................................................ .................... .................... .................... .................... ....................

32810 C Close chest after drainage ............................................................... .................... .................... .................... .................... ....................

32815 C Close bronchial fistula ...................................................................... .................... .................... .................... .................... ....................

32820 C Reconstruct injured chest ................................................................ .................... .................... .................... .................... ....................

32850 C Donor pneumonectomy .................................................................... .................... .................... .................... .................... ....................

32851 C Lung transplant, single ..................................................................... .................... .................... .................... .................... ....................

32852 C Lung transplant with bypass ............................................................ .................... .................... .................... .................... ....................

32853 C Lung transplant, double ................................................................... .................... .................... .................... .................... ....................

32854 C Lung transplant with bypass ............................................................ .................... .................... .................... .................... ....................

32900 C Removal of rib(s) .............................................................................. .................... .................... .................... .................... ....................

32905 C Revise & repair chest wall ............................................................... .................... .................... .................... .................... ....................

32906 C Revise & repair chest wall ............................................................... .................... .................... .................... .................... ....................

32940 C Revision of lung ............................................................................... .................... .................... .................... .................... ....................

32960 T Therapeutic pneumothorax .............................................................. 0070 3.64 $180.53 $79.60 $36.11

32997 C Total lung lavage .............................................................................. .................... .................... .................... .................... ....................

32999 T Chest surgery procedure ................................................................. 0070 3.64 $180.53 $79.60 $36.11

33010 T Drainage of heart sac ...................................................................... 0070 3.64 $180.53 $79.60 $36.11

33011 T Repeat drainage of heart sac .......................................................... 0070 3.64 $180.53 $79.60 $36.11

33015 C Incision of heart sac ......................................................................... .................... .................... .................... .................... ....................

33020 C Incision of heart sac ......................................................................... .................... .................... .................... .................... ....................

33025 C Incision of heart sac ......................................................................... .................... .................... .................... .................... ....................

33030 C Partial removal of heart sac ............................................................. .................... .................... .................... .................... ....................

33031 C Partial removal of heart sac ............................................................. .................... .................... .................... .................... ....................

33050 C Removal of heart sac lesion ............................................................ .................... .................... .................... .................... ....................

33120 C Removal of heart lesion ................................................................... .................... .................... .................... .................... ....................

33130 C Removal of heart lesion ................................................................... .................... .................... .................... .................... ....................

33140 C Heart revascularize (tmr) ................................................................. .................... .................... .................... .................... ....................

*33141 C Heart TMR w/ other procedure ........................................................ .................... .................... .................... .................... ....................

33200 C Insertion of heart pacemaker ........................................................... .................... .................... .................... .................... ....................

33201 C Insertion of heart pacemaker ........................................................... .................... .................... .................... .................... ....................

33206 T Insertion of heart pacemaker ........................................................... 0089 78.45 $3,890.81 $2,275.19 $778.16

33207 T Insertion of heart pacemaker ........................................................... 0089 78.45 $3,890.81 $2,275.19 $778.16

33208 T Insertion of heart pacemaker ........................................................... 0089 78.45 $3,890.81 $2,275.19 $778.16

33210 T Insertion of heart electrode .............................................................. 0106 18.96 $940.34 $503.07 $188.07

33211 T Insertion of heart electrode .............................................................. 0106 18.96 $940.34 $503.07 $188.07

33212 T Insertion of pulse generator ............................................................. 0090 78.28 $3,882.37 $2,133.88 $776.47

33213 T Insertion of pulse generator ............................................................. 0090 78.28 $3,882.37 $2,133.88 $776.47

33214 T Upgrade of pacemaker system ........................................................ 0089 78.45 $3,890.81 $2,275.19 $778.16

33216 T Revise eltrd pacing-defib ................................................................. 0106 18.96 $940.34 $503.07 $188.07

33217 T Revise eltrd pacing-defib ................................................................. 0106 18.96 $940.34 $503.07 $188.07

33218 T Revise eltrd pacing-defib ................................................................. 0106 18.96 $940.34 $503.07 $188.07

33220 T Revise eltrd pacing-defib ................................................................. 0106 18.96 $940.34 $503.07 $188.07

33222 T Revise pocket, pacemaker ............................................................... 0026 12.11 $600.61 $277.92 $120.12

33223 T Revise pocket, pacing-defib ............................................................. 0026 12.11 $600.61 $277.92 $120.12

33233 T Removal of pacemaker system ....................................................... 0105 15.06 $746.92 $372.32 $149.38

33234 T Removal of pacemaker system ....................................................... 0105 15.06 $746.92 $372.32 $149.38

67872

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

33235 T Removal pacemaker electrode ........................................................ 0105 15.06 $746.92 $372.32 $149.38

33236 C Remove electrode/thoracotomy ....................................................... .................... .................... .................... .................... ....................

33237 C Remove electrode/thoracotomy ....................................................... .................... .................... .................... .................... ....................

33238 C Remove electrode/thoracotomy ....................................................... .................... .................... .................... .................... ....................

33240 T Insert pulse generator ...................................................................... 0107 147.51 $7,315.91 $5,086.37 $1,463.18

33241 T Remove pulse generator .................................................................. 0105 15.06 $746.92 $372.32 $149.38

33243 C Remove eltrd/thoracotomy ............................................................... .................... .................... .................... .................... ....................

33244 T Remove eltrd, transven .................................................................... 0105 15.06 $746.92 $372.32 $149.38

33245 C Insert epic eltrd pace-defib .............................................................. .................... .................... .................... .................... ....................

33246 C Insert epic eltrd/generator ................................................................ .................... .................... .................... .................... ....................

33249 T Eltrd/insert pace-defib ...................................................................... 0108 210.84 $10,456.84 $5,484.72 $2,091.37

33250 C Ablate heart dysrhythm focus .......................................................... .................... .................... .................... .................... ....................

33251 C Ablate heart dysrhythm focus .......................................................... .................... .................... .................... .................... ....................

33253 C Reconstruct atria .............................................................................. .................... .................... .................... .................... ....................

33261 C Ablate heart dysrhythm focus .......................................................... .................... .................... .................... .................... ....................

33282 S Implant pat-active ht record ............................................................. 0974 8.25 $409.17 .................... $81.83

33284 T Remove pat-active ht record ............................................................ 0109 6.53 $323.86 $133.51 $64.77

33300 C Repair of heart wound ..................................................................... .................... .................... .................... .................... ....................

33305 C Repair of heart wound ..................................................................... .................... .................... .................... .................... ....................

33310 C Exploratory heart surgery ................................................................. .................... .................... .................... .................... ....................

33315 C Exploratory heart surgery ................................................................. .................... .................... .................... .................... ....................

33320 C Repair major blood vessel(s) ........................................................... .................... .................... .................... .................... ....................

33321 C Repair major vessel ......................................................................... .................... .................... .................... .................... ....................

33322 C Repair major blood vessel(s) ........................................................... .................... .................... .................... .................... ....................

33330 C Insert major vessel graft .................................................................. .................... .................... .................... .................... ....................

33332 C Insert major vessel graft .................................................................. .................... .................... .................... .................... ....................

33335 C Insert major vessel graft .................................................................. .................... .................... .................... .................... ....................

33400 C Repair of aortic valve ....................................................................... .................... .................... .................... .................... ....................

33401 C Valvuloplasty, open .......................................................................... .................... .................... .................... .................... ....................

33403 C Valvuloplasty, w/cp bypass .............................................................. .................... .................... .................... .................... ....................

33404 C Prepare heart-aorta conduit ............................................................. .................... .................... .................... .................... ....................

33405 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33406 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33410 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33411 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33412 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33413 C Replacement of aortic valve ............................................................ .................... .................... .................... .................... ....................

33414 C Repair of aortic valve ....................................................................... .................... .................... .................... .................... ....................

33415 C Revision, subvalvular tissue ............................................................. .................... .................... .................... .................... ....................

33416 C Revise ventricle muscle ................................................................... .................... .................... .................... .................... ....................

33417 C Repair of aortic valve ....................................................................... .................... .................... .................... .................... ....................

33420 C Revision of mitral valve .................................................................... .................... .................... .................... .................... ....................

33422 C Revision of mitral valve .................................................................... .................... .................... .................... .................... ....................

33425 C Repair of mitral valve ....................................................................... .................... .................... .................... .................... ....................

33426 C Repair of mitral valve ....................................................................... .................... .................... .................... .................... ....................

33427 C Repair of mitral valve ....................................................................... .................... .................... .................... .................... ....................

33430 C Replacement of mitral valve ............................................................ .................... .................... .................... .................... ....................

33460 C Revision of tricuspid valve ............................................................... .................... .................... .................... .................... ....................

33463 C Valvuloplasty, tricuspid ..................................................................... .................... .................... .................... .................... ....................

33464 C Valvuloplasty, tricuspid ..................................................................... .................... .................... .................... .................... ....................

33465 C Replace tricuspid valve .................................................................... .................... .................... .................... .................... ....................

33468 C Revision of tricuspid valve ............................................................... .................... .................... .................... .................... ....................

33470 C Revision of pulmonary valve ............................................................ .................... .................... .................... .................... ....................

33471 C Valvotomy, pulmonary valve ............................................................ .................... .................... .................... .................... ....................

33472 C Revision of pulmonary valve ............................................................ .................... .................... .................... .................... ....................

33474 C Revision of pulmonary valve ............................................................ .................... .................... .................... .................... ....................

33475 C Replacement, pulmonary valve ........................................................ .................... .................... .................... .................... ....................

33476 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

33478 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

33496 C Repair, prosth valve clot .................................................................. .................... .................... .................... .................... ....................

33500 C Repair heart vessel fistula ............................................................... .................... .................... .................... .................... ....................

33501 C Repair heart vessel fistula ............................................................... .................... .................... .................... .................... ....................

33502 C Coronary artery correction ............................................................... .................... .................... .................... .................... ....................

33503 C Coronary artery graft ........................................................................ .................... .................... .................... .................... ....................

33504 C Coronary artery graft ........................................................................ .................... .................... .................... .................... ....................

33505 C Repair artery w/tunnel ...................................................................... .................... .................... .................... .................... ....................

33506 C Repair artery, translocation .............................................................. .................... .................... .................... .................... ....................

33510 C CABG, vein, single ........................................................................... .................... .................... .................... .................... ....................

33511 C CABG, vein, two ............................................................................... .................... .................... .................... .................... ....................

33512 C CABG, vein, three ............................................................................ .................... .................... .................... .................... ....................

33513 C CABG, vein, four .............................................................................. .................... .................... .................... .................... ....................

33514 C CABG, vein, five ............................................................................... .................... .................... .................... .................... ....................

33516 C Cabg, vein, six or more .................................................................... .................... .................... .................... .................... ....................

33517 C CABG, artery-vein, single ................................................................ .................... .................... .................... .................... ....................

67873

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

33518 C CABG, artery-vein, two .................................................................... .................... .................... .................... .................... ....................

33519 C CABG, artery-vein, three .................................................................. .................... .................... .................... .................... ....................

33521 C CABG, artery-vein, four .................................................................... .................... .................... .................... .................... ....................

33522 C CABG, artery-vein, five .................................................................... .................... .................... .................... .................... ....................

33523 C Cabg, art-vein, six or more .............................................................. .................... .................... .................... .................... ....................

33530 C Coronary artery, bypass/reop .......................................................... .................... .................... .................... .................... ....................

33533 C CABG, arterial, single ...................................................................... .................... .................... .................... .................... ....................

33534 C CABG, arterial, two .......................................................................... .................... .................... .................... .................... ....................

33535 C CABG, arterial, three ........................................................................ .................... .................... .................... .................... ....................

33536 C Cabg, arterial, four or more ............................................................. .................... .................... .................... .................... ....................

33542 C Removal of heart lesion ................................................................... .................... .................... .................... .................... ....................

33545 C Repair of heart damage ................................................................... .................... .................... .................... .................... ....................

33572 C Open coronary endarterectomy ....................................................... .................... .................... .................... .................... ....................

33600 C Closure of valve ............................................................................... .................... .................... .................... .................... ....................

33602 C Closure of valve ............................................................................... .................... .................... .................... .................... ....................

33606 C Anastomosis/artery-aorta ................................................................. .................... .................... .................... .................... ....................

33608 C Repair anomaly w/conduit ................................................................ .................... .................... .................... .................... ....................

33610 C Repair by enlargement ..................................................................... .................... .................... .................... .................... ....................

33611 C Repair double ventricle .................................................................... .................... .................... .................... .................... ....................

33612 C Repair double ventricle .................................................................... .................... .................... .................... .................... ....................

33615 C Repair, simple fontan ....................................................................... .................... .................... .................... .................... ....................

33617 C Repair, modified fontan .................................................................... .................... .................... .................... .................... ....................

33619 C Repair single ventricle ...................................................................... .................... .................... .................... .................... ....................

33641 C Repair heart septum defect ............................................................. .................... .................... .................... .................... ....................

33645 C Revision of heart veins .................................................................... .................... .................... .................... .................... ....................

33647 C Repair heart septum defects ............................................................ .................... .................... .................... .................... ....................

33660 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33665 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33670 C Repair of heart chambers ................................................................ .................... .................... .................... .................... ....................

33681 C Repair heart septum defect ............................................................. .................... .................... .................... .................... ....................

33684 C Repair heart septum defect ............................................................. .................... .................... .................... .................... ....................

33688 C Repair heart septum defect ............................................................. .................... .................... .................... .................... ....................

33690 C Reinforce pulmonary artery .............................................................. .................... .................... .................... .................... ....................

33692 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33694 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33697 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33702 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33710 C Repair of heart defects .................................................................... .................... .................... .................... .................... ....................

33720 C Repair of heart defect ...................................................................... .................... .................... .................... .................... ....................

33722 C Repair of heart defect ...................................................................... .................... .................... .................... .................... ....................

33730 C Repair heart-vein defect(s) .............................................................. .................... .................... .................... .................... ....................

33732 C Repair heart-vein defect ................................................................... .................... .................... .................... .................... ....................

33735 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

33736 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

33737 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

33750 C Major vessel shunt ........................................................................... .................... .................... .................... .................... ....................

33755 C Major vessel shunt ........................................................................... .................... .................... .................... .................... ....................

33762 C Major vessel shunt ........................................................................... .................... .................... .................... .................... ....................

33764 C Major vessel shunt & graft ............................................................... .................... .................... .................... .................... ....................

33766 C Major vessel shunt ........................................................................... .................... .................... .................... .................... ....................

33767 C Major vessel shunt ........................................................................... .................... .................... .................... .................... ....................

33770 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33771 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33774 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33775 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33776 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33777 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33778 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33779 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33780 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33781 C Repair great vessels defect ............................................................. .................... .................... .................... .................... ....................

33786 C Repair arterial trunk ......................................................................... .................... .................... .................... .................... ....................

33788 C Revision of pulmonary artery ........................................................... .................... .................... .................... .................... ....................

33800 C Aortic suspension ............................................................................. .................... .................... .................... .................... ....................

33802 C Repair vessel defect ........................................................................ .................... .................... .................... .................... ....................

33803 C Repair vessel defect ........................................................................ .................... .................... .................... .................... ....................

33813 C Repair septal defect ......................................................................... .................... .................... .................... .................... ....................

33814 C Repair septal defect ......................................................................... .................... .................... .................... .................... ....................

33820 C Revise major vessel ......................................................................... .................... .................... .................... .................... ....................

33822 C Revise major vessel ......................................................................... .................... .................... .................... .................... ....................

33824 C Revise major vessel ......................................................................... .................... .................... .................... .................... ....................

33840 C Remove aorta constriction ............................................................... .................... .................... .................... .................... ....................

33845 C Remove aorta constriction ............................................................... .................... .................... .................... .................... ....................

33851 C Remove aorta constriction ............................................................... .................... .................... .................... .................... ....................

67874

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

33852 C Repair septal defect ......................................................................... .................... .................... .................... .................... ....................

33853 C Repair septal defect ......................................................................... .................... .................... .................... .................... ....................

33860 C Ascending aortic graft ...................................................................... .................... .................... .................... .................... ....................

33861 C Ascending aortic graft ...................................................................... .................... .................... .................... .................... ....................

33863 C Ascending aortic graft ...................................................................... .................... .................... .................... .................... ....................

33870 C Transverse aortic arch graft ............................................................. .................... .................... .................... .................... ....................

33875 C Thoracic aortic graft ......................................................................... .................... .................... .................... .................... ....................

33877 C Thoracoabdominal graft ................................................................... .................... .................... .................... .................... ....................

33910 C Remove lung artery emboli .............................................................. .................... .................... .................... .................... ....................

33915 C Remove lung artery emboli .............................................................. .................... .................... .................... .................... ....................

33916 C Surgery of great vessel .................................................................... .................... .................... .................... .................... ....................

33917 C Repair pulmonary artery .................................................................. .................... .................... .................... .................... ....................

33918 C Repair pulmonary atresia ................................................................. .................... .................... .................... .................... ....................

33919 C Repair pulmonary atresia ................................................................. .................... .................... .................... .................... ....................

33920 C Repair pulmonary atresia ................................................................. .................... .................... .................... .................... ....................

33922 C Transect pulmonary artery ............................................................... .................... .................... .................... .................... ....................

33924 C Remove pulmonary shunt ................................................................ .................... .................... .................... .................... ....................

33930 C Removal of donor heart/lung ........................................................... .................... .................... .................... .................... ....................

33935 C Transplantation, heart/lung .............................................................. .................... .................... .................... .................... ....................

33940 C Removal of donor heart ................................................................... .................... .................... .................... .................... ....................

33945 C Transplantation of heart ................................................................... .................... .................... .................... .................... ....................

33960 C External circulation assist ................................................................ .................... .................... .................... .................... ....................

33961 C External circulation assist ................................................................ .................... .................... .................... .................... ....................

33968 C Remove aortic assist device ............................................................ .................... .................... .................... .................... ....................

33970 C Aortic circulation assist .................................................................... .................... .................... .................... .................... ....................

33971 C Aortic circulation assist .................................................................... .................... .................... .................... .................... ....................

33973 C Insert balloon device ........................................................................ .................... .................... .................... .................... ....................

33974 C Remove intra-aortic balloon ............................................................. .................... .................... .................... .................... ....................

33975 C Implant ventricular device ................................................................ .................... .................... .................... .................... ....................

33976 C Implant ventricular device ................................................................ .................... .................... .................... .................... ....................

33977 C Remove ventricular device ............................................................... .................... .................... .................... .................... ....................

33978 C Remove ventricular device ............................................................... .................... .................... .................... .................... ....................

33999 T Cardiac surgery procedure .............................................................. 0070 3.64 $180.53 $79.60 $36.11

34001 C Removal of artery clot ...................................................................... .................... .................... .................... .................... ....................

34051 C Removal of artery clot ...................................................................... .................... .................... .................... .................... ....................

34101 T Removal of artery clot ...................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

34111 T Removal of arm artery clot .............................................................. 0088 26.49 $1,313.80 $678.68 $262.76

34151 C Removal of artery clot ...................................................................... .................... .................... .................... .................... ....................

34201 T Removal of artery clot ...................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

34203 T Removal of leg artery clot ................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

34401 C Removal of vein clot ........................................................................ .................... .................... .................... .................... ....................

34421 T Removal of vein clot ........................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

34451 C Removal of vein clot ........................................................................ .................... .................... .................... .................... ....................

34471 T Removal of vein clot ........................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

34490 T Removal of vein clot ........................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

34501 T Repair valve, femoral vein ............................................................... 0088 26.49 $1,313.80 $678.68 $262.76

34502 C Reconstruct vena cava .................................................................... .................... .................... .................... .................... ....................

34510 T Transposition of vein valve .............................................................. 0088 26.49 $1,313.80 $678.68 $262.76

34520 T Cross-over vein graft ........................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

34530 T Leg vein fusion ................................................................................. 0088 26.49 $1,313.80 $678.68 $262.76

*34800 C Endovasc abdo repair w/tube .......................................................... .................... .................... .................... .................... ....................

*34802 C Endovasc abdo repr w/device .......................................................... .................... .................... .................... .................... ....................

*34804 C Endovasc abdo repr w/device .......................................................... .................... .................... .................... .................... ....................

*34808 C Endovasc abdo occlud device ......................................................... .................... .................... .................... .................... ....................

*34812 C xpose for endoprosth, aortic ............................................................ .................... .................... .................... .................... ....................

*34813 C xpose for endoprosth, femoral ......................................................... .................... .................... .................... .................... ....................

*34820 C xpose for endoprosth, iliac ............................................................... .................... .................... .................... .................... ....................

*34825 C endovasc extend prosth, init ............................................................ .................... .................... .................... .................... ....................

*34826 C endovasc extend prosth,addl ........................................................... .................... .................... .................... .................... ....................

*34830 C open aortic tube prosth repr ............................................................ .................... .................... .................... .................... ....................

*34831 C open aortoiliac prosth repr ............................................................... .................... .................... .................... .................... ....................

*34832 C open aortofemor prosth repr ............................................................ .................... .................... .................... .................... ....................

35001 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35002 C Repair artery rupture, neck .............................................................. .................... .................... .................... .................... ....................

35005 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35011 T Repair defect of artery ..................................................................... 0093 12.82 $635.82 $277.34 $127.16

35013 C Repair artery rupture, arm ............................................................... .................... .................... .................... .................... ....................

35021 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35022 C Repair artery rupture, chest ............................................................. .................... .................... .................... .................... ....................

35045 C Repair defect of arm artery .............................................................. .................... .................... .................... .................... ....................

35081 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35082 C Repair artery rupture, aorta ............................................................. .................... .................... .................... .................... ....................

35091 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35092 C Repair artery rupture, aorta ............................................................. .................... .................... .................... .................... ....................

67875

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

35102 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35103 C Repair artery rupture, groin .............................................................. .................... .................... .................... .................... ....................

35111 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35112 C Repair artery rupture,spleen ............................................................ .................... .................... .................... .................... ....................

35121 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35122 C Repair artery rupture, belly .............................................................. .................... .................... .................... .................... ....................

35131 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35132 C Repair artery rupture, groin .............................................................. .................... .................... .................... .................... ....................

35141 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35142 C Repair artery rupture, thigh .............................................................. .................... .................... .................... .................... ....................

35151 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35152 C Repair artery rupture, knee .............................................................. .................... .................... .................... .................... ....................

35161 C Repair defect of artery ..................................................................... .................... .................... .................... .................... ....................

35162 C Repair artery rupture ........................................................................ .................... .................... .................... .................... ....................

35180 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35182 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35184 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35188 T Repair blood vessel lesion ............................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35189 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35190 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35201 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35206 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35207 T Repair blood vessel lesion ............................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35211 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35216 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35221 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35226 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35231 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35236 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35241 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35246 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35251 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35256 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35261 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35266 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35271 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35276 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35281 C Repair blood vessel lesion ............................................................... .................... .................... .................... .................... ....................

35286 T Repair blood vessel lesion ............................................................... 0093 12.82 $635.82 $277.34 $127.16

35301 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35311 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35321 T Rechanneling of artery ..................................................................... 0093 12.82 $635.82 $277.34 $127.16

35331 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35341 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35351 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35355 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35361 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35363 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35371 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35372 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35381 C Rechanneling of artery ..................................................................... .................... .................... .................... .................... ....................

35390 C Reoperation, carotid add-on ............................................................ .................... .................... .................... .................... ....................

35400 C Angioscopy ....................................................................................... .................... .................... .................... .................... ....................

35450 C Repair arterial blockage ................................................................... .................... .................... .................... .................... ....................

35452 C Repair arterial blockage ................................................................... .................... .................... .................... .................... ....................

35454 C Repair arterial blockage ................................................................... .................... .................... .................... .................... ....................

35456 C Repair arterial blockage ................................................................... .................... .................... .................... .................... ....................

35458 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35459 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35460 T Repair venous blockage .................................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35470 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35471 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35472 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35473 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35474 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35475 T Repair arterial blockage ................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35476 T Repair venous blockage .................................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35480 C Atherectomy, open ........................................................................... .................... .................... .................... .................... ....................

35481 T Atherectomy, open ........................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35482 C Atherectomy, open ........................................................................... .................... .................... .................... .................... ....................

35483 C Atherectomy, open ........................................................................... .................... .................... .................... .................... ....................

35484 T Atherectomy, open ........................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35485 T Atherectomy, open ........................................................................... 0081 28.81 $1,428.86 $710.91 $285.77

35490 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

67876

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

35491 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35492 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35493 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35494 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35495 T Atherectomy, percutaneous ............................................................. 0081 28.81 $1,428.86 $710.91 $285.77

35500 T Harvest vein for bypass ................................................................... 0091 14.79 $733.52 $348.23 $146.70

35501 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35506 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35507 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35508 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35509 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35511 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35515 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35516 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35518 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35521 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35526 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35531 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35533 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35536 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35541 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35546 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35548 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35549 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35551 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35556 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35558 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35560 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35563 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35565 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35566 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35571 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35582 C Vein bypass graft ............................................................................. .................... .................... .................... .................... ....................

35583 C Vein bypass graft ............................................................................. .................... .................... .................... .................... ....................

35585 C Vein bypass graft ............................................................................. .................... .................... .................... .................... ....................

35587 C Vein bypass graft ............................................................................. .................... .................... .................... .................... ....................

*35600 C Harvest artery for CABG .................................................................. .................... .................... .................... .................... ....................

35601 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35606 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35612 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35616 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35621 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35623 C Bypass graft, not vein ...................................................................... .................... .................... .................... .................... ....................

35626 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35631 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35636 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35641 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35642 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35645 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35646 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35650 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35651 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35654 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35656 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35661 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35663 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35665 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35666 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35671 C Artery bypass graft ........................................................................... .................... .................... .................... .................... ....................

35681 C Composite bypass graft ................................................................... .................... .................... .................... .................... ....................

35682 C Composite bypass graft ................................................................... .................... .................... .................... .................... ....................

35683 C Composite bypass graft ................................................................... .................... .................... .................... .................... ....................

35691 C Arterial transposition ........................................................................ .................... .................... .................... .................... ....................

35693 C Arterial transposition ........................................................................ .................... .................... .................... .................... ....................

35694 C Arterial transposition ........................................................................ .................... .................... .................... .................... ....................

35695 C Arterial transposition ........................................................................ .................... .................... .................... .................... ....................

35700 C Reoperation, bypass graft ................................................................ .................... .................... .................... .................... ....................

35701 C Exploration, carotid artery ................................................................ .................... .................... .................... .................... ....................

35721 C Exploration, femoral artery ............................................................... .................... .................... .................... .................... ....................

35741 C Exploration popliteal artery .............................................................. .................... .................... .................... .................... ....................

35761 T Exploration of artery/vein ................................................................. 0115 19.34 $959.19 $506.74 $191.84

35800 C Explore neck vessels ....................................................................... .................... .................... .................... .................... ....................

35820 C Explore chest vessels ...................................................................... .................... .................... .................... .................... ....................

35840 C Explore abdominal vessels .............................................................. .................... .................... .................... .................... ....................

67877

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

35860 T Explore limb vessels ........................................................................ 0115 19.34 $959.19 $506.74 $191.84

35870 C Repair vessel graft defect ................................................................ .................... .................... .................... .................... ....................

35875 T Removal of clot in graft .................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35876 T Removal of clot in graft .................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35879 T Revise graft w/vein ........................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35881 T Revise graft w/vein ........................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

35901 C Excision, graft, neck ......................................................................... .................... .................... .................... .................... ....................

35903 T Excision, graft, extremity .................................................................. 0115 19.34 $959.19 $506.74 $191.84

35905 C Excision, graft, thorax ...................................................................... .................... .................... .................... .................... ....................

35907 C Excision, graft, abdomen ................................................................. .................... .................... .................... .................... ....................

36000 N Place needle in vein ......................................................................... .................... .................... .................... .................... ....................

36005 N Injection, venography ....................................................................... .................... .................... .................... .................... ....................

36010 N Place catheter in vein ...................................................................... .................... .................... .................... .................... ....................

36011 N Place catheter in vein ...................................................................... .................... .................... .................... .................... ....................

36012 N Place catheter in vein ...................................................................... .................... .................... .................... .................... ....................

36013 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36014 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36015 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36100 N Establish access to artery ................................................................ .................... .................... .................... .................... ....................

36120 N Establish access to artery ................................................................ .................... .................... .................... .................... ....................

36140 N Establish access to artery ................................................................ .................... .................... .................... .................... ....................

36145 N Artery to vein shunt .......................................................................... .................... .................... .................... .................... ....................

36160 N Establish access to aorta ................................................................. .................... .................... .................... .................... ....................

36200 N Place catheter in aorta ..................................................................... .................... .................... .................... .................... ....................

36215 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36216 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36217 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36218 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36245 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36246 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36247 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36248 N Place catheter in artery .................................................................... .................... .................... .................... .................... ....................

36260 T Insertion of infusion pump ................................................................ 0119 9.87 $489.59 $161.50 $97.92

36261 T Revision of infusion pump ................................................................ 0124 2.55 $126.64 $81.36 $25.33

36262 T Removal of infusion pump ............................................................... 0109 6.53 $323.86 $133.51 $64.77

36299 T Vessel injection procedure ............................................................... 0089 78.45 $3,890.81 $2,275.19 $778.16

36400 N Drawing blood .................................................................................. .................... .................... .................... .................... ....................

36405 N Drawing blood .................................................................................. .................... .................... .................... .................... ....................

36406 N Drawing blood .................................................................................. .................... .................... .................... .................... ....................

36410 N Drawing blood .................................................................................. .................... .................... .................... .................... ....................

36415 E Drawing blood .................................................................................. .................... .................... .................... .................... ....................

36420 T Establish access to vein .................................................................. 0032 5.40 $267.82 $119.52 $53.56

36425 T Establish access to vein .................................................................. 0032 5.40 $267.82 $119.52 $53.56

36430 S Blood transfusion service ................................................................. 0110 5.83 $289.15 $122.73 $57.83

36440 S Blood transfusion service ................................................................. 0110 5.83 $289.15 $122.73 $57.83

36450 S Exchange transfusion service .......................................................... 0110 5.83 $289.15 $122.73 $57.83

36455 S Exchange transfusion service .......................................................... 0110 5.83 $289.15 $122.73 $57.83

36460 S Transfusion service, fetal ................................................................. 0110 5.83 $289.15 $122.73 $57.83

36468 T Injection(s), spider veins .................................................................. 0098 1.19 $59.02 $20.88 $11.80

36469 T Injection(s), spider veins .................................................................. 0098 1.19 $59.02 $20.88 $11.80

36470 T Injection therapy of vein ................................................................... 0098 1.19 $59.02 $20.88 $11.80

36471 T Injection therapy of veins ................................................................. 0098 1.19 $59.02 $20.88 $11.80

36481 N Insertion of catheter, vein ................................................................ .................... .................... .................... .................... ....................

36488 T Insertion of catheter, vein ................................................................ 0032 5.40 $267.82 $119.52 $53.56

36489 T Insertion of catheter, vein ................................................................ 0032 5.40 $267.82 $119.52 $53.56

36490 T Insertion of catheter, vein ................................................................ 0032 5.40 $267.82 $119.52 $53.56

36491 T Insertion of catheter, vein ................................................................ 0032 5.40 $267.82 $119.52 $53.56

36493 T Repositioning of cvc ......................................................................... 0032 5.40 $267.82 $119.52 $53.56

36500 N Insertion of catheter, vein ................................................................ .................... .................... .................... .................... ....................

36510 C Insertion of catheter, vein ................................................................ .................... .................... .................... .................... ....................

36520 S Plasma and/or cell exchange ........................................................... 0111 14.17 $702.77 $300.74 $140.55

36521 S Apheresis w/ adsorp/reinfuse ........................................................... 0111 14.17 $702.77 $300.74 $140.55

36522 S Photopheresis .................................................................................. 0112 39.60 $1,964.01 $663.65 $392.80

36530 T Insertion of infusion pump ................................................................ 0119 9.87 $489.59 $161.50 $97.92

36531 T Revision of infusion pump ................................................................ 0124 2.55 $126.64 $81.36 $25.33

36532 T Removal of infusion pump ............................................................... 0109 6.53 $323.86 $133.51 $64.77

36533 T Insertion of access device ............................................................... 0115 19.34 $959.19 $506.74 $191.84

36534 T Revision of access device ............................................................... 0103 13.09 $649.21 $295.70 $129.84

36535 T Removal of access device ............................................................... 0109 6.53 $323.86 $133.51 $64.77

*36540 N Collect blood venous device ............................................................ .................... .................... .................... .................... ....................

36550 T Declot vascular device ..................................................................... 0970 0.52 $25.79 .................... $5.16

36600 N Withdrawal of arterial blood ............................................................. .................... .................... .................... .................... ....................

36620 N Insertion catheter, artery .................................................................. .................... .................... .................... .................... ....................

36625 N Insertion catheter, artery .................................................................. .................... .................... .................... .................... ....................

67878

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

36640 T Insertion catheter, artery .................................................................. 0032 5.40 $267.82 $119.52 $53.56

36660 C Insertion catheter, artery .................................................................. .................... .................... .................... .................... ....................

36680 T Insert needle, bone cavity ................................................................ 0120 1.66 $82.33 $42.67 $16.47

36800 T Insertion of cannula .......................................................................... 0115 19.34 $959.19 $506.74 $191.84

36810 T Insertion of cannula .......................................................................... 0115 19.34 $959.19 $506.74 $191.84

36815 T Insertion of cannula .......................................................................... 0115 19.34 $959.19 $506.74 $191.84

36819 T Av fusion by basilic vein .................................................................. 0093 12.82 $635.82 $277.34 $127.16

36821 T Av fusion direct any site ................................................................... 0088 26.49 $1,313.80 $678.68 $262.76

36822 C Insertion of cannula(s) ..................................................................... .................... .................... .................... .................... ....................

36823 C Insertion of cannula(s) ..................................................................... .................... .................... .................... .................... ....................

36825 T Artery-vein graft ................................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

36830 T Artery-vein graft ................................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

36831 T Av fistula excision ............................................................................ 0088 26.49 $1,313.80 $678.68 $262.76

36832 T Av fistula revision ............................................................................. 0088 26.49 $1,313.80 $678.68 $262.76

36833 T Av fistula revision ............................................................................. 0088 26.49 $1,313.80 $678.68 $262.76

36834 T Repair A-V aneurysm ....................................................................... 0093 12.82 $635.82 $277.34 $127.16

36835 T Artery to vein shunt .......................................................................... 0115 19.34 $959.19 $506.74 $191.84

36860 T External cannula declotting .............................................................. 0115 19.34 $959.19 $506.74 $191.84

36861 T Cannula declotting ........................................................................... 0115 19.34 $959.19 $506.74 $191.84

*36870 T AV fistula revision, open .................................................................. 0093 12.82 $635.82 $277.34 $127.16

37140 C Revision of circulation ...................................................................... .................... .................... .................... .................... ....................

37145 C Revision of circulation ...................................................................... .................... .................... .................... .................... ....................

37160 C Revision of circulation ...................................................................... .................... .................... .................... .................... ....................

37180 C Revision of circulation ...................................................................... .................... .................... .................... .................... ....................

37181 C Splice spleen/kidney veins ............................................................... .................... .................... .................... .................... ....................

37195 C Thrombolytic therapy, stroke ............................................................ .................... .................... .................... .................... ....................

37200 T Transcatheter biopsy ........................................................................ 0005 5.41 $268.32 $119.75 $53.66

37201 T Transcatheter therapy infuse ........................................................... 0120 1.66 $82.33 $42.67 $16.47

37202 T Transcatheter therapy infuse ........................................................... 0120 1.66 $82.33 $42.67 $16.47

37203 T Transcatheter retrieval ..................................................................... 0103 13.09 $649.21 $295.70 $129.84

37204 T Transcatheter occlusion ................................................................... 0103 13.09 $649.21 $295.70 $129.84

37205 T Transcatheter stent .......................................................................... 0229 34.81 $1,726.44 $1,030.12 $345.29

37206 T Transcatheter stent add-on .............................................................. 0229 34.81 $1,726.44 $1,030.12 $345.29

37207 T Transcatheter stent .......................................................................... 0229 34.81 $1,726.44 $1,030.12 $345.29

37208 T Transcatheter stent add-on .............................................................. 0229 34.81 $1,726.44 $1,030.12 $345.29

37209 T Exchange arterial catheter ............................................................... 0103 13.09 $649.21 $295.70 $129.84

37250 T Iv us first vessel add-on ................................................................... 0103 13.09 $649.21 $295.70 $129.84

37251 T Iv us each add vessel add-on .......................................................... 0103 13.09 $649.21 $295.70 $129.84

37565 T Ligation of neck vein ........................................................................ 0093 12.82 $635.82 $277.34 $127.16

37600 T Ligation of neck artery ..................................................................... 0093 12.82 $635.82 $277.34 $127.16

37605 T Ligation of neck artery ..................................................................... 0091 14.79 $733.52 $348.23 $146.70

37606 T Ligation of neck artery ..................................................................... 0091 14.79 $733.52 $348.23 $146.70

37607 T Ligation of a-v fistula ........................................................................ 0092 20.21 $1,002.34 $505.37 $200.47

37609 T Temporal artery procedure .............................................................. 0020 6.51 $322.87 $130.53 $64.57

37615 T Ligation of neck artery ..................................................................... 0091 14.79 $733.52 $348.23 $146.70

37616 C Ligation of chest artery .................................................................... .................... .................... .................... .................... ....................

37617 C Ligation of abdomen artery .............................................................. .................... .................... .................... .................... ....................

37618 C Ligation of extremity artery .............................................................. .................... .................... .................... .................... ....................

37620 T Revision of major vein ..................................................................... 0091 14.79 $733.52 $348.23 $146.70

37650 T Revision of major vein ..................................................................... 0091 14.79 $733.52 $348.23 $146.70

37660 C Revision of major vein ..................................................................... .................... .................... .................... .................... ....................

37700 T Revise leg vein ................................................................................. 0091 14.79 $733.52 $348.23 $146.70

37720 T Removal of leg vein ......................................................................... 0092 20.21 $1,002.34 $505.37 $200.47

37730 T Removal of leg veins ....................................................................... 0092 20.21 $1,002.34 $505.37 $200.47

37735 T Removal of leg veins/lesion ............................................................. 0092 20.21 $1,002.34 $505.37 $200.47

37760 T Revision of leg veins ........................................................................ 0091 14.79 $733.52 $348.23 $146.70

37780 T Revision of leg vein .......................................................................... 0091 14.79 $733.52 $348.23 $146.70

37785 T Revise secondary varicosity ............................................................ 0091 14.79 $733.52 $348.23 $146.70

37788 C Revascularization, penis .................................................................. .................... .................... .................... .................... ....................

37790 T Penile venous occlusion .................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

37799 T Vascular surgery procedure ............................................................. 0020 6.51 $322.87 $130.53 $64.57

38100 C Removal of spleen, total .................................................................. .................... .................... .................... .................... ....................

38101 C Removal of spleen, partial ............................................................... .................... .................... .................... .................... ....................

38102 C Removal of spleen, total .................................................................. .................... .................... .................... .................... ....................

38115 C Repair of ruptured spleen ................................................................ .................... .................... .................... .................... ....................

38120 T Laparoscopy, splenectomy .............................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

38129 T Laparoscope proc, spleen ................................................................ 0130 25.36 $1,257.75 $659.53 $251.55

38200 N Injection for spleen x-ray .................................................................. .................... .................... .................... .................... ....................

38230 S Bone marrow collection .................................................................... 0123 4.13 $204.83 $40.97 $40.97

38231 S Stem cell collection .......................................................................... 0111 14.17 $702.77 $300.74 $140.55

38240 S Bone marrow/stem transplant .......................................................... 0123 4.13 $204.83 $40.97 $40.97

38241 S Bone marrow/stem transplant .......................................................... 0123 4.13 $204.83 $40.97 $40.97

38300 T Drainage, lymph node lesion ........................................................... 0008 6.15 $305.02 $113.67 $61.00

38305 T Drainage, lymph node lesion ........................................................... 0008 6.15 $305.02 $113.67 $61.00

67879

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

38308 T Incision of lymph channels ............................................................... 0113 13.89 $688.89 $326.55 $137.78

38380 C Thoracic duct procedure .................................................................. .................... .................... .................... .................... ....................

38381 C Thoracic duct procedure .................................................................. .................... .................... .................... .................... ....................

38382 C Thoracic duct procedure .................................................................. .................... .................... .................... .................... ....................

38500 T Biopsy/removal, lymph nodes .......................................................... 0113 13.89 $688.89 $326.55 $137.78

38505 T Needle biopsy, lymph nodes ............................................................ 0005 5.41 $268.32 $119.75 $53.66

38510 T Biopsy/removal, lymph nodes .......................................................... 0113 13.89 $688.89 $326.55 $137.78

38520 T Biopsy/removal, lymph nodes .......................................................... 0113 13.89 $688.89 $326.55 $137.78

38525 T Biopsy/removal, lymph nodes .......................................................... 0113 13.89 $688.89 $326.55 $137.78

38530 T Biopsy/removal, lymph nodes .......................................................... 0113 13.89 $688.89 $326.55 $137.78

38542 T Explore deep node(s), neck ............................................................. 0114 19.56 $970.10 $493.78 $194.02

38550 T Removal, neck/armpit lesion ............................................................ 0113 13.89 $688.89 $326.55 $137.78

38555 T Removal, neck/armpit lesion ............................................................ 0114 19.56 $970.10 $493.78 $194.02

38562 C Removal, pelvic lymph nodes .......................................................... .................... .................... .................... .................... ....................

38564 C Removal, abdomen lymph nodes .................................................... .................... .................... .................... .................... ....................

38570 T Laparoscopy, lymph node biop ........................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

38571 T Laparoscopy, lymphadenectomy ..................................................... 0132 48.91 $2,425.74 $1,239.22 $485.15

38572 T Laparoscopy, lymphadenectomy ..................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

38589 T Laparoscope proc, lymphatic ........................................................... 0130 25.36 $1,257.75 $659.53 $251.55

38700 C Removal of lymph nodes, neck ....................................................... .................... .................... .................... .................... ....................

38720 T Removal of lymph nodes, neck ....................................................... 0114 19.56 $970.10 $493.78 $194.02

38724 C Removal of lymph nodes, neck ....................................................... .................... .................... .................... .................... ....................

38740 T Remove armpit lymph nodes ........................................................... 0114 19.56 $970.10 $493.78 $194.02

38745 T Remove armpit lymph nodes ........................................................... 0114 19.56 $970.10 $493.78 $194.02

38746 C Remove thoracic lymph nodes ........................................................ .................... .................... .................... .................... ....................

38747 C Remove abdominal lymph nodes .................................................... .................... .................... .................... .................... ....................

38760 T Remove groin lymph nodes ............................................................. 0114 19.56 $970.10 $493.78 $194.02

38765 C Remove groin lymph nodes ............................................................. .................... .................... .................... .................... ....................

38770 C Remove pelvis lymph nodes ............................................................ .................... .................... .................... .................... ....................

38780 C Remove abdomen lymph nodes ...................................................... .................... .................... .................... .................... ....................

38790 N Inject for lymphatic x-ray .................................................................. .................... .................... .................... .................... ....................

38792 N Identify sentinel node ....................................................................... .................... .................... .................... .................... ....................

38794 N Access thoracic lymph duct ............................................................. .................... .................... .................... .................... ....................

38999 T Blood/lymph system procedure ........................................................ 0008 6.15 $305.02 $113.67 $61.00

39000 C Exploration of chest ......................................................................... .................... .................... .................... .................... ....................

39010 C Exploration of chest ......................................................................... .................... .................... .................... .................... ....................

39200 C Removal chest lesion ....................................................................... .................... .................... .................... .................... ....................

39220 C Removal chest lesion ....................................................................... .................... .................... .................... .................... ....................

39400 T Visualization of chest ....................................................................... 0076 8.06 $399.75 $197.05 $79.95

39499 C Chest procedure ............................................................................... .................... .................... .................... .................... ....................

39501 C Repair diaphragm laceration ............................................................ .................... .................... .................... .................... ....................

39502 C Repair paraesophageal hernia ......................................................... .................... .................... .................... .................... ....................

39503 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39520 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39530 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39531 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39540 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39541 C Repair of diaphragm hernia ............................................................. .................... .................... .................... .................... ....................

39545 C Revision of diaphragm ..................................................................... .................... .................... .................... .................... ....................

39560 C Resect diaphragm, simple ............................................................... .................... .................... .................... .................... ....................

39561 C Resect diaphragm, complex ............................................................ .................... .................... .................... .................... ....................

39599 C Diaphragm surgery procedure ......................................................... .................... .................... .................... .................... ....................

40490 T Biopsy of lip ...................................................................................... 0252 5.18 $256.90 $114.24 $51.38

40500 T Partial excision of lip ........................................................................ 0253 12.02 $596.14 $284.00 $119.23

40510 T Partial excision of lip ........................................................................ 0254 12.45 $617.47 $272.41 $123.49

40520 T Partial excision of lip ........................................................................ 0253 12.02 $596.14 $284.00 $119.23

40525 T Reconstruct lip with flap ................................................................... 0254 12.45 $617.47 $272.41 $123.49

40527 T Reconstruct lip with flap ................................................................... 0254 12.45 $617.47 $272.41 $123.49

40530 T Partial removal of lip ........................................................................ 0254 12.45 $617.47 $272.41 $123.49

40650 T Repair lip .......................................................................................... 0253 12.02 $596.14 $284.00 $119.23

40652 T Repair lip .......................................................................................... 0253 12.02 $596.14 $284.00 $119.23

40654 T Repair lip .......................................................................................... 0254 12.45 $617.47 $272.41 $123.49

40700 T Repair cleft lip/nasal ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

40701 T Repair cleft lip/nasal ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

40702 T Repair cleft lip/nasal ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

40720 T Repair cleft lip/nasal ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

40761 T Repair cleft lip/nasal ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

40799 T Lip surgery procedure ...................................................................... 0253 12.02 $596.14 $284.00 $119.23

40800 T Drainage of mouth lesion ................................................................. 0251 1.68 $83.32 $27.99 $16.66

40801 T Drainage of mouth lesion ................................................................. 0252 5.18 $256.90 $114.24 $51.38

40804 T Removal, foreign body, mouth ......................................................... 0251 1.68 $83.32 $27.99 $16.66

40805 T Removal, foreign body, mouth ......................................................... 0252 5.18 $256.90 $114.24 $51.38

40806 T Incision of lip fold ............................................................................. 0251 1.68 $83.32 $27.99 $16.66

40808 T Biopsy of mouth lesion ..................................................................... 0251 1.68 $83.32 $27.99 $16.66

67880

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

40810 T Excision of mouth lesion .................................................................. 0253 12.02 $596.14 $284.00 $119.23

40812 T Excise/repair mouth lesion ............................................................... 0252 5.18 $256.90 $114.24 $51.38

40814 T Excise/repair mouth lesion ............................................................... 0253 12.02 $596.14 $284.00 $119.23

40816 T Excision of mouth lesion .................................................................. 0253 12.02 $596.14 $284.00 $119.23

40818 T Excise oral mucosa for graft ............................................................ 0251 1.68 $83.32 $27.99 $16.66

40819 T Excise lip or cheek fold .................................................................... 0252 5.18 $256.90 $114.24 $51.38

40820 T Treatment of mouth lesion ............................................................... 0253 12.02 $596.14 $284.00 $119.23

40830 T Repair mouth laceration ................................................................... 0251 1.68 $83.32 $27.99 $16.66

40831 T Repair mouth laceration ................................................................... 0253 12.02 $596.14 $284.00 $119.23

40840 T Reconstruction of mouth .................................................................. 0254 12.45 $617.47 $272.41 $123.49

40842 T Reconstruction of mouth .................................................................. 0254 12.45 $617.47 $272.41 $123.49

40843 T Reconstruction of mouth .................................................................. 0254 12.45 $617.47 $272.41 $123.49

40844 T Reconstruction of mouth .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

40845 T Reconstruction of mouth .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

40899 T Mouth surgery procedure ................................................................. 0252 5.18 $256.90 $114.24 $51.38

41000 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41005 T Drainage of mouth lesion ................................................................. 0251 1.68 $83.32 $27.99 $16.66

41006 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41007 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41008 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41009 T Drainage of mouth lesion ................................................................. 0251 1.68 $83.32 $27.99 $16.66

41010 T Incision of tongue fold ...................................................................... 0253 12.02 $596.14 $284.00 $119.23

41015 T Drainage of mouth lesion ................................................................. 0252 5.18 $256.90 $114.24 $51.38

41016 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41017 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41018 T Drainage of mouth lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41100 T Biopsy of tongue .............................................................................. 0252 5.18 $256.90 $114.24 $51.38

41105 T Biopsy of tongue .............................................................................. 0253 12.02 $596.14 $284.00 $119.23

41108 T Biopsy of floor of mouth ................................................................... 0252 5.18 $256.90 $114.24 $51.38

41110 T Excision of tongue lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41112 T Excision of tongue lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41113 T Excision of tongue lesion ................................................................. 0253 12.02 $596.14 $284.00 $119.23

41114 T Excision of tongue lesion ................................................................. 0254 12.45 $617.47 $272.41 $123.49

41115 T Excision of tongue fold ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41116 T Excision of mouth lesion .................................................................. 0253 12.02 $596.14 $284.00 $119.23

41120 T Partial removal of tongue ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

41130 C Partial removal of tongue ................................................................. .................... .................... .................... .................... ....................

41135 C Tongue and neck surgery ................................................................ .................... .................... .................... .................... ....................

41140 C Removal of tongue ........................................................................... .................... .................... .................... .................... ....................

41145 C Tongue removal, neck surgery ........................................................ .................... .................... .................... .................... ....................

41150 C Tongue, mouth, jaw surgery ............................................................ .................... .................... .................... .................... ....................

41153 C Tongue, mouth, neck surgery .......................................................... .................... .................... .................... .................... ....................

41155 C Tongue, jaw, & neck surgery ........................................................... .................... .................... .................... .................... ....................

41250 T Repair tongue laceration .................................................................. 0251 1.68 $83.32 $27.99 $16.66

41251 T Repair tongue laceration .................................................................. 0253 12.02 $596.14 $284.00 $119.23

41252 T Repair tongue laceration .................................................................. 0253 12.02 $596.14 $284.00 $119.23

41500 T Fixation of tongue ............................................................................ 0253 12.02 $596.14 $284.00 $119.23

41510 T Tongue to lip surgery ....................................................................... 0253 12.02 $596.14 $284.00 $119.23

41520 T Reconstruction, tongue fold ............................................................. 0253 12.02 $596.14 $284.00 $119.23

41599 T Tongue and mouth surgery .............................................................. 0251 1.68 $83.32 $27.99 $16.66

41800 T Drainage of gum lesion .................................................................... 0251 1.68 $83.32 $27.99 $16.66

41805 T Removal foreign body, gum ............................................................. 0253 12.02 $596.14 $284.00 $119.23

41806 T Removal foreign body,jawbone ........................................................ 0253 12.02 $596.14 $284.00 $119.23

41820 T Excision, gum, each quadrant ......................................................... 0252 5.18 $256.90 $114.24 $51.38

41821 T Excision of gum flap ......................................................................... 0252 5.18 $256.90 $114.24 $51.38

41822 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41823 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41825 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41826 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41827 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41828 T Excision of gum lesion ..................................................................... 0253 12.02 $596.14 $284.00 $119.23

41830 T Removal of gum tissue .................................................................... 0253 12.02 $596.14 $284.00 $119.23

41850 T Treatment of gum lesion .................................................................. 0253 12.02 $596.14 $284.00 $119.23

41870 T Gum graft ......................................................................................... 0253 12.02 $596.14 $284.00 $119.23

41872 T Repair gum ....................................................................................... 0253 12.02 $596.14 $284.00 $119.23

41874 T Repair tooth socket .......................................................................... 0253 12.02 $596.14 $284.00 $119.23

41899 T Dental surgery procedure ................................................................ 0253 12.02 $596.14 $284.00 $119.23

42000 T Drainage mouth roof lesion .............................................................. 0251 1.68 $83.32 $27.99 $16.66

42100 T Biopsy roof of mouth ........................................................................ 0252 5.18 $256.90 $114.24 $51.38

42104 T Excision lesion, mouth roof .............................................................. 0253 12.02 $596.14 $284.00 $119.23

42106 T Excision lesion, mouth roof .............................................................. 0253 12.02 $596.14 $284.00 $119.23

42107 T Excision lesion, mouth roof .............................................................. 0254 12.45 $617.47 $272.41 $123.49

42120 T Remove palate/lesion ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42140 T Excision of uvula .............................................................................. 0252 5.18 $256.90 $114.24 $51.38

67881

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

42145 T Repair palate, pharynx/uvula ........................................................... 0254 12.45 $617.47 $272.41 $123.49

42160 T Treatment mouth roof lesion ............................................................ 0253 12.02 $596.14 $284.00 $119.23

42180 T Repair palate .................................................................................... 0251 1.68 $83.32 $27.99 $16.66

42182 T Repair palate .................................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42200 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42205 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42210 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42215 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42220 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42225 T Reconstruct cleft palate ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42226 T Lengthening of palate ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42227 T Lengthening of palate ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42235 T Repair palate .................................................................................... 0254 12.45 $617.47 $272.41 $123.49

42260 T Repair nose to lip fistula .................................................................. 0253 12.02 $596.14 $284.00 $119.23

42280 T Preparation, palate mold .................................................................. 0251 1.68 $83.32 $27.99 $16.66

42281 T Insertion, palate prosthesis .............................................................. 0253 12.02 $596.14 $284.00 $119.23

42299 T Palate/uvula surgery ........................................................................ 0251 1.68 $83.32 $27.99 $16.66

42300 T Drainage of salivary gland ............................................................... 0253 12.02 $596.14 $284.00 $119.23

42305 T Drainage of salivary gland ............................................................... 0253 12.02 $596.14 $284.00 $119.23

42310 T Drainage of salivary gland ............................................................... 0251 1.68 $83.32 $27.99 $16.66

42320 T Drainage of salivary gland ............................................................... 0251 1.68 $83.32 $27.99 $16.66

42325 T Create salivary cyst drain ................................................................ 0252 5.18 $256.90 $114.24 $51.38

42326 T Create salivary cyst drain ................................................................ 0252 5.18 $256.90 $114.24 $51.38

42330 T Removal of salivary stone ................................................................ 0252 5.18 $256.90 $114.24 $51.38

42335 T Removal of salivary stone ................................................................ 0253 12.02 $596.14 $284.00 $119.23

42340 T Removal of salivary stone ................................................................ 0253 12.02 $596.14 $284.00 $119.23

42400 T Biopsy of salivary gland ................................................................... 0004 1.84 $91.26 $32.57 $18.25

42405 T Biopsy of salivary gland ................................................................... 0253 12.02 $596.14 $284.00 $119.23

42408 T Excision of salivary cyst ................................................................... 0253 12.02 $596.14 $284.00 $119.23

42409 T Drainage of salivary cyst .................................................................. 0253 12.02 $596.14 $284.00 $119.23

42410 T Excise parotid gland/lesion .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42415 T Excise parotid gland/lesion .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42420 T Excise parotid gland/lesion .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42425 T Excise parotid gland/lesion .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42426 C Excise parotid gland/lesion .............................................................. .................... .................... .................... .................... ....................

42440 T Excise submaxillary gland ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

42450 T Excise sublingual gland ................................................................... 0253 12.02 $596.14 $284.00 $119.23

42500 T Repair salivary duct ......................................................................... 0254 12.45 $617.47 $272.41 $123.49

42505 T Repair salivary duct ......................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42507 T Parotid duct diversion ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42508 T Parotid duct diversion ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42509 T Parotid duct diversion ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42510 T Parotid duct diversion ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42550 N Injection for salivary x-ray ................................................................ .................... .................... .................... .................... ....................

42600 T Closure of salivary fistula ................................................................. 0253 12.02 $596.14 $284.00 $119.23

42650 T Dilation of salivary duct .................................................................... 0252 5.18 $256.90 $114.24 $51.38

42660 T Dilation of salivary duct .................................................................... 0252 5.18 $256.90 $114.24 $51.38

42665 T Ligation of salivary duct ................................................................... 0253 12.02 $596.14 $284.00 $119.23

42699 T Salivary surgery procedure .............................................................. 0253 12.02 $596.14 $284.00 $119.23

42700 T Drainage of tonsil abscess ............................................................... 0251 1.68 $83.32 $27.99 $16.66

42720 T Drainage of throat abscess .............................................................. 0253 12.02 $596.14 $284.00 $119.23

42725 T Drainage of throat abscess .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42800 T Biopsy of throat ................................................................................ 0252 5.18 $256.90 $114.24 $51.38

42802 T Biopsy of throat ................................................................................ 0253 12.02 $596.14 $284.00 $119.23

42804 T Biopsy of upper nose/throat ............................................................. 0253 12.02 $596.14 $284.00 $119.23

42806 T Biopsy of upper nose/throat ............................................................. 0253 12.02 $596.14 $284.00 $119.23

42808 T Excise pharynx lesion ...................................................................... 0253 12.02 $596.14 $284.00 $119.23

42809 T Remove pharynx foreign body ......................................................... 0251 1.68 $83.32 $27.99 $16.66

42810 T Excision of neck cyst ....................................................................... 0253 12.02 $596.14 $284.00 $119.23

42815 T Excision of neck cyst ....................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42820 T Remove tonsils and adenoids .......................................................... 0258 18.62 $923.48 $462.81 $184.70

42821 T Remove tonsils and adenoids .......................................................... 0258 18.62 $923.48 $462.81 $184.70

42825 T Removal of tonsils ............................................................................ 0258 18.62 $923.48 $462.81 $184.70

42826 T Removal of tonsils ............................................................................ 0258 18.62 $923.48 $462.81 $184.70

42830 T Removal of adenoids ....................................................................... 0258 18.62 $923.48 $462.81 $184.70

42831 T Removal of adenoids ....................................................................... 0258 18.62 $923.48 $462.81 $184.70

42835 T Removal of adenoids ....................................................................... 0258 18.62 $923.48 $462.81 $184.70

42836 T Removal of adenoids ....................................................................... 0258 18.62 $923.48 $462.81 $184.70

42842 C Extensive surgery of throat .............................................................. .................... .................... .................... .................... ....................

42844 T Extensive surgery of throat .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

42845 C Extensive surgery of throat .............................................................. .................... .................... .................... .................... ....................

42860 T Excision of tonsil tags ...................................................................... 0258 18.62 $923.48 $462.81 $184.70

42870 T Excision of lingual tonsil ................................................................... 0258 18.62 $923.48 $462.81 $184.70

42890 T Partial removal of pharynx ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

67882

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

42892 T Revision of pharyngeal walls ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42894 C Revision of pharyngeal walls ........................................................... .................... .................... .................... .................... ....................

42900 T Repair throat wound ......................................................................... 0253 12.02 $596.14 $284.00 $119.23

42950 T Reconstruction of throat ................................................................... 0254 12.45 $617.47 $272.41 $123.49

42953 C Repair throat, esophagus ................................................................. .................... .................... .................... .................... ....................

42955 T Surgical opening of throat ................................................................ 0254 12.45 $617.47 $272.41 $123.49

42960 T Control throat bleeding ..................................................................... 0250 2.21 $109.61 $38.54 $21.92

42961 C Control throat bleeding ..................................................................... .................... .................... .................... .................... ....................

42962 T Control throat bleeding ..................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

42970 T Control nose/throat bleeding ............................................................ 0250 2.21 $109.61 $38.54 $21.92

42971 C Control nose/throat bleeding ............................................................ .................... .................... .................... .................... ....................

42972 T Control nose/throat bleeding ............................................................ 0253 12.02 $596.14 $284.00 $119.23

42999 T Throat surgery procedure ................................................................ 0252 5.18 $256.90 $114.24 $51.38

43020 T Incision of esophagus ...................................................................... 0254 12.45 $617.47 $272.41 $123.49

43030 C Throat muscle surgery ..................................................................... .................... .................... .................... .................... ....................

43045 C Incision of esophagus ...................................................................... .................... .................... .................... .................... ....................

43100 C Excision of esophagus lesion .......................................................... .................... .................... .................... .................... ....................

43101 C Excision of esophagus lesion .......................................................... .................... .................... .................... .................... ....................

43107 C Removal of esophagus .................................................................... .................... .................... .................... .................... ....................

43108 C Removal of esophagus .................................................................... .................... .................... .................... .................... ....................

43112 C Removal of esophagus .................................................................... .................... .................... .................... .................... ....................

43113 C Removal of esophagus .................................................................... .................... .................... .................... .................... ....................

43116 C Partial removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43117 C Partial removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43118 C Partial removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43121 C Partial removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43122 C Parital removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43123 C Partial removal of esophagus .......................................................... .................... .................... .................... .................... ....................

43124 C Removal of esophagus .................................................................... .................... .................... .................... .................... ....................

43130 T Removal of esophagus pouch ......................................................... 0254 12.45 $617.47 $272.41 $123.49

43135 C Removal of esophagus pouch ......................................................... .................... .................... .................... .................... ....................

43200 T Esophagus endoscopy ..................................................................... 0141 7.15 $354.61 $184.67 $70.92

43202 T Esophagus endoscopy, biopsy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43204 T Esophagus endoscopy & inject ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43205 T Esophagus endoscopy/ligation ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43215 T Esophagus endoscopy ..................................................................... 0141 7.15 $354.61 $184.67 $70.92

43216 T Esophagus endoscopy/lesion .......................................................... 0141 7.15 $354.61 $184.67 $70.92

43217 T Esophagus endoscopy ..................................................................... 0141 7.15 $354.61 $184.67 $70.92

43219 T Esophagus endoscopy ..................................................................... 0141 7.15 $354.61 $184.67 $70.92

43220 T Esoph endoscopy, dilation ............................................................... 0141 7.15 $354.61 $184.67 $70.92

43226 T Esoph endoscopy, dilation ............................................................... 0141 7.15 $354.61 $184.67 $70.92

43227 T Esoph endoscopy, repair ................................................................. 0141 7.15 $354.61 $184.67 $70.92

43228 T Esoph endoscopy, ablation .............................................................. 0141 7.15 $354.61 $184.67 $70.92

*43231 T Esoph endoscopy w/ US exam ........................................................ 0141 7.15 $354.61 $184.67 $70.92

*43232 T Esoph endoscopy w/ US fn bx ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43234 T Upper GI endoscopy, exam ............................................................. 0141 7.15 $354.61 $184.67 $70.92

43235 T Uppr gi endoscopy, diagnosis .......................................................... 0141 7.15 $354.61 $184.67 $70.92

43239 T Upper GI endoscopy, biopsy ........................................................... 0141 7.15 $354.61 $184.67 $70.92

*43240 T Esoph endoscopy w/ drain cyst ....................................................... 0141 7.15 $354.61 $184.67 $70.92

43241 T Upper GI endoscopy with tube ........................................................ 0141 7.15 $354.61 $184.67 $70.92

*43242 T Uppr GI endoscopy w/ US fn bx ...................................................... 0141 7.15 $354.61 $184.67 $70.92

43243 T Upper GI endoscopy & inject ........................................................... 0141 7.15 $354.61 $184.67 $70.92

43244 T Upper GI endoscopy/ligation ............................................................ 0141 7.15 $354.61 $184.67 $70.92

43245 T Operative upper GI endoscopy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43246 T Place gastrostomy tube ................................................................... 0141 7.15 $354.61 $184.67 $70.92

43247 T Operative upper GI endoscopy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43248 T Uppr gi endoscopy/guide wire ......................................................... 0141 7.15 $354.61 $184.67 $70.92

43249 T Esoph endoscopy, dilation ............................................................... 0141 7.15 $354.61 $184.67 $70.92

43250 T Upper GI endoscopy/tumor .............................................................. 0141 7.15 $354.61 $184.67 $70.92

43251 T Operative upper GI endoscopy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43255 T Operative upper GI endoscopy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

*43256 T Uppr GI endoscopy w/ stent ............................................................ 0141 7.15 $354.61 $184.67 $70.92

43258 T Operative upper GI endoscopy ........................................................ 0141 7.15 $354.61 $184.67 $70.92

43259 T Endoscopic ultrasound exam ........................................................... 0141 7.15 $354.61 $184.67 $70.92

43260 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43261 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43262 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43263 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43264 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43265 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43267 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43268 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43269 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43271 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

67883

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

43272 T Endo cholangiopancreatograph ....................................................... 0151 10.53 $522.25 $245.46 $104.45

43280 T Laparoscopy, fundoplasty ................................................................ 0132 48.91 $2,425.74 $1,239.22 $485.15

43289 T Laparoscope proc, esoph ................................................................ 0130 25.36 $1,257.75 $659.53 $251.55

43300 C Repair of esophagus ........................................................................ .................... .................... .................... .................... ....................

43305 C Repair esophagus and fistula .......................................................... .................... .................... .................... .................... ....................

43310 C Repair of esophagus ........................................................................ .................... .................... .................... .................... ....................

43312 C Repair esophagus and fistula .......................................................... .................... .................... .................... .................... ....................

43320 C Fuse esophagus & stomach ............................................................ .................... .................... .................... .................... ....................

43324 C Revise esophagus & stomach ......................................................... .................... .................... .................... .................... ....................

43325 C Revise esophagus & stomach ......................................................... .................... .................... .................... .................... ....................

43326 C Revise esophagus & stomach ......................................................... .................... .................... .................... .................... ....................

43330 C Repair of esophagus ........................................................................ .................... .................... .................... .................... ....................

43331 C Repair of esophagus ........................................................................ .................... .................... .................... .................... ....................

43340 C Fuse esophagus & intestine ............................................................ .................... .................... .................... .................... ....................

43341 C Fuse esophagus & intestine ............................................................ .................... .................... .................... .................... ....................

43350 C Surgical opening, esophagus ........................................................... .................... .................... .................... .................... ....................

43351 C Surgical opening, esophagus ........................................................... .................... .................... .................... .................... ....................

43352 C Surgical opening, esophagus ........................................................... .................... .................... .................... .................... ....................

43360 C Gastrointestinal repair ...................................................................... .................... .................... .................... .................... ....................

43361 C Gastrointestinal repair ...................................................................... .................... .................... .................... .................... ....................

*44383 T Ileoscopy through stoma w/stent ..................................................... 0142 7.45 $369.49 $162.42 $73.90

43400 C Ligate esophagus veins ................................................................... .................... .................... .................... .................... ....................

43401 C Esophagus surgery for veins ........................................................... .................... .................... .................... .................... ....................

43405 C Ligate/staple esophagus .................................................................. .................... .................... .................... .................... ....................

43410 C Repair esophagus wound ................................................................ .................... .................... .................... .................... ....................

43415 C Repair esophagus wound ................................................................ .................... .................... .................... .................... ....................

43420 C Repair esophagus opening .............................................................. .................... .................... .................... .................... ....................

43425 C Repair esophagus opening .............................................................. .................... .................... .................... .................... ....................

43450 T Dilate esophagus ............................................................................. 0140 4.74 $235.09 $107.24 $47.02

43453 T Dilate esophagus ............................................................................. 0140 4.74 $235.09 $107.24 $47.02

43456 T Dilate esophagus ............................................................................. 0140 4.74 $235.09 $107.24 $47.02

43458 T Dilate esophagus ............................................................................. 0140 4.74 $235.09 $107.24 $47.02

43460 C Pressure treatment esophagus ........................................................ .................... .................... .................... .................... ....................

43496 C Free jejunum flap, microvasc ........................................................... .................... .................... .................... .................... ....................

43499 T Esophagus surgery procedure ......................................................... 0140 4.74 $235.09 $107.24 $47.02

43500 C Surgical opening of stomach ........................................................... .................... .................... .................... .................... ....................

43501 C Surgical repair of stomach ............................................................... .................... .................... .................... .................... ....................

43502 C Surgical repair of stomach ............................................................... .................... .................... .................... .................... ....................

43510 C Surgical opening of stomach ........................................................... .................... .................... .................... .................... ....................

43520 C Incision of pyloric muscle ................................................................. .................... .................... .................... .................... ....................

43600 T Biopsy of stomach ............................................................................ 0141 7.15 $354.61 $184.67 $70.92

43605 C Biopsy of stomach ............................................................................ .................... .................... .................... .................... ....................

43610 C Excision of stomach lesion .............................................................. .................... .................... .................... .................... ....................

43611 C Excision of stomach lesion .............................................................. .................... .................... .................... .................... ....................

43620 C Removal of stomach ........................................................................ .................... .................... .................... .................... ....................

43621 C Removal of stomach ........................................................................ .................... .................... .................... .................... ....................

43622 C Removal of stomach ........................................................................ .................... .................... .................... .................... ....................

43631 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43632 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43633 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43634 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43635 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43638 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43639 C Removal of stomach, partial ............................................................ .................... .................... .................... .................... ....................

43640 C Vagotomy & pylorus repair .............................................................. .................... .................... .................... .................... ....................

43641 C Vagotomy & pylorus repair .............................................................. .................... .................... .................... .................... ....................

43651 T Laparoscopy, vagus nerve ............................................................... 0132 48.91 $2,425.74 $1,239.22 $485.15

43652 T Laparoscopy, vagus nerve ............................................................... 0132 48.91 $2,425.74 $1,239.22 $485.15

43653 T Laparoscopy, gastrostomy ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

43659 T Laparoscope proc, stom .................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

*43752 E Nasal/orogastric w/stent ................................................................... .................... .................... .................... .................... ....................

43750 T Place gastrostomy tube ................................................................... 0141 7.15 $354.61 $184.67 $70.92

43760 T Change gastrostomy tube ................................................................ 0121 2.36 $117.05 $52.53 $23.41

43761 T Reposition gastrostomy tube ........................................................... 0121 2.36 $117.05 $52.53 $23.41

43800 C Reconstruction of pylorus ................................................................ .................... .................... .................... .................... ....................

43810 C Fusion of stomach and bowel .......................................................... .................... .................... .................... .................... ....................

43820 C Fusion of stomach and bowel .......................................................... .................... .................... .................... .................... ....................

43825 C Fusion of stomach and bowel .......................................................... .................... .................... .................... .................... ....................

43830 T Place gastrostomy tube ................................................................... 0141 7.15 $354.61 $184.67 $70.92

43831 T Place gastrostomy tube ................................................................... 0141 7.15 $354.61 $184.67 $70.92

43832 C Place gastrostomy tube ................................................................... .................... .................... .................... .................... ....................

43840 C Repair of stomach lesion ................................................................. .................... .................... .................... .................... ....................

43842 C Gastroplasty for obesity ................................................................... .................... .................... .................... .................... ....................

43843 C Gastroplasty for obesity ................................................................... .................... .................... .................... .................... ....................

67884

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

43846 C Gastric bypass for obesity ............................................................... .................... .................... .................... .................... ....................

43847 C Gastric bypass for obesity ............................................................... .................... .................... .................... .................... ....................

43848 C Revision gastroplasty ....................................................................... .................... .................... .................... .................... ....................

43850 C Revise stomach-bowel fusion .......................................................... .................... .................... .................... .................... ....................

43855 C Revise stomach-bowel fusion .......................................................... .................... .................... .................... .................... ....................

43860 C Revise stomach-bowel fusion .......................................................... .................... .................... .................... .................... ....................

43865 C Revise stomach-bowel fusion .......................................................... .................... .................... .................... .................... ....................

43870 T Repair stomach opening .................................................................. 0025 3.74 $185.49 $70.66 $37.10

43880 C Repair stomach-bowel fistula ........................................................... .................... .................... .................... .................... ....................

43999 T Stomach surgery procedure ............................................................. 0121 2.36 $117.05 $52.53 $23.41

44005 C Freeing of bowel adhesion ............................................................... .................... .................... .................... .................... ....................

44010 C Incision of small bowel ..................................................................... .................... .................... .................... .................... ....................

44015 C Insert needle cath bowel .................................................................. .................... .................... .................... .................... ....................

44020 C Exploration of small bowel ............................................................... .................... .................... .................... .................... ....................

44021 C Decompress small bowel ................................................................. .................... .................... .................... .................... ....................

44025 C Incision of large bowel ..................................................................... .................... .................... .................... .................... ....................

44050 C Reduce bowel obstruction ................................................................ .................... .................... .................... .................... ....................

44055 C Correct malrotation of bowel ............................................................ .................... .................... .................... .................... ....................

44100 T Biopsy of bowel ................................................................................ 0141 7.15 $354.61 $184.67 $70.92

44110 C Excision of bowel lesion(s) .............................................................. .................... .................... .................... .................... ....................

44111 C Excision of bowel lesion(s) .............................................................. .................... .................... .................... .................... ....................

44120 C Removal of small intestine ............................................................... .................... .................... .................... .................... ....................

44121 C Removal of small intestine ............................................................... .................... .................... .................... .................... ....................

44125 C Removal of small intestine ............................................................... .................... .................... .................... .................... ....................

44130 C Bowel to bowel fusion ...................................................................... .................... .................... .................... .................... ....................

*44132 C Enterectomy, cadaver donor ............................................................ .................... .................... .................... .................... ....................

*44133 C Enterectomy, live donor ................................................................... .................... .................... .................... .................... ....................

*44135 C Intestine transplnt, cadaver .............................................................. .................... .................... .................... .................... ....................

*44136 C Intestine transplnt, live ..................................................................... .................... .................... .................... .................... ....................

44139 C Mobilization of colon ........................................................................ .................... .................... .................... .................... ....................

44140 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44141 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44143 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44144 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44145 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44146 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44147 C Partial removal of colon ................................................................... .................... .................... .................... .................... ....................

44150 C Removal of colon ............................................................................. .................... .................... .................... .................... ....................

44151 C Removal of colon/ileostomy ............................................................. .................... .................... .................... .................... ....................

44152 C Removal of colon/ileostomy ............................................................. .................... .................... .................... .................... ....................

44153 C Removal of colon/ileostomy ............................................................. .................... .................... .................... .................... ....................

44155 C Removal of colon/ileostomy ............................................................. .................... .................... .................... .................... ....................

44156 C Removal of colon/ileostomy ............................................................. .................... .................... .................... .................... ....................

44160 C Removal of colon ............................................................................. .................... .................... .................... .................... ....................

44200 T Laparoscopy, enterolysis ................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

44201 T Laparoscopy, jejunostomy ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

44202 C Laparo, resect intestine .................................................................... .................... .................... .................... .................... ....................

44209 T Laparoscope proc, intestine ............................................................. 0130 25.36 $1,257.75 $659.53 $251.55

44300 C Open bowel to skin .......................................................................... .................... .................... .................... .................... ....................

44310 C Ileostomy/jejunostomy ...................................................................... .................... .................... .................... .................... ....................

44312 T Revision of ileostomy ....................................................................... 0026 12.11 $600.61 $277.92 $120.12

44314 C Revision of ileostomy ....................................................................... .................... .................... .................... .................... ....................

44316 C Devise bowel pouch ......................................................................... .................... .................... .................... .................... ....................

44320 C Colostomy ........................................................................................ .................... .................... .................... .................... ....................

44322 C Colostomy with biopsies .................................................................. .................... .................... .................... .................... ....................

44340 T Revision of colostomy ...................................................................... 0026 12.11 $600.61 $277.92 $120.12

44345 C Revision of colostomy ...................................................................... .................... .................... .................... .................... ....................

44346 C Revision of colostomy ...................................................................... .................... .................... .................... .................... ....................

44360 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44361 T Small bowel endoscopy/biopsy ........................................................ 0142 7.45 $369.49 $162.42 $73.90

44363 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44364 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44365 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44366 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44369 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

*44370 T Small bowel endoscopy/stent .......................................................... 0142 7.45 $369.49 $162.42 $73.90

44372 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44373 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44376 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44377 T Small bowel endoscopy/biopsy ........................................................ 0142 7.45 $369.49 $162.42 $73.90

44378 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

*44379 T Small bowel endoscopy/stent .......................................................... 0142 7.45 $369.49 $162.42 $73.90

44380 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

44382 T Small bowel endoscopy ................................................................... 0142 7.45 $369.49 $162.42 $73.90

67885

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

44385 T Endoscopy of bowel pouch .............................................................. 0143 7.98 $395.78 $199.12 $79.16

44386 T Endoscopy, bowel pouch/biop ......................................................... 0143 7.98 $395.78 $199.12 $79.16

44388 T Colon endoscopy ............................................................................. 0143 7.98 $395.78 $199.12 $79.16

44389 T Colonoscopy with biopsy ................................................................. 0143 7.98 $395.78 $199.12 $79.16

44390 T Colonoscopy for foreign body .......................................................... 0143 7.98 $395.78 $199.12 $79.16

44391 T Colonoscopy for bleeding ................................................................ 0143 7.98 $395.78 $199.12 $79.16

44392 T Colonoscopy & polypectomy ............................................................ 0143 7.98 $395.78 $199.12 $79.16

44393 T Colonoscopy, lesion removal ........................................................... 0143 7.98 $395.78 $199.12 $79.16

44394 T Colonoscopy w/snare ....................................................................... 0143 7.98 $395.78 $199.12 $79.16

*44397 T Colonoscopy w/stent ........................................................................ 0143 7.98 $395.78 $199.12 $79.16

44500 T Intro, gastrointestinal tube ................................................................ 0121 2.36 $117.05 $52.53 $23.41

44602 C Suture, small intestine ...................................................................... .................... .................... .................... .................... ....................

44603 C Suture, small intestine ...................................................................... .................... .................... .................... .................... ....................

44604 C Suture, large intestine ...................................................................... .................... .................... .................... .................... ....................

44605 C Repair of bowel lesion ..................................................................... .................... .................... .................... .................... ....................

44615 C Intestinal stricturoplasty .................................................................... .................... .................... .................... .................... ....................

44620 C Repair bowel opening ...................................................................... .................... .................... .................... .................... ....................

44625 C Repair bowel opening ...................................................................... .................... .................... .................... .................... ....................

44626 C Repair bowel opening ...................................................................... .................... .................... .................... .................... ....................

44640 C Repair bowel-skin fistula .................................................................. .................... .................... .................... .................... ....................

44650 C Repair bowel fistula .......................................................................... .................... .................... .................... .................... ....................

44660 C Repair bowel-bladder fistula ............................................................ .................... .................... .................... .................... ....................

44661 C Repair bowel-bladder fistula ............................................................ .................... .................... .................... .................... ....................

44680 C Surgical revision, intestine ............................................................... .................... .................... .................... .................... ....................

44700 C Suspend bowel w/prosthesis ........................................................... .................... .................... .................... .................... ....................

44799 T Intestine surgery procedure ............................................................. 0142 7.45 $369.49 $162.42 $73.90

44800 C Excision of bowel pouch .................................................................. .................... .................... .................... .................... ....................

44820 C Excision of mesentery lesion ........................................................... .................... .................... .................... .................... ....................

44850 C Repair of mesentery ......................................................................... .................... .................... .................... .................... ....................

44899 C Bowel surgery procedure ................................................................. .................... .................... .................... .................... ....................

44900 C Drain app abscess, open ................................................................. .................... .................... .................... .................... ....................

44901 C Drain app abscess, percut ............................................................... .................... .................... .................... .................... ....................

44950 C Appendectomy ................................................................................. .................... .................... .................... .................... ....................

44955 C Appendectomy add-on ..................................................................... .................... .................... .................... .................... ....................

44960 C Appendectomy ................................................................................. .................... .................... .................... .................... ....................

44970 T Laparoscopy, appendectomy ........................................................... 0130 25.36 $1,257.75 $659.53 $251.55

44979 T Laparoscope proc, app .................................................................... 0130 25.36 $1,257.75 $659.53 $251.55

45000 T Drainage of pelvic abscess .............................................................. 0149 12.86 $637.80 $293.06 $127.56

45005 T Drainage of rectal abscess .............................................................. 0148 2.34 $116.06 $43.59 $23.21

45020 T Drainage of rectal abscess .............................................................. 0149 12.86 $637.80 $293.06 $127.56

45100 T Biopsy of rectum .............................................................................. 0149 12.86 $637.80 $293.06 $127.56

45108 T Removal of anorectal lesion ............................................................ 0150 17.68 $876.86 $437.12 $175.37

45110 C Removal of rectum ........................................................................... .................... .................... .................... .................... ....................

45111 C Partial removal of rectum ................................................................. .................... .................... .................... .................... ....................

45112 C Removal of rectum ........................................................................... .................... .................... .................... .................... ....................

45113 C Partial proctectomy .......................................................................... .................... .................... .................... .................... ....................

45114 C Partial removal of rectum ................................................................. .................... .................... .................... .................... ....................

45116 C Partial removal of rectum ................................................................. .................... .................... .................... .................... ....................

45119 C Remove rectum w/reservoir ............................................................. .................... .................... .................... .................... ....................

45120 C Removal of rectum ........................................................................... .................... .................... .................... .................... ....................

45121 C Removal of rectum and colon .......................................................... .................... .................... .................... .................... ....................

45123 C Partial proctectomy .......................................................................... .................... .................... .................... .................... ....................

45126 C Pelvic exenteration ........................................................................... .................... .................... .................... .................... ....................

45130 C Excision of rectal prolapse ............................................................... .................... .................... .................... .................... ....................

45135 C Excision of rectal prolapse ............................................................... .................... .................... .................... .................... ....................

45150 T Excision of rectal stricture ................................................................ 0150 17.68 $876.86 $437.12 $175.37

45160 T Excision of rectal lesion ................................................................... 0150 17.68 $876.86 $437.12 $175.37

45170 T Excision of rectal lesion ................................................................... 0150 17.68 $876.86 $437.12 $175.37

45190 T Destruction, rectal tumor .................................................................. 0150 17.68 $876.86 $437.12 $175.37

45300 T Proctosigmoidoscopy ....................................................................... 0146 2.83 $140.36 $65.15 $28.07

45303 T Proctosigmoidoscopy ....................................................................... 0146 2.83 $140.36 $65.15 $28.07

45305 T Proctosigmoidoscopy & biopsy ........................................................ 0146 2.83 $140.36 $65.15 $28.07

45307 T Proctosigmoidoscopy ....................................................................... 0146 2.83 $140.36 $65.15 $28.07

45308 T Proctosigmoidoscopy ....................................................................... 0147 6.26 $310.47 $149.11 $62.09

45309 T Proctosigmoidoscopy ....................................................................... 0147 6.26 $310.47 $149.11 $62.09

45315 T Proctosigmoidoscopy ....................................................................... 0147 6.26 $310.47 $149.11 $62.09

45317 T Proctosigmoidoscopy ....................................................................... 0146 2.83 $140.36 $65.15 $28.07

45320 T Proctosigmoidoscopy ....................................................................... 0147 6.26 $310.47 $149.11 $62.09

45321 T Proctosigmoidoscopy ....................................................................... 0147 6.26 $310.47 $149.11 $62.09

*45327 T Proctosigmoidoscopy w/stent ........................................................... 0147 6.26 $310.47 $149.11 $62.09

45330 T Diagnostic sigmoidoscopy ................................................................ 0146 2.83 $140.36 $65.15 $28.07

45331 T Sigmoidoscopy and biopsy .............................................................. 0146 2.83 $140.36 $65.15 $28.07

45332 T Sigmoidoscopy w/fb removal ........................................................... 0146 2.83 $140.36 $65.15 $28.07

45333 T Sigmoidoscopy & polypectomy ........................................................ 0147 6.26 $310.47 $149.11 $62.09

67886

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

45334 T Sigmoidoscopy for bleeding ............................................................. 0147 6.26 $310.47 $149.11 $62.09

45337 T Sigmoidoscopy & decompress ......................................................... 0147 6.26 $310.47 $149.11 $62.09

45338 T Sigmoidoscopy w/tumr remove ........................................................ 0147 6.26 $310.47 $149.11 $62.09

45339 T Sigmoidoscopy w/ablate tumr .......................................................... 0147 6.26 $310.47 $149.11 $62.09

*45341 T Sigmoidoscopy w/ultrasound ........................................................... 0147 6.26 $310.47 $149.11 $62.09

*45342 T Sigmoidoscopy w/ US guide bx ....................................................... 0147 6.26 $310.47 $149.11 $62.09

*45345 T Sigmoidoscopy w/stent .................................................................... 0147 6.26 $310.47 $149.11 $62.09

45355 T Surgical colonoscopy ....................................................................... 0143 7.98 $395.78 $199.12 $79.16

45378 T Diagnostic colonoscopy ................................................................... 0143 7.98 $395.78 $199.12 $79.16

45379 T Colonoscopy ..................................................................................... 0143 7.98 $395.78 $199.12 $79.16

45380 T Colonoscopy and biopsy .................................................................. 0143 7.98 $395.78 $199.12 $79.16

45382 T Colonoscopy/control bleeding .......................................................... 0143 7.98 $395.78 $199.12 $79.16

45383 T Lesion removal colonoscopy ............................................................ 0143 7.98 $395.78 $199.12 $79.16

45384 T Colonoscopy ..................................................................................... 0143 7.98 $395.78 $199.12 $79.16

45385 T Lesion removal colonoscopy ............................................................ 0143 7.98 $395.78 $199.12 $79.16

*45387 T Colonoscopy w/stent ........................................................................ 0143 7.98 $395.78 $199.12 $79.16

45500 T Repair of rectum .............................................................................. 0150 17.68 $876.86 $437.12 $175.37

45505 T Repair of rectum .............................................................................. 0150 17.68 $876.86 $437.12 $175.37

45520 T Treatment of rectal prolapse ............................................................ 0098 1.19 $59.02 $20.88 $11.80

45540 C Correct rectal prolapse ..................................................................... .................... .................... .................... .................... ....................

45541 C Correct rectal prolapse ..................................................................... .................... .................... .................... .................... ....................

45550 C Repair rectum/remove sigmoid ........................................................ .................... .................... .................... .................... ....................

45560 T Repair of rectocele ........................................................................... 0150 17.68 $876.86 $437.12 $175.37

45562 C Exploration/repair of rectum ............................................................. .................... .................... .................... .................... ....................

45563 C Exploration/repair of rectum ............................................................. .................... .................... .................... .................... ....................

45800 C Repair rect/bladder fistula ................................................................ .................... .................... .................... .................... ....................

45805 C Repair fistula w/colostomy ............................................................... .................... .................... .................... .................... ....................

45820 C Repair rectourethral fistula ............................................................... .................... .................... .................... .................... ....................

45825 C Repair fistula w/colostomy ............................................................... .................... .................... .................... .................... ....................

45900 T Reduction of rectal prolapse ............................................................ 0148 2.34 $116.06 $43.59 $23.21

45905 T Dilation of anal sphincter ................................................................. 0149 12.86 $637.80 $293.06 $127.56

45910 T Dilation of rectal narrowing .............................................................. 0149 12.86 $637.80 $293.06 $127.56

45915 T Remove rectal obstruction ............................................................... 0148 2.34 $116.06 $43.59 $23.21

45999 T Rectum surgery procedure .............................................................. 0148 2.34 $116.06 $43.59 $23.21

46030 T Removal of rectal marker ................................................................. 0149 12.86 $637.80 $293.06 $127.56

46040 T Incision of rectal abscess ................................................................. 0148 2.34 $116.06 $43.59 $23.21

46045 T Incision of rectal abscess ................................................................. 0150 17.68 $876.86 $437.12 $175.37

46050 T Incision of anal abscess ................................................................... 0148 2.34 $116.06 $43.59 $23.21

46060 T Incision of rectal abscess ................................................................. 0150 17.68 $876.86 $437.12 $175.37

46070 T Incision of anal septum .................................................................... 0148 2.34 $116.06 $43.59 $23.21

46080 T Incision of anal sphincter ................................................................. 0149 12.86 $637.80 $293.06 $127.56

46083 T Incise external hemorrhoid ............................................................... 0148 2.34 $116.06 $43.59 $23.21

46200 T Removal of anal fissure ................................................................... 0150 17.68 $876.86 $437.12 $175.37

46210 T Removal of anal crypt ...................................................................... 0149 12.86 $637.80 $293.06 $127.56

46211 T Removal of anal crypts .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46220 T Removal of anal tab ......................................................................... 0149 12.86 $637.80 $293.06 $127.56

46221 T Ligation of hemorrhoid(s) ................................................................. 0148 2.34 $116.06 $43.59 $23.21

46230 T Removal of anal tabs ....................................................................... 0149 12.86 $637.80 $293.06 $127.56

46250 T Hemorrhoidectomy ........................................................................... 0150 17.68 $876.86 $437.12 $175.37

46255 T Hemorrhoidectomy ........................................................................... 0150 17.68 $876.86 $437.12 $175.37

46257 T Remove hemorrhoids & fissure ....................................................... 0150 17.68 $876.86 $437.12 $175.37

46258 T Remove hemorrhoids & fistula ......................................................... 0150 17.68 $876.86 $437.12 $175.37

46260 T Hemorrhoidectomy ........................................................................... 0150 17.68 $876.86 $437.12 $175.37

46261 T Remove hemorrhoids & fissure ....................................................... 0150 17.68 $876.86 $437.12 $175.37

46262 T Remove hemorrhoids & fistula ......................................................... 0150 17.68 $876.86 $437.12 $175.37

46270 T Removal of anal fistula .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46275 T Removal of anal fistula .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46280 T Removal of anal fistula .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46285 T Removal of anal fistula .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46288 T Repair anal fistula ............................................................................ 0150 17.68 $876.86 $437.12 $175.37

46320 T Removal of hemorrhoid clot ............................................................. 0148 2.34 $116.06 $43.59 $23.21

46500 T Injection into hemorrhoids ................................................................ 0148 2.34 $116.06 $43.59 $23.21

46600 N Diagnostic anoscopy ........................................................................ .................... .................... .................... .................... ....................

46604 T Anoscopy and dilation ...................................................................... 0144 2.23 $110.60 $49.32 $22.12

46606 T Anoscopy and biopsy ....................................................................... 0145 7.46 $369.98 $179.39 $74.00

46608 T Anoscopy/ remove for body ............................................................. 0144 2.23 $110.60 $49.32 $22.12

46610 T Anoscopy/remove lesion .................................................................. 0145 7.46 $369.98 $179.39 $74.00

46611 T Anoscopy .......................................................................................... 0145 7.46 $369.98 $179.39 $74.00

46612 T Anoscopy/ remove lesions ............................................................... 0145 7.46 $369.98 $179.39 $74.00

46614 T Anoscopy/control bleeding ............................................................... 0145 7.46 $369.98 $179.39 $74.00

46615 T Anoscopy .......................................................................................... 0145 7.46 $369.98 $179.39 $74.00

46700 T Repair of anal stricture ..................................................................... 0150 17.68 $876.86 $437.12 $175.37

46705 C Repair of anal stricture ..................................................................... .................... .................... .................... .................... ....................

46715 C Repair of anovaginal fistula ............................................................. .................... .................... .................... .................... ....................

67887

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

46716 C Repair of anovaginal fistula ............................................................. .................... .................... .................... .................... ....................

46730 C Construction of absent anus ............................................................ .................... .................... .................... .................... ....................

46735 C Construction of absent anus ............................................................ .................... .................... .................... .................... ....................

46740 C Construction of absent anus ............................................................ .................... .................... .................... .................... ....................

46742 C Repair of imperforated anus ............................................................ .................... .................... .................... .................... ....................

46744 C Repair of cloacal anomaly ............................................................... .................... .................... .................... .................... ....................

46746 C Repair of cloacal anomaly ............................................................... .................... .................... .................... .................... ....................

46748 C Repair of cloacal anomaly ............................................................... .................... .................... .................... .................... ....................

46750 T Repair of anal sphincter ................................................................... 0150 17.68 $876.86 $437.12 $175.37

46751 C Repair of anal sphincter ................................................................... .................... .................... .................... .................... ....................

46753 T Reconstruction of anus .................................................................... 0150 17.68 $876.86 $437.12 $175.37

46754 T Removal of suture from anus .......................................................... 0149 12.86 $637.80 $293.06 $127.56

46760 T Repair of anal sphincter ................................................................... 0150 17.68 $876.86 $437.12 $175.37

46761 T Repair of anal sphincter ................................................................... 0150 17.68 $876.86 $437.12 $175.37

46762 T Implant artificial sphincter ................................................................ 0150 17.68 $876.86 $437.12 $175.37

46900 T Destruction, anal lesion(s) ............................................................... 0016 3.53 $175.07 $74.67 $35.01

46910 T Destruction, anal lesion(s) ............................................................... 0016 3.53 $175.07 $74.67 $35.01

46916 T Cryosurgery, anal lesion(s) .............................................................. 0016 3.53 $175.07 $74.67 $35.01

46917 T Laser surgery, anal lesions .............................................................. 0014 1.50 $74.39 $24.55 $14.88

46922 T Excision of anal lesion(s) ................................................................. 0017 12.45 $617.47 $289.16 $123.49

46924 T Destruction, anal lesion(s) ............................................................... 0017 12.45 $617.47 $289.16 $123.49

46934 T Destruction of hemorrhoids .............................................................. 0148 2.34 $116.06 $43.59 $23.21

46935 T Destruction of hemorrhoids .............................................................. 0148 2.34 $116.06 $43.59 $23.21

46936 T Destruction of hemorrhoids .............................................................. 0149 12.86 $637.80 $293.06 $127.56

46937 T Cryotherapy of rectal lesion ............................................................. 0150 17.68 $876.86 $437.12 $175.37

46938 T Cryotherapy of rectal lesion ............................................................. 0150 17.68 $876.86 $437.12 $175.37

46940 T Treatment of anal fissure ................................................................. 0149 12.86 $637.80 $293.06 $127.56

46942 T Treatment of anal fissure ................................................................. 0149 12.86 $637.80 $293.06 $127.56

46945 T Ligation of hemorrhoids ................................................................... 0148 2.34 $116.06 $43.59 $23.21

46946 T Ligation of hemorrhoids ................................................................... 0148 2.34 $116.06 $43.59 $23.21

46999 T Anus surgery procedure ................................................................... 0149 12.86 $637.80 $293.06 $127.56

47000 T Needle biopsy of liver ...................................................................... 0005 5.41 $268.32 $119.75 $53.66

47001 C Needle biopsy, liver add-on ............................................................. .................... .................... .................... .................... ....................

47010 C Open drainage, liver lesion .............................................................. .................... .................... .................... .................... ....................

47011 C Percut drain, liver lesion .................................................................. .................... .................... .................... .................... ....................

47015 C Inject/aspirate liver cyst .................................................................... .................... .................... .................... .................... ....................

47100 C Wedge biopsy of liver ...................................................................... .................... .................... .................... .................... ....................

47120 C Partial removal of liver ..................................................................... .................... .................... .................... .................... ....................

47122 C Extensive removal of liver ................................................................ .................... .................... .................... .................... ....................

47125 C Partial removal of liver ..................................................................... .................... .................... .................... .................... ....................

47130 C Partial removal of liver ..................................................................... .................... .................... .................... .................... ....................

47133 C Removal of donor liver ..................................................................... .................... .................... .................... .................... ....................

47134 C Partial removal, donor liver .............................................................. .................... .................... .................... .................... ....................

47135 C Transplantation of liver ..................................................................... .................... .................... .................... .................... ....................

47136 C Transplantation of liver ..................................................................... .................... .................... .................... .................... ....................

47300 C Surgery for liver lesion ..................................................................... .................... .................... .................... .................... ....................

47350 C Repair liver wound ........................................................................... .................... .................... .................... .................... ....................

47360 C Repair liver wound ........................................................................... .................... .................... .................... .................... ....................

47361 C Repair liver wound ........................................................................... .................... .................... .................... .................... ....................

47362 C Repair liver wound ........................................................................... .................... .................... .................... .................... ....................

*47379 T Laparoscope procedure, liver .......................................................... 0130 25.36 $1,257.75 $659.53 $251.55

47399 T Liver surgery procedure ................................................................... 0005 5.41 $268.32 $119.75 $53.66

47400 C Incision of liver duct ......................................................................... .................... .................... .................... .................... ....................

47420 C Incision of bile duct .......................................................................... .................... .................... .................... .................... ....................

47425 C Incision of bile duct .......................................................................... .................... .................... .................... .................... ....................

47460 C Incise bile duct sphincter ................................................................. .................... .................... .................... .................... ....................

47480 C Incision of gallbladder ...................................................................... .................... .................... .................... .................... ....................

47490 C Incision of gallbladder ...................................................................... .................... .................... .................... .................... ....................

47500 N Injection for liver x-rays .................................................................... .................... .................... .................... .................... ....................

47505 N Injection for liver x-rays .................................................................... .................... .................... .................... .................... ....................

47510 T Insert catheter, bile duct .................................................................. 0152 8.22 $407.68 $207.38 $81.54

47511 T Insert bile duct drain ........................................................................ 0152 8.22 $407.68 $207.38 $81.54

47525 T Change bile duct catheter ................................................................ 0122 5.04 $249.96 $114.93 $49.99

47530 T Revise/reinsert bile tube .................................................................. 0121 2.36 $117.05 $52.53 $23.41

47550 C Bile duct endoscopy add-on ............................................................ .................... .................... .................... .................... ....................

47552 T Biliary endoscopy thru skin .............................................................. 0152 8.22 $407.68 $207.38 $81.54

47553 T Biliary endoscopy thru skin .............................................................. 0152 8.22 $407.68 $207.38 $81.54

47554 T Biliary endoscopy thru skin .............................................................. 0152 8.22 $407.68 $207.38 $81.54

47555 T Biliary endoscopy thru skin .............................................................. 0152 8.22 $407.68 $207.38 $81.54

47556 T Biliary endoscopy thru skin .............................................................. 0152 8.22 $407.68 $207.38 $81.54

47560 T Laparoscopy w/cholangio ................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

47561 T Laparo w/cholangio/biopsy ............................................................... 0130 25.36 $1,257.75 $659.53 $251.55

47562 T Laparoscopic cholecystectomy ........................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

47563 T Laparo cholecystectomy/graph ........................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

67888

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

47564 T Laparo cholecystectomy/explr .......................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

47570 C Laparo cholecystoenterostomy ........................................................ .................... .................... .................... .................... ....................

47579 T Laparoscope proc, biliary ................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

47600 C Removal of gallbladder .................................................................... .................... .................... .................... .................... ....................

47605 C Removal of gallbladder .................................................................... .................... .................... .................... .................... ....................

47610 C Removal of gallbladder .................................................................... .................... .................... .................... .................... ....................

47612 C Removal of gallbladder .................................................................... .................... .................... .................... .................... ....................

47620 C Removal of gallbladder .................................................................... .................... .................... .................... .................... ....................

47630 T Remove bile duct stone ................................................................... 0152 8.22 $407.68 $207.38 $81.54

47700 C Exploration of bile ducts ................................................................... .................... .................... .................... .................... ....................

47701 C Bile duct revision .............................................................................. .................... .................... .................... .................... ....................

47711 C Excision of bile duct tumor ............................................................... .................... .................... .................... .................... ....................

47712 C Excision of bile duct tumor ............................................................... .................... .................... .................... .................... ....................

47715 C Excision of bile duct cyst ................................................................. .................... .................... .................... .................... ....................

47716 C Fusion of bile duct cyst .................................................................... .................... .................... .................... .................... ....................

47720 C Fuse gallbladder & bowel ................................................................ .................... .................... .................... .................... ....................

47721 C Fuse upper gi structures .................................................................. .................... .................... .................... .................... ....................

47740 C Fuse gallbladder & bowel ................................................................ .................... .................... .................... .................... ....................

47741 C Fuse gallbladder & bowel ................................................................ .................... .................... .................... .................... ....................

47760 C Fuse bile ducts and bowel ............................................................... .................... .................... .................... .................... ....................

47765 C Fuse liver ducts & bowel .................................................................. .................... .................... .................... .................... ....................

47780 C Fuse bile ducts and bowel ............................................................... .................... .................... .................... .................... ....................

47785 C Fuse bile ducts and bowel ............................................................... .................... .................... .................... .................... ....................

47800 C Reconstruction of bile ducts ............................................................. .................... .................... .................... .................... ....................

47801 C Placement, bile duct support ........................................................... .................... .................... .................... .................... ....................

47802 C Fuse liver duct & intestine ............................................................... .................... .................... .................... .................... ....................

47900 C Suture bile duct injury ...................................................................... .................... .................... .................... .................... ....................

47999 T Bile tract surgery procedure ............................................................. 0121 2.36 $117.05 $52.53 $23.41

48000 C Drainage of abdomen ...................................................................... .................... .................... .................... .................... ....................

48001 C Placement of drain, pancreas .......................................................... .................... .................... .................... .................... ....................

48005 C Resect/debride pancreas ................................................................. .................... .................... .................... .................... ....................

48020 C Removal of pancreatic stone ........................................................... .................... .................... .................... .................... ....................

48100 C Biopsy of pancreas .......................................................................... .................... .................... .................... .................... ....................

48102 T Needle biopsy, pancreas ................................................................. 0005 5.41 $268.32 $119.75 $53.66

48120 C Removal of pancreas lesion ............................................................ .................... .................... .................... .................... ....................

48140 C Partial removal of pancreas ............................................................. .................... .................... .................... .................... ....................

48145 C Partial removal of pancreas ............................................................. .................... .................... .................... .................... ....................

48146 C Pancreatectomy ............................................................................... .................... .................... .................... .................... ....................

48148 C Removal of pancreatic duct ............................................................. .................... .................... .................... .................... ....................

48150 C Partial removal of pancreas ............................................................. .................... .................... .................... .................... ....................

48152 C Pancreatectomy ............................................................................... .................... .................... .................... .................... ....................

48153 C Pancreatectomy ............................................................................... .................... .................... .................... .................... ....................

48154 C Pancreatectomy ............................................................................... .................... .................... .................... .................... ....................

48155 C Removal of pancreas ....................................................................... .................... .................... .................... .................... ....................

48160 E Pancreas removal/transplant ........................................................... .................... .................... .................... .................... ....................

48180 C Fuse pancreas and bowel ................................................................ .................... .................... .................... .................... ....................

48400 C Injection, intraop add-on .................................................................. .................... .................... .................... .................... ....................

48500 C Surgery of pancreas cyst ................................................................. .................... .................... .................... .................... ....................

48510 C Drain pancreatic pseudocyst ............................................................ .................... .................... .................... .................... ....................

48511 C Drain pancreatic pseudocyst ............................................................ .................... .................... .................... .................... ....................

48520 C Fuse pancreas cyst and bowel ........................................................ .................... .................... .................... .................... ....................

48540 C Fuse pancreas cyst and bowel ........................................................ .................... .................... .................... .................... ....................

48545 C Pancreatorrhaphy ............................................................................. .................... .................... .................... .................... ....................

48547 C Duodenal exclusion .......................................................................... .................... .................... .................... .................... ....................

48550 E Donor pancreatectomy ..................................................................... .................... .................... .................... .................... ....................

48554 E Transpl allograft pancreas ............................................................... .................... .................... .................... .................... ....................

48556 C Removal, allograft pancreas ............................................................ .................... .................... .................... .................... ....................

48999 T Pancreas surgery procedure ............................................................ 0005 5.41 $268.32 $119.75 $53.66

49000 C Exploration of abdomen ................................................................... .................... .................... .................... .................... ....................

49002 C Reopening of abdomen .................................................................... .................... .................... .................... .................... ....................

49010 C Exploration behind abdomen ........................................................... .................... .................... .................... .................... ....................

49020 C Drain abdominal abscess ................................................................. .................... .................... .................... .................... ....................

49021 C Drain abdominal abscess ................................................................. .................... .................... .................... .................... ....................

49040 C Drain, open, abdom abscess ........................................................... .................... .................... .................... .................... ....................

49041 C Drain, percut, abdom abscess ......................................................... .................... .................... .................... .................... ....................

49060 C Drain, open, retrop abscess ............................................................. .................... .................... .................... .................... ....................

49061 C Drain, percut, retroper absc ............................................................. .................... .................... .................... .................... ....................

49062 C Drain to peritoneal cavity ................................................................. .................... .................... .................... .................... ....................

49080 T Puncture, peritoneal cavity ............................................................... 0070 3.64 $180.53 $79.60 $36.11

49081 T Removal of abdominal fluid ............................................................. 0070 3.64 $180.53 $79.60 $36.11

49085 T Remove abdomen foreign body ....................................................... 0153 19.62 $973.08 $496.31 $194.62

49180 T Biopsy, abdominal mass .................................................................. 0005 5.41 $268.32 $119.75 $53.66

49200 C Removal of abdominal lesion ........................................................... .................... .................... .................... .................... ....................

49201 C Removal of abdominal lesion ........................................................... .................... .................... .................... .................... ....................

67889

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

49215 C Excise sacral spine tumor ................................................................ .................... .................... .................... .................... ....................

49220 C Multiple surgery, abdomen ............................................................... .................... .................... .................... .................... ....................

49250 T Excision of umbilicus ........................................................................ 0153 19.62 $973.08 $496.31 $194.62

49255 C Removal of omentum ....................................................................... .................... .................... .................... .................... ....................

49320 T Diag laparo separate proc ............................................................... 0130 25.36 $1,257.75 $659.53 $251.55

49321 T Laparoscopy, biopsy ........................................................................ 0130 25.36 $1,257.75 $659.53 $251.55

49322 T Laparoscopy, aspiration ................................................................... 0130 25.36 $1,257.75 $659.53 $251.55

49323 T Laparo drain lymphocele .................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

49329 T Laparo proc, abdm/per/oment .......................................................... 0130 25.36 $1,257.75 $659.53 $251.55

49400 N Air injection into abdomen ............................................................... .................... .................... .................... .................... ....................

49420 T Insert abdominal drain ..................................................................... 0153 19.62 $973.08 $496.31 $194.62

49421 T Insert abdominal drain ..................................................................... 0153 19.62 $973.08 $496.31 $194.62

49422 T Remove perm cannula/catheter ....................................................... 0105 15.06 $746.92 $372.32 $149.38

49423 T Exchange drainage catheter ............................................................ 0153 19.62 $973.08 $496.31 $194.62

49424 N Assess cyst, contrast inject .............................................................. .................... .................... .................... .................... ....................

49425 C Insert abdomen-venous drain .......................................................... .................... .................... .................... .................... ....................

49426 T Revise abdomen-venous shunt ....................................................... 0153 19.62 $973.08 $496.31 $194.62

49427 N Injection, abdominal shunt ............................................................... .................... .................... .................... .................... ....................

49428 C Ligation of shunt ............................................................................... .................... .................... .................... .................... ....................

49429 T Removal of shunt ............................................................................. 0105 15.06 $746.92 $372.32 $149.38

49495 T Repair inguinal hernia, init ............................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49496 T Repair inguinal hernia, init ............................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49500 T Repair inguinal hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49501 T Repair inguinal hernia, init ............................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49505 T Repair inguinal hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49507 T Repair inguinal hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49520 T Rerepair inguinal hernia ................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49521 T Repair inguinal hernia, rec ............................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49525 T Repair inguinal hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49540 T Repair lumbar hernia ....................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49550 T Repair femoral hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49553 T Repair femoral hernia, init ................................................................ 0154 22.43 $1,112.45 $556.98 $222.49

49555 T Repair femoral hernia ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49557 T Repair femoral hernia, recur ............................................................ 0154 22.43 $1,112.45 $556.98 $222.49

49560 T Repair abdominal hernia .................................................................. 0154 22.43 $1,112.45 $556.98 $222.49

49561 T Repair incisional hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49565 T Rerepair abdominal hernia ............................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49566 T Repair incisional hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49568 T Hernia repair w/mesh ....................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49570 T Repair epigastric hernia ................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49572 T Repair epigastric hernia ................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49580 T Repair umbilical hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49582 T Repair umbilical hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49585 T Repair umbilical hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49587 T Repair umbilical hernia .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49590 T Repair abdominal hernia .................................................................. 0154 22.43 $1,112.45 $556.98 $222.49

49600 T Repair umbilical lesion ..................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

49605 C Repair umbilical lesion ..................................................................... .................... .................... .................... .................... ....................

49606 C Repair umbilical lesion ..................................................................... .................... .................... .................... .................... ....................

49610 C Repair umbilical lesion ..................................................................... .................... .................... .................... .................... ....................

49611 C Repair umbilical lesion ..................................................................... .................... .................... .................... .................... ....................

49650 T Laparo hernia repair initial ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

49651 T Laparo hernia repair recur ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

49659 T Laparo proc, hernia repair ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

49900 C Repair of abdominal wall ................................................................. .................... .................... .................... .................... ....................

49905 C Omental flap ..................................................................................... .................... .................... .................... .................... ....................

49906 C Free omental flap, microvasc ........................................................... .................... .................... .................... .................... ....................

49999 T Abdomen surgery procedure ........................................................... 0121 2.36 $117.05 $52.53 $23.41

50010 C Exploration of kidney ........................................................................ .................... .................... .................... .................... ....................

50020 C Renal abscess, open drain .............................................................. .................... .................... .................... .................... ....................

50021 C Renal abscess, percut drain ............................................................ .................... .................... .................... .................... ....................

50040 C Drainage of kidney ........................................................................... .................... .................... .................... .................... ....................

50045 C Exploration of kidney ........................................................................ .................... .................... .................... .................... ....................

50060 C Removal of kidney stone ................................................................. .................... .................... .................... .................... ....................

50065 C Incision of kidney ............................................................................. .................... .................... .................... .................... ....................

50070 C Incision of kidney ............................................................................. .................... .................... .................... .................... ....................

50075 C Removal of kidney stone ................................................................. .................... .................... .................... .................... ....................

50080 T Removal of kidney stone ................................................................. 0163 28.98 $1,437.30 $792.58 $287.46

50081 T Removal of kidney stone ................................................................. 0163 28.98 $1,437.30 $792.58 $287.46

50100 C Revise kidney blood vessels ............................................................ .................... .................... .................... .................... ....................

50120 C Exploration of kidney ........................................................................ .................... .................... .................... .................... ....................

50125 C Explore and drain kidney ................................................................. .................... .................... .................... .................... ....................

50130 C Removal of kidney stone ................................................................. .................... .................... .................... .................... ....................

50135 C Exploration of kidney ........................................................................ .................... .................... .................... .................... ....................

67890

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

50200 T Biopsy of kidney ............................................................................... 0005 5.41 $268.32 $119.75 $53.66

50205 C Biopsy of kidney ............................................................................... .................... .................... .................... .................... ....................

50220 C Removal of kidney ........................................................................... .................... .................... .................... .................... ....................

50225 C Removal of kidney ........................................................................... .................... .................... .................... .................... ....................

50230 C Removal of kidney ........................................................................... .................... .................... .................... .................... ....................

50234 C Removal of kidney & ureter ............................................................. .................... .................... .................... .................... ....................

50236 C Removal of kidney & ureter ............................................................. .................... .................... .................... .................... ....................

50240 C Partial removal of kidney ................................................................. .................... .................... .................... .................... ....................

50280 C Removal of kidney lesion ................................................................. .................... .................... .................... .................... ....................

50290 C Removal of kidney lesion ................................................................. .................... .................... .................... .................... ....................

50300 C Removal of donor kidney ................................................................. .................... .................... .................... .................... ....................

50320 C Removal of donor kidney ................................................................. .................... .................... .................... .................... ....................

50340 C Removal of kidney ........................................................................... .................... .................... .................... .................... ....................

50360 C Transplantation of kidney ................................................................. .................... .................... .................... .................... ....................

50365 C Transplantation of kidney ................................................................. .................... .................... .................... .................... ....................

50370 C Remove transplanted kidney ........................................................... .................... .................... .................... .................... ....................

50380 C Reimplantation of kidney .................................................................. .................... .................... .................... .................... ....................

50390 T Drainage of kidney lesion ................................................................ 0005 5.41 $268.32 $119.75 $53.66

50392 T Insert kidney drain ............................................................................ 0160 5.43 $269.30 $110.11 $53.86

50393 T Insert ureteral tube ........................................................................... 0160 5.43 $269.30 $110.11 $53.86

50394 N Injection for kidney x-ray .................................................................. .................... .................... .................... .................... ....................

50395 T Create passage to kidney ................................................................ 0160 5.43 $269.30 $110.11 $53.86

50396 T Measure kidney pressure ................................................................. 0165 3.89 $192.92 $91.76 $38.58

50398 T Change kidney tube ......................................................................... 0122 5.04 $249.96 $114.93 $49.99

50400 C Revision of kidney/ureter ................................................................. .................... .................... .................... .................... ....................

50405 C Revision of kidney/ureter ................................................................. .................... .................... .................... .................... ....................

50500 C Repair of kidney wound ................................................................... .................... .................... .................... .................... ....................

50520 C Close kidney-skin fistula .................................................................. .................... .................... .................... .................... ....................

50525 C Repair renal-abdomen fistula ........................................................... .................... .................... .................... .................... ....................

50526 C Repair renal-abdomen fistula ........................................................... .................... .................... .................... .................... ....................

50540 C Revision of horseshoe kidney .......................................................... .................... .................... .................... .................... ....................

50541 T Laparo ablate renal cyst .................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

50544 T Laparoscopy, pyeloplasty ................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

*50545 C Laparo radical nephrectomy ............................................................ .................... .................... .................... .................... ....................

50546 C Laparoscopic nephrectomy .............................................................. .................... .................... .................... .................... ....................

50547 C Laparo removal donor kidney .......................................................... .................... .................... .................... .................... ....................

50548 C Laparo-asst remove k/ureter ............................................................ .................... .................... .................... .................... ....................

50549 T Laparoscope proc, renal .................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

50551 T Kidney endoscopy ............................................................................ 0161 10.94 $542.58 $249.36 $108.52

50553 T Kidney endoscopy ............................................................................ 0161 10.94 $542.58 $249.36 $108.52

50555 T Kidney endoscopy & biopsy ............................................................. 0161 10.94 $542.58 $249.36 $108.52

50557 T Kidney endoscopy & treatment ........................................................ 0161 10.94 $542.58 $249.36 $108.52

50559 T Renal endoscopy/radiotracer ........................................................... 0161 10.94 $542.58 $249.36 $108.52

50561 T Kidney endoscopy & treatment ........................................................ 0161 10.94 $542.58 $249.36 $108.52

50570 C Kidney endoscopy ............................................................................ .................... .................... .................... .................... ....................

50572 C Kidney endoscopy ............................................................................ .................... .................... .................... .................... ....................

50574 C Kidney endoscopy & biopsy ............................................................. .................... .................... .................... .................... ....................

50575 C Kidney endoscopy ............................................................................ .................... .................... .................... .................... ....................

50576 C Kidney endoscopy & treatment ........................................................ .................... .................... .................... .................... ....................

50578 C Renal endoscopy/radiotracer ........................................................... .................... .................... .................... .................... ....................

50580 C Kidney endoscopy & treatment ........................................................ .................... .................... .................... .................... ....................

50590 T Fragmenting of kidney stone ........................................................... 0169 46.72 $2,317.13 $1,384.20 $463.43

50600 C Exploration of ureter ......................................................................... .................... .................... .................... .................... ....................

50605 C Insert ureteral support ...................................................................... .................... .................... .................... .................... ....................

50610 C Removal of ureter stone .................................................................. .................... .................... .................... .................... ....................

50620 C Removal of ureter stone .................................................................. .................... .................... .................... .................... ....................

50630 C Removal of ureter stone .................................................................. .................... .................... .................... .................... ....................

50650 C Removal of ureter ............................................................................ .................... .................... .................... .................... ....................

50660 C Removal of ureter ............................................................................ .................... .................... .................... .................... ....................

50684 N Injection for ureter x-ray ................................................................... .................... .................... .................... .................... ....................

50686 T Measure ureter pressure .................................................................. 0165 3.89 $192.92 $91.76 $38.58

50688 T Change of ureter tube ...................................................................... 0121 2.36 $117.05 $52.53 $23.41

50690 N Injection for ureter x-ray ................................................................... .................... .................... .................... .................... ....................

50700 C Revision of ureter ............................................................................. .................... .................... .................... .................... ....................

50715 C Release of ureter ............................................................................. .................... .................... .................... .................... ....................

50722 C Release of ureter ............................................................................. .................... .................... .................... .................... ....................

50725 C Release/revise ureter ....................................................................... .................... .................... .................... .................... ....................

50727 C Revise ureter .................................................................................... .................... .................... .................... .................... ....................

50728 C Revise ureter .................................................................................... .................... .................... .................... .................... ....................

50740 C Fusion of ureter & kidney ................................................................. .................... .................... .................... .................... ....................

50750 C Fusion of ureter & kidney ................................................................. .................... .................... .................... .................... ....................

50760 C Fusion of ureters .............................................................................. .................... .................... .................... .................... ....................

50770 C Splicing of ureters ............................................................................ .................... .................... .................... .................... ....................

50780 C Reimplant ureter in bladder ............................................................. .................... .................... .................... .................... ....................

67891

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

50782 C Reimplant ureter in bladder ............................................................. .................... .................... .................... .................... ....................

50783 C Reimplant ureter in bladder ............................................................. .................... .................... .................... .................... ....................

50785 C Reimplant ureter in bladder ............................................................. .................... .................... .................... .................... ....................

50800 C Implant ureter in bowel .................................................................... .................... .................... .................... .................... ....................

50810 C Fusion of ureter & bowel .................................................................. .................... .................... .................... .................... ....................

50815 C Urine shunt to bowel ........................................................................ .................... .................... .................... .................... ....................

50820 C Construct bowel bladder .................................................................. .................... .................... .................... .................... ....................

50825 C Construct bowel bladder .................................................................. .................... .................... .................... .................... ....................

50830 C Revise urine flow .............................................................................. .................... .................... .................... .................... ....................

50840 C Replace ureter by bowel .................................................................. .................... .................... .................... .................... ....................

50845 C Appendico-vesicostomy ................................................................... .................... .................... .................... .................... ....................

50860 C Transplant ureter to skin .................................................................. .................... .................... .................... .................... ....................

50900 C Repair of ureter ................................................................................ .................... .................... .................... .................... ....................

50920 C Closure ureter/skin fistula ................................................................ .................... .................... .................... .................... ....................

50930 C Closure ureter/bowel fistula ............................................................. .................... .................... .................... .................... ....................

50940 C Release of ureter ............................................................................. .................... .................... .................... .................... ....................

50945 T Laparoscopy ureterolithotomy .......................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

*50947 T Laparoscopy new ureter/bladder ..................................................... 0130 25.36 $1,257.75 $659.53 $251.55

*50948 T Laparoscopy new ureter/bladder ..................................................... 0130 25.36 $1,257.75 $659.53 $251.55

*50949 T Laparoscope proc, ureter ................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

50951 T Endoscopy of ureter ......................................................................... 0162 17.49 $867.44 $427.49 $173.49

50953 T Endoscopy of ureter ......................................................................... 0162 17.49 $867.44 $427.49 $173.49

50955 T Ureter endoscopy & biopsy .............................................................. 0162 17.49 $867.44 $427.49 $173.49

50957 T Ureter endoscopy & treatment ......................................................... 0162 17.49 $867.44 $427.49 $173.49

50959 T Ureter endoscopy & tracer ............................................................... 0162 17.49 $867.44 $427.49 $173.49

50961 T Ureter endoscopy & treatment ......................................................... 0162 17.49 $867.44 $427.49 $173.49

50970 T Ureter endoscopy ............................................................................. 0162 17.49 $867.44 $427.49 $173.49

50972 T Ureter endoscopy & catheter ........................................................... 0162 17.49 $867.44 $427.49 $173.49

50974 T Ureter endoscopy & biopsy .............................................................. 0162 17.49 $867.44 $427.49 $173.49

50976 T Ureter endoscopy & treatment ......................................................... 0162 17.49 $867.44 $427.49 $173.49

50978 T Ureter endoscopy & tracer ............................................................... 0162 17.49 $867.44 $427.49 $173.49

50980 T Ureter endoscopy & treatment ......................................................... 0162 17.49 $867.44 $427.49 $173.49

51000 T Drainage of bladder ......................................................................... 0165 3.89 $192.92 $91.76 $38.58

51005 T Drainage of bladder ......................................................................... 0164 2.17 $107.64 $33.03 $21.53

51010 T Drainage of bladder ......................................................................... 0165 3.89 $192.92 $91.76 $38.58

51020 T Incise & treat bladder ....................................................................... 0162 17.49 $867.44 $427.49 $173.49

51030 T Incise & treat bladder ....................................................................... 0162 17.49 $867.44 $427.49 $173.49

51040 T Incise & drain bladder ...................................................................... 0162 17.49 $867.44 $427.49 $173.49

51045 T Incise bladder/drain ureter ............................................................... 0162 17.49 $867.44 $427.49 $173.49

51050 T Removal of bladder stone ................................................................ 0162 17.49 $867.44 $427.49 $173.49

51060 C Removal of ureter stone .................................................................. .................... .................... .................... .................... ....................

51065 T Removal of ureter stone .................................................................. 0162 17.49 $867.44 $427.49 $173.49

51080 T Drainage of bladder abscess ........................................................... 0008 6.15 $305.02 $113.67 $61.00

51500 T Removal of bladder cyst .................................................................. 0154 22.43 $1,112.45 $556.98 $222.49

51520 T Removal of bladder lesion ............................................................... 0162 17.49 $867.44 $427.49 $173.49

51525 C Removal of bladder lesion ............................................................... .................... .................... .................... .................... ....................

51530 C Removal of bladder lesion ............................................................... .................... .................... .................... .................... ....................

51535 C Repair of ureter lesion ..................................................................... .................... .................... .................... .................... ....................

51550 C Partial removal of bladder ................................................................ .................... .................... .................... .................... ....................

51555 C Partial removal of bladder ................................................................ .................... .................... .................... .................... ....................

51565 C Revise bladder & ureter(s) ............................................................... .................... .................... .................... .................... ....................

51570 C Removal of bladder .......................................................................... .................... .................... .................... .................... ....................

51575 C Removal of bladder & nodes ........................................................... .................... .................... .................... .................... ....................

51580 C Remove bladder/revise tract ............................................................ .................... .................... .................... .................... ....................

51585 C Removal of bladder & nodes ........................................................... .................... .................... .................... .................... ....................

51590 C Remove bladder/revise tract ............................................................ .................... .................... .................... .................... ....................

51595 C Remove bladder/revise tract ............................................................ .................... .................... .................... .................... ....................

51596 C Remove bladder/create pouch ......................................................... .................... .................... .................... .................... ....................

51597 C Removal of pelvic structures ............................................................ .................... .................... .................... .................... ....................

51600 N Injection for bladder x-ray ................................................................ .................... .................... .................... .................... ....................

51605 N Preparation for bladder xray ............................................................ .................... .................... .................... .................... ....................

51610 N Injection for bladder x-ray ................................................................ .................... .................... .................... .................... ....................

51700 T Irrigation of bladder .......................................................................... 0164 2.17 $107.64 $33.03 $21.53

51705 T Change of bladder tube ................................................................... 0121 2.36 $117.05 $52.53 $23.41

51710 T Change of bladder tube ................................................................... 0121 2.36 $117.05 $52.53 $23.41

51715 T Endoscopic injection/implant ............................................................ 0167 21.06 $1,044.50 $555.84 $208.90

51720 T Treatment of bladder lesion ............................................................. 0165 3.89 $192.92 $91.76 $38.58

51725 T Simple cystometrogram ................................................................... 0165 3.89 $192.92 $91.76 $38.58

51726 T Complex cystometrogram ................................................................ 0165 3.89 $192.92 $91.76 $38.58

51736 T Urine flow measurement .................................................................. 0164 2.17 $107.64 $33.03 $21.53

51741 T Electro-uroflowmetry, first ................................................................ 0164 2.17 $107.64 $33.03 $21.53

51772 T Urethra pressure profile ................................................................... 0165 3.89 $192.92 $91.76 $38.58

51784 T Anal/urinary muscle study ................................................................ 0164 2.17 $107.64 $33.03 $21.53

51785 T Anal/urinary muscle study ................................................................ 0164 2.17 $107.64 $33.03 $21.53

67892

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

51792 T Urinary reflex study .......................................................................... 0165 3.89 $192.92 $91.76 $38.58

51795 T Urine voiding pressure study ........................................................... 0164 2.17 $107.64 $33.03 $21.53

51797 T Intraabdominal pressure test ........................................................... 0164 2.17 $107.64 $33.03 $21.53

51800 C Revision of bladder/urethra .............................................................. .................... .................... .................... .................... ....................

51820 C Revision of urinary tract ................................................................... .................... .................... .................... .................... ....................

51840 C Attach bladder/urethra ...................................................................... .................... .................... .................... .................... ....................

51841 C Attach bladder/urethra ...................................................................... .................... .................... .................... .................... ....................

51845 C Repair bladder neck ......................................................................... .................... .................... .................... .................... ....................

51860 C Repair of bladder wound .................................................................. .................... .................... .................... .................... ....................

51865 C Repair of bladder wound .................................................................. .................... .................... .................... .................... ....................

51880 T Repair of bladder opening ............................................................... 0162 17.49 $867.44 $427.49 $173.49

51900 C Repair bladder/vagina lesion ........................................................... .................... .................... .................... .................... ....................

51920 C Close bladder-uterus fistula ............................................................. .................... .................... .................... .................... ....................

51925 C Hysterectomy/bladder repair ............................................................ .................... .................... .................... .................... ....................

51940 C Correction of bladder defect ............................................................ .................... .................... .................... .................... ....................

51960 C Revision of bladder & bowel ............................................................ .................... .................... .................... .................... ....................

51980 C Construct bladder opening ............................................................... .................... .................... .................... .................... ....................

51990 T Laparo urethral suspension ............................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

51992 T Laparo sling operation ..................................................................... 0132 48.91 $2,425.74 $1,239.22 $485.15

52000 T Cystoscopy ....................................................................................... 0160 5.43 $269.30 $110.11 $53.86

52005 T Cystoscopy & ureter catheter .......................................................... 0161 10.94 $542.58 $249.36 $108.52

52007 T Cystoscopy and biopsy .................................................................... 0161 10.94 $542.58 $249.36 $108.52

52010 T Cystoscopy & duct catheter ............................................................. 0161 10.94 $542.58 $249.36 $108.52

52204 T Cystoscopy ....................................................................................... 0161 10.94 $542.58 $249.36 $108.52

52214 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52224 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52234 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52235 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52240 T Cystoscopy and treatment ............................................................... 0163 28.98 $1,437.30 $792.58 $287.46

52250 T Cystoscopy and radiotracer ............................................................. 0162 17.49 $867.44 $427.49 $173.49

52260 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52265 T Cystoscopy and treatment ............................................................... 0160 5.43 $269.30 $110.11 $53.86

52270 T Cystoscopy & revise urethra ............................................................ 0161 10.94 $542.58 $249.36 $108.52

52275 T Cystoscopy & revise urethra ............................................................ 0161 10.94 $542.58 $249.36 $108.52

52276 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52277 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52281 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52282 T Cystoscopy, implant stent ................................................................ 0162 17.49 $867.44 $427.49 $173.49

52283 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52285 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52290 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52300 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52301 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52305 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52310 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52315 T Cystoscopy and treatment ............................................................... 0161 10.94 $542.58 $249.36 $108.52

52317 T Remove bladder stone ..................................................................... 0162 17.49 $867.44 $427.49 $173.49

52318 T Remove bladder stone ..................................................................... 0162 17.49 $867.44 $427.49 $173.49

52320 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52325 T Cystoscopy, stone removal .............................................................. 0162 17.49 $867.44 $427.49 $173.49

52327 T Cystoscopy, inject material .............................................................. 0161 10.94 $542.58 $249.36 $108.52

52330 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52332 T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52334 T Create passage to kidney ................................................................ 0162 17.49 $867.44 $427.49 $173.49

52335D T Endoscopy of urinary tract ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52336D T Cystoscopy, stone removal .............................................................. 0162 17.49 $867.44 $427.49 $173.49

52337D T Cystoscopy, stone removal .............................................................. 0162 17.49 $867.44 $427.49 $173.49

52338D T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52339D T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

52340D T Cystoscopy and treatment ............................................................... 0162 17.49 $867.44 $427.49 $173.49

*52341 T Cysto w/ureter stricture treatment .................................................... 0162 17.49 $867.44 $427.49 $173.49

*52342 T Cysto w/up stricture treatment ......................................................... 0162 17.49 $867.44 $427.49 $173.49

*52343 T Cysto w/renal stricture treatment ..................................................... 0162 17.49 $867.44 $427.49 $173.49

*52344 T Cysto/uretero, stone removal ........................................................... 0162 17.49 $867.44 $427.49 $173.49

*52345 T Cysto/uretero w/up stricture ............................................................. 0162 17.49 $867.44 $427.49 $173.49

*52346 T Cystouretero w/renal strict ............................................................... 0162 17.49 $867.44 $427.49 $173.49

*52351 T Cystouretero &/or pyeloscope .......................................................... 0161 10.94 $542.58 $249.36 $108.52

*52352 T Cystouretero w/stone removal ......................................................... 0162 17.49 $867.44 $427.49 $173.49

*52353 T Cystouretero w/lithotripsy ................................................................. 0162 17.49 $867.44 $427.49 $173.49

*52354 T Cystouretero w/biopsy ...................................................................... 0162 17.49 $867.44 $427.49 $173.49

*52355 T Cystouretero w/excise tumor ........................................................... 0162 17.49 $867.44 $427.49 $173.49

*52400 T Cystouretero w/congen repr ............................................................. 0162 17.49 $867.44 $427.49 $173.49

52450 T Incision of prostate ........................................................................... 0162 17.49 $867.44 $427.49 $173.49

52500 T Revision of bladder neck ................................................................. 0162 17.49 $867.44 $427.49 $173.49

67893

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

52510 T Dilation prostatic urethra .................................................................. 0161 10.94 $542.58 $249.36 $108.52

52601 T Prostatectomy (TURP) ..................................................................... 0163 28.98 $1,437.30 $792.58 $287.46

52606 T Control postop bleeding ................................................................... 0162 17.49 $867.44 $427.49 $173.49

52612 T Prostatectomy, first stage ................................................................ 0163 28.98 $1,437.30 $792.58 $287.46

52614 T Prostatectomy, second stage ........................................................... 0163 28.98 $1,437.30 $792.58 $287.46

52620 T Remove residual prostate ................................................................ 0163 28.98 $1,437.30 $792.58 $287.46

52630 T Remove prostate regrowth ............................................................... 0163 28.98 $1,437.30 $792.58 $287.46

52640 T Relieve bladder contracture ............................................................. 0162 17.49 $867.44 $427.49 $173.49

52647 T Laser surgery of prostate ................................................................. 0163 28.98 $1,437.30 $792.58 $287.46

52648 T Laser surgery of prostate ................................................................. 0163 28.98 $1,437.30 $792.58 $287.46

52700 T Drainage of prostate abscess .......................................................... 0162 17.49 $867.44 $427.49 $173.49

53000 T Incision of urethra ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

53010 T Incision of urethra ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

53020 T Incision of urethra ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

53025 T Incision of urethra ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

53040 T Drainage of urethra abscess ............................................................ 0166 10.17 $504.39 $218.73 $100.88

53060 T Drainage of urethra abscess ............................................................ 0166 10.17 $504.39 $218.73 $100.88

53080 T Drainage of urinary leakage ............................................................. 0166 10.17 $504.39 $218.73 $100.88

53085 C Drainage of urinary leakage ............................................................. .................... .................... .................... .................... ....................

53200 T Biopsy of urethra .............................................................................. 0166 10.17 $504.39 $218.73 $100.88

53210 T Removal of urethra .......................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53215 T Removal of urethra .......................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53220 T Treatment of urethra lesion .............................................................. 0168 24.94 $1,236.93 $536.11 $247.39

53230 T Removal of urethra lesion ................................................................ 0168 24.94 $1,236.93 $536.11 $247.39

53235 T Removal of urethra lesion ................................................................ 0168 24.94 $1,236.93 $536.11 $247.39

53240 T Surgery for urethra pouch ................................................................ 0168 24.94 $1,236.93 $536.11 $247.39

53250 T Removal of urethra gland ................................................................ 0166 10.17 $504.39 $218.73 $100.88

53260 T Treatment of urethra lesion .............................................................. 0166 10.17 $504.39 $218.73 $100.88

53265 T Treatment of urethra lesion .............................................................. 0166 10.17 $504.39 $218.73 $100.88

53270 T Removal of urethra gland ................................................................ 0167 21.06 $1,044.50 $555.84 $208.90

53275 T Repair of urethra defect ................................................................... 0166 10.17 $504.39 $218.73 $100.88

53400 T Revise urethra, stage 1 .................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53405 T Revise urethra, stage 2 .................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53410 T Reconstruction of urethra ................................................................. 0168 24.94 $1,236.93 $536.11 $247.39

53415 C Reconstruction of urethra ................................................................. .................... .................... .................... .................... ....................

53420 T Reconstruct urethra, stage 1 ........................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53425 T Reconstruct urethra, stage 2 ........................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53430 T Reconstruction of urethra ................................................................. 0168 24.94 $1,236.93 $536.11 $247.39

53440 T Correct bladder function ................................................................... 0182 52.11 $2,584.45 $1,525.05 $516.89

53442 T Remove perineal prosthesis ............................................................ 0166 10.17 $504.39 $218.73 $100.88

53443 C Reconstruction of urethra ................................................................. .................... .................... .................... .................... ....................

53445 T Correct urine flow control ................................................................. 0182 52.11 $2,584.45 $1,525.05 $516.89

53447 T Remove artificial sphincter ............................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53449 T Correct artificial sphincter ................................................................ 0168 24.94 $1,236.93 $536.11 $247.39

53450 T Revision of urethra ........................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53460 T Revision of urethra ........................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53502 T Repair of urethra injury .................................................................... 0166 10.17 $504.39 $218.73 $100.88

53505 T Repair of urethra injury .................................................................... 0167 21.06 $1,044.50 $555.84 $208.90

53510 T Repair of urethra injury .................................................................... 0166 10.17 $504.39 $218.73 $100.88

53515 T Repair of urethra injury .................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53520 T Repair of urethra defect ................................................................... 0168 24.94 $1,236.93 $536.11 $247.39

53600 T Dilate urethra stricture ...................................................................... 0164 2.17 $107.64 $33.03 $21.53

53601 T Dilate urethra stricture ...................................................................... 0164 2.17 $107.64 $33.03 $21.53

53605 T Dilate urethra stricture ...................................................................... 0161 10.94 $542.58 $249.36 $108.52

53620 T Dilate urethra stricture ...................................................................... 0165 3.89 $192.92 $91.76 $38.58

53621 T Dilate urethra stricture ...................................................................... 0164 2.17 $107.64 $33.03 $21.53

53660 T Dilation of urethra ............................................................................. 0164 2.17 $107.64 $33.03 $21.53

53661 T Dilation of urethra ............................................................................. 0164 2.17 $107.64 $33.03 $21.53

53665 T Dilation of urethra ............................................................................. 0166 10.17 $504.39 $218.73 $100.88

53670 N Insert urinary catheter ...................................................................... .................... .................... .................... .................... ....................

53675 T Insert urinary catheter ...................................................................... 0164 2.17 $107.64 $33.03 $21.53

53850 T Prostatic microwave thermotx .......................................................... 0980 38.67 $1,917.89 .................... $383.58

53852 T Prostatic rf thermotx ......................................................................... 0980 38.67 $1,917.89 .................... $383.58

53899 T Urology surgery procedure .............................................................. 0165 3.89 $192.92 $91.76 $38.58

54000 T Slitting of prepuce ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

54001 T Slitting of prepuce ............................................................................ 0166 10.17 $504.39 $218.73 $100.88

54015 T Drain penis lesion ............................................................................ 0008 6.15 $305.02 $113.67 $61.00

54050 T Destruction, penis lesion(s) .............................................................. 0013 0.91 $45.13 $17.66 $9.03

54055 T Destruction, penis lesion(s) .............................................................. 0016 3.53 $175.07 $74.67 $35.01

54056 T Cryosurgery, penis lesion(s) ............................................................ 0013 0.91 $45.13 $17.66 $9.03

54057 T Laser surg, penis lesion(s) ............................................................... 0017 12.45 $617.47 $289.16 $123.49

54060 T Excision of penis lesion(s) ............................................................... 0017 12.45 $617.47 $289.16 $123.49

54065 T Destruction, penis lesion(s) .............................................................. 0017 12.45 $617.47 $289.16 $123.49

54100 T Biopsy of penis ................................................................................. 0020 6.51 $322.87 $130.53 $64.57

67894

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

54105 T Biopsy of penis ................................................................................. 0021 10.49 $520.26 $236.51 $104.05

54110 T Treatment of penis lesion ................................................................ 0181 32.37 $1,605.43 $906.36 $321.09

54111 T Treat penis lesion, graft ................................................................... 0181 32.37 $1,605.43 $906.36 $321.09

54112 T Treat penis lesion, graft ................................................................... 0181 32.37 $1,605.43 $906.36 $321.09

54115 T Treatment of penis lesion ................................................................ 0008 6.15 $305.02 $113.67 $61.00

54120 T Partial removal of penis ................................................................... 0181 32.37 $1,605.43 $906.36 $321.09

54125 C Removal of penis ............................................................................. .................... .................... .................... .................... ....................

54130 C Remove penis & nodes .................................................................... .................... .................... .................... .................... ....................

54135 C Remove penis & nodes .................................................................... .................... .................... .................... .................... ....................

54150 T Circumcision ..................................................................................... 0180 13.62 $675.49 $304.87 $135.10

54152 T Circumcision ..................................................................................... 0180 13.62 $675.49 $304.87 $135.10

54160 T Circumcision ..................................................................................... 0180 13.62 $675.49 $304.87 $135.10

54161 T Circumcision ..................................................................................... 0180 13.62 $675.49 $304.87 $135.10

54200 T Treatment of penis lesion ................................................................ 0165 3.89 $192.92 $91.76 $38.58

54205 T Treatment of penis lesion ................................................................ 0181 32.37 $1,605.43 $906.36 $321.09

54220 T Treatment of penis lesion ................................................................ 0165 3.89 $192.92 $91.76 $38.58

54230 N Prepare penis study ......................................................................... .................... .................... .................... .................... ....................

54231 T Dynamic cavernosometry ................................................................. 0165 3.89 $192.92 $91.76 $38.58

54235 T Penile injection ................................................................................. 0164 2.17 $107.64 $33.03 $21.53

54240 T Penis study ....................................................................................... 0164 2.17 $107.64 $33.03 $21.53

54250 T Penis study ....................................................................................... 0165 3.89 $192.92 $91.76 $38.58

54300 T Revision of penis .............................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54304 T Revision of penis .............................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54308 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54312 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54316 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54318 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54322 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54324 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54326 T Reconstruction of urethra ................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54328 T Revise penis/urethra ........................................................................ 0181 32.37 $1,605.43 $906.36 $321.09

54332 C Revise penis/urethra ........................................................................ .................... .................... .................... .................... ....................

54336 C Revise penis/urethra ........................................................................ .................... .................... .................... .................... ....................

54340 T Secondary urethral surgery .............................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54344 T Secondary urethral surgery .............................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54348 T Secondary urethral surgery .............................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54352 T Reconstruct urethra/penis ................................................................ 0181 32.37 $1,605.43 $906.36 $321.09

54360 T Penis plastic surgery ........................................................................ 0181 32.37 $1,605.43 $906.36 $321.09

54380 T Repair penis ..................................................................................... 0181 32.37 $1,605.43 $906.36 $321.09

54385 T Repair penis ..................................................................................... 0181 32.37 $1,605.43 $906.36 $321.09

54390 C Repair penis and bladder ................................................................. .................... .................... .................... .................... ....................

54400 T Insert semi-rigid prosthesis .............................................................. 0182 52.11 $2,584.45 $1,525.05 $516.89

54401 T Insert self-contd prosthesis .............................................................. 0182 52.11 $2,584.45 $1,525.05 $516.89

54402 T Remove penis prosthesis ................................................................. 0185 32.37 $1,605.43 $906.36 $321.09

54405 T Insert multi-comp prosthesis ............................................................ 0182 52.11 $2,584.45 $1,525.05 $516.89

54407 T Remove multi-comp prosthesis ........................................................ 0185 32.37 $1,605.43 $906.36 $321.09

54409 T Revise penis prosthesis ................................................................... 0185 32.37 $1,605.43 $906.36 $321.09

54420 T Revision of penis .............................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54430 C Revision of penis .............................................................................. .................... .................... .................... .................... ....................

54435 T Revision of penis .............................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54440 T Repair of penis ................................................................................. 0181 32.37 $1,605.43 $906.36 $321.09

54450 T Preputial stretching .......................................................................... 0165 3.89 $192.92 $91.76 $38.58

54500 T Biopsy of testis ................................................................................. 0005 5.41 $268.32 $119.75 $53.66

54505 T Biopsy of testis ................................................................................. 0183 18.26 $905.62 $448.94 $181.12

54510 T Removal of testis lesion ................................................................... 0183 18.26 $905.62 $448.94 $181.12

*54512 T Excise lesion testis ........................................................................... 0183 18.26 $905.62 $448.94 $181.12

54520 T Removal of testis ............................................................................. 0183 18.26 $905.62 $448.94 $181.12

*54522 T Orchiectomy, partial ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

54530 T Removal of testis ............................................................................. 0154 22.43 $1,112.45 $556.98 $222.49

54535 C Extensive testis surgery ................................................................... .................... .................... .................... .................... ....................

54550 T Exploration for testis ........................................................................ 0154 22.43 $1,112.45 $556.98 $222.49

54560 C Exploration for testis ........................................................................ .................... .................... .................... .................... ....................

54600 T Reduce testis torsion ....................................................................... 0183 18.26 $905.62 $448.94 $181.12

54620 T Suspension of testis ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

54640 T Suspension of testis ......................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

54650 C Orchiopexy (Fowler-Stephens) ........................................................ .................... .................... .................... .................... ....................

54660 T Revision of testis .............................................................................. 0183 18.26 $905.62 $448.94 $181.12

54670 T Repair testis injury ........................................................................... 0183 18.26 $905.62 $448.94 $181.12

54680 T Relocation of testis(es) .................................................................... 0183 18.26 $905.62 $448.94 $181.12

54690 T Laparoscopy, orchiectomy ............................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

54692 T Laparoscopy, orchiopexy ................................................................. 0132 48.91 $2,425.74 $1,239.22 $485.15

54699 T Laparoscope proc, testis .................................................................. 0130 25.36 $1,257.75 $659.53 $251.55

54700 T Drainage of scrotum ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

54800 T Biopsy of epididymis ........................................................................ 0004 1.84 $91.26 $32.57 $18.25

67895

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

54820 T Exploration of epididymis ................................................................. 0183 18.26 $905.62 $448.94 $181.12

54830 T Remove epididymis lesion ............................................................... 0183 18.26 $905.62 $448.94 $181.12

54840 T Remove epididymis lesion ............................................................... 0183 18.26 $905.62 $448.94 $181.12

54860 T Removal of epididymis ..................................................................... 0183 18.26 $905.62 $448.94 $181.12

54861 T Removal of epididymis ..................................................................... 0183 18.26 $905.62 $448.94 $181.12

54900 T Fusion of spermatic ducts ................................................................ 0183 18.26 $905.62 $448.94 $181.12

54901 T Fusion of spermatic ducts ................................................................ 0183 18.26 $905.62 $448.94 $181.12

55000 T Drainage of hydrocele ...................................................................... 0004 1.84 $91.26 $32.57 $18.25

55040 T Removal of hydrocele ...................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

55041 T Removal of hydroceles .................................................................... 0154 22.43 $1,112.45 $556.98 $222.49

55060 T Repair of hydrocele .......................................................................... 0183 18.26 $905.62 $448.94 $181.12

55100 T Drainage of scrotum abscess .......................................................... 0008 6.15 $305.02 $113.67 $61.00

55110 T Explore scrotum ............................................................................... 0183 18.26 $905.62 $448.94 $181.12

55120 T Removal of scrotum lesion .............................................................. 0183 18.26 $905.62 $448.94 $181.12

55150 T Removal of scrotum ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

55175 T Revision of scrotum ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

55180 T Revision of scrotum ......................................................................... 0183 18.26 $905.62 $448.94 $181.12

55200 T Incision of sperm duct ...................................................................... 0183 18.26 $905.62 $448.94 $181.12

55250 T Removal of sperm duct(s) ................................................................ 0183 18.26 $905.62 $448.94 $181.12

55300 N Prepare, sperm duct x-ray ............................................................... .................... .................... .................... .................... ....................

55400 T Repair of sperm duct ....................................................................... 0183 18.26 $905.62 $448.94 $181.12

55450 T Ligation of sperm duct ..................................................................... 0183 18.26 $905.62 $448.94 $181.12

55500 T Removal of hydrocele ...................................................................... 0183 18.26 $905.62 $448.94 $181.12

55520 T Removal of sperm cord lesion ......................................................... 0183 18.26 $905.62 $448.94 $181.12

55530 T Revise spermatic cord veins ............................................................ 0183 18.26 $905.62 $448.94 $181.12

55535 T Revise spermatic cord veins ............................................................ 0154 22.43 $1,112.45 $556.98 $222.49

55540 T Revise hernia & sperm veins ........................................................... 0154 22.43 $1,112.45 $556.98 $222.49

55550 T Laparo ligate spermatic vein ............................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

55559 T Laparo proc, spermatic cord ............................................................ 0130 25.36 $1,257.75 $659.53 $251.55

55600 C Incise sperm duct pouch .................................................................. .................... .................... .................... .................... ....................

55605 C Incise sperm duct pouch .................................................................. .................... .................... .................... .................... ....................

55650 C Remove sperm duct pouch .............................................................. .................... .................... .................... .................... ....................

55680 T Remove sperm pouch lesion ........................................................... 0183 18.26 $905.62 $448.94 $181.12

55700 T Biopsy of prostate ............................................................................ 0184 4.94 $245.01 $122.96 $49.00

55705 T Biopsy of prostate ............................................................................ 0184 4.94 $245.01 $122.96 $49.00

55720 T Drainage of prostate abscess .......................................................... 0162 17.49 $867.44 $427.49 $173.49

55725 T Drainage of prostate abscess .......................................................... 0162 17.49 $867.44 $427.49 $173.49

55801 C Removal of prostate ......................................................................... .................... .................... .................... .................... ....................

55810 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55812 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55815 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55821 C Removal of prostate ......................................................................... .................... .................... .................... .................... ....................

55831 C Removal of prostate ......................................................................... .................... .................... .................... .................... ....................

55840 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55842 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55845 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55859 T Percut/needle insert, pros ................................................................ 0162 17.49 $867.44 $427.49 $173.49

55860 T Surgical exposure, prostate ............................................................. 0165 3.89 $192.92 $91.76 $38.58

55862 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55865 C Extensive prostate surgery .............................................................. .................... .................... .................... .................... ....................

55870 T Electroejaculation ............................................................................. 0197 2.40 $119.03 $49.55 $23.81

*55873 T Cryoablate prostate .......................................................................... 0980 38.67 $1,917.89 .................... $383.58

55899 T Genital surgery procedure ............................................................... 0164 2.17 $107.64 $33.03 $21.53

55970 E Sex transformation, M to F .............................................................. .................... .................... .................... .................... ....................

55980 E Sex transformation, F to M .............................................................. .................... .................... .................... .................... ....................

56405 T I & D of vulva/perineum ................................................................... 0192 2.38 $118.04 $35.33 $23.61

56420 T Drainage of gland abscess .............................................................. 0192 2.38 $118.04 $35.33 $23.61

56440 T Surgery for vulva lesion ................................................................... 0194 16.21 $803.96 $395.94 $160.79

56441 T Lysis of labial lesion(s) ..................................................................... 0193 8.93 $442.89 $171.13 $88.58

56501 T Destruction, vulva lesion(s) .............................................................. 0016 3.53 $175.07 $74.67 $35.01

56515 T Destruction, vulva lesion(s) .............................................................. 0017 12.45 $617.47 $289.16 $123.49

56605 T Biopsy of vulva/perineum ................................................................. 0019 4.00 $198.39 $78.91 $39.68

56606 T Biopsy of vulva/perineum ................................................................. 0019 4.00 $198.39 $78.91 $39.68

56620 T Partial removal of vulva ................................................................... 0195 18.68 $926.46 $483.80 $185.29

56625 T Complete removal of vulva .............................................................. 0195 18.68 $926.46 $483.80 $185.29

56630 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56631 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56632 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56633 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56634 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56637 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56640 C Extensive vulva surgery ................................................................... .................... .................... .................... .................... ....................

56700 T Partial removal of hymen ................................................................. 0194 16.21 $803.96 $395.94 $160.79

56720 T Incision of hymen ............................................................................. 0193 8.93 $442.89 $171.13 $88.58

67896

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

56740 T Remove vagina gland lesion ............................................................ 0194 16.21 $803.96 $395.94 $160.79

56800 T Repair of vagina ............................................................................... 0194 16.21 $803.96 $395.94 $160.79

56805 T Repair clitoris ................................................................................... 0194 16.21 $803.96 $395.94 $160.79

56810 T Repair of perineum .......................................................................... 0194 16.21 $803.96 $395.94 $160.79

57000 T Exploration of vagina ....................................................................... 0194 16.21 $803.96 $395.94 $160.79

57010 T Drainage of pelvic abscess .............................................................. 0194 16.21 $803.96 $395.94 $160.79

57020 T Drainage of pelvic fluid .................................................................... 0193 8.93 $442.89 $171.13 $88.58

*57022 T I & D vaginal hematoma, OB ........................................................... 0007 3.68 $182.51 $72.03 $36.50

*57023 T I & D vaginal hematoma, trauma ..................................................... 0007 3.68 $182.51 $72.03 $36.50

57061 T Destruction vagina lesion(s) ............................................................. 0194 16.21 $803.96 $395.94 $160.79

57065 T Destruction vagina lesion(s) ............................................................. 0194 16.21 $803.96 $395.94 $160.79

57100 T Biopsy of vagina ............................................................................... 0192 2.38 $118.04 $35.33 $23.61

57105 T Biopsy of vagina ............................................................................... 0194 16.21 $803.96 $395.94 $160.79

57106 T Remove vagina wall, partial ............................................................. 0194 16.21 $803.96 $395.94 $160.79

57107 T Remove vagina tissue, part ............................................................. 0194 16.21 $803.96 $395.94 $160.79

57109 T Vaginectomy partial w/nodes ........................................................... 0194 16.21 $803.96 $395.94 $160.79

57110 C Remove vagina wall, complete ........................................................ .................... .................... .................... .................... ....................

57111 C Remove vagina tissue, compl .......................................................... .................... .................... .................... .................... ....................

57112 C Vaginectomy w/nodes, compl .......................................................... .................... .................... .................... .................... ....................

57120 T Closure of vagina ............................................................................. 0194 16.21 $803.96 $395.94 $160.79

57130 T Remove vagina lesion ...................................................................... 0194 16.21 $803.96 $395.94 $160.79

57135 T Remove vagina lesion ...................................................................... 0194 16.21 $803.96 $395.94 $160.79

57150 T Treat vagina infection ....................................................................... 0192 2.38 $118.04 $35.33 $23.61

57160 T Insert pessary/other device .............................................................. 0191 1.19 $59.02 $17.43 $11.80

57170 T Fitting of diaphragm/cap .................................................................. 0191 1.19 $59.02 $17.43 $11.80

57180 T Treat vaginal bleeding ...................................................................... 0192 2.38 $118.04 $35.33 $23.61

57200 T Repair of vagina ............................................................................... 0194 16.21 $803.96 $395.94 $160.79

57210 T Repair vagina/perineum ................................................................... 0194 16.21 $803.96 $395.94 $160.79

57220 T Revision of urethra ........................................................................... 0195 18.68 $926.46 $483.80 $185.29

57230 T Repair of urethral lesion ................................................................... 0194 16.21 $803.96 $395.94 $160.79

57240 T Repair bladder & vagina .................................................................. 0195 18.68 $926.46 $483.80 $185.29

57250 T Repair rectum & vagina ................................................................... 0195 18.68 $926.46 $483.80 $185.29

57260 T Repair of vagina ............................................................................... 0195 18.68 $926.46 $483.80 $185.29

57265 T Extensive repair of vagina ............................................................... 0195 18.68 $926.46 $483.80 $185.29

57268 T Repair of bowel bulge ...................................................................... 0195 18.68 $926.46 $483.80 $185.29

57270 C Repair of bowel pouch ..................................................................... .................... .................... .................... .................... ....................

57280 C Suspension of vagina ....................................................................... .................... .................... .................... .................... ....................

57282 C Repair of vaginal prolapse ............................................................... .................... .................... .................... .................... ....................

57284 T Repair paravaginal defect ................................................................ 0195 18.68 $926.46 $483.80 $185.29

*57287 T Revise/remove sling repair .............................................................. 0195 18.68 $926.46 $483.80 $185.29

57288 T Repair bladder defect ....................................................................... 0195 18.68 $926.46 $483.80 $185.29

57289 T Repair bladder & vagina .................................................................. 0195 18.68 $926.46 $483.80 $185.29

57291 T Construction of vagina ..................................................................... 0195 18.68 $926.46 $483.80 $185.29

57292 C Construct vagina with graft .............................................................. .................... .................... .................... .................... ....................

57300 T Repair rectum-vagina fistula ............................................................ 0195 18.68 $926.46 $483.80 $185.29

57305 C Repair rectum-vagina fistula ............................................................ .................... .................... .................... .................... ....................

57307 C Fistula repair & colostomy ............................................................... .................... .................... .................... .................... ....................

57308 C Fistula repair, transperine ................................................................ .................... .................... .................... .................... ....................

57310 T Repair urethrovaginal lesion ............................................................ 0195 18.68 $926.46 $483.80 $185.29

57311 C Repair urethrovaginal lesion ............................................................ .................... .................... .................... .................... ....................

57320 T Repair bladder-vagina lesion ........................................................... 0195 18.68 $926.46 $483.80 $185.29

57330 T Repair bladder-vagina lesion ........................................................... 0195 18.68 $926.46 $483.80 $185.29

57335 C Repair vagina ................................................................................... .................... .................... .................... .................... ....................

57400 T Dilation of vagina ............................................................................. 0194 16.21 $803.96 $395.94 $160.79

57410 T Pelvic examination ........................................................................... 0194 16.21 $803.96 $395.94 $160.79

57415 T Remove vaginal foreign body .......................................................... 0194 16.21 $803.96 $395.94 $160.79

57452 T Examination of vagina ...................................................................... 0191 1.19 $59.02 $17.43 $11.80

57454 T Vagina examination & biopsy .......................................................... 0192 2.38 $118.04 $35.33 $23.61

57460 T Cervix excision ................................................................................. 0193 8.93 $442.89 $171.13 $88.58

57500 T Biopsy of cervix ................................................................................ 0193 8.93 $442.89 $171.13 $88.58

57505 T Endocervical curettage ..................................................................... 0192 2.38 $118.04 $35.33 $23.61

57510 T Cauterization of cervix ..................................................................... 0193 8.93 $442.89 $171.13 $88.58

57511 T Cryocautery of cervix ....................................................................... 0192 2.38 $118.04 $35.33 $23.61

57513 T Laser surgery of cervix .................................................................... 0193 8.93 $442.89 $171.13 $88.58

57520 T Conization of cervix .......................................................................... 0194 16.21 $803.96 $395.94 $160.79

57522 T Conization of cervix .......................................................................... 0195 18.68 $926.46 $483.80 $185.29

57530 T Removal of cervix ............................................................................ 0195 18.68 $926.46 $483.80 $185.29

57531 C Removal of cervix, radical ................................................................ .................... .................... .................... .................... ....................

57540 C Removal of residual cervix ............................................................... .................... .................... .................... .................... ....................

57545 C Remove cervix/repair pelvis ............................................................. .................... .................... .................... .................... ....................

57550 T Removal of residual cervix ............................................................... 0195 18.68 $926.46 $483.80 $185.29

57555 T Remove cervix/repair vagina ........................................................... 0195 18.68 $926.46 $483.80 $185.29

57556 T Remove cervix, repair bowel ........................................................... 0195 18.68 $926.46 $483.80 $185.29

57700 T Revision of cervix ............................................................................. 0194 16.21 $803.96 $395.94 $160.79

67897

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

57720 T Revision of cervix ............................................................................. 0194 16.21 $803.96 $395.94 $160.79

57800 T Dilation of cervical canal .................................................................. 0193 8.93 $442.89 $171.13 $88.58

57820 T D & c of residual cervix .................................................................... 0196 14.47 $717.66 $357.98 $143.53

58100 T Biopsy of uterus lining ...................................................................... 0191 1.19 $59.02 $17.43 $11.80

58120 T Dilation and curettage ...................................................................... 0196 14.47 $717.66 $357.98 $143.53

58140 C Removal of uterus lesion ................................................................. .................... .................... .................... .................... ....................

58145 T Removal of uterus lesion ................................................................. 0195 18.68 $926.46 $483.80 $185.29

58150 C Total hysterectomy ........................................................................... .................... .................... .................... .................... ....................

58152 C Total hysterectomy ........................................................................... .................... .................... .................... .................... ....................

58180 C Partial hysterectomy ......................................................................... .................... .................... .................... .................... ....................

58200 C Extensive hysterectomy ................................................................... .................... .................... .................... .................... ....................

58210 C Extensive hysterectomy ................................................................... .................... .................... .................... .................... ....................

58240 C Removal of pelvis contents .............................................................. .................... .................... .................... .................... ....................

58260 C Vaginal hysterectomy ....................................................................... .................... .................... .................... .................... ....................

58262 C Vaginal hysterectomy ....................................................................... .................... .................... .................... .................... ....................

58263 C Vaginal hysterectomy ....................................................................... .................... .................... .................... .................... ....................

58267 C Hysterectomy & vagina repair .......................................................... .................... .................... .................... .................... ....................

58270 C Hysterectomy & vagina repair .......................................................... .................... .................... .................... .................... ....................

58275 C Hysterectomy/revise vagina ............................................................. .................... .................... .................... .................... ....................

58280 C Hysterectomy/revise vagina ............................................................. .................... .................... .................... .................... ....................

58285 C Extensive hysterectomy ................................................................... .................... .................... .................... .................... ....................

58300 E Insert intrauterine device .................................................................. .................... .................... .................... .................... ....................

58301 T Remove intrauterine device ............................................................. 0191 1.19 $59.02 $17.43 $11.80

58321 T Artificial insemination ....................................................................... 0197 2.40 $119.03 $49.55 $23.81

58322 T Artificial insemination ....................................................................... 0197 2.40 $119.03 $49.55 $23.81

58323 T Sperm washing ................................................................................ 0197 2.40 $119.03 $49.55 $23.81

58340 N Catheter for hysterography .............................................................. .................... .................... .................... .................... ....................

58345 T Reopen fallopian tube ...................................................................... 0194 16.21 $803.96 $395.94 $160.79

58350 T Reopen fallopian tube ...................................................................... 0194 16.21 $803.96 $395.94 $160.79

*58353 T Endometr ablate, thermal ................................................................. 0193 8.93 $442.89 $171.13 $88.58

58400 C Suspension of uterus ....................................................................... .................... .................... .................... .................... ....................

58410 C Suspension of uterus ....................................................................... .................... .................... .................... .................... ....................

58520 C Repair of ruptured uterus ................................................................. .................... .................... .................... .................... ....................

58540 C Revision of uterus ............................................................................ .................... .................... .................... .................... ....................

58550 T Laparo-asst vag hysterectomy ......................................................... 0132 48.91 $2,425.74 $1,239.22 $485.15

58551 T Laparoscopy, remove myoma .......................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

58555 T Hysteroscopy, dx, sep proc ............................................................. 0191 1.19 $59.02 $17.43 $11.80

58558 T Hysteroscopy, biopsy ....................................................................... 0190 17.85 $885.29 $443.89 $177.06

58559 T Hysteroscopy, lysis .......................................................................... 0190 17.85 $885.29 $443.89 $177.06

58560 T Hysteroscopy, resect septum ........................................................... 0190 17.85 $885.29 $443.89 $177.06

58561 T Hysteroscopy, remove myoma ........................................................ 0190 17.85 $885.29 $443.89 $177.06

58562 T Hysteroscopy, remove fb ................................................................. 0190 17.85 $885.29 $443.89 $177.06

58563 T Hysteroscopy, ablation ..................................................................... 0190 17.85 $885.29 $443.89 $177.06

58578 T Laparo proc, uterus .......................................................................... 0190 17.85 $885.29 $443.89 $177.06

58579 T Hysteroscope procedure .................................................................. 0190 17.85 $885.29 $443.89 $177.06

58600 T Division of fallopian tube .................................................................. 0194 16.21 $803.96 $395.94 $160.79

58605 C Division of fallopian tube .................................................................. .................... .................... .................... .................... ....................

58611 C Ligate oviduct(s) add-on .................................................................. .................... .................... .................... .................... ....................

58615 T Occlude fallopian tube(s) ................................................................. 0194 16.21 $803.96 $395.94 $160.79

58660 T Laparoscopy, lysis ............................................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

58661 T Laparoscopy, remove adnexa .......................................................... 0131 41.81 $2,073.61 $1,089.88 $414.72

58662 T Laparoscopy, excise lesions ............................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

58670 T Laparoscopy, tubal cautery .............................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

58671 T Laparoscopy, tubal block ................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

58672 T Laparoscopy, fimbrioplasty .............................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

58673 T Laparoscopy, salpingostomy ............................................................ 0131 41.81 $2,073.61 $1,089.88 $414.72

58679 T Laparo proc, oviduct-ovary .............................................................. 0130 25.36 $1,257.75 $659.53 $251.55

58700 C Removal of fallopian tube ................................................................ .................... .................... .................... .................... ....................

58720 C Removal of ovary/tube(s) ................................................................. .................... .................... .................... .................... ....................

58740 C Revise fallopian tube(s) ................................................................... .................... .................... .................... .................... ....................

58750 C Repair oviduct .................................................................................. .................... .................... .................... .................... ....................

58752 C Revise ovarian tube(s) ..................................................................... .................... .................... .................... .................... ....................

58760 C Remove tubal obstruction ................................................................ .................... .................... .................... .................... ....................

58770 C Create new tubal opening ................................................................ .................... .................... .................... .................... ....................

58800 T Drainage of ovarian cyst(s) .............................................................. 0195 18.68 $926.46 $483.80 $185.29

58805 C Drainage of ovarian cyst(s) .............................................................. .................... .................... .................... .................... ....................

58820 T Drain ovary abscess, open .............................................................. 0195 18.68 $926.46 $483.80 $185.29

58822 C Drain ovary abscess, percut ............................................................ .................... .................... .................... .................... ....................

58823 C Drain pelvic abscess, percut ............................................................ .................... .................... .................... .................... ....................

58825 C Transposition, ovary(s) ..................................................................... .................... .................... .................... .................... ....................

58900 T Biopsy of ovary(s) ............................................................................ 0195 18.68 $926.46 $483.80 $185.29

58920 T Partial removal of ovary(s) ............................................................... 0195 18.68 $926.46 $483.80 $185.29

58925 T Removal of ovarian cyst(s) .............................................................. 0195 18.68 $926.46 $483.80 $185.29

58940 C Removal of ovary(s) ......................................................................... .................... .................... .................... .................... ....................

67898

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

58943 C Removal of ovary(s) ......................................................................... .................... .................... .................... .................... ....................

58950 C Resect ovarian malignancy .............................................................. .................... .................... .................... .................... ....................

58951 C Resect ovarian malignancy .............................................................. .................... .................... .................... .................... ....................

58952 C Resect ovarian malignancy .............................................................. .................... .................... .................... .................... ....................

58960 C Exploration of abdomen ................................................................... .................... .................... .................... .................... ....................

58970 T Retrieval of oocyte ........................................................................... 0194 16.21 $803.96 $395.94 $160.79

58974 T Transfer of embryo ........................................................................... 0197 2.40 $119.03 $49.55 $23.81

58976 T Transfer of embryo ........................................................................... 0197 2.40 $119.03 $49.55 $23.81

58999 T Genital surgery procedure ............................................................... 0019 4.00 $198.39 $78.91 $39.68

59000 T Amniocentesis .................................................................................. 0198 1.34 $66.46 $33.03 $13.29

59012 T Fetal cord puncture,prenatal ............................................................ 0198 1.34 $66.46 $33.03 $13.29

59015 T Chorion biopsy ................................................................................. 0198 1.34 $66.46 $33.03 $13.29

59020 T Fetal contract stress test .................................................................. 0198 1.34 $66.46 $33.03 $13.29

59025 T Fetal non-stress test ........................................................................ 0198 1.34 $66.46 $33.03 $13.29

59030 T Fetal scalp blood sample ................................................................. 0198 1.34 $66.46 $33.03 $13.29

59050 T Fetal monitor w/report ...................................................................... 0198 1.34 $66.46 $33.03 $13.29

59051 E Fetal monitor/interpret only .............................................................. .................... .................... .................... .................... ....................

59100 C Remove uterus lesion ...................................................................... .................... .................... .................... .................... ....................

59120 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59121 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59130 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59135 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59136 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59140 C Treat ectopic pregnancy .................................................................. .................... .................... .................... .................... ....................

59150 T Treat ectopic pregnancy .................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

59151 T Treat ectopic pregnancy .................................................................. 0131 41.81 $2,073.61 $1,089.88 $414.72

59160 T D & c after delivery .......................................................................... 0196 14.47 $717.66 $357.98 $143.53

59200 T Insert cervical dilator ........................................................................ 0191 1.19 $59.02 $17.43 $11.80

59300 T Episiotomy or vaginal repair ............................................................ 0194 16.21 $803.96 $395.94 $160.79

59320 T Revision of cervix ............................................................................. 0194 16.21 $803.96 $395.94 $160.79

59325 C Revision of cervix ............................................................................. .................... .................... .................... .................... ....................

59350 C Repair of uterus ............................................................................... .................... .................... .................... .................... ....................

59400 E Obstetrical care ................................................................................ .................... .................... .................... .................... ....................

59409 T Obstetrical care ................................................................................ 0199 11.20 $555.48 $157.83 $111.10

59410 E Obstetrical care ................................................................................ .................... .................... .................... .................... ....................

59412 T Antepartum manipulation ................................................................. 0199 11.20 $555.48 $157.83 $111.10

59414 T Deliver placenta ............................................................................... 0199 11.20 $555.48 $157.83 $111.10

59425 E Antepartum care only ....................................................................... .................... .................... .................... .................... ....................

59426 E Antepartum care only ....................................................................... .................... .................... .................... .................... ....................

59430 E Care after delivery ............................................................................ .................... .................... .................... .................... ....................

59510 E Cesarean delivery ............................................................................ .................... .................... .................... .................... ....................

59514 C Cesarean delivery only .................................................................... .................... .................... .................... .................... ....................

59515 E Cesarean delivery ............................................................................ .................... .................... .................... .................... ....................

59525 C Remove uterus after cesarean ........................................................ .................... .................... .................... .................... ....................

59610 E Vbac delivery .................................................................................... .................... .................... .................... .................... ....................

59612 T Vbac delivery only ............................................................................ 0199 11.20 $555.48 $157.83 $111.10

59614 E Vbac care after delivery ................................................................... .................... .................... .................... .................... ....................

59618 E Attempted vbac delivery ................................................................... .................... .................... .................... .................... ....................

59620 C Attempted vbac delivery only ........................................................... .................... .................... .................... .................... ....................

59622 E Attempted vbac after care ................................................................ .................... .................... .................... .................... ....................

59812 T Treatment of miscarriage ................................................................. 0201 13.00 $644.75 $329.65 $128.95

59820 T Care of miscarriage .......................................................................... 0201 13.00 $644.75 $329.65 $128.95

59821 T Treatment of miscarriage ................................................................. 0201 13.00 $644.75 $329.65 $128.95

59830 C Treat uterus infection ....................................................................... .................... .................... .................... .................... ....................

59840 T Abortion ............................................................................................ 0200 13.89 $688.89 $373.23 $137.78

59841 T Abortion ............................................................................................ 0200 13.89 $688.89 $373.23 $137.78

59850 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59851 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59852 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59855 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59856 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59857 C Abortion ............................................................................................ .................... .................... .................... .................... ....................

59866 T Abortion (mpr) .................................................................................. 0198 1.34 $66.46 $33.03 $13.29

59870 T Evacuate mole of uterus .................................................................. 0201 13.00 $644.75 $329.65 $128.95

59871 T Remove cerclage suture .................................................................. 0194 16.21 $803.96 $395.94 $160.79

59898 T Laparo proc, ob care/deliver ............................................................ 0130 25.36 $1,257.75 $659.53 $251.55

59899 T Maternity care procedure ................................................................. 0198 1.34 $66.46 $33.03 $13.29

60000 T Drain thyroid/tongue cyst ................................................................. 0253 12.02 $596.14 $284.00 $119.23

60001 T Aspirate/inject thyriod cyst ............................................................... 0002 0.62 $30.75 $17.66 $6.15

60100 T Biopsy of thyroid .............................................................................. 0004 1.84 $91.26 $32.57 $18.25

60200 T Remove thyroid lesion ..................................................................... 0114 19.56 $970.10 $493.78 $194.02

60210 T Partial thyroid excision ..................................................................... 0114 19.56 $970.10 $493.78 $194.02

60212 T Parital thyroid excision ..................................................................... 0114 19.56 $970.10 $493.78 $194.02

60220 T Partial removal of thyroid ................................................................. 0114 19.56 $970.10 $493.78 $194.02

67899

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

60225 T Partial removal of thyroid ................................................................. 0114 19.56 $970.10 $493.78 $194.02

60240 T Removal of thyroid ........................................................................... 0114 19.56 $970.10 $493.78 $194.02

60252 T Removal of thyroid ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

60254 C Extensive thyroid surgery ................................................................. .................... .................... .................... .................... ....................

60260 T Repeat thyroid surgery ..................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

60270 C Removal of thyroid ........................................................................... .................... .................... .................... .................... ....................

60271 C Removal of thyroid ........................................................................... .................... .................... .................... .................... ....................

60280 T Remove thyroid duct lesion ............................................................. 0114 19.56 $970.10 $493.78 $194.02

60281 T Remove thyroid duct lesion ............................................................. 0114 19.56 $970.10 $493.78 $194.02

60500 T Explore parathyroid glands .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

60502 C Re-explore parathyroids ................................................................... .................... .................... .................... .................... ....................

60505 C Explore parathyroid glands .............................................................. .................... .................... .................... .................... ....................

60512 T Autotransplant parathyroid ............................................................... 0020 6.51 $322.87 $130.53 $64.57

60520 C Removal of thymus gland ................................................................ .................... .................... .................... .................... ....................

60521 C Removal of thymus gland ................................................................ .................... .................... .................... .................... ....................

60522 C Removal of thymus gland ................................................................ .................... .................... .................... .................... ....................

60540 C Explore adrenal gland ...................................................................... .................... .................... .................... .................... ....................

60545 C Explore adrenal gland ...................................................................... .................... .................... .................... .................... ....................

60600 C Remove carotid body lesion ............................................................ .................... .................... .................... .................... ....................

60605 C Remove carotid body lesion ............................................................ .................... .................... .................... .................... ....................

60650 C Laparoscopy adrenalectomy ............................................................ .................... .................... .................... .................... ....................

60659 T Laparo proc, endocrine .................................................................... 0130 25.36 $1,257.75 $659.53 $251.55

60699 T Endocrine surgery procedure ........................................................... 0004 1.84 $91.26 $32.57 $18.25

61000 T Remove cranial cavity fluid .............................................................. 0212 3.64 $180.53 $88.78 $36.11

61001 T Remove cranial cavity fluid .............................................................. 0212 3.64 $180.53 $88.78 $36.11

61020 T Remove brain cavity fluid ................................................................. 0212 3.64 $180.53 $88.78 $36.11

61026 T Injection into brain canal .................................................................. 0212 3.64 $180.53 $88.78 $36.11

61050 T Remove brain canal fluid ................................................................. 0212 3.64 $180.53 $88.78 $36.11

61055 T Injection into brain canal .................................................................. 0212 3.64 $180.53 $88.78 $36.11

61070 T Brain canal shunt procedure ............................................................ 0212 3.64 $180.53 $88.78 $36.11

61105 C Twist drill hole .................................................................................. .................... .................... .................... .................... ....................

61107 C Drill skull for implantation ................................................................. .................... .................... .................... .................... ....................

61108 C Drill skull for drainage ...................................................................... .................... .................... .................... .................... ....................

61120 C Burr hole for puncture ...................................................................... .................... .................... .................... .................... ....................

61140 C Pierce skull for biopsy ...................................................................... .................... .................... .................... .................... ....................

61150 C Pierce skull for drainage .................................................................. .................... .................... .................... .................... ....................

61151 C Pierce skull for drainage .................................................................. .................... .................... .................... .................... ....................

61154 C Pierce skull & remove clot ............................................................... .................... .................... .................... .................... ....................

61156 C Pierce skull for drainage .................................................................. .................... .................... .................... .................... ....................

61210 C Pierce skull, implant device ............................................................. .................... .................... .................... .................... ....................

61215 T Insert brain-fluid device .................................................................... 0224 17.89 $887.27 $453.41 $177.45

61250 C Pierce skull & explore ...................................................................... .................... .................... .................... .................... ....................

61253 C Pierce skull & explore ...................................................................... .................... .................... .................... .................... ....................

61304 C Open skull for exploration ................................................................ .................... .................... .................... .................... ....................

61305 C Open skull for exploration ................................................................ .................... .................... .................... .................... ....................

61312 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61313 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61314 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61315 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61320 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61321 C Open skull for drainage .................................................................... .................... .................... .................... .................... ....................

61330 T Decompress eye socket ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

61332 C Explore/biopsy eye socket ............................................................... .................... .................... .................... .................... ....................

61333 C Explore orbit/remove lesion ............................................................. .................... .................... .................... .................... ....................

61334 C Explore orbit/remove object ............................................................. .................... .................... .................... .................... ....................

61340 C Relieve cranial pressure .................................................................. .................... .................... .................... .................... ....................

61343 C Incise skull (press relief) .................................................................. .................... .................... .................... .................... ....................

61345 C Relieve cranial pressure .................................................................. .................... .................... .................... .................... ....................

61440 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61450 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61458 C Incise skull for brain wound ............................................................. .................... .................... .................... .................... ....................

61460 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61470 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61480 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61490 C Incise skull for surgery ..................................................................... .................... .................... .................... .................... ....................

61500 C Removal of skull lesion .................................................................... .................... .................... .................... .................... ....................

61501 C Remove infected skull bone ............................................................. .................... .................... .................... .................... ....................

61510 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61512 C Remove brain lining lesion ............................................................... .................... .................... .................... .................... ....................

61514 C Removal of brain abscess ............................................................... .................... .................... .................... .................... ....................

61516 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61518 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61519 C Remove brain lining lesion ............................................................... .................... .................... .................... .................... ....................

61520 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

67900

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

61521 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61522 C Removal of brain abscess ............................................................... .................... .................... .................... .................... ....................

61524 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61526 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61530 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61531 C Implant brain electrodes ................................................................... .................... .................... .................... .................... ....................

61533 C Implant brain electrodes ................................................................... .................... .................... .................... .................... ....................

61534 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61535 C Remove brain electrodes ................................................................. .................... .................... .................... .................... ....................

61536 C Removal of brain lesion ................................................................... .................... .................... .................... .................... ....................

61538 C Removal of brain tissue ................................................................... .................... .................... .................... .................... ....................

61539 C Removal of brain tissue ................................................................... .................... .................... .................... .................... ....................

61541 C Incision of brain tissue ..................................................................... .................... .................... .................... .................... ....................

61542 C Removal of brain tissue ................................................................... .................... .................... .................... .................... ....................

61543 C Removal of brain tissue ................................................................... .................... .................... .................... .................... ....................

61544 C Remove & treat brain lesion ............................................................ .................... .................... .................... .................... ....................

61545 C Excision of brain tumor .................................................................... .................... .................... .................... .................... ....................

61546 C Removal of pituitary gland ............................................................... .................... .................... .................... .................... ....................

61548 C Removal of pituitary gland ............................................................... .................... .................... .................... .................... ....................

61550 C Release of skull seams .................................................................... .................... .................... .................... .................... ....................

61552 C Release of skull seams .................................................................... .................... .................... .................... .................... ....................

61556 C Incise skull/sutures ........................................................................... .................... .................... .................... .................... ....................

61557 C Incise skull/sutures ........................................................................... .................... .................... .................... .................... ....................

61558 C Excision of skull/sutures ................................................................... .................... .................... .................... .................... ....................

61559 C Excision of skull/sutures ................................................................... .................... .................... .................... .................... ....................

61563 C Excision of skull tumor ..................................................................... .................... .................... .................... .................... ....................

61564 C Excision of skull tumor ..................................................................... .................... .................... .................... .................... ....................

61570 C Remove foreign body, brain ............................................................. .................... .................... .................... .................... ....................

61571 C Incise skull for brain wound ............................................................. .................... .................... .................... .................... ....................

61575 C Skull base/brainstem surgery ........................................................... .................... .................... .................... .................... ....................

61576 C Skull base/brainstem surgery ........................................................... .................... .................... .................... .................... ....................

61580 C Craniofacial approach, skull ............................................................. .................... .................... .................... .................... ....................

61581 C Craniofacial approach, skull ............................................................. .................... .................... .................... .................... ....................

61582 C Craniofacial approach, skull ............................................................. .................... .................... .................... .................... ....................

61583 C Craniofacial approach, skull ............................................................. .................... .................... .................... .................... ....................

61584 C Orbitocranial approach/skull ............................................................. .................... .................... .................... .................... ....................

61585 C Orbitocranial approach/skull ............................................................. .................... .................... .................... .................... ....................

61586 C Resect nasopharynx, skull ............................................................... .................... .................... .................... .................... ....................

61590 C Infratemporal approach/skull ............................................................ .................... .................... .................... .................... ....................

61591 C Infratemporal approach/skull ............................................................ .................... .................... .................... .................... ....................

61592 C Orbitocranial approach/skull ............................................................. .................... .................... .................... .................... ....................

61595 C Transtemporal approach/skull .......................................................... .................... .................... .................... .................... ....................

61596 C Transcochlear approach/skull .......................................................... .................... .................... .................... .................... ....................

61597 C Transcondylar approach/skull .......................................................... .................... .................... .................... .................... ....................

61598 C Transpetrosal approach/skull ........................................................... .................... .................... .................... .................... ....................

61600 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61601 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61605 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61606 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61607 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61608 C Resect/excise cranial lesion ............................................................. .................... .................... .................... .................... ....................

61609 C Transect artery, sinus ...................................................................... .................... .................... .................... .................... ....................

61610 C Transect artery, sinus ...................................................................... .................... .................... .................... .................... ....................

61611 C Transect artery, sinus ...................................................................... .................... .................... .................... .................... ....................

61612 C Transect artery, sinus ...................................................................... .................... .................... .................... .................... ....................

61613 C Remove aneurysm, sinus ................................................................ .................... .................... .................... .................... ....................

61615 C Resect/excise lesion, skull ............................................................... .................... .................... .................... .................... ....................

61616 C Resect/excise lesion, skull ............................................................... .................... .................... .................... .................... ....................

61618 C Repair dura ...................................................................................... .................... .................... .................... .................... ....................

61619 C Repair dura ...................................................................................... .................... .................... .................... .................... ....................

61624 C Occlusion/embolization cath ............................................................ .................... .................... .................... .................... ....................

61626 C Occlusion/embolization cath ............................................................ .................... .................... .................... .................... ....................

61680 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

61682 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

61684 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

61686 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

61690 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

61692 C Intracranial vessel surgery ............................................................... .................... .................... .................... .................... ....................

*61697 C Brain aneurysm repair, complex ...................................................... .................... .................... .................... .................... ....................

*61698 C Brain aneurysm repair, complex ...................................................... .................... .................... .................... .................... ....................

61700 C Inner skull vessel surgery ................................................................ .................... .................... .................... .................... ....................

61702 C Inner skull vessel surgery ................................................................ .................... .................... .................... .................... ....................

61703 C Clamp neck artery ............................................................................ .................... .................... .................... .................... ....................

61705 C Revise circulation to head ................................................................ .................... .................... .................... .................... ....................

67901

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

61708 C Revise circulation to head ................................................................ .................... .................... .................... .................... ....................

61710 C Revise circulation to head ................................................................ .................... .................... .................... .................... ....................

61711 C Fusion of skull arteries ..................................................................... .................... .................... .................... .................... ....................

61720 C Incise skull/brain surgery ................................................................. .................... .................... .................... .................... ....................

61735 C Incise skull/brain surgery ................................................................. .................... .................... .................... .................... ....................

61750 C Incise skull/brain biopsy ................................................................... .................... .................... .................... .................... ....................

61751 C Brain biopsy w/ ct/mr guide ............................................................. .................... .................... .................... .................... ....................

61760 C Implant brain electrodes ................................................................... .................... .................... .................... .................... ....................

61770 C Incise skull for treatment .................................................................. .................... .................... .................... .................... ....................

61790 T Treat trigeminal nerve ...................................................................... 0220 13.96 $692.36 $326.21 $138.47

61791 C Treat trigeminal tract ........................................................................ .................... .................... .................... .................... ....................

61793 E Focus radiation beam ...................................................................... .................... .................... .................... .................... ....................

61795 S Brain surgery using computer .......................................................... 0302 8.21 $407.18 $216.55 $81.44

61850 C Implant neuroelectrodes ................................................................... .................... .................... .................... .................... ....................

61860 C Implant neuroelectrodes ................................................................... .................... .................... .................... .................... ....................

61862 C Implant neurostimul, subcort ............................................................ .................... .................... .................... .................... ....................

61870 C Implant neuroelectrodes ................................................................... .................... .................... .................... .................... ....................

61875 C Implant neuroelectrodes ................................................................... .................... .................... .................... .................... ....................

61880 T Revise/remove neuroelectrode ........................................................ 0105 15.06 $746.92 $372.32 $149.38

61885 T Implant neurostim one array ............................................................ 0222 124.43 $6,171.23 $2,955.13 $1,234.25

61886 T Implant neurostim arrays ................................................................. 0222 124.43 $6,171.23 $2,955.13 $1,234.25

61888 T Revise/remove neuroreceiver .......................................................... 0105 15.06 $746.92 $372.32 $149.38

62000 C Treat skull fracture ........................................................................... .................... .................... .................... .................... ....................

62005 C Treat skull fracture ........................................................................... .................... .................... .................... .................... ....................

62010 C Treatment of head injury .................................................................. .................... .................... .................... .................... ....................

62100 C Repair brain fluid leakage ................................................................ .................... .................... .................... .................... ....................

62115 C Reduction of skull defect .................................................................. .................... .................... .................... .................... ....................

62116 C Reduction of skull defect .................................................................. .................... .................... .................... .................... ....................

62117 C Reduction of skull defect .................................................................. .................... .................... .................... .................... ....................

62120 C Repair skull cavity lesion ................................................................. .................... .................... .................... .................... ....................

62121 C Incise skull repair ............................................................................. .................... .................... .................... .................... ....................

62140 C Repair of skull defect ....................................................................... .................... .................... .................... .................... ....................

62141 C Repair of skull defect ....................................................................... .................... .................... .................... .................... ....................

62142 C Remove skull plate/flap .................................................................... .................... .................... .................... .................... ....................

62143 C Replace skull plate/flap .................................................................... .................... .................... .................... .................... ....................

62145 C Repair of skull & brain ..................................................................... .................... .................... .................... .................... ....................

62146 C Repair of skull with graft .................................................................. .................... .................... .................... .................... ....................

62147 C Repair of skull with graft .................................................................. .................... .................... .................... .................... ....................

62180 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62190 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62192 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62194 T Replace/irrigate catheter .................................................................. 0121 2.36 $117.05 $52.53 $23.41

62200 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62201 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62220 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62223 C Establish brain cavity shunt ............................................................. .................... .................... .................... .................... ....................

62225 T Replace/irrigate catheter .................................................................. 0121 2.36 $117.05 $52.53 $23.41

62230 T Replace/revise brain shunt .............................................................. 0224 17.89 $887.27 $453.41 $177.45

*62252 S CSF shunt reprogram ...................................................................... 0102 0.45 $22.32 $12.62 $4.46

62256 C Remove brain cavity shunt .............................................................. .................... .................... .................... .................... ....................

62258 C Replace brain cavity shunt ............................................................... .................... .................... .................... .................... ....................

62263 T Lysis epidural adhesions .................................................................. 0212 3.64 $180.53 $88.78 $36.11

62268 T Drain spinal cord cyst ...................................................................... 0212 3.64 $180.53 $88.78 $36.11

62269 T Needle biopsy, spinal cord ............................................................... 0005 5.41 $268.32 $119.75 $53.66

62270 T Spinal fluid tap, diagnostic ............................................................... 0210 3.00 $148.79 $62.40 $29.76

62272 T Drain spinal fluid .............................................................................. 0210 3.00 $148.79 $62.40 $29.76

62273 T Treat epidural spine lesion ............................................................... 0212 3.64 $180.53 $88.78 $36.11

62280 T Treat spinal cord lesion .................................................................... 0212 3.64 $180.53 $88.78 $36.11

62281 T Treat spinal cord lesion .................................................................... 0212 3.64 $180.53 $88.78 $36.11

62282 T Treat spinal canal lesion .................................................................. 0212 3.64 $180.53 $88.78 $36.11

62284 N Injection for myelogram .................................................................... .................... .................... .................... .................... ....................

62287 T Percutaneous diskectomy ................................................................ 0220 13.96 $692.36 $326.21 $138.47

62290 N Inject for spine disk x-ray ................................................................. .................... .................... .................... .................... ....................

62291 N Inject for spine disk x-ray ................................................................. .................... .................... .................... .................... ....................

62292 T Injection into disk lesion ................................................................... 0212 3.64 $180.53 $88.78 $36.11

62294 T Injection into spinal artery ................................................................ 0212 3.64 $180.53 $88.78 $36.11

62310 T Inject spine c/t .................................................................................. 0212 3.64 $180.53 $88.78 $36.11

62311 T Inject spine l/s (cd) ........................................................................... 0212 3.64 $180.53 $88.78 $36.11

62318 T Inject spine w/cath, c/t ..................................................................... 0212 3.64 $180.53 $88.78 $36.11

62319 T Inject spine w/cath l/s (cd) ............................................................... 0212 3.64 $180.53 $88.78 $36.11

62350 T Implant spinal canal cath ................................................................. 0223 7.05 $349.65 $154.27 $69.93

62351 C Implant spinal canal cath ................................................................. .................... .................... .................... .................... ....................

62355 T Remove spinal canal catheter ......................................................... 0105 15.06 $746.92 $372.32 $149.38

62360 T Insert spine infusion device ............................................................. 0226 5.62 $278.73 $109.42 $55.75

67902

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

62361 T Implant spine infusion pump ............................................................ 0227 11.17 $553.99 $330.11 $110.80

62362 T Implant spine infusion pump ............................................................ 0227 11.17 $553.99 $330.11 $110.80

62365 T Remove spine infusion device ......................................................... 0105 15.06 $746.92 $372.32 $149.38

62367 S Analyze spine infusion pump ........................................................... 0102 0.45 $22.32 $12.62 $4.46

62368 S Analyze spine infusion pump ........................................................... 0102 0.45 $22.32 $12.62 $4.46

63001 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63003 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63005 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63011 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63012 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63015 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63016 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63017 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63020 C Neck spine disk surgery ................................................................... .................... .................... .................... .................... ....................

63030 C Low back disk surgery ..................................................................... .................... .................... .................... .................... ....................

63035 C Spinal disk surgery add-on .............................................................. .................... .................... .................... .................... ....................

63040 C Neck spine disk surgery ................................................................... .................... .................... .................... .................... ....................

63042 C Low back disk surgery ..................................................................... .................... .................... .................... .................... ....................

*63043 C Laminotomy, addl cervical ............................................................... .................... .................... .................... .................... ....................

*63044 C Laminotomy, addl lumbar ................................................................. .................... .................... .................... .................... ....................

63045 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63046 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63047 C Removal of spinal lamina ................................................................. .................... .................... .................... .................... ....................

63048 C Remove spinal lamina add-on ......................................................... .................... .................... .................... .................... ....................

63055 C Decompress spinal cord .................................................................. .................... .................... .................... .................... ....................

63056 C Decompress spinal cord .................................................................. .................... .................... .................... .................... ....................

63057 C Decompress spine cord add-on ....................................................... .................... .................... .................... .................... ....................

63064 C Decompress spinal cord .................................................................. .................... .................... .................... .................... ....................

63066 C Decompress spine cord add-on ....................................................... .................... .................... .................... .................... ....................

63075 C Neck spine disk surgery ................................................................... .................... .................... .................... .................... ....................

63076 C Neck spine disk surgery ................................................................... .................... .................... .................... .................... ....................

63077 C Spine disk surgery, thorax ............................................................... .................... .................... .................... .................... ....................

63078 C Spine disk surgery, thorax ............................................................... .................... .................... .................... .................... ....................

63081 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63082 C Remove vertebral body add-on ....................................................... .................... .................... .................... .................... ....................

63085 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63086 C Remove vertebral body add-on ....................................................... .................... .................... .................... .................... ....................

63087 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63088 C Remove vertebral body add-on ....................................................... .................... .................... .................... .................... ....................

63090 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63091 C Remove vertebral body add-on ....................................................... .................... .................... .................... .................... ....................

63170 C Incise spinal cord tract(s) ................................................................. .................... .................... .................... .................... ....................

63172 C Drainage of spinal cyst .................................................................... .................... .................... .................... .................... ....................

63173 C Drainage of spinal cyst .................................................................... .................... .................... .................... .................... ....................

63180 C Revise spinal cord ligaments ........................................................... .................... .................... .................... .................... ....................

63182 C Revise spinal cord ligaments ........................................................... .................... .................... .................... .................... ....................

63185 C Incise spinal column/nerves ............................................................. .................... .................... .................... .................... ....................

63190 C Incise spinal column/nerves ............................................................. .................... .................... .................... .................... ....................

63191 C Incise spinal column/nerves ............................................................. .................... .................... .................... .................... ....................

63194 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63195 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63196 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63197 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63198 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63199 C Incise spinal column & cord ............................................................. .................... .................... .................... .................... ....................

63200 C Release of spinal cord ..................................................................... .................... .................... .................... .................... ....................

63250 C Revise spinal cord vessels .............................................................. .................... .................... .................... .................... ....................

63251 C Revise spinal cord vessels .............................................................. .................... .................... .................... .................... ....................

63252 C Revise spinal cord vessels .............................................................. .................... .................... .................... .................... ....................

63265 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63266 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63267 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63268 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63270 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63271 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63272 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63273 C Excise intraspinal lesion ................................................................... .................... .................... .................... .................... ....................

63275 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63276 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63277 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63278 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63280 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63281 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63282 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

67903

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

63283 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63285 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63286 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63287 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63290 C Biopsy/excise spinal tumor .............................................................. .................... .................... .................... .................... ....................

63300 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63301 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63302 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63303 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63304 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63305 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63306 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63307 C Removal of vertebral body ............................................................... .................... .................... .................... .................... ....................

63308 C Remove vertebral body add-on ....................................................... .................... .................... .................... .................... ....................

63600 T Remove spinal cord lesion ............................................................... 0220 13.96 $692.36 $326.21 $138.47

63610 T Stimulation of spinal cord ................................................................. 0220 13.96 $692.36 $326.21 $138.47

63615 T Remove lesion of spinal cord .......................................................... 0220 13.96 $692.36 $326.21 $138.47

63650 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

63655 C Implant neuroelectrodes ................................................................... .................... .................... .................... .................... ....................

63660 T Revise/remove neuroelectrode ........................................................ 0105 15.06 $746.92 $372.32 $149.38

63685 T Implant neuroreceiver ...................................................................... 0222 124.43 $6,171.23 $2,955.13 $1,234.25

63688 T Revise/remove neuroreceiver .......................................................... 0105 15.06 $746.92 $372.32 $149.38

63700 C Repair of spinal herniation ............................................................... .................... .................... .................... .................... ....................

63702 C Repair of spinal herniation ............................................................... .................... .................... .................... .................... ....................

63704 C Repair of spinal herniation ............................................................... .................... .................... .................... .................... ....................

63706 C Repair of spinal herniation ............................................................... .................... .................... .................... .................... ....................

63707 C Repair spinal fluid leakage ............................................................... .................... .................... .................... .................... ....................

63709 C Repair spinal fluid leakage ............................................................... .................... .................... .................... .................... ....................

63710 C Graft repair of spine defect .............................................................. .................... .................... .................... .................... ....................

63740 C Install spinal shunt ........................................................................... .................... .................... .................... .................... ....................

63741 T Install spinal shunt ........................................................................... 0228 25.06 $1,242.88 $696.46 $248.58

63744 T Revision of spinal shunt ................................................................... 0228 25.06 $1,242.88 $696.46 $248.58

63746 T Removal of spinal shunt .................................................................. 0109 6.53 $323.86 $133.51 $64.77

64400 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64402 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64405 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64408 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64410 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64412 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64413 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64415 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64417 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64418 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64420 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64421 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64425 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64430 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64435 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64445 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64450 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64470 T Inj paravertebral c/t .......................................................................... 0211 3.32 $164.66 $74.78 $32.93

64472 T Inj paravertebral c/t add-on .............................................................. 0211 3.32 $164.66 $74.78 $32.93

64475 T Inj paravertebral l/s .......................................................................... 0211 3.32 $164.66 $74.78 $32.93

64476 T Inj paravertebral l/s add-on .............................................................. 0211 3.32 $164.66 $74.78 $32.93

64479 T Inj foramen epidural c/t .................................................................... 0211 3.32 $164.66 $74.78 $32.93

64480 T Inj foramen epidural add-on ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64483 T Inj foramen epidural l/s .................................................................... 0211 3.32 $164.66 $74.78 $32.93

64484 T Inj foramen epidural add-on ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64505 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64508 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64510 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64520 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64530 T Injection for nerve block ................................................................... 0211 3.32 $164.66 $74.78 $32.93

64550 A Apply neurostimulator ...................................................................... .................... .................... .................... .................... ....................

64553 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64555 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64560 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64565 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64573 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64575 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64577 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64580 T Implant neuroelectrodes ................................................................... 0225 17.72 $878.84 $408.33 $175.77

64585 T Revise/remove neuroelectrode ........................................................ 0105 15.06 $746.92 $372.32 $149.38

64590 T Implant neuroreceiver ...................................................................... 0222 124.43 $6,171.23 $2,955.13 $1,234.25

67904

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

64595 T Revise/remove neuroreceiver .......................................................... 0105 15.06 $746.92 $372.32 $149.38

64600 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64605 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64610 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64612 T Destroy nerve, face muscle ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64613 T Destroy nerve, spine muscle ........................................................... 0211 3.32 $164.66 $74.78 $32.93

*64614 S Desrtoy nerve, extrem musc ............................................................ 0971 1.55 $76.88 .................... $15.38

64620 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64622 T Destr paravertebrl nerve l/s ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64623 T Destr paravertebral n add-on ........................................................... 0211 3.32 $164.66 $74.78 $32.93

64626 T Destr paravertebrl nerve c/t ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64627 T Destr paravertebral n add-on ........................................................... 0211 3.32 $164.66 $74.78 $32.93

64630 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64640 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64680 T Injection treatment of nerve ............................................................. 0211 3.32 $164.66 $74.78 $32.93

64702 T Revise finger/toe nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64704 T Revise hand/foot nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64708 T Revise arm/leg nerve ....................................................................... 0220 13.96 $692.36 $326.21 $138.47

64712 T Revision of sciatic nerve .................................................................. 0220 13.96 $692.36 $326.21 $138.47

64713 T Revision of arm nerve(s) .................................................................. 0220 13.96 $692.36 $326.21 $138.47

64714 T Revise low back nerve(s) ................................................................. 0220 13.96 $692.36 $326.21 $138.47

64716 T Revision of cranial nerve ................................................................. 0220 13.96 $692.36 $326.21 $138.47

64718 T Revise ulnar nerve at elbow ............................................................ 0220 13.96 $692.36 $326.21 $138.47

64719 T Revise ulnar nerve at wrist .............................................................. 0220 13.96 $692.36 $326.21 $138.47

64721 T Carpal tunnel surgery ....................................................................... 0220 13.96 $692.36 $326.21 $138.47

64722 T Relieve pressure on nerve(s) ........................................................... 0220 13.96 $692.36 $326.21 $138.47

64726 T Release foot/toe nerve ..................................................................... 0220 13.96 $692.36 $326.21 $138.47

64727 T Internal nerve revision ...................................................................... 0220 13.96 $692.36 $326.21 $138.47

64732 T Incision of brow nerve ...................................................................... 0220 13.96 $692.36 $326.21 $138.47

64734 T Incision of cheek nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64736 T Incision of chin nerve ....................................................................... 0220 13.96 $692.36 $326.21 $138.47

64738 T Incision of jaw nerve ........................................................................ 0220 13.96 $692.36 $326.21 $138.47

64740 T Incision of tongue nerve ................................................................... 0220 13.96 $692.36 $326.21 $138.47

64742 T Incision of facial nerve ..................................................................... 0220 13.96 $692.36 $326.21 $138.47

64744 T Incise nerve, back of head ............................................................... 0220 13.96 $692.36 $326.21 $138.47

64746 T Incise diaphragm nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64752 C Incision of vagus nerve .................................................................... .................... .................... .................... .................... ....................

64755 C Incision of stomach nerves .............................................................. .................... .................... .................... .................... ....................

64760 C Incision of vagus nerve .................................................................... .................... .................... .................... .................... ....................

64761 T Incision of pelvis nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64763 C Incise hip/thigh nerve ....................................................................... .................... .................... .................... .................... ....................

64766 C Incise hip/thigh nerve ....................................................................... .................... .................... .................... .................... ....................

64771 T Sever cranial nerve .......................................................................... 0220 13.96 $692.36 $326.21 $138.47

64772 T Incision of spinal nerve .................................................................... 0220 13.96 $692.36 $326.21 $138.47

64774 T Remove skin nerve lesion ................................................................ 0220 13.96 $692.36 $326.21 $138.47

64776 T Remove digit nerve lesion ............................................................... 0220 13.96 $692.36 $326.21 $138.47

64778 T Digit nerve surgery add-on .............................................................. 0220 13.96 $692.36 $326.21 $138.47

64782 T Remove limb nerve lesion ............................................................... 0220 13.96 $692.36 $326.21 $138.47

64783 T Limb nerve surgery add-on .............................................................. 0220 13.96 $692.36 $326.21 $138.47

64784 T Remove nerve lesion ....................................................................... 0220 13.96 $692.36 $326.21 $138.47

64786 T Remove sciatic nerve lesion ............................................................ 0221 18.36 $910.58 $463.62 $182.12

64787 T Implant nerve end ............................................................................ 0220 13.96 $692.36 $326.21 $138.47

64788 T Remove skin nerve lesion ................................................................ 0220 13.96 $692.36 $326.21 $138.47

64790 T Removal of nerve lesion .................................................................. 0220 13.96 $692.36 $326.21 $138.47

64792 T Removal of nerve lesion .................................................................. 0221 18.36 $910.58 $463.62 $182.12

64795 T Biopsy of nerve ................................................................................ 0220 13.96 $692.36 $326.21 $138.47

64802 C Remove sympathetic nerves ............................................................ .................... .................... .................... .................... ....................

64804 C Remove sympathetic nerves ............................................................ .................... .................... .................... .................... ....................

64809 C Remove sympathetic nerves ............................................................ .................... .................... .................... .................... ....................

64818 C Remove sympathetic nerves ............................................................ .................... .................... .................... .................... ....................

64820 C Remove sympathetic nerves ............................................................ .................... .................... .................... .................... ....................

64831 T Repair of digit nerve ......................................................................... 0221 18.36 $910.58 $463.62 $182.12

64832 T Repair nerve add-on ........................................................................ 0221 18.36 $910.58 $463.62 $182.12

64834 T Repair of hand or foot nerve ............................................................ 0221 18.36 $910.58 $463.62 $182.12

64835 T Repair of hand or foot nerve ............................................................ 0221 18.36 $910.58 $463.62 $182.12

64836 T Repair of hand or foot nerve ............................................................ 0221 18.36 $910.58 $463.62 $182.12

64837 T Repair nerve add-on ........................................................................ 0221 18.36 $910.58 $463.62 $182.12

64840 T Repair of leg nerve .......................................................................... 0221 18.36 $910.58 $463.62 $182.12

64856 T Repair/transpose nerve .................................................................... 0221 18.36 $910.58 $463.62 $182.12

64857 T Repair arm/leg nerve ....................................................................... 0221 18.36 $910.58 $463.62 $182.12

64858 T Repair sciatic nerve ......................................................................... 0221 18.36 $910.58 $463.62 $182.12

64859 T Nerve surgery ................................................................................... 0221 18.36 $910.58 $463.62 $182.12

64861 T Repair of arm nerves ....................................................................... 0221 18.36 $910.58 $463.62 $182.12

64862 T Repair of low back nerves ............................................................... 0221 18.36 $910.58 $463.62 $182.12

67905

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

64864 T Repair of facial nerve ....................................................................... 0221 18.36 $910.58 $463.62 $182.12

64865 T Repair of facial nerve ....................................................................... 0221 18.36 $910.58 $463.62 $182.12

64866 C Fusion of facial/other nerve ............................................................. .................... .................... .................... .................... ....................

64868 C Fusion of facial/other nerve ............................................................. .................... .................... .................... .................... ....................

64870 T Fusion of facial/other nerve ............................................................. 0221 18.36 $910.58 $463.62 $182.12

64872 T Subsequent repair of nerve ............................................................. 0221 18.36 $910.58 $463.62 $182.12

64874 T Repair & revise nerve add-on .......................................................... 0221 18.36 $910.58 $463.62 $182.12

64876 T Repair nerve/shorten bone .............................................................. 0221 18.36 $910.58 $463.62 $182.12

64885 T Nerve graft, head or neck ................................................................ 0221 18.36 $910.58 $463.62 $182.12

64886 T Nerve graft, head or neck ................................................................ 0221 18.36 $910.58 $463.62 $182.12

64890 T Nerve graft, hand or foot .................................................................. 0221 18.36 $910.58 $463.62 $182.12

64891 T Nerve graft, hand or foot .................................................................. 0221 18.36 $910.58 $463.62 $182.12

64892 T Nerve graft, arm or leg ..................................................................... 0221 18.36 $910.58 $463.62 $182.12

64893 T Nerve graft, arm or leg ..................................................................... 0221 18.36 $910.58 $463.62 $182.12

64895 T Nerve graft, hand or foot .................................................................. 0221 18.36 $910.58 $463.62 $182.12

64896 T Nerve graft, hand or foot .................................................................. 0221 18.36 $910.58 $463.62 $182.12

64897 T Nerve graft, arm or leg ..................................................................... 0221 18.36 $910.58 $463.62 $182.12

64898 T Nerve graft, arm or leg ..................................................................... 0221 18.36 $910.58 $463.62 $182.12

64901 T Nerve graft add-on ........................................................................... 0221 18.36 $910.58 $463.62 $182.12

64902 T Nerve graft add-on ........................................................................... 0221 18.36 $910.58 $463.62 $182.12

64905 T Nerve pedicle transfer ...................................................................... 0221 18.36 $910.58 $463.62 $182.12

64907 T Nerve pedicle transfer ...................................................................... 0221 18.36 $910.58 $463.62 $182.12

64999 T Nervous system surgery .................................................................. 0211 3.32 $164.66 $74.78 $32.93

65091 T Revise eye ....................................................................................... 0242 23.70 $1,175.42 $597.36 $235.08

65093 T Revise eye with implant ................................................................... 0241 16.60 $823.30 $384.47 $164.66

65101 T Removal of eye ................................................................................ 0242 23.70 $1,175.42 $597.36 $235.08

65103 T Remove eye/insert implant .............................................................. 0242 23.70 $1,175.42 $597.36 $235.08

65105 T Remove eye/attach implant ............................................................. 0242 23.70 $1,175.42 $597.36 $235.08

65110 T Removal of eye ................................................................................ 0242 23.70 $1,175.42 $597.36 $235.08

65112 T Remove eye/revise socket ............................................................... 0242 23.70 $1,175.42 $597.36 $235.08

65114 T Remove eye/revise socket ............................................................... 0242 23.70 $1,175.42 $597.36 $235.08

65125 T Revise ocular implant ....................................................................... 0240 13.47 $668.06 $315.31 $133.61

65130 T Insert ocular implant ......................................................................... 0241 16.60 $823.30 $384.47 $164.66

65135 T Insert ocular implant ......................................................................... 0241 16.60 $823.30 $384.47 $164.66

65140 T Attach ocular implant ....................................................................... 0242 23.70 $1,175.42 $597.36 $235.08

65150 T Revise ocular implant ....................................................................... 0241 16.60 $823.30 $384.47 $164.66

65155 T Reinsert ocular implant .................................................................... 0242 23.70 $1,175.42 $597.36 $235.08

65175 T Removal of ocular implant ............................................................... 0240 13.47 $668.06 $315.31 $133.61

65205 S Remove foreign body from eye ....................................................... 0231 2.64 $130.94 $59.87 $26.19

65210 S Remove foreign body from eye ....................................................... 0231 2.64 $130.94 $59.87 $26.19

65220 S Remove foreign body from eye ....................................................... 0231 2.64 $130.94 $59.87 $26.19

65222 S Remove foreign body from eye ....................................................... 0231 2.64 $130.94 $59.87 $26.19

65235 T Remove foreign body from eye ....................................................... 0232 6.04 $299.56 $134.66 $59.91

65260 T Remove foreign body from eye ....................................................... 0237 33.96 $1,684.28 $852.68 $336.86

65265 T Remove foreign body from eye ....................................................... 0237 33.96 $1,684.28 $852.68 $336.86

65270 T Repair of eye wound ........................................................................ 0240 13.47 $668.06 $315.31 $133.61

65272 T Repair of eye wound ........................................................................ 0232 6.04 $299.56 $134.66 $59.91

65273 C Repair of eye wound ........................................................................ .................... .................... .................... .................... ....................

65275 T Repair of eye wound ........................................................................ 0233 13.79 $683.93 $331.60 $136.79

65280 T Repair of eye wound ........................................................................ 0233 13.79 $683.93 $331.60 $136.79

65285 T Repair of eye wound ........................................................................ 0234 20.64 $1,023.66 $502.16 $204.73

65286 T Repair of eye wound ........................................................................ 0232 6.04 $299.56 $134.66 $59.91

65290 T Repair of eye socket wound ............................................................ 0243 17.99 $892.23 $431.39 $178.45

65400 T Removal of eye lesion ..................................................................... 0232 6.04 $299.56 $134.66 $59.91

65410 T Biopsy of cornea .............................................................................. 0233 13.79 $683.93 $331.60 $136.79

65420 T Removal of eye lesion ..................................................................... 0233 13.79 $683.93 $331.60 $136.79

65426 T Removal of eye lesion ..................................................................... 0233 13.79 $683.93 $331.60 $136.79

65430 S Corneal smear .................................................................................. 0231 2.64 $130.94 $59.87 $26.19

65435 T Curette/treat cornea ......................................................................... 0239 6.26 $310.47 $123.42 $62.09

65436 T Curette/treat cornea ......................................................................... 0232 6.04 $299.56 $134.66 $59.91

65450 T Treatment of corneal lesion ............................................................. 0232 6.04 $299.56 $134.66 $59.91

65600 T Revision of cornea ........................................................................... 0240 13.47 $668.06 $315.31 $133.61

65710 T Corneal transplant ............................................................................ 0244 32.88 $1,630.72 $851.42 $326.14

65730 T Corneal transplant ............................................................................ 0244 32.88 $1,630.72 $851.42 $326.14

65750 T Corneal transplant ............................................................................ 0244 32.88 $1,630.72 $851.42 $326.14

65755 T Corneal transplant ............................................................................ 0244 32.88 $1,630.72 $851.42 $326.14

65760 E Revision of cornea ........................................................................... .................... .................... .................... .................... ....................

65765 E Revision of cornea ........................................................................... .................... .................... .................... .................... ....................

65767 E Corneal tissue transplant ................................................................. .................... .................... .................... .................... ....................

65770 T Revise cornea with implant .............................................................. 0244 32.88 $1,630.72 $851.42 $326.14

65771 E Radial keratotomy ............................................................................ .................... .................... .................... .................... ....................

65772 T Correction of astigmatism ................................................................ 0232 6.04 $299.56 $134.66 $59.91

65775 T Correction of astigmatism ................................................................ 0233 13.79 $683.93 $331.60 $136.79

65800 T Drainage of eye ................................................................................ 0232 6.04 $299.56 $134.66 $59.91

67906

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

65805 T Drainage of eye ................................................................................ 0233 13.79 $683.93 $331.60 $136.79

65810 T Drainage of eye ................................................................................ 0233 13.79 $683.93 $331.60 $136.79

65815 T Drainage of eye ................................................................................ 0233 13.79 $683.93 $331.60 $136.79

65820 T Relieve inner eye pressure .............................................................. 0232 6.04 $299.56 $134.66 $59.91

65850 T Incision of eye .................................................................................. 0234 20.64 $1,023.66 $502.16 $204.73

65855 T Laser surgery of eye ........................................................................ 0247 4.89 $242.52 $112.86 $48.50

65860 T Incise inner eye adhesions .............................................................. 0247 4.89 $242.52 $112.86 $48.50

65865 T Incise inner eye adhesions .............................................................. 0233 13.79 $683.93 $331.60 $136.79

65870 T Incise inner eye adhesions .............................................................. 0233 13.79 $683.93 $331.60 $136.79

65875 T Incise inner eye adhesions .............................................................. 0233 13.79 $683.93 $331.60 $136.79

65880 T Incise inner eye adhesions .............................................................. 0232 6.04 $299.56 $134.66 $59.91

65900 T Remove eye lesion .......................................................................... 0232 6.04 $299.56 $134.66 $59.91

65920 T Remove implant from eye ................................................................ 0233 13.79 $683.93 $331.60 $136.79

65930 T Remove blood clot from eye ............................................................ 0233 13.79 $683.93 $331.60 $136.79

66020 T Injection treatment of eye ................................................................ 0232 6.04 $299.56 $134.66 $59.91

66030 T Injection treatment of eye ................................................................ 0232 6.04 $299.56 $134.66 $59.91

66130 T Remove eye lesion .......................................................................... 0233 13.79 $683.93 $331.60 $136.79

66150 T Glaucoma surgery ............................................................................ 0233 13.79 $683.93 $331.60 $136.79

66155 T Glaucoma surgery ............................................................................ 0234 20.64 $1,023.66 $502.16 $204.73

66160 T Glaucoma surgery ............................................................................ 0234 20.64 $1,023.66 $502.16 $204.73

66165 T Glaucoma surgery ............................................................................ 0234 20.64 $1,023.66 $502.16 $204.73

66170 T Glaucoma surgery ............................................................................ 0234 20.64 $1,023.66 $502.16 $204.73

66172 T Incision of eye .................................................................................. 0234 20.64 $1,023.66 $502.16 $204.73

66180 T Implant eye shunt ............................................................................. 0234 20.64 $1,023.66 $502.16 $204.73

66185 T Revise eye shunt ............................................................................. 0234 20.64 $1,023.66 $502.16 $204.73

66220 T Repair eye lesion ............................................................................. 0236 6.70 $332.29 $147.96 $66.46

66225 T Repair/graft eye lesion ..................................................................... 0234 20.64 $1,023.66 $502.16 $204.73

66250 T Follow-up surgery of eye ................................................................. 0233 13.79 $683.93 $331.60 $136.79

66500 T Incision of iris ................................................................................... 0232 6.04 $299.56 $134.66 $59.91

66505 T Incision of iris ................................................................................... 0232 6.04 $299.56 $134.66 $59.91

66600 T Remove iris and lesion .................................................................... 0233 13.79 $683.93 $331.60 $136.79

66605 T Removal of iris ................................................................................. 0233 13.79 $683.93 $331.60 $136.79

66625 T Removal of iris ................................................................................. 0232 6.04 $299.56 $134.66 $59.91

66630 T Removal of iris ................................................................................. 0233 13.79 $683.93 $331.60 $136.79

66635 T Removal of iris ................................................................................. 0233 13.79 $683.93 $331.60 $136.79

66680 T Repair iris & ciliary body .................................................................. 0233 13.79 $683.93 $331.60 $136.79

66682 T Repair iris & ciliary body .................................................................. 0233 13.79 $683.93 $331.60 $136.79

66700 T Destruction, ciliary body ................................................................... 0232 6.04 $299.56 $134.66 $59.91

66710 T Destruction, ciliary body ................................................................... 0232 6.04 $299.56 $134.66 $59.91

66720 T Destruction, ciliary body ................................................................... 0232 6.04 $299.56 $134.66 $59.91

66740 T Destruction, ciliary body ................................................................... 0233 13.79 $683.93 $331.60 $136.79

66761 T Revision of iris .................................................................................. 0247 4.89 $242.52 $112.86 $48.50

66762 T Revision of iris .................................................................................. 0247 4.89 $242.52 $112.86 $48.50

66770 T Removal of inner eye lesion ............................................................ 0247 4.89 $242.52 $112.86 $48.50

66820 T Incision, secondary cataract ............................................................ 0232 6.04 $299.56 $134.66 $59.91

66821 T After cataract laser surgery .............................................................. 0247 4.89 $242.52 $112.86 $48.50

66825 T Reposition intraocular lens ............................................................... 0233 13.79 $683.93 $331.60 $136.79

66830 T Removal of lens lesion ..................................................................... 0232 6.04 $299.56 $134.66 $59.91

66840 T Removal of lens material ................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

66850 T Removal of lens material ................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

66852 T Removal of lens material ................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

66920 T Extraction of lens ............................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

66930 T Extraction of lens ............................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

66940 T Extraction of lens ............................................................................. 0245 26.55 $1,316.77 $623.85 $263.35

*66982 T Cataract surgery, complex ............................................................... 0246 26.55 $1,316.77 $623.85 $263.35

66983 T Remove cataract/insert lens ............................................................ 0246 26.55 $1,316.77 $623.85 $263.35

66984 T Remove cataract/insert lens ............................................................ 0246 26.55 $1,316.77 $623.85 $263.35

66985 T Insert lens prosthesis ....................................................................... 0246 26.55 $1,316.77 $623.85 $263.35

66986 T Exchange lens prosthesis ................................................................ 0246 26.55 $1,316.77 $623.85 $263.35

66999 T Eye surgery procedure ..................................................................... 0247 4.89 $242.52 $112.86 $48.50

67005 T Partial removal of eye fluid .............................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67010 T Partial removal of eye fluid .............................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67015 T Release of eye fluid ......................................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67025 T Replace eye fluid ............................................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67027 T Implant eye drug system .................................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67028 T Injection eye drug ............................................................................. 0236 6.70 $332.29 $147.96 $66.46

67030 T Incise inner eye strands ................................................................... 0236 6.70 $332.29 $147.96 $66.46

67031 T Laser surgery, eye strands .............................................................. 0247 4.89 $242.52 $112.86 $48.50

67036 T Removal of inner eye fluid ............................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67038 T Strip retinal membrane ..................................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67039 T Laser treatment of retina .................................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67040 T Laser treatment of retina .................................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67101 T Repair detached retina ..................................................................... 0236 6.70 $332.29 $147.96 $66.46

67105 T Repair detached retina ..................................................................... 0248 4.19 $207.81 $94.05 $41.56

67907

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

67107 T Repair detached retina ..................................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67108 T Repair detached retina ..................................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67110 T Repair detached retina ..................................................................... 0236 6.70 $332.29 $147.96 $66.46

67112 T Rerepair detached retina ................................................................. 0237 33.96 $1,684.28 $852.68 $336.86

67115 T Release encircling material .............................................................. 0236 6.70 $332.29 $147.96 $66.46

67120 T Remove eye implant material .......................................................... 0236 6.70 $332.29 $147.96 $66.46

67121 T Remove eye implant material .......................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67141 T Treatment of retina ........................................................................... 0235 2.94 $145.81 $78.91 $29.16

67145 T Treatment of retina ........................................................................... 0248 4.19 $207.81 $94.05 $41.56

67208 T Treatment of retinal lesion ............................................................... 0235 2.94 $145.81 $78.91 $29.16

67210 T Treatment of retinal lesion ............................................................... 0248 4.19 $207.81 $94.05 $41.56

67218 T Treatment of retinal lesion ............................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67220 T Treatment of choroid lesion ............................................................. 0237 33.96 $1,684.28 $852.68 $336.86

*67221 T Treatment of choroid lesion ............................................................. 0235 2.94 $145.81 $78.91 $29.16

67227 T Treatment of retinal lesion ............................................................... 0235 2.94 $145.81 $78.91 $29.16

67228 T Treatment of retinal lesion ............................................................... 0248 4.19 $207.81 $94.05 $41.56

67250 T Reinforce eye wall ............................................................................ 0240 13.47 $668.06 $315.31 $133.61

67255 T Reinforce/graft eye wall ................................................................... 0237 33.96 $1,684.28 $852.68 $336.86

67299 T Eye surgery procedure ..................................................................... 0248 4.19 $207.81 $94.05 $41.56

67311 T Revise eye muscle ........................................................................... 0243 17.99 $892.23 $431.39 $178.45

67312 T Revise two eye muscles .................................................................. 0243 17.99 $892.23 $431.39 $178.45

67314 T Revise eye muscle ........................................................................... 0243 17.99 $892.23 $431.39 $178.45

67316 T Revise two eye muscles .................................................................. 0243 17.99 $892.23 $431.39 $178.45

67318 T Revise eye muscle(s) ....................................................................... 0243 17.99 $892.23 $431.39 $178.45

67320 T Revise eye muscle(s) add-on .......................................................... 0243 17.99 $892.23 $431.39 $178.45

67331 T Eye surgery follow-up add-on .......................................................... 0243 17.99 $892.23 $431.39 $178.45

67332 T Rerevise eye muscles add-on ......................................................... 0243 17.99 $892.23 $431.39 $178.45

67334 T Revise eye muscle w/suture ............................................................ 0243 17.99 $892.23 $431.39 $178.45

67335 T Eye suture during surgery ................................................................ 0243 17.99 $892.23 $431.39 $178.45

67340 T Revise eye muscle add-on .............................................................. 0243 17.99 $892.23 $431.39 $178.45

67343 T Release eye tissue ........................................................................... 0243 17.99 $892.23 $431.39 $178.45

67345 T Destroy nerve of eye muscle ........................................................... 0238 2.80 $138.87 $58.96 $27.77

67350 S Biopsy eye muscle ........................................................................... 0231 2.64 $130.94 $59.87 $26.19

67399 T Eye muscle surgery procedure ........................................................ 0243 17.99 $892.23 $431.39 $178.45

67400 T Explore/biopsy eye socket ............................................................... 0241 16.60 $823.30 $384.47 $164.66

67405 T Explore/drain eye socket .................................................................. 0241 16.60 $823.30 $384.47 $164.66

67412 T Explore/treat eye socket .................................................................. 0241 16.60 $823.30 $384.47 $164.66

67413 T Explore/treat eye socket .................................................................. 0241 16.60 $823.30 $384.47 $164.66

67414 T Explr/decompress eye socket .......................................................... 0242 23.70 $1,175.42 $597.36 $235.08

67415 T Aspiration, orbital contents ............................................................... 0239 6.26 $310.47 $123.42 $62.09

67420 T Explore/treat eye socket .................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

67430 T Explore/treat eye socket .................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

67440 T Explore/drain eye socket .................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

67445 T Explr/decompress eye socket .......................................................... 0242 23.70 $1,175.42 $597.36 $235.08

67450 T Explore/biopsy eye socket ............................................................... 0242 23.70 $1,175.42 $597.36 $235.08

67500 S Inject/treat eye socket ...................................................................... 0231 2.64 $130.94 $59.87 $26.19

67505 T Inject/treat eye socket ...................................................................... 0238 2.80 $138.87 $58.96 $27.77

67515 T Inject/treat eye socket ...................................................................... 0239 6.26 $310.47 $123.42 $62.09

67550 T Insert eye socket implant ................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

67560 T Revise eye socket implant ............................................................... 0241 16.60 $823.30 $384.47 $164.66

67570 T Decompress optic nerve .................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

67599 T Orbit surgery procedure ................................................................... 0239 6.26 $310.47 $123.42 $62.09

67700 T Drainage of eyelid abscess .............................................................. 0238 2.80 $138.87 $58.96 $27.77

67710 T Incision of eyelid .............................................................................. 0239 6.26 $310.47 $123.42 $62.09

67715 T Incision of eyelid fold ....................................................................... 0240 13.47 $668.06 $315.31 $133.61

67800 T Remove eyelid lesion ....................................................................... 0238 2.80 $138.87 $58.96 $27.77

67801 T Remove eyelid lesions ..................................................................... 0239 6.26 $310.47 $123.42 $62.09

67805 T Remove eyelid lesions ..................................................................... 0238 2.80 $138.87 $58.96 $27.77

67808 T Remove eyelid lesion(s) ................................................................... 0240 13.47 $668.06 $315.31 $133.61

67810 T Biopsy of eyelid ................................................................................ 0238 2.80 $138.87 $58.96 $27.77

67820 T Revise eyelashes ............................................................................. 0238 2.80 $138.87 $58.96 $27.77

67825 T Revise eyelashes ............................................................................. 0238 2.80 $138.87 $58.96 $27.77

67830 T Revise eyelashes ............................................................................. 0239 6.26 $310.47 $123.42 $62.09

67835 T Revise eyelashes ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

67840 T Remove eyelid lesion ....................................................................... 0239 6.26 $310.47 $123.42 $62.09

67850 T Treat eyelid lesion ............................................................................ 0239 6.26 $310.47 $123.42 $62.09

67875 T Closure of eyelid by suture .............................................................. 0239 6.26 $310.47 $123.42 $62.09

67880 T Revision of eyelid ............................................................................. 0232 6.04 $299.56 $134.66 $59.91

67882 T Revision of eyelid ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

67900 T Repair brow defect ........................................................................... 0240 13.47 $668.06 $315.31 $133.61

67901 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67902 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67903 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67904 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67908

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

67906 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67908 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67909 T Revise eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67911 T Revise eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67914 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67915 T Repair eyelid defect ......................................................................... 0239 6.26 $310.47 $123.42 $62.09

67916 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67917 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67921 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67922 T Repair eyelid defect ......................................................................... 0239 6.26 $310.47 $123.42 $62.09

67923 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67924 T Repair eyelid defect ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

67930 T Repair eyelid wound ........................................................................ 0240 13.47 $668.06 $315.31 $133.61

67935 T Repair eyelid wound ........................................................................ 0240 13.47 $668.06 $315.31 $133.61

67938 T Remove eyelid foreign body ............................................................ 0238 2.80 $138.87 $58.96 $27.77

67950 T Revision of eyelid ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

67961 T Revision of eyelid ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

67966 T Revision of eyelid ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

67971 T Reconstruction of eyelid ................................................................... 0241 16.60 $823.30 $384.47 $164.66

67973 T Reconstruction of eyelid ................................................................... 0241 16.60 $823.30 $384.47 $164.66

67974 T Reconstruction of eyelid ................................................................... 0241 16.60 $823.30 $384.47 $164.66

67975 T Reconstruction of eyelid ................................................................... 0240 13.47 $668.06 $315.31 $133.61

67999 T Revision of eyelid ............................................................................. 0240 13.47 $668.06 $315.31 $133.61

68020 T Incise/drain eyelid lining ................................................................... 0240 13.47 $668.06 $315.31 $133.61

68040 T Treatment of eyelid lesions .............................................................. 0239 6.26 $310.47 $123.42 $62.09

68100 T Biopsy of eyelid lining ...................................................................... 0232 6.04 $299.56 $134.66 $59.91

68110 S Remove eyelid lining lesion ............................................................. 0231 2.64 $130.94 $59.87 $26.19

68115 T Remove eyelid lining lesion ............................................................. 0239 6.26 $310.47 $123.42 $62.09

68130 T Remove eyelid lining lesion ............................................................. 0233 13.79 $683.93 $331.60 $136.79

68135 T Remove eyelid lining lesion ............................................................. 0239 6.26 $310.47 $123.42 $62.09

68200 S Treat eyelid by injection ................................................................... 0230 0.98 $48.61 $22.48 $9.72

68320 T Revise/graft eyelid lining .................................................................. 0240 13.47 $668.06 $315.31 $133.61

68325 T Revise/graft eyelid lining .................................................................. 0242 23.70 $1,175.42 $597.36 $235.08

68326 T Revise/graft eyelid lining .................................................................. 0241 16.60 $823.30 $384.47 $164.66

68328 T Revise/graft eyelid lining .................................................................. 0241 16.60 $823.30 $384.47 $164.66

68330 T Revise eyelid lining .......................................................................... 0233 13.79 $683.93 $331.60 $136.79

68335 T Revise/graft eyelid lining .................................................................. 0241 16.60 $823.30 $384.47 $164.66

68340 T Separate eyelid adhesions ............................................................... 0240 13.47 $668.06 $315.31 $133.61

68360 T Revise eyelid lining .......................................................................... 0234 20.64 $1,023.66 $502.16 $204.73

68362 T Revise eyelid lining .......................................................................... 0234 20.64 $1,023.66 $502.16 $204.73

68399 T Eyelid lining surgery ......................................................................... 0239 6.26 $310.47 $123.42 $62.09

68400 T Incise/drain tear gland ...................................................................... 0238 2.80 $138.87 $58.96 $27.77

68420 T Incise/drain tear sac ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

68440 T Incise tear duct opening ................................................................... 0238 2.80 $138.87 $58.96 $27.77

68500 T Removal of tear gland ...................................................................... 0241 16.60 $823.30 $384.47 $164.66

68505 T Partial removal, tear gland ............................................................... 0241 16.60 $823.30 $384.47 $164.66

68510 T Biopsy of tear gland ......................................................................... 0240 13.47 $668.06 $315.31 $133.61

68520 T Removal of tear sac ......................................................................... 0241 16.60 $823.30 $384.47 $164.66

68525 T Biopsy of tear sac ............................................................................ 0240 13.47 $668.06 $315.31 $133.61

68530 T Clearance of tear duct ..................................................................... 0240 13.47 $668.06 $315.31 $133.61

68540 T Remove tear gland lesion ................................................................ 0241 16.60 $823.30 $384.47 $164.66

68550 T Remove tear gland lesion ................................................................ 0242 23.70 $1,175.42 $597.36 $235.08

68700 T Repair tear ducts .............................................................................. 0241 16.60 $823.30 $384.47 $164.66

68705 T Revise tear duct opening ................................................................. 0238 2.80 $138.87 $58.96 $27.77

68720 T Create tear sac drain ....................................................................... 0242 23.70 $1,175.42 $597.36 $235.08

68745 T Create tear duct drain ...................................................................... 0241 16.60 $823.30 $384.47 $164.66

68750 T Create tear duct drain ...................................................................... 0242 23.70 $1,175.42 $597.36 $235.08

68760 T Close tear duct opening ................................................................... 0238 2.80 $138.87 $58.96 $27.77

68761 S Close tear duct opening ................................................................... 0231 2.64 $130.94 $59.87 $26.19

68770 T Close tear system fistula .................................................................. 0240 13.47 $668.06 $315.31 $133.61

68801 S Dilate tear duct opening ................................................................... 0231 2.64 $130.94 $59.87 $26.19

68810 S Probe nasolacrimal duct .................................................................. 0231 2.64 $130.94 $59.87 $26.19

68811 T Probe nasolacrimal duct .................................................................. 0240 13.47 $668.06 $315.31 $133.61

68815 T Probe nasolacrimal duct .................................................................. 0240 13.47 $668.06 $315.31 $133.61

68840 S Explore/irrigate tear ducts ................................................................ 0231 2.64 $130.94 $59.87 $26.19

68850 N Injection for tear sac x-ray ............................................................... .................... .................... .................... .................... ....................

68899 S Tear duct system surgery ................................................................ 0231 2.64 $130.94 $59.87 $26.19

69000 T Drain external ear lesion .................................................................. 0006 2.00 $99.19 $33.95 $19.84

69005 T Drain external ear lesion .................................................................. 0007 3.68 $182.51 $72.03 $36.50

69020 T Drain outer ear canal lesion ............................................................. 0006 2.00 $99.19 $33.95 $19.84

69090 E Pierce earlobes ................................................................................ .................... .................... .................... .................... ....................

69100 T Biopsy of external ear ...................................................................... 0019 4.00 $198.39 $78.91 $39.68

69105 T Biopsy of external ear canal ............................................................ 0253 12.02 $596.14 $284.00 $119.23

69110 T Remove external ear, partial ............................................................ 0020 6.51 $322.87 $130.53 $64.57

67909

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

69120 T Removal of external ear ................................................................... 0253 12.02 $596.14 $284.00 $119.23

69140 T Remove ear canal lesion(s) ............................................................. 0254 12.45 $617.47 $272.41 $123.49

69145 T Remove ear canal lesion(s) ............................................................. 0020 6.51 $322.87 $130.53 $64.57

69150 C Extensive ear canal surgery ............................................................ .................... .................... .................... .................... ....................

69155 C Extensive ear/neck surgery .............................................................. .................... .................... .................... .................... ....................

69200 X Clear outer ear canal ....................................................................... 0340 1.04 $51.58 $12.85 $10.32

69205 T Clear outer ear canal ....................................................................... 0022 12.49 $619.45 $292.94 $123.89

69210 X Remove impacted ear wax .............................................................. 0340 1.04 $51.58 $12.85 $10.32

69220 T Clean out mastoid cavity .................................................................. 0012 0.53 $26.29 $9.18 $5.26

69222 T Clean out mastoid cavity .................................................................. 0253 12.02 $596.14 $284.00 $119.23

69300 T Revise external ear .......................................................................... 0254 12.45 $617.47 $272.41 $123.49

69310 T Rebuild outer ear canal .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69320 T Rebuild outer ear canal .................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69399 T Outer ear surgery procedure ........................................................... 0252 5.18 $256.90 $114.24 $51.38

69400 T Inflate middle ear canal .................................................................... 0251 1.68 $83.32 $27.99 $16.66

69401 N Inflate middle ear canal .................................................................... .................... .................... .................... .................... ....................

69405 T Catheterize middle ear canal ........................................................... 0252 5.18 $256.90 $114.24 $51.38

69410 T Inset middle ear (baffle) ................................................................... 0252 5.18 $256.90 $114.24 $51.38

69420 T Incision of eardrum .......................................................................... 0252 5.18 $256.90 $114.24 $51.38

69421 T Incision of eardrum .......................................................................... 0253 12.02 $596.14 $284.00 $119.23

69424 T Remove ventilating tube .................................................................. 0252 5.18 $256.90 $114.24 $51.38

69433 T Create eardrum opening .................................................................. 0252 5.18 $256.90 $114.24 $51.38

69436 T Create eardrum opening .................................................................. 0253 12.02 $596.14 $284.00 $119.23

69440 T Exploration of middle ear ................................................................. 0253 12.02 $596.14 $284.00 $119.23

69450 T Eardrum revision .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69501 T Mastoidectomy ................................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69502 C Mastoidectomy ................................................................................. .................... .................... .................... .................... ....................

69505 T Remove mastoid structures ............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69511 T Extensive mastoid surgery ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69530 T Extensive mastoid surgery ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69535 C Remove part of temporal bone ........................................................ .................... .................... .................... .................... ....................

69540 T Remove ear lesion ........................................................................... 0253 12.02 $596.14 $284.00 $119.23

69550 T Remove ear lesion ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69552 T Remove ear lesion ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69554 C Remove ear lesion ........................................................................... .................... .................... .................... .................... ....................

69601 T Mastoid surgery revision .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69602 T Mastoid surgery revision .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69603 T Mastoid surgery revision .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69604 T Mastoid surgery revision .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69605 T Mastoid surgery revision .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69610 T Repair of eardrum ............................................................................ 0253 12.02 $596.14 $284.00 $119.23

69620 T Repair of eardrum ............................................................................ 0253 12.02 $596.14 $284.00 $119.23

69631 T Repair eardrum structures ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69632 T Rebuild eardrum structures .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69633 T Rebuild eardrum structures .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69635 T Repair eardrum structures ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69636 T Rebuild eardrum structures .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69637 T Rebuild eardrum structures .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69641 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69642 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69643 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69644 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69645 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69646 T Revise middle ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69650 T Release middle ear bone ................................................................. 0254 12.45 $617.47 $272.41 $123.49

69660 T Revise middle ear bone ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69661 T Revise middle ear bone ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69662 T Revise middle ear bone ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69666 T Repair middle ear structures ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69667 T Repair middle ear structures ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69670 T Remove mastoid air cells ................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69676 T Remove middle ear nerve ................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69700 T Close mastoid fistula ........................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69710 E Implant/replace hearing aid .............................................................. .................... .................... .................... .................... ....................

69711 T Remove/repair hearing aid ............................................................... 0256 25.40 $1,259.74 $623.05 $251.95

*69714 T Implant temple bone w/stimul .......................................................... 0256 25.40 $1,259.74 $623.05 $251.95

*69715 T Temple bne implnt w/stimulat .......................................................... 0256 25.40 $1,259.74 $623.05 $251.95

*69717 T Temple bone implant revision .......................................................... 0256 25.40 $1,259.74 $623.05 $251.95

*69718 T Revise temple bone implant ............................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69720 T Release facial nerve ........................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69725 T Release facial nerve ........................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69740 T Repair facial nerve ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69745 T Repair facial nerve ........................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69799 T Middle ear surgery procedure .......................................................... 0253 12.02 $596.14 $284.00 $119.23

67910

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

69801 T Incise inner ear ................................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69802 T Incise inner ear ................................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69805 T Explore inner ear .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69806 T Explore inner ear .............................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69820 T Establish inner ear window .............................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69840 T Revise inner ear window .................................................................. 0256 25.40 $1,259.74 $623.05 $251.95

69905 T Remove inner ear ............................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69910 T Remove inner ear & mastoid ........................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69915 T Incise inner ear nerve ...................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69930 T Implant cochlear device ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69949 T Inner ear surgery procedure ............................................................ 0253 12.02 $596.14 $284.00 $119.23

69950 C Incise inner ear nerve ...................................................................... .................... .................... .................... .................... ....................

69955 T Release facial nerve ........................................................................ 0256 25.40 $1,259.74 $623.05 $251.95

69960 T Release inner ear canal ................................................................... 0256 25.40 $1,259.74 $623.05 $251.95

69970 C Remove inner ear lesion .................................................................. .................... .................... .................... .................... ....................

69979 T Temporal bone surgery .................................................................... 0252 5.18 $256.90 $114.24 $51.38

69990 N Microsurgery add-on ........................................................................ .................... .................... .................... .................... ....................

70010 S Contrast x-ray of brain ..................................................................... 0274 4.83 $239.55 $128.12 $47.91

70015 S Contrast x-ray of brain ..................................................................... 0274 4.83 $239.55 $128.12 $47.91

70030 X X-ray eye for foreign body ............................................................... 0260 0.79 $39.18 $22.02 $7.84

70100 X X-ray exam of jaw ............................................................................ 0260 0.79 $39.18 $22.02 $7.84

70110 X X-ray exam of jaw ............................................................................ 0260 0.79 $39.18 $22.02 $7.84

70120 X X-ray exam of mastoids ................................................................... 0260 0.79 $39.18 $22.02 $7.84

70130 X X-ray exam of mastoids ................................................................... 0260 0.79 $39.18 $22.02 $7.84

70134 X X-ray exam of middle ear ................................................................ 0261 1.38 $68.44 $38.77 $13.69

70140 X X-ray exam of facial bones .............................................................. 0260 0.79 $39.18 $22.02 $7.84

70150 X X-ray exam of facial bones .............................................................. 0260 0.79 $39.18 $22.02 $7.84

70160 X X-ray exam of nasal bones .............................................................. 0260 0.79 $39.18 $22.02 $7.84

70170 X X-ray exam of tear duct ................................................................... 0263 1.68 $83.32 $45.88 $16.66

70190 X X-ray exam of eye sockets .............................................................. 0260 0.79 $39.18 $22.02 $7.84

70200 X X-ray exam of eye sockets .............................................................. 0260 0.79 $39.18 $22.02 $7.84

70210 X X-ray exam of sinuses ..................................................................... 0260 0.79 $39.18 $22.02 $7.84

70220 X X-ray exam of sinuses ..................................................................... 0260 0.79 $39.18 $22.02 $7.84

70240 X X-ray exam, pituitary saddle ............................................................ 0260 0.79 $39.18 $22.02 $7.84

70250 X X-ray exam of skull .......................................................................... 0260 0.79 $39.18 $22.02 $7.84

70260 X X-ray exam of skull .......................................................................... 0261 1.38 $68.44 $38.77 $13.69

70300 X X-ray exam of teeth ......................................................................... 0262 0.40 $19.83 $10.90 $3.97

70310 X X-ray exam of teeth ......................................................................... 0262 0.40 $19.83 $10.90 $3.97

70320 X Full mouth x-ray of teeth .................................................................. 0262 0.40 $19.83 $10.90 $3.97

70328 X X-ray exam of jaw joint .................................................................... 0260 0.79 $39.18 $22.02 $7.84

70330 X X-ray exam of jaw joints .................................................................. 0260 0.79 $39.18 $22.02 $7.84

70332 S X-ray exam of jaw joint .................................................................... 0275 2.74 $135.89 $72.26 $27.18

70336 S Magnetic image, jaw joint ................................................................ 0284 8.02 $397.76 $257.39 $79.55

70350 X X-ray head for orthodontia ............................................................... 0260 0.79 $39.18 $22.02 $7.84

70355 X Panoramic x-ray of jaws .................................................................. 0260 0.79 $39.18 $22.02 $7.84

70360 X X-ray exam of neck .......................................................................... 0260 0.79 $39.18 $22.02 $7.84

70370 X Throat x-ray & fluoroscopy ............................................................... 0273 2.49 $123.49 $61.02 $24.70

70371 X Speech evaluation, complex ............................................................ 0272 1.40 $69.43 $39.00 $13.89

70373 X Contrast x-ray of larynx .................................................................... 0263 1.68 $83.32 $45.88 $16.66

70380 X X-ray exam of salivary gland ........................................................... 0260 0.79 $39.18 $22.02 $7.84

70390 X X-ray exam of salivary duct ............................................................. 0263 1.68 $83.32 $45.88 $16.66

70450 S CAT scan of head or brain .............................................................. 0283 4.89 $242.52 $179.39 $48.50

70460 S Contrast CAT scan of head ............................................................. 0283 4.89 $242.52 $179.39 $48.50

70470 S Contrast CAT scans of head ........................................................... 0283 4.89 $242.52 $179.39 $48.50

70480 S CAT scan of skull ............................................................................. 0283 4.89 $242.52 $179.39 $48.50

70481 S Contrast CAT scan of skull .............................................................. 0283 4.89 $242.52 $179.39 $48.50

70482 S Contrast CAT scans of skull ............................................................ 0283 4.89 $242.52 $179.39 $48.50

70486 S Cat scan of face/jaw ........................................................................ 0282 2.38 $118.04 $94.51 $23.61

70487 S Contrast CAT scan, face/jaw ........................................................... 0283 4.89 $242.52 $179.39 $48.50

70488 S Contrast cat scans, face/jaw ............................................................ 0283 4.89 $242.52 $179.39 $48.50

70490 S CAT scan of neck tissue .................................................................. 0283 4.89 $242.52 $179.39 $48.50

70491 S Contrast CAT of neck tissue ............................................................ 0283 4.89 $242.52 $179.39 $48.50

70492 S Contrast CAT of neck tissue ............................................................ 0283 4.89 $242.52 $179.39 $48.50

*70496 S Ct angiography, head ....................................................................... 0283 4.89 $242.52 $179.39 $48.50

*70498 S Ct angiography, neck ....................................................................... 0283 4.89 $242.52 $179.39 $48.50

70540 S Magnetic image, face/neck .............................................................. 0284 8.02 $397.76 $257.39 $79.55

70541D S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*70542 S MR (eg, proton) imaging .................................................................. 0284 8.02 $397.76 $257.39 $79.55

*70543 S MR (eg, proton) imaging .................................................................. 0284 8.02 $397.76 $257.39 $79.55

*70544 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*70545 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*70546 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*70547 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*70548 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

67911

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*70549 S MR angiography ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

70551 S Magnetic image, brain (MRI) ........................................................... 0284 8.02 $397.76 $257.39 $79.55

70552 S Magnetic image, brain (MRI) ........................................................... 0284 8.02 $397.76 $257.39 $79.55

70553 S Magnetic image, brain (mri) ............................................................. 0284 8.02 $397.76 $257.39 $79.55

71010 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71015 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71020 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71021 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71022 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71023 X Chest x-ray and fluoroscopy ............................................................ 0272 1.40 $69.43 $39.00 $13.89

71030 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71034 X Chest x-ray and fluoroscopy ............................................................ 0272 1.40 $69.43 $39.00 $13.89

71035 X Chest x-ray ....................................................................................... 0260 0.79 $39.18 $22.02 $7.84

71036D X X-ray guidance for biopsy ................................................................ 0273 2.49 $123.49 $61.02 $24.70

71040 X Contrast x-ray of bronchi ................................................................. 0263 1.68 $83.32 $45.88 $16.66

71060 X Contrast x-ray of bronchi ................................................................. 0263 1.68 $83.32 $45.88 $16.66

71090 X X-ray & pacemaker insertion ........................................................... 0273 2.49 $123.49 $61.02 $24.70

71100 X X-ray exam of ribs ............................................................................ 0260 0.79 $39.18 $22.02 $7.84

71101 X X-ray exam of ribs/chest .................................................................. 0260 0.79 $39.18 $22.02 $7.84

71110 X X-ray exam of ribs ............................................................................ 0260 0.79 $39.18 $22.02 $7.84

71111 X X-ray exam of ribs/ chest ................................................................. 0261 1.38 $68.44 $38.77 $13.69

71120 X X-ray exam of breastbone ............................................................... 0260 0.79 $39.18 $22.02 $7.84

71130 X X-ray exam of breastbone ............................................................... 0260 0.79 $39.18 $22.02 $7.84

71250 S Cat scan of chest ............................................................................. 0283 4.89 $242.52 $179.39 $48.50

71260 S Contrast CAT scan of chest ............................................................. 0283 4.89 $242.52 $179.39 $48.50

71270 S Contrast CAT scans of chest ........................................................... 0283 4.89 $242.52 $179.39 $48.50

*71275 S CT angiography, chest ..................................................................... 0283 4.89 $242.52 $179.39 $48.50

71550 S Magnetic image, chest (mri) ............................................................ 0284 8.02 $397.76 $257.39 $79.55

*71551 S MRI chest w/ dye ............................................................................. 0284 8.02 $397.76 $257.39 $79.55

*71552 S MRI chest w/o dye ........................................................................... 0284 8.02 $397.76 $257.39 $79.55

71555 S Magnetic image, chest (mra) ........................................................... 0284 8.02 $397.76 $257.39 $79.55

72010 X X-ray exam of spine ......................................................................... 0261 1.38 $68.44 $38.77 $13.69

72020 X X-ray exam of spine ......................................................................... 0260 0.79 $39.18 $22.02 $7.84

72040 X X-ray exam of neck spine ................................................................ 0260 0.79 $39.18 $22.02 $7.84

72050 X X-ray exam of neck spine ................................................................ 0261 1.38 $68.44 $38.77 $13.69

72052 X X-ray exam of neck spine ................................................................ 0261 1.38 $68.44 $38.77 $13.69

72069 X X-ray exam of trunk spine ................................................................ 0260 0.79 $39.18 $22.02 $7.84

72070 X X-ray exam of thoracic spine ........................................................... 0260 0.79 $39.18 $22.02 $7.84

72072 X X-ray exam of thoracic spine ........................................................... 0260 0.79 $39.18 $22.02 $7.84

72074 X X-ray exam of thoracic spine ........................................................... 0260 0.79 $39.18 $22.02 $7.84

72080 X X-ray exam of trunk spine ................................................................ 0260 0.79 $39.18 $22.02 $7.84

72090 X X-ray exam of trunk spine ................................................................ 0260 0.79 $39.18 $22.02 $7.84

72100 X X-ray exam of lower spine ............................................................... 0260 0.79 $39.18 $22.02 $7.84

72110 X X-ray exam of lower spine ............................................................... 0261 1.38 $68.44 $38.77 $13.69

72114 X X-ray exam of lower spine ............................................................... 0261 1.38 $68.44 $38.77 $13.69

72120 X X-ray exam of lower spine ............................................................... 0260 0.79 $39.18 $22.02 $7.84

72125 S CAT scan of neck spine ................................................................... 0283 4.89 $242.52 $179.39 $48.50

72126 S Contrast CAT scan of neck .............................................................. 0283 4.89 $242.52 $179.39 $48.50

72127 S Contrast CAT scans of neck ............................................................ 0283 4.89 $242.52 $179.39 $48.50

72128 S CAT scan of thorax spine ................................................................ 0283 4.89 $242.52 $179.39 $48.50

72129 S Contrast CAT scan of thorax ........................................................... 0283 4.89 $242.52 $179.39 $48.50

72130 S Contrast CAT scans of thorax ......................................................... 0283 4.89 $242.52 $179.39 $48.50

72131 S CAT scan of lower spine .................................................................. 0283 4.89 $242.52 $179.39 $48.50

72132 S Contrast CAT of lower spine ............................................................ 0283 4.89 $242.52 $179.39 $48.50

72133 S Contrst cat scans, low spine ............................................................ 0283 4.89 $242.52 $179.39 $48.50

72141 S Magnetic image, neck spine ............................................................ 0284 8.02 $397.76 $257.39 $79.55

72142 S Magnetic image, neck spine ............................................................ 0284 8.02 $397.76 $257.39 $79.55

72146 S Magnetic image, chest spine ........................................................... 0284 8.02 $397.76 $257.39 $79.55

72147 S Magnetic image, chest spine ........................................................... 0284 8.02 $397.76 $257.39 $79.55

72148 S Magnetic image, lumbar spine ......................................................... 0284 8.02 $397.76 $257.39 $79.55

72149 S Magnetic image, lumbar spine ......................................................... 0284 8.02 $397.76 $257.39 $79.55

72156 S Magnetic image, neck spine ............................................................ 0284 8.02 $397.76 $257.39 $79.55

72157 S Magnetic image, chest spine ........................................................... 0284 8.02 $397.76 $257.39 $79.55

72158 S Magnetic image, lumbar spine ......................................................... 0284 8.02 $397.76 $257.39 $79.55

72159 E Magnetic image, spine (mra) ........................................................... .................... .................... .................... .................... ....................

72170 X X-ray exam of pelvis ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

72190 X X-ray exam of pelvis ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

*72191 S CT angiograph pelv w/o & w/ dye ................................................... 0283 4.89 $242.52 $179.39 $48.50

72192 S CAT scan of pelvis ........................................................................... 0283 4.89 $242.52 $179.39 $48.50

72193 S Contrast CAT scan of pelvis ............................................................ 0283 4.89 $242.52 $179.39 $48.50

72194 S Contrast CAT scans of pelvis .......................................................... 0283 4.89 $242.52 $179.39 $48.50

*72195 S MRI pelvis w/o dye ........................................................................... 0284 8.02 $397.76 $257.39 $79.55

72196 S Magnetic image, pelvis .................................................................... 0284 8.02 $397.76 $257.39 $79.55

*72197 S MRI pelvis w/o & w/ dye .................................................................. 0284 8.02 $397.76 $257.39 $79.55

67912

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

72198 E Magnetic image, pelvis (mra) ........................................................... .................... .................... .................... .................... ....................

72200 X X-ray exam sacroiliac joints ............................................................. 0260 0.79 $39.18 $22.02 $7.84

72202 X X-ray exam sacroiliac joints ............................................................. 0260 0.79 $39.18 $22.02 $7.84

72220 X X-ray exam of tailbone ..................................................................... 0260 0.79 $39.18 $22.02 $7.84

72240 S Contrast x-ray of neck spine ............................................................ 0274 4.83 $239.55 $128.12 $47.91

72255 S Contrast x-ray, thorax spine ............................................................. 0274 4.83 $239.55 $128.12 $47.91

72265 S Contrast x-ray, lower spine .............................................................. 0274 4.83 $239.55 $128.12 $47.91

72270 S Contrast x-ray of spine ..................................................................... 0274 4.83 $239.55 $128.12 $47.91

72275 S Epidurography .................................................................................. 0274 4.83 $239.55 $128.12 $47.91

72285 S X-ray c/t spine disk .......................................................................... 0274 4.83 $239.55 $128.12 $47.91

72295 S X-ray of lower spine disk ................................................................. 0274 4.83 $239.55 $128.12 $47.91

73000 X X-ray exam of collar bone ................................................................ 0260 0.79 $39.18 $22.02 $7.84

73010 X X-ray exam of shoulder blade .......................................................... 0260 0.79 $39.18 $22.02 $7.84

73020 X X-ray exam of shoulder .................................................................... 0260 0.79 $39.18 $22.02 $7.84

73030 X X-ray exam of shoulder .................................................................... 0260 0.79 $39.18 $22.02 $7.84

73040 S Contrast x-ray of shoulder ............................................................... 0275 2.74 $135.89 $72.26 $27.18

73050 X X-ray exam of shoulders .................................................................. 0260 0.79 $39.18 $22.02 $7.84

73060 X X-ray exam of humerus ................................................................... 0260 0.79 $39.18 $22.02 $7.84

73070 X X-ray exam of elbow ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

73080 X X-ray exam of elbow ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

73085 S Contrast x-ray of elbow .................................................................... 0275 2.74 $135.89 $72.26 $27.18

73090 X X-ray exam of forearm ..................................................................... 0260 0.79 $39.18 $22.02 $7.84

73092 X X-ray exam of arm, infant ................................................................ 0260 0.79 $39.18 $22.02 $7.84

73100 X X-ray exam of wrist .......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73110 X X-ray exam of wrist .......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73115 S Contrast x-ray of wrist ...................................................................... 0275 2.74 $135.89 $72.26 $27.18

73120 X X-ray exam of hand ......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73130 X X-ray exam of hand ......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73140 X X-ray exam of finger(s) .................................................................... 0260 0.79 $39.18 $22.02 $7.84

73200 S CAT scan of arm .............................................................................. 0283 4.89 $242.52 $179.39 $48.50

73201 S Contrast CAT scan of arm ............................................................... 0283 4.89 $242.52 $179.39 $48.50

73202 S Contrast CAT scans of arm ............................................................. 0283 4.89 $242.52 $179.39 $48.50

*73206 S CT angio upr extrm w/o & w/ dye .................................................... 0283 4.89 $242.52 $179.39 $48.50

*73218 S MRI upper extrm w/o dye ................................................................ 0284 8.02 $397.76 $257.39 $79.55

*73219 S MRI upper extrm w/ dye .................................................................. 0284 8.02 $397.76 $257.39 $79.55

73220 S Magnetic image, arm/hand .............................................................. 0284 8.02 $397.76 $257.39 $79.55

73221 S Magnetic image, joint of arm ........................................................... 0284 8.02 $397.76 $257.39 $79.55

*73222 S MRI joint upr extrm w/ dye ............................................................... 0284 8.02 $397.76 $257.39 $79.55

*73223 S MRI joint upr extrm w/o & w/ dye .................................................... 0284 8.02 $397.76 $257.39 $79.55

73225 E Magnetic image, upper (mra) ........................................................... .................... .................... .................... .................... ....................

73500 X X-ray exam of hip ............................................................................. 0260 0.79 $39.18 $22.02 $7.84

73510 X X-ray exam of hip ............................................................................. 0260 0.79 $39.18 $22.02 $7.84

73520 X X-ray exam of hips ........................................................................... 0260 0.79 $39.18 $22.02 $7.84

73525 S Contrast x-ray of hip ........................................................................ 0275 2.74 $135.89 $72.26 $27.18

73530 X X-ray exam of hip ............................................................................. 0261 1.38 $68.44 $38.77 $13.69

73540 X X-ray exam of pelvis & hips ............................................................. 0260 0.79 $39.18 $22.02 $7.84

73542 S X-ray exam, sacroiliac joint .............................................................. 0275 2.74 $135.89 $72.26 $27.18

73550 X X-ray exam of thigh .......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73560 X X-ray exam of knee, 1 or 2 .............................................................. 0260 0.79 $39.18 $22.02 $7.84

73562 X X-ray exam of knee, 3 ..................................................................... 0260 0.79 $39.18 $22.02 $7.84

73564 X X-ray exam, knee, 4 or more ........................................................... 0260 0.79 $39.18 $22.02 $7.84

73565 X X-ray exam of knees ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

73580 S Contrast x-ray of knee joint .............................................................. 0275 2.74 $135.89 $72.26 $27.18

73590 X X-ray exam of lower leg ................................................................... 0260 0.79 $39.18 $22.02 $7.84

73592 X X-ray exam of leg, infant .................................................................. 0261 1.38 $68.44 $38.77 $13.69

73600 X X-ray exam of ankle ......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73610 X X-ray exam of ankle ......................................................................... 0260 0.79 $39.18 $22.02 $7.84

73615 S Contrast x-ray of ankle ..................................................................... 0275 2.74 $135.89 $72.26 $27.18

73620 X X-ray exam of foot ........................................................................... 0260 0.79 $39.18 $22.02 $7.84

73630 X X-ray exam of foot ........................................................................... 0260 0.79 $39.18 $22.02 $7.84

73650 X X-ray exam of heel ........................................................................... 0260 0.79 $39.18 $22.02 $7.84

73660 X X-ray exam of toe(s) ........................................................................ 0260 0.79 $39.18 $22.02 $7.84

73700 S CAT scan of leg ............................................................................... 0283 4.89 $242.52 $179.39 $48.50

73701 S Contrast CAT scan of leg ................................................................ 0283 4.89 $242.52 $179.39 $48.50

73702 S Contrast CAT scans of leg ............................................................... 0283 4.89 $242.52 $179.39 $48.50

*73706 S CT angio lwr extr w/o & w/ dye ....................................................... 0283 4.89 $242.52 $179.39 $48.50

*73718 S MRI lower extrem w/o dye ............................................................... 0284 8.02 $397.76 $257.39 $79.55

*73719 S MRI lower extrem w/ dye ................................................................. 0284 8.02 $397.76 $257.39 $79.55

73720 S Magnetic image, leg/foot .................................................................. 0284 8.02 $397.76 $257.39 $79.55

73721 S Magnetic image, joint of leg ............................................................. 0284 8.02 $397.76 $257.39 $79.55

*73722 S MRI joint lwr extrm w/ dye ............................................................... 0284 8.02 $397.76 $257.39 $79.55

*73723 S MRI joint lwr extrm w/o & w/ dye ..................................................... 0284 8.02 $397.76 $257.39 $79.55

73725 S Magnetic image/lower (mra) ............................................................ 0284 8.02 $397.76 $257.39 $79.55

74000 X X-ray exam of abdomen .................................................................. 0260 0.79 $39.18 $22.02 $7.84

67913

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

74010 X X-ray exam of abdomen .................................................................. 0260 0.79 $39.18 $22.02 $7.84

74020 X X-ray exam of abdomen .................................................................. 0260 0.79 $39.18 $22.02 $7.84

74022 X X-ray exam series, abdomen ........................................................... 0261 1.38 $68.44 $38.77 $13.69

74150 S CAT scan of abdomen ..................................................................... 0283 4.89 $242.52 $179.39 $48.50

74160 S Contrast CAT scan of abdomen ...................................................... 0283 4.89 $242.52 $179.39 $48.50

74170 S Contrast CAT scans, abdomen ........................................................ 0283 4.89 $242.52 $179.39 $48.50

*74175 S CT angio abdom w/o & w/ dye ........................................................ 0283 4.89 $242.52 $179.39 $48.50

74181 S Magnetic image/abdomen (mri) ....................................................... 0284 8.02 $397.76 $257.39 $79.55

*74182 S MRI abdomen w/ dye ....................................................................... 0284 8.02 $397.76 $257.39 $79.55

*74183 S MRI abdomen w/o & w/ dye ............................................................ 0284 8.02 $397.76 $257.39 $79.55

74185 S Magnetic image/abdomen (MRA) .................................................... 0284 8.02 $397.76 $257.39 $79.55

74190 X X-ray exam of peritoneum ............................................................... 0263 1.68 $83.32 $45.88 $16.66

74210 S Contrst x-ray exam of throat ............................................................ 0276 1.79 $88.78 $49.78 $17.76

74220 S Contrast x-ray, esophagus ............................................................... 0276 1.79 $88.78 $49.78 $17.76

74230 S Cinema x-ray, throat/esoph .............................................................. 0276 1.79 $88.78 $49.78 $17.76

74235 S Remove esophagus obstruction ...................................................... 0296 3.57 $177.06 $100.25 $35.41

74240 S X-ray exam, upper gi tract ............................................................... 0276 1.79 $88.78 $49.78 $17.76

74241 S X-ray exam, upper gi tract ............................................................... 0276 1.79 $88.78 $49.78 $17.76

74245 S X-ray exam, upper gi tract ............................................................... 0277 2.47 $122.50 $69.28 $24.50

74246 S Contrst x-ray uppr gi tract ................................................................ 0276 1.79 $88.78 $49.78 $17.76

74247 S Contrst x-ray uppr gi tract ................................................................ 0276 1.79 $88.78 $49.78 $17.76

74249 S Contrst x-ray uppr gi tract ................................................................ 0277 2.47 $122.50 $69.28 $24.50

74250 S X-ray exam of small bowel .............................................................. 0276 1.79 $88.78 $49.78 $17.76

74251 S X-ray exam of small bowel .............................................................. 0277 2.47 $122.50 $69.28 $24.50

74260 S X-ray exam of small bowel .............................................................. 0277 2.47 $122.50 $69.28 $24.50

74270 S Contrast x-ray exam of colon ........................................................... 0276 1.79 $88.78 $49.78 $17.76

74280 S Contrast x-ray exam of colon ........................................................... 0277 2.47 $122.50 $69.28 $24.50

74283 S Contrast x-ray exam of colon ........................................................... 0276 1.79 $88.78 $49.78 $17.76

74290 S Contrast x-ray, gallbladder ............................................................... 0276 1.79 $88.78 $49.78 $17.76

74291 S Contrast x-rays, gallbladder ............................................................. 0276 1.79 $88.78 $49.78 $17.76

74300 X X-ray bile ducts/pancreas ................................................................ 0263 1.68 $83.32 $45.88 $16.66

74301 X X-rays at surgery add-on ................................................................. 0263 1.68 $83.32 $45.88 $16.66

74305 X X-ray bile ducts/pancreas ................................................................ 0263 1.68 $83.32 $45.88 $16.66

74320 X Contrast x-ray of bile ducts .............................................................. 0264 3.83 $189.96 $108.97 $37.99

74327 S X-ray bile stone removal .................................................................. 0296 3.57 $177.06 $100.25 $35.41

74328 X Xray bile duct endoscopy ................................................................. 0264 3.83 $189.96 $108.97 $37.99

74329 X X-ray for pancreas endoscopy ......................................................... 0264 3.83 $189.96 $108.97 $37.99

74330 X X-ray bile/panc endoscopy ............................................................... 0264 3.83 $189.96 $108.97 $37.99

74340 X X-ray guide for GI tube .................................................................... 0272 1.40 $69.43 $39.00 $13.89

74350 X X-ray guide, stomach tube ............................................................... 0264 3.83 $189.96 $108.97 $37.99

74355 X X-ray guide, intestinal tube .............................................................. 0264 3.83 $189.96 $108.97 $37.99

74360 S X-ray guide, GI dilation .................................................................... 0296 3.57 $177.06 $100.25 $35.41

74363 S X-ray, bile duct dilation .................................................................... 0297 6.13 $304.03 $172.51 $60.81

74400 S Contrst x-ray, urinary tract ............................................................... 0278 2.85 $141.35 $81.67 $28.27

74410 S Contrst x-ray, urinary tract ............................................................... 0278 2.85 $141.35 $81.67 $28.27

74415 S Contrst x-ray, urinary tract ............................................................... 0278 2.85 $141.35 $81.67 $28.27

74420 S Contrst x-ray, urinary tract ............................................................... 0278 2.85 $141.35 $81.67 $28.27

74425 S Contrst x-ray, urinary tract ............................................................... 0278 2.85 $141.35 $81.67 $28.27

74430 S Contrast x-ray, bladder .................................................................... 0278 2.85 $141.35 $81.67 $28.27

74440 S X-ray, male genital tract ................................................................... 0278 2.85 $141.35 $81.67 $28.27

74445 S X-ray exam of penis ......................................................................... 0278 2.85 $141.35 $81.67 $28.27

74450 S X-ray, urethra/bladder ...................................................................... 0278 2.85 $141.35 $81.67 $28.27

74455 S X-ray, urethra/bladder ...................................................................... 0278 2.85 $141.35 $81.67 $28.27

74470 X X-ray exam of kidney lesion ............................................................ 0264 3.83 $189.96 $108.97 $37.99

74475 S X-ray control, cath insert .................................................................. 0297 6.13 $304.03 $172.51 $60.81

74480 S X-ray control, cath insert .................................................................. 0297 6.13 $304.03 $172.51 $60.81

74485 S X-ray guide, GU dilation ................................................................... 0296 3.57 $177.06 $100.25 $35.41

74710 X X-ray measurement of pelvis ........................................................... 0260 0.79 $39.18 $22.02 $7.84

74740 X X-ray, female genital tract ................................................................ 0264 3.83 $189.96 $108.97 $37.99

74742 X X-ray, fallopian tube ......................................................................... 0264 3.83 $189.96 $108.97 $37.99

74775 S X-ray exam of perineum .................................................................. 0278 2.85 $141.35 $81.67 $28.27

75552 S Magnetic image, myocardium .......................................................... 0284 8.02 $397.76 $257.39 $79.55

75553 S Magnetic image, myocardium .......................................................... 0284 8.02 $397.76 $257.39 $79.55

75554 S Cardiac MRI/function ........................................................................ 0284 8.02 $397.76 $257.39 $79.55

75555 S Cardiac MRI/limited study ................................................................ 0284 8.02 $397.76 $257.39 $79.55

75556 E Cardiac MRI/flow mapping ............................................................... .................... .................... .................... .................... ....................

75600 S Contrast x-ray exam of aorta ........................................................... 0280 14.98 $742.95 $380.12 $148.59

75605 S Contrast x-ray exam of aorta ........................................................... 0280 14.98 $742.95 $380.12 $148.59

75625 S Contrast x-ray exam of aorta ........................................................... 0280 14.98 $742.95 $380.12 $148.59

75630 S X-ray aorta, leg arteries ................................................................... 0280 14.98 $742.95 $380.12 $148.59

*75635 S CT angio abdominal arteries ............................................................ 0283 4.89 $242.52 $179.39 $48.50

75650 S Artery x-rays, head & neck .............................................................. 0280 14.98 $742.95 $380.12 $148.59

75658 S Artery x-rays, arm ............................................................................ 0280 14.98 $742.95 $380.12 $148.59

75660 S Artery x-rays, head & neck .............................................................. 0279 6.30 $312.46 $174.57 $62.49

67914

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

75662 S Artery x-rays, head & neck .............................................................. 0279 6.30 $312.46 $174.57 $62.49

75665 S Artery x-rays, head & neck .............................................................. 0280 14.98 $742.95 $380.12 $148.59

75671 S Artery x-rays, head & neck .............................................................. 0280 14.98 $742.95 $380.12 $148.59

75676 S Artery x-rays, neck ........................................................................... 0280 14.98 $742.95 $380.12 $148.59

75680 S Artery x-rays, neck ........................................................................... 0280 14.98 $742.95 $380.12 $148.59

75685 S Artery x-rays, spine .......................................................................... 0279 6.30 $312.46 $174.57 $62.49

75705 S Artery x-rays, spine .......................................................................... 0279 6.30 $312.46 $174.57 $62.49

75710 S Artery x-rays, arm/leg ....................................................................... 0280 14.98 $742.95 $380.12 $148.59

75716 S Artery x-rays, arms/legs ................................................................... 0280 14.98 $742.95 $380.12 $148.59

75722 S Artery x-rays, kidney ........................................................................ 0280 14.98 $742.95 $380.12 $148.59

75724 S Artery x-rays, kidneys ...................................................................... 0280 14.98 $742.95 $380.12 $148.59

75726 S Artery x-rays, abdomen .................................................................... 0280 14.98 $742.95 $380.12 $148.59

75731 S Artery x-rays, adrenal gland ............................................................. 0280 14.98 $742.95 $380.12 $148.59

75733 S Artery x-rays, adrenals ..................................................................... 0280 14.98 $742.95 $380.12 $148.59

75736 S Artery x-rays, pelvis ......................................................................... 0280 14.98 $742.95 $380.12 $148.59

75741 S Artery x-rays, lung ............................................................................ 0279 6.30 $312.46 $174.57 $62.49

75743 S Artery x-rays, lungs .......................................................................... 0280 14.98 $742.95 $380.12 $148.59

75746 S Artery x-rays, lung ............................................................................ 0279 6.30 $312.46 $174.57 $62.49

75756 S Artery x-rays, chest .......................................................................... 0279 6.30 $312.46 $174.57 $62.49

75774 S Artery x-ray, each vessel ................................................................. 0280 14.98 $742.95 $380.12 $148.59

75790 S Visualize A-V shunt .......................................................................... 0281 4.40 $218.22 $115.16 $43.64

75801 X Lymph vessel x-ray, arm/leg ............................................................ 0264 3.83 $189.96 $108.97 $37.99

75803 X Lymph vessel x-ray,arms/legs ......................................................... 0264 3.83 $189.96 $108.97 $37.99

75805 X Lymph vessel x-ray, trunk ................................................................ 0264 3.83 $189.96 $108.97 $37.99

75807 X Lymph vessel x-ray, trunk ................................................................ 0264 3.83 $189.96 $108.97 $37.99

75809 X Nonvascular shunt, x-ray ................................................................. 0264 3.83 $189.96 $108.97 $37.99

75810 S Vein x-ray, spleen/liver ..................................................................... 0279 6.30 $312.46 $174.57 $62.49

75820 S Vein x-ray, arm/leg ........................................................................... 0281 4.40 $218.22 $115.16 $43.64

75822 S Vein x-ray, arms/legs ....................................................................... 0281 4.40 $218.22 $115.16 $43.64

75825 S Vein x-ray, trunk ............................................................................... 0279 6.30 $312.46 $174.57 $62.49

75827 S Vein x-ray, chest .............................................................................. 0279 6.30 $312.46 $174.57 $62.49

75831 S Vein x-ray, kidney ............................................................................ 0279 6.30 $312.46 $174.57 $62.49

75833 S Vein x-ray, kidneys ........................................................................... 0279 6.30 $312.46 $174.57 $62.49

75840 S Vein x-ray, adrenal gland ................................................................. 0279 6.30 $312.46 $174.57 $62.49

75842 S Vein x-ray, adrenal glands ............................................................... 0279 6.30 $312.46 $174.57 $62.49

75860 S Vein x-ray, neck ............................................................................... 0279 6.30 $312.46 $174.57 $62.49

75870 S Vein x-ray, skull ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75872 S Vein x-ray, skull ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75880 S Vein x-ray, eye socket ..................................................................... 0279 6.30 $312.46 $174.57 $62.49

75885 S Vein x-ray, liver ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75887 S Vein x-ray, liver ................................................................................ 0280 14.98 $742.95 $380.12 $148.59

75889 S Vein x-ray, liver ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75891 S Vein x-ray, liver ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75893 N Venous sampling by catheter .......................................................... .................... .................... .................... .................... ....................

75894 S X-rays, transcath therapy ................................................................. 0297 6.13 $304.03 $172.51 $60.81

75896 S X-rays, transcath therapy ................................................................. 0297 6.13 $304.03 $172.51 $60.81

75898 X Follow-up angiogram ........................................................................ 0264 3.83 $189.96 $108.97 $37.99

75900 C Arterial catheter exchange ............................................................... .................... .................... .................... .................... ....................

75940 X X-ray placement, vein filter .............................................................. 0264 3.83 $189.96 $108.97 $37.99

75945 S Intravascular us ................................................................................ 0267 2.72 $134.90 $80.06 $26.98

75946 S Intravascular us add-on ................................................................... 0267 2.72 $134.90 $80.06 $26.98

*75952 C Abdom aneurysm endovas repr ....................................................... .................... .................... .................... .................... ....................

*75953 C Abdom aneurysm endovas repr ....................................................... .................... .................... .................... .................... ....................

75960 S Transcatheter intro, stent ................................................................. 0279 6.30 $312.46 $174.57 $62.49

75961 S Retrieval, broken catheter ................................................................ 0279 6.30 $312.46 $174.57 $62.49

75962 S Repair arterial blockage ................................................................... 0280 14.98 $742.95 $380.12 $148.59

75964 S Repair artery blockage, each ........................................................... 0279 6.30 $312.46 $174.57 $62.49

75966 S Repair arterial blockage ................................................................... 0280 14.98 $742.95 $380.12 $148.59

75968 S Repair artery blockage, each ........................................................... 0279 6.30 $312.46 $174.57 $62.49

75970 S Vascular biopsy ................................................................................ 0279 6.30 $312.46 $174.57 $62.49

75978 S Repair venous blockage .................................................................. 0279 6.30 $312.46 $174.57 $62.49

75980 S Contrast xray exam bile duct ........................................................... 0297 6.13 $304.03 $172.51 $60.81

75982 S Contrast xray exam bile duct ........................................................... 0297 6.13 $304.03 $172.51 $60.81

75984 S Xray control catheter change ........................................................... 0296 3.57 $177.06 $100.25 $35.41

75989 X Abscess drainage under x-ray ......................................................... 0273 2.49 $123.49 $61.02 $24.70

75992 S Atherectomy, x-ray exam ................................................................. 0279 6.30 $312.46 $174.57 $62.49

75993 T Atherectomy, x-ray exam ................................................................. 0081 28.81 $1,428.86 $710.91 $285.77

75994 T Atherectomy, x-ray exam ................................................................. 0081 28.81 $1,428.86 $710.91 $285.77

75995 S Atherectomy, x-ray exam ................................................................. 0279 6.30 $312.46 $174.57 $62.49

75996 T Atherectomy, x-ray exam ................................................................. 0081 28.81 $1,428.86 $710.91 $285.77

76000 X Fluoroscope examination ................................................................. 0272 1.40 $69.43 $39.00 $13.89

76001 X Fluoroscope exam, extensive .......................................................... 0273 2.49 $123.49 $61.02 $24.70

76003 X Needle localization by x-ray ............................................................. 0272 1.40 $69.43 $39.00 $13.89

76005 X Fluoroguide for spine inject .............................................................. 0273 2.49 $123.49 $61.02 $24.70

67915

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

76006 X X-ray stress view .............................................................................. 0261 1.38 $68.44 $38.77 $13.69

76010 X X-ray, nose to rectum ...................................................................... 0260 0.79 $39.18 $22.02 $7.84

*76012 S Percut vertebroplasty fluor ............................................................... 0274 4.83 $239.55 $128.12 $47.91

*76013 S Percut vertebroplasty CT ................................................................. 0274 4.83 $239.55 $128.12 $47.91

76020 X X-rays for bone age ......................................................................... 0261 1.38 $68.44 $38.77 $13.69

76040 X X-rays, bone evaluation ................................................................... 0260 0.79 $39.18 $22.02 $7.84

76061 X X-rays, bone survey ......................................................................... 0261 1.38 $68.44 $38.77 $13.69

76062 X X-rays, bone survey ......................................................................... 0261 1.38 $68.44 $38.77 $13.69

76065 X X-rays, bone evaluation ................................................................... 0261 1.38 $68.44 $38.77 $13.69

76066 X Joint(s) survey, single film ............................................................... 0260 0.79 $39.18 $22.02 $7.84

76070 E CT scan, bone density study ........................................................... .................... .................... .................... .................... ....................

76075 S Dual energy x-ray study ................................................................... 0971 1.55 $76.88 .................... $15.38

76076 T Dual energy x-ray study ................................................................... 0970 0.52 $25.79 .................... $5.16

76078 X Photodensitometry ........................................................................... 0261 1.38 $68.44 $38.77 $13.69

76080 X X-ray exam of fistula ........................................................................ 0263 1.68 $83.32 $45.88 $16.66

76086 X X-ray of mammary duct ................................................................... 0263 1.68 $83.32 $45.88 $16.66

76088 X X-ray of mammary ducts .................................................................. 0263 1.68 $83.32 $45.88 $16.66

76090 S Mammogram, one breast ................................................................. 0271 0.70 $34.72 $19.50 $6.94

76091 S Mammogram, both breasts .............................................................. 0271 0.70 $34.72 $19.50 $6.94

76092 A Mammogram, screening .................................................................. .................... .................... .................... .................... ....................

76093 S Magnetic image, breast .................................................................... 0284 8.02 $397.76 $257.39 $79.55

76094 S Magnetic image, both breasts .......................................................... 0284 8.02 $397.76 $257.39 $79.55

76095 X Stereotactic breast biopsy ................................................................ 0264 3.83 $189.96 $108.97 $37.99

76096 X X-ray of needle wire, breast ............................................................. 0263 1.68 $83.32 $45.88 $16.66

76098 X X-ray exam, breast specimen .......................................................... 0260 0.79 $39.18 $22.02 $7.84

76100 X X-ray exam of body section ............................................................. 0261 1.38 $68.44 $38.77 $13.69

76101 X Complex body section x-ray ............................................................ 0263 1.68 $83.32 $45.88 $16.66

76102 X Complex body section x-rays ........................................................... 0264 3.83 $189.96 $108.97 $37.99

76120 X Cinematic x-rays .............................................................................. 0261 1.38 $68.44 $38.77 $13.69

76125 X Cinematic x-rays add-on .................................................................. 0261 1.38 $68.44 $38.77 $13.69

76140 E X-ray consultation ............................................................................ .................... .................... .................... .................... ....................

76150 X X-ray exam, dry process .................................................................. 0260 0.79 $39.18 $22.02 $7.84

76350 N Special x-ray contrast study ............................................................. .................... .................... .................... .................... ....................

76355 S CAT scan for localization ................................................................. 0283 4.89 $242.52 $179.39 $48.50

76360 S CAT scan for needle biopsy ............................................................ 0283 4.89 $242.52 $179.39 $48.50

76365D S CAT scan for cyst aspiration ............................................................ 0283 4.89 $242.52 $179.39 $48.50

76370 S CAT scan for therapy guide ............................................................. 0282 2.38 $118.04 $94.51 $23.61

76375 S 3d/holograph reconstr add-on .......................................................... 0282 2.38 $118.04 $94.51 $23.61

76380 S CAT scan follow-up study ................................................................ 0282 2.38 $118.04 $94.51 $23.61

76390 S Mr spectroscopy ............................................................................... 0284 8.02 $397.76 $257.39 $79.55

*76393 X MR guidance for needle place ......................................................... 0273 2.49 $123.49 $61.02 $24.70

76400 S Magnetic image, bone marrow ........................................................ 0284 8.02 $397.76 $257.39 $79.55

76499 X Radiographic procedure ................................................................... 0260 0.79 $39.18 $22.02 $7.84

76506 S Echo exam of head .......................................................................... 0266 1.79 $88.78 $57.35 $17.76

76511 S Echo exam of eye ............................................................................ 0266 1.79 $88.78 $57.35 $17.76

76512 S Echo exam of eye ............................................................................ 0266 1.79 $88.78 $57.35 $17.76

76513 S Echo exam of eye, water bath ......................................................... 0265 1.17 $58.03 $38.08 $11.61

76516 S Echo exam of eye ............................................................................ 0266 1.79 $88.78 $57.35 $17.76

76519 S Echo exam of eye ............................................................................ 0266 1.79 $88.78 $57.35 $17.76

76529 S Echo exam of eye ............................................................................ 0265 1.17 $58.03 $38.08 $11.61

76536 S Echo exam of head and neck .......................................................... 0265 1.17 $58.03 $38.08 $11.61

76604 S Echo exam of chest ......................................................................... 0266 1.79 $88.78 $57.35 $17.76

76645 S Echo exam of breast(s) .................................................................... 0265 1.17 $58.03 $38.08 $11.61

76700 S Echo exam of abdomen ................................................................... 0266 1.79 $88.78 $57.35 $17.76

76705 S Echo exam of abdomen ................................................................... 0266 1.79 $88.78 $57.35 $17.76

76770 S Echo exam abdomen back wall ....................................................... 0266 1.79 $88.78 $57.35 $17.76

76775 S Echo exam abdomen back wall ....................................................... 0266 1.79 $88.78 $57.35 $17.76

76778 S Echo exam kidney transplant ........................................................... 0266 1.79 $88.78 $57.35 $17.76

76800 S Echo exam spinal canal ................................................................... 0266 1.79 $88.78 $57.35 $17.76

76805 S Echo exam of pregnant uterus ........................................................ 0266 1.79 $88.78 $57.35 $17.76

76810 S Echo exam of pregnant uterus ........................................................ 0265 1.17 $58.03 $38.08 $11.61

76815 S Echo exam of pregnant uterus ........................................................ 0265 1.17 $58.03 $38.08 $11.61

76816 S Echo exam follow-up/repeat ............................................................ 0265 1.17 $58.03 $38.08 $11.61

76818 S Fetal biophysical profile ................................................................... 0266 1.79 $88.78 $57.35 $17.76

*76819 S Fetl biophys profil w/o stress ........................................................... 0266 1.79 $88.78 $57.35 $17.76

76825 S Echo exam of fetal heart .................................................................. 0269 4.40 $218.22 $114.01 $43.64

76826 S Echo exam of fetal heart .................................................................. 0269 4.40 $218.22 $114.01 $43.64

76827 S Echo exam of fetal heart .................................................................. 0269 4.40 $218.22 $114.01 $43.64

76828 S Echo exam of fetal heart .................................................................. 0269 4.40 $218.22 $114.01 $43.64

76830 S Echo exam, transvaginal .................................................................. 0266 1.79 $88.78 $57.35 $17.76

76831 S Echo exam, uterus ........................................................................... 0266 1.79 $88.78 $57.35 $17.76

76856 S Echo exam of pelvis ......................................................................... 0266 1.79 $88.78 $57.35 $17.76

76857 S Echo exam of pelvis ......................................................................... 0265 1.17 $58.03 $38.08 $11.61

76870 S Echo exam of scrotum ..................................................................... 0266 1.79 $88.78 $57.35 $17.76

67916

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

76872 S Echo exam, transrectal .................................................................... 0266 1.79 $88.78 $57.35 $17.76

76873 S Echograp trans r, pros study ........................................................... 0266 1.79 $88.78 $57.35 $17.76

76880 S Echo exam of extremity ................................................................... 0266 1.79 $88.78 $57.35 $17.76

76885 S Echo exam, infant hips .................................................................... 0266 1.79 $88.78 $57.35 $17.76

76886 S Echo exam, infant hips .................................................................... 0266 1.79 $88.78 $57.35 $17.76

76930 X Echo guide for heart sac tap ........................................................... 0268 2.23 $110.60 $69.51 $22.12

76932 X Echo guide for heart biopsy ............................................................. 0268 2.23 $110.60 $69.51 $22.12

76934D X Echo guide for chest tap .................................................................. 0268 2.23 $110.60 $69.51 $22.12

76936 X Echo guide for artery repair ............................................................. 0268 2.23 $110.60 $69.51 $22.12

76938D X Echo exam for drainage ................................................................... 0268 2.23 $110.60 $69.51 $22.12

76941 X Echo guide for transfusion ............................................................... 0268 2.23 $110.60 $69.51 $22.12

76942 X Echo guide for biopsy ...................................................................... 0268 2.23 $110.60 $69.51 $22.12

76945 X Echo guide, villus sampling ............................................................. 0268 2.23 $110.60 $69.51 $22.12

76946 X Echo guide for amniocentesis .......................................................... 0268 2.23 $110.60 $69.51 $22.12

76948 X Echo guide, ova aspiration .............................................................. 0268 2.23 $110.60 $69.51 $22.12

76950 X Echo guidance radiotherapy ............................................................ 0268 2.23 $110.60 $69.51 $22.12

76960D X Echo guidance radiotherapy ............................................................ 0268 2.23 $110.60 $69.51 $22.12

76965 X Echo guidance radiotherapy ............................................................ 0268 2.23 $110.60 $69.51 $22.12

76970 S Ultrasound exam follow-up .............................................................. 0265 1.17 $58.03 $38.08 $11.61

76975 S GI endoscopic ultrasound ................................................................ 0266 1.79 $88.78 $57.35 $17.76

76977 S Us bone density measure ................................................................ 0265 1.17 $58.03 $38.08 $11.61

76986 S Echo exam at surgery ...................................................................... 0266 1.79 $88.78 $57.35 $17.76

76999 S Echo examination procedure ........................................................... 0266 1.79 $88.78 $57.35 $17.76

77261 E Radiation therapy planning .............................................................. .................... .................... .................... .................... ....................

77262 E Radiation therapy planning .............................................................. .................... .................... .................... .................... ....................

77263 E Radiation therapy planning .............................................................. .................... .................... .................... .................... ....................

77280 X Set radiation therapy field ................................................................ 0304 1.49 $73.90 $41.52 $14.78

77285 X Set radiation therapy field ................................................................ 0305 4.06 $201.36 $97.50 $40.27

77290 X Set radiation therapy field ................................................................ 0305 4.06 $201.36 $97.50 $40.27

77295 X Set radiation therapy field ................................................................ 0310 13.98 $693.35 $339.05 $138.67

77299 E Radiation therapy planning .............................................................. .................... .................... .................... .................... ....................

77300 X Radiation therapy dose plan ............................................................ 0304 1.49 $73.90 $41.52 $14.78

77305 X Radiation therapy dose plan ............................................................ 0304 1.49 $73.90 $41.52 $14.78

77310 X Radiation therapy dose plan ............................................................ 0304 1.49 $73.90 $41.52 $14.78

77315 X Radiation therapy dose plan ............................................................ 0305 4.06 $201.36 $97.50 $40.27

77321 X Radiation therapy port plan .............................................................. 0305 4.06 $201.36 $97.50 $40.27

77326 X Radiation therapy dose plan ............................................................ 0305 4.06 $201.36 $97.50 $40.27

77327 X Radiation therapy dose plan ............................................................ 0305 4.06 $201.36 $97.50 $40.27

77328 X Radiation therapy dose plan ............................................................ 0305 4.06 $201.36 $97.50 $40.27

77331 X Special radiation dosimetry .............................................................. 0304 1.49 $73.90 $41.52 $14.78

77332 X Radiation treatment aid(s) ................................................................ 0303 2.83 $140.36 $69.28 $28.07

77333 X Radiation treatment aid(s) ................................................................ 0303 2.83 $140.36 $69.28 $28.07

77334 X Radiation treatment aid(s) ................................................................ 0303 2.83 $140.36 $69.28 $28.07

77336 X Radiation physics consult ................................................................ 0311 1.32 $65.46 $31.66 $13.09

77370 X Radiation physics consult ................................................................ 0311 1.32 $65.46 $31.66 $13.09

77399 X External radiation dosimetry ............................................................ 0311 1.32 $65.46 $31.66 $13.09

77401 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77402 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77403 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77404 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77406 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77407 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77408 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77409 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77411 S Radiation treatment delivery ............................................................ 0301 2.21 $109.61 $52.53 $21.92

77412 S Radiation treatment delivery ............................................................ 0301 2.21 $109.61 $52.53 $21.92

77413 S Radiation treatment delivery ............................................................ 0301 2.21 $109.61 $52.53 $21.92

77414 S Radiation treatment delivery ............................................................ 0300 1.98 $98.20 $47.72 $19.64

77416 S Radiation treatment delivery ............................................................ 0301 2.21 $109.61 $52.53 $21.92

77417 X Radiology port film(s) ....................................................................... 0260 0.79 $39.18 $22.02 $7.84

77427 E Radiation tx management, x5 .......................................................... .................... .................... .................... .................... ....................

77431 E Radiation therapy management ....................................................... .................... .................... .................... .................... ....................

77432 E Stereotactic radiation trmt ................................................................ .................... .................... .................... .................... ....................

77470 S Special radiation treatment .............................................................. 0302 8.21 $407.18 $216.55 $81.44

77499 E Radiation therapy management ....................................................... .................... .................... .................... .................... ....................

77520 S Proton beam delivery ....................................................................... 0974 8.25 $409.17 .................... $81.83

*77522 S Proton trmt, simple w/ comp ............................................................ 0974 8.25 $409.17 .................... $81.83

77523 S Proton beam delivery ....................................................................... 0976 18.05 $895.21 .................... $179.04

*77525 S Proton treatment, complex ............................................................... 0976 18.05 $895.21 .................... $179.04

77600 S Hyperthermia treatment ................................................................... 0314 5.88 $291.62 $150.95 $58.32

77605 S Hyperthermia treatment ................................................................... 0314 5.88 $291.62 $150.95 $58.32

77610 S Hyperthermia treatment ................................................................... 0314 5.88 $291.62 $150.95 $58.32

77615 S Hyperthermia treatment ................................................................... 0314 5.88 $291.62 $150.95 $58.32

77620 S Hyperthermia treatment ................................................................... 0314 5.88 $291.62 $150.95 $58.32

67917

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

77750 S Infuse radioactive materials ............................................................. 0301 2.21 $109.61 $52.53 $21.92

77761 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77762 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77763 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77776 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77777 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77778 S Radioelement application ................................................................. 0312 4.09 $202.85 $109.65 $40.57

77781 S High intensity brachytherapy ............................................................ 0313 7.89 $391.31 $164.02 $78.26

77782 S High intensity brachytherapy ............................................................ 0313 7.89 $391.31 $164.02 $78.26

77783 S High intensity brachytherapy ............................................................ 0313 7.89 $391.31 $164.02 $78.26

77784 S High intensity brachytherapy ............................................................ 0313 7.89 $391.31 $164.02 $78.26

77789 S Radioelement application ................................................................. 0300 1.98 $98.20 $47.72 $19.64

77790 N Radioelement handling .................................................................... .................... .................... .................... .................... ....................

77799 S Radium/radioisotope therapy ........................................................... 0313 7.89 $391.31 $164.02 $78.26

78000 S Thyroid, single uptake ...................................................................... 0290 1.94 $96.21 $55.51 $19.24

78001 S Thyroid, multiple uptakes ................................................................. 0290 1.94 $96.21 $55.51 $19.24

78003 S Thyroid suppress/stimul ................................................................... 0290 1.94 $96.21 $55.51 $19.24

78006 S Thyroid imaging with uptake ............................................................ 0291 3.15 $156.22 $93.14 $31.24

78007 S Thyroid image, mult uptakes ............................................................ 0291 3.15 $156.22 $93.14 $31.24

78010 S Thyroid imaging ................................................................................ 0290 1.94 $96.21 $55.51 $19.24

78011 S Thyroid imaging with flow ................................................................ 0290 1.94 $96.21 $55.51 $19.24

78015 S Thyroid met imaging ........................................................................ 0291 3.15 $156.22 $93.14 $31.24

78016 S Thyroid met imaging/studies ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78018 S Thyroid met imaging, body .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78020 S Thyroid met uptake .......................................................................... 0292 4.36 $216.24 $126.63 $43.25

78070 S Parathyroid nuclear imaging ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78075 S Adrenal nuclear imaging .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78099 S Endocrine nuclear procedure ........................................................... 0290 1.94 $96.21 $55.51 $19.24

78102 S Bone marrow imaging, ltd ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78103 S Bone marrow imaging, mult ............................................................. 0292 4.36 $216.24 $126.63 $43.25

78104 S Bone marrow imaging, body ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78110 S Plasma volume, single ..................................................................... 0291 3.15 $156.22 $93.14 $31.24

78111 S Plasma volume, multiple .................................................................. 0291 3.15 $156.22 $93.14 $31.24

78120 S Red cell mass, single ....................................................................... 0291 3.15 $156.22 $93.14 $31.24

78121 S Red cell mass, multiple .................................................................... 0291 3.15 $156.22 $93.14 $31.24

78122 S Blood volume ................................................................................... 0292 4.36 $216.24 $126.63 $43.25

78130 S Red cell survival study ..................................................................... 0292 4.36 $216.24 $126.63 $43.25

78135 S Red cell survival kinetics .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78140 S Red cell sequestration ..................................................................... 0292 4.36 $216.24 $126.63 $43.25

78160 S Plasma iron turnover ........................................................................ 0292 4.36 $216.24 $126.63 $43.25

78162 S Iron absorption exam ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78170 S Red cell iron utilization ..................................................................... 0292 4.36 $216.24 $126.63 $43.25

78172 S Total body iron estimation ................................................................ 0292 4.36 $216.24 $126.63 $43.25

78185 S Spleen imaging ................................................................................ 0291 3.15 $156.22 $93.14 $31.24

78190 S Platelet survival, kinetics .................................................................. 0291 3.15 $156.22 $93.14 $31.24

78191 S Platelet survival ................................................................................ 0291 3.15 $156.22 $93.14 $31.24

78195 S Lymph system imaging .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78199 S Blood/lymph nuclear exam ............................................................... 0290 1.94 $96.21 $55.51 $19.24

78201 S Liver imaging .................................................................................... 0291 3.15 $156.22 $93.14 $31.24

78202 S Liver imaging with flow ..................................................................... 0291 3.15 $156.22 $93.14 $31.24

78205 S Liver imaging (3D) ............................................................................ 0292 4.36 $216.24 $126.63 $43.25

78206 S Liver image (3d) w/flow .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78215 S Liver and spleen imaging ................................................................. 0291 3.15 $156.22 $93.14 $31.24

78216 S Liver & spleen image/flow ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78220 S Liver function study .......................................................................... 0292 4.36 $216.24 $126.63 $43.25

78223 S Hepatobiliary imaging ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78230 S Salivary gland imaging ..................................................................... 0291 3.15 $156.22 $93.14 $31.24

78231 S Serial salivary imaging ..................................................................... 0291 3.15 $156.22 $93.14 $31.24

78232 S Salivary gland function exam ........................................................... 0291 3.15 $156.22 $93.14 $31.24

78258 S Esophageal motility study ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78261 S Gastric mucosa imaging .................................................................. 0291 3.15 $156.22 $93.14 $31.24

78262 S Gastroesophageal reflux exam ........................................................ 0291 3.15 $156.22 $93.14 $31.24

78264 S Gastric emptying study .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78267 A Breath tst attain/anal c-14 ................................................................ .................... .................... .................... .................... ....................

78268 A Breath test analysis, c-14 ................................................................ .................... .................... .................... .................... ....................

78270 S Vit B-12 absorption exam ................................................................ 0290 1.94 $96.21 $55.51 $19.24

78271 S Vit B-12 absorp exam, IF ................................................................. 0290 1.94 $96.21 $55.51 $19.24

78272 S Vit B-12 absorp, combined .............................................................. 0291 3.15 $156.22 $93.14 $31.24

78278 S Acute GI blood loss imaging ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78282 S GI protein loss exam ........................................................................ 0290 1.94 $96.21 $55.51 $19.24

78290 S Meckel’s divert exam ....................................................................... 0291 3.15 $156.22 $93.14 $31.24

78291 S Leveen/shunt patency exam ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78299 S GI nuclear procedure ....................................................................... 0290 1.94 $96.21 $55.51 $19.24

78300 S Bone imaging, limited area .............................................................. 0291 3.15 $156.22 $93.14 $31.24

67918

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

78305 S Bone imaging, multiple areas .......................................................... 0292 4.36 $216.24 $126.63 $43.25

78306 S Bone imaging, whole body ............................................................... 0292 4.36 $216.24 $126.63 $43.25

78315 S Bone imaging, 3 phase .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78320 S Bone imaging (3D) ........................................................................... 0292 4.36 $216.24 $126.63 $43.25

78350 X Bone mineral, single photon ............................................................ 0261 1.38 $68.44 $38.77 $13.69

78351 E Bone mineral, dual photon ............................................................... .................... .................... .................... .................... ....................

78399 S Musculoskeletal nuclear exam ......................................................... 0290 1.94 $96.21 $55.51 $19.24

78414 S Non-imaging heart function .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78428 S Cardiac shunt imaging ..................................................................... 0292 4.36 $216.24 $126.63 $43.25

78445 S Vascular flow imaging ...................................................................... 0291 3.15 $156.22 $93.14 $31.24

78455 S Venous thrombosis study ................................................................. 0291 3.15 $156.22 $93.14 $31.24

78456 S Acute venous thrombus image ........................................................ 0291 3.15 $156.22 $93.14 $31.24

78457 S Venous thrombosis imaging ............................................................. 0291 3.15 $156.22 $93.14 $31.24

78458 S Ven thrombosis images, bilat ........................................................... 0291 3.15 $156.22 $93.14 $31.24

78459 E Heart muscle imaging (PET) ............................................................ .................... .................... .................... .................... ....................

78460 S Heart muscle blood, single .............................................................. 0286 7.28 $361.06 $200.04 $72.21

78461 S Heart muscle blood, multiple ........................................................... 0286 7.28 $361.06 $200.04 $72.21

78464 S Heart image (3d), single .................................................................. 0286 7.28 $361.06 $200.04 $72.21

78465 S Heart image (3d), multiple ............................................................... 0286 7.28 $361.06 $200.04 $72.21

78466 S Heart infarct image ........................................................................... 0292 4.36 $216.24 $126.63 $43.25

78468 S Heart infarct image (ef) .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78469 S Heart infarct image (3D) .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78472 S Gated heart, planar, single .............................................................. 0286 7.28 $361.06 $200.04 $72.21

78473 S Gated heart, multiple ........................................................................ 0286 7.28 $361.06 $200.04 $72.21

78478 S Heart wall motion add-on ................................................................. 0286 7.28 $361.06 $200.04 $72.21

78480 S Heart function add-on ...................................................................... 0286 7.28 $361.06 $200.04 $72.21

78481 S Heart first pass, single ..................................................................... 0286 7.28 $361.06 $200.04 $72.21

78483 S Heart first pass, multiple .................................................................. 0286 7.28 $361.06 $200.04 $72.21

78491 E Heart image (pet), single ................................................................. .................... .................... .................... .................... ....................

78492 E Heart image (pet), multiple .............................................................. .................... .................... .................... .................... ....................

78494 S Heart image, spect ........................................................................... 0296 3.57 $177.06 $100.25 $35.41

78496 S Heart first pass add-on .................................................................... 0296 3.57 $177.06 $100.25 $35.41

78499 S Cardiovascular nuclear exam .......................................................... 0292 4.36 $216.24 $126.63 $43.25

78580 S Lung perfusion imaging .................................................................... 0291 3.15 $156.22 $93.14 $31.24

78584 S Lung V/Q image single breath ......................................................... 0292 4.36 $216.24 $126.63 $43.25

78585 S Lung V/Q imaging ............................................................................ 0292 4.36 $216.24 $126.63 $43.25

78586 S Aerosol lung image, single ............................................................... 0292 4.36 $216.24 $126.63 $43.25

78587 S Aerosol lung image, multiple ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78588 S Perfusion lung image ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78591 S Vent image, 1 breath, 1 proj ............................................................ 0291 3.15 $156.22 $93.14 $31.24

78593 S Vent image, 1 proj, gas .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78594 S Vent image, mult proj, gas ............................................................... 0292 4.36 $216.24 $126.63 $43.25

78596 S Lung differential function .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78599 S Respiratory nuclear exam ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78600 S Brain imaging, ltd static .................................................................... 0292 4.36 $216.24 $126.63 $43.25

78601 S Brain imaging, ltd w/ flow ................................................................. 0292 4.36 $216.24 $126.63 $43.25

78605 S Brain imaging, complete .................................................................. 0291 3.15 $156.22 $93.14 $31.24

78606 S Brain imaging, compl w/flow ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78607 S Brain imaging (3D) ........................................................................... 0292 4.36 $216.24 $126.63 $43.25

78608 E Brain imaging (PET) ......................................................................... .................... .................... .................... .................... ....................

78609 E Brain imaging (PET) ......................................................................... .................... .................... .................... .................... ....................

78610 S Brain flow imaging only .................................................................... 0291 3.15 $156.22 $93.14 $31.24

78615 S Cerebral blood flow imaging ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78630 S Cerebrospinal fluid scan .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78635 S CSF ventriculography ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78645 S CSF shunt evaluation ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78647 S Cerebrospinal fluid scan .................................................................. 0292 4.36 $216.24 $126.63 $43.25

78650 S CSF leakage imaging ....................................................................... 0292 4.36 $216.24 $126.63 $43.25

78660 S Nuclear exam of tear flow ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78699 S Nervous system nuclear exam ........................................................ 0292 4.36 $216.24 $126.63 $43.25

78700 S Kidney imaging, static ...................................................................... 0291 3.15 $156.22 $93.14 $31.24

78701 S Kidney imaging with flow ................................................................. 0291 3.15 $156.22 $93.14 $31.24

78704 S Imaging renogram ............................................................................ 0292 4.36 $216.24 $126.63 $43.25

78707 S Kidney flow/function image .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78708 S Kidney flow/function image .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78709 S Kidney flow/function image .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78710 S Kidney imaging (3D) ........................................................................ 0292 4.36 $216.24 $126.63 $43.25

78715 S Renal vascular flow exam ................................................................ 0291 3.15 $156.22 $93.14 $31.24

78725 S Kidney function study ....................................................................... 0291 3.15 $156.22 $93.14 $31.24

78730 S Urinary bladder retention ................................................................. 0291 3.15 $156.22 $93.14 $31.24

78740 S Ureteral reflux study ......................................................................... 0291 3.15 $156.22 $93.14 $31.24

78760 S Testicular imaging ............................................................................ 0291 3.15 $156.22 $93.14 $31.24

78761 S Testicular imaging/flow ..................................................................... 0291 3.15 $156.22 $93.14 $31.24

78799 S Genitourinary nuclear exam ............................................................. 0292 4.36 $216.24 $126.63 $43.25

67919

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

78800 S Tumor imaging, limited area ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78801 S Tumor imaging, mult areas .............................................................. 0292 4.36 $216.24 $126.63 $43.25

78802 S Tumor imaging, whole body ............................................................. 0292 4.36 $216.24 $126.63 $43.25

78803 S Tumor imaging (3D) ......................................................................... 0292 4.36 $216.24 $126.63 $43.25

78805 S Abscess imaging, ltd area ................................................................ 0292 4.36 $216.24 $126.63 $43.25

78806 S Abscess imaging, whole body ......................................................... 0292 4.36 $216.24 $126.63 $43.25

78807 S Nuclear localization/abscess ............................................................ 0292 4.36 $216.24 $126.63 $43.25

78810 E Tumor imaging (PET) ....................................................................... .................... .................... .................... .................... ....................

78890 N Nuclear medicine data proc ............................................................. .................... .................... .................... .................... ....................

78891 N Nuclear med data proc .................................................................... .................... .................... .................... .................... ....................

78990 N Provide diag radionuclide(s) ............................................................ .................... .................... .................... .................... ....................

78999 S Nuclear diagnostic exam .................................................................. 0291 3.15 $156.22 $93.14 $31.24

79000 S Init hyperthyroid therapy .................................................................. 0294 5.13 $254.43 $144.06 $50.89

79001 S Repeat hyperthyroid therapy ............................................................ 0294 5.13 $254.43 $144.06 $50.89

79020 S Thyroid ablation ................................................................................ 0294 5.13 $254.43 $144.06 $50.89

79030 S Thyroid ablation, carcinoma ............................................................. 0294 5.13 $254.43 $144.06 $50.89

79035 S Thyroid metastatic therapy ............................................................... 0294 5.13 $254.43 $144.06 $50.89

79100 S Hematopoetic nuclear therapy ......................................................... 0294 5.13 $254.43 $144.06 $50.89

79200 S Intracavitary nuclear trmt ................................................................. 0295 19.85 $984.48 $609.17 $196.90

79300 S Interstitial nuclear therapy ................................................................ 0294 5.13 $254.43 $144.06 $50.89

79400 S Nonhemato nuclear therapy ............................................................. 0295 19.85 $984.48 $609.17 $196.90

79420 S Intravascular nuclear ther ................................................................ 0295 19.85 $984.48 $609.17 $196.90

79440 S Nuclear joint therapy ........................................................................ 0294 5.13 $254.43 $144.06 $50.89

79900 N Provide ther radiopharm(s) .............................................................. .................... .................... .................... .................... ....................

79999 S Nuclear medicine therapy ................................................................ 0294 5.13 $254.43 $144.06 $50.89

80048 A Basic metabolic panel ...................................................................... .................... .................... .................... .................... ....................

80050 A General health panel ........................................................................ .................... .................... .................... .................... ....................

80051 A Electrolyte panel ............................................................................... .................... .................... .................... .................... ....................

80053 A Comprehen metabolic panel ............................................................ .................... .................... .................... .................... ....................

80055 A Obstetric panel ................................................................................. .................... .................... .................... .................... ....................

80061 A Lipid panel ........................................................................................ .................... .................... .................... .................... ....................

80069 A Renal function panel ........................................................................ .................... .................... .................... .................... ....................

80072 A Arthritis panel ................................................................................... .................... .................... .................... .................... ....................

80074 A Acute hepatitis panel ........................................................................ .................... .................... .................... .................... ....................

80076 A Hepatic function panel ..................................................................... .................... .................... .................... .................... ....................

80090 A Torch antibody panel ....................................................................... .................... .................... .................... .................... ....................

80100 A Drug screen ...................................................................................... .................... .................... .................... .................... ....................

80101 A Drug screen ...................................................................................... .................... .................... .................... .................... ....................

80102 A Drug confirmation ............................................................................. .................... .................... .................... .................... ....................

80103 N Drug analysis, tissue prep ............................................................... .................... .................... .................... .................... ....................

80150 A Assay of amikacin ............................................................................ .................... .................... .................... .................... ....................

80152 A Assay of amitriptyline ....................................................................... .................... .................... .................... .................... ....................

80154 A Assay of benzodiazepines ............................................................... .................... .................... .................... .................... ....................

80156 A Assay of carbamazepine .................................................................. .................... .................... .................... .................... ....................

*80157 A Assay of carbamazepine, free ......................................................... .................... .................... .................... .................... ....................

80158 A Assay of cyclosporine ...................................................................... .................... .................... .................... .................... ....................

80160 A Assay of desipramine ....................................................................... .................... .................... .................... .................... ....................

80162 A Assay of digoxin ............................................................................... .................... .................... .................... .................... ....................

80164 A Assay, dipropylacetic acid ................................................................ .................... .................... .................... .................... ....................

80166 A Assay of doxepin .............................................................................. .................... .................... .................... .................... ....................

80168 A Assay of ethosuximide ..................................................................... .................... .................... .................... .................... ....................

80170 A Assay of gentamicin ......................................................................... .................... .................... .................... .................... ....................

80172 A Assay of gold ................................................................................... .................... .................... .................... .................... ....................

*80173 A Assay of haloperidol ......................................................................... .................... .................... .................... .................... ....................

80174 A Assay of imipramine ......................................................................... .................... .................... .................... .................... ....................

80176 A Assay of lidocaine ............................................................................ .................... .................... .................... .................... ....................

80178 A Assay of lithium ................................................................................ .................... .................... .................... .................... ....................

80182 A Assay of nortriptyline ........................................................................ .................... .................... .................... .................... ....................

80184 A Assay of phenobarbital .................................................................... .................... .................... .................... .................... ....................

80185 A Assay of phenytoin, total .................................................................. .................... .................... .................... .................... ....................

80186 A Assay of phenytoin, free .................................................................. .................... .................... .................... .................... ....................

80188 A Assay of primidone .......................................................................... .................... .................... .................... .................... ....................

80190 A Assay of procainamide ..................................................................... .................... .................... .................... .................... ....................

80192 A Assay of procainamide ..................................................................... .................... .................... .................... .................... ....................

80194 A Assay of quinidine ............................................................................ .................... .................... .................... .................... ....................

80196 A Assay of salicylate ........................................................................... .................... .................... .................... .................... ....................

80197 A Assay of tacrolimus .......................................................................... .................... .................... .................... .................... ....................

80198 A Assay of theophylline ....................................................................... .................... .................... .................... .................... ....................

80200 A Assay of tobramycin ......................................................................... .................... .................... .................... .................... ....................

80201 A Assay of topiramate ......................................................................... .................... .................... .................... .................... ....................

80202 A Assay of vancomycin ....................................................................... .................... .................... .................... .................... ....................

80299 A Quantitative assay, drug .................................................................. .................... .................... .................... .................... ....................

80400 A Acth stimulation panel ...................................................................... .................... .................... .................... .................... ....................

80402 A Acth stimulation panel ...................................................................... .................... .................... .................... .................... ....................

67920

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

80406 A Acth stimulation panel ...................................................................... .................... .................... .................... .................... ....................

80408 A Aldosterone suppression eval .......................................................... .................... .................... .................... .................... ....................

80410 A Calcitonin stimul panel ..................................................................... .................... .................... .................... .................... ....................

80412 A CRH stimulation panel ..................................................................... .................... .................... .................... .................... ....................

80414 A Testosterone response .................................................................... .................... .................... .................... .................... ....................

80415 A Estradiol response panel ................................................................. .................... .................... .................... .................... ....................

80416 A Renin stimulation panel .................................................................... .................... .................... .................... .................... ....................

80417 A Renin stimulation panel .................................................................... .................... .................... .................... .................... ....................

80418 A Pituitary evaluation panel ................................................................. .................... .................... .................... .................... ....................

80420 A Dexamethasone panel ..................................................................... .................... .................... .................... .................... ....................

80422 A Glucagon tolerance panel ................................................................ .................... .................... .................... .................... ....................

80424 A Glucagon tolerance panel ................................................................ .................... .................... .................... .................... ....................

80426 A Gonadotropin hormone panel .......................................................... .................... .................... .................... .................... ....................

80428 A Growth hormone panel .................................................................... .................... .................... .................... .................... ....................

80430 A Growth hormone panel .................................................................... .................... .................... .................... .................... ....................

80432 A Insulin suppression panel ................................................................ .................... .................... .................... .................... ....................

80434 A Insulin tolerance panel ..................................................................... .................... .................... .................... .................... ....................

80435 A Insulin tolerance panel ..................................................................... .................... .................... .................... .................... ....................

80436 A Metyrapone panel ............................................................................ .................... .................... .................... .................... ....................

80438 A TRH stimulation panel ...................................................................... .................... .................... .................... .................... ....................

80439 A TRH stimulation panel ...................................................................... .................... .................... .................... .................... ....................

80440 A TRH stimulation panel ...................................................................... .................... .................... .................... .................... ....................

80500 X Lab pathology consultation .............................................................. 0343 0.45 $22.32 $12.16 $4.46

80502 X Lab pathology consultation .............................................................. 0343 0.45 $22.32 $12.16 $4.46

81000 A Urinalysis, nonauto w/scope ............................................................ .................... .................... .................... .................... ....................

81001 A Urinalysis, auto w/scope .................................................................. .................... .................... .................... .................... ....................

81002 A Urinalysis nonauto w/o scope .......................................................... .................... .................... .................... .................... ....................

81003 A Urinalysis, auto, w/o scope .............................................................. .................... .................... .................... .................... ....................

81005 A Urinalysis .......................................................................................... .................... .................... .................... .................... ....................

81007 A Urine screen for bacteria ................................................................. .................... .................... .................... .................... ....................

81015 A Microscopic exam of urine ............................................................... .................... .................... .................... .................... ....................

81020 A Urinalysis, glass test ........................................................................ .................... .................... .................... .................... ....................

81025 A Urine pregnancy test ........................................................................ .................... .................... .................... .................... ....................

81050 A Urinalysis, volume measure ............................................................. .................... .................... .................... .................... ....................

81099 X Urinalysis test procedure ................................................................. 0349 0.48 $23.65 $4.73 $4.73

82000 A Assay of blood acetaldehyde ........................................................... .................... .................... .................... .................... ....................

82003 A Assay of acetaminophen .................................................................. .................... .................... .................... .................... ....................

82009 A Test for acetone/ketones ................................................................. .................... .................... .................... .................... ....................

82010 A Acetone assay .................................................................................. .................... .................... .................... .................... ....................

82013 A Acetylcholinesterase assay .............................................................. .................... .................... .................... .................... ....................

82016 A Acylcarnitines, qual .......................................................................... .................... .................... .................... .................... ....................

82017 A Acylcarnitines, quant ........................................................................ .................... .................... .................... .................... ....................

82024 A Assay of acth ................................................................................... .................... .................... .................... .................... ....................

82030 A Assay of adp & amp ........................................................................ .................... .................... .................... .................... ....................

82040 A Assay of serum albumin .................................................................. .................... .................... .................... .................... ....................

82042 A Assay of urine albumin .................................................................... .................... .................... .................... .................... ....................

82043 A Microalbumin, quantitative ............................................................... .................... .................... .................... .................... ....................

82044 A Microalbumin, semiquant ................................................................. .................... .................... .................... .................... ....................

82055 A Assay of ethanol .............................................................................. .................... .................... .................... .................... ....................

82075 A Assay of breath ethanol ................................................................... .................... .................... .................... .................... ....................

82085 A Assay of aldolase ............................................................................. .................... .................... .................... .................... ....................

82088 A Assay of aldosterone ....................................................................... .................... .................... .................... .................... ....................

82101 A Assay of urine alkaloids ................................................................... .................... .................... .................... .................... ....................

82103 A Alpha-1-antitrypsin, total .................................................................. .................... .................... .................... .................... ....................

82104 A Alpha-1-antitrypsin, pheno ............................................................... .................... .................... .................... .................... ....................

82105 A Alpha-fetoprotein, serum .................................................................. .................... .................... .................... .................... ....................

82106 A Alpha-fetoprotein, amniotic .............................................................. .................... .................... .................... .................... ....................

82108 A Assay of aluminum ........................................................................... .................... .................... .................... .................... ....................

82120 A Amines, vaginal fluid qual ................................................................ .................... .................... .................... .................... ....................

82127 A Amino acid, single qual .................................................................... .................... .................... .................... .................... ....................

82128 A Amino acids, mult qual ..................................................................... .................... .................... .................... .................... ....................

82131 A Amino acids, single quant ................................................................ .................... .................... .................... .................... ....................

82135 A Assay, aminolevulinic acid ............................................................... .................... .................... .................... .................... ....................

82136 A Amino acids, quant, 2-5 ................................................................... .................... .................... .................... .................... ....................

82139 A Amino acids, quan, 6 or more ......................................................... .................... .................... .................... .................... ....................

82140 A Assay of ammonia ........................................................................... .................... .................... .................... .................... ....................

82143 A Amniotic fluid scan ........................................................................... .................... .................... .................... .................... ....................

82145 A Assay of amphetamines ................................................................... .................... .................... .................... .................... ....................

82150 A Assay of amylase ............................................................................. .................... .................... .................... .................... ....................

82154 A Androstanediol glucuronide .............................................................. .................... .................... .................... .................... ....................

82157 A Assay of androstenedione ............................................................... .................... .................... .................... .................... ....................

82160 A Assay of androsterone ..................................................................... .................... .................... .................... .................... ....................

82163 A Assay of angiotensin II ..................................................................... .................... .................... .................... .................... ....................

82164 A Angiotensin I enzyme test ................................................................ .................... .................... .................... .................... ....................

67921

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

82172 A Assay of apolipoprotein .................................................................... .................... .................... .................... .................... ....................

82175 A Assay of arsenic ............................................................................... .................... .................... .................... .................... ....................

82180 A Assay of ascorbic acid ..................................................................... .................... .................... .................... .................... ....................

82190 A Atomic absorption ............................................................................ .................... .................... .................... .................... ....................

82205 A Assay of barbiturates ....................................................................... .................... .................... .................... .................... ....................

82232 A Assay of beta-2 protein .................................................................... .................... .................... .................... .................... ....................

82239 A Bile acids, total ................................................................................. .................... .................... .................... .................... ....................

82240 A Bile acids, cholylglycine ................................................................... .................... .................... .................... .................... ....................

82247 A Bilirubin, total .................................................................................... .................... .................... .................... .................... ....................

82248 A Bilirubin, direct .................................................................................. .................... .................... .................... .................... ....................

82251D A Assay of bilirubin .............................................................................. .................... .................... .................... .................... ....................

82252 A Fecal bilirubin test ............................................................................ .................... .................... .................... .................... ....................

82261 A Assay of biotinidase ......................................................................... .................... .................... .................... .................... ....................

82270 A Test for blood, feces ........................................................................ .................... .................... .................... .................... ....................

82273 A Test for blood, other source ............................................................. .................... .................... .................... .................... ....................

82286 A Assay of bradykinin .......................................................................... .................... .................... .................... .................... ....................

82300 A Assay of cadmium ............................................................................ .................... .................... .................... .................... ....................

82306 A Assay of vitamin D ........................................................................... .................... .................... .................... .................... ....................

82307 A Assay of vitamin D ........................................................................... .................... .................... .................... .................... ....................

82308 A Assay of calcitonin ........................................................................... .................... .................... .................... .................... ....................

82310 A Assay of calcium .............................................................................. .................... .................... .................... .................... ....................

82330 A Assay of calcium .............................................................................. .................... .................... .................... .................... ....................

82331 A Calcium infusion test ........................................................................ .................... .................... .................... .................... ....................

82340 A Assay of calcium in urine ................................................................. .................... .................... .................... .................... ....................

82355 A Calculus (stone) analysis ................................................................. .................... .................... .................... .................... ....................

82360 A Calculus (stone) assay ..................................................................... .................... .................... .................... .................... ....................

82365 A Calculus (stone) assay ..................................................................... .................... .................... .................... .................... ....................

82370 A X-ray assay, calculus ....................................................................... .................... .................... .................... .................... ....................

*82373 A Carb deficient transferrin .................................................................. .................... .................... .................... .................... ....................

82374 A Assay, blood carbon dioxide ............................................................ .................... .................... .................... .................... ....................

82375 A Assay, blood carbon monoxide ........................................................ .................... .................... .................... .................... ....................

82376 A Test for carbon monoxide ................................................................ .................... .................... .................... .................... ....................

82378 A Carcinoembryonic antigen ............................................................... .................... .................... .................... .................... ....................

82379 A Assay of carnitine ............................................................................. .................... .................... .................... .................... ....................

82380 A Assay of carotene ............................................................................ .................... .................... .................... .................... ....................

82382 A Assay, urine catecholamines ........................................................... .................... .................... .................... .................... ....................

82383 A Assay, blood catecholamines .......................................................... .................... .................... .................... .................... ....................

82384 A Assay, three catecholamines ........................................................... .................... .................... .................... .................... ....................

82387 A Assay of cathepsin-d ........................................................................ .................... .................... .................... .................... ....................

82390 A Assay of ceruloplasmin .................................................................... .................... .................... .................... .................... ....................

82397 A Chemiluminescent assay ................................................................. .................... .................... .................... .................... ....................

82415 A Assay of chloramphenicol ................................................................ .................... .................... .................... .................... ....................

82435 A Assay of blood chloride .................................................................... .................... .................... .................... .................... ....................

82436 A Assay of urine chloride .................................................................... .................... .................... .................... .................... ....................

82438 A Assay, other fluid chlorides .............................................................. .................... .................... .................... .................... ....................

82441 A Test for chlorohydrocarbons ............................................................ .................... .................... .................... .................... ....................

82465 A Assay of serum cholesterol .............................................................. .................... .................... .................... .................... ....................

82480 A Assay, serum cholinesterase ........................................................... .................... .................... .................... .................... ....................

82482 A Assay, rbc cholinesterase ................................................................ .................... .................... .................... .................... ....................

82485 A Assay, chondroitin sulfate ................................................................ .................... .................... .................... .................... ....................

82486 A Gas/liquid chromatography .............................................................. .................... .................... .................... .................... ....................

82487 A Paper chromatography ..................................................................... .................... .................... .................... .................... ....................

82488 A Paper chromatography ..................................................................... .................... .................... .................... .................... ....................

82489 A Thin layer chromatography .............................................................. .................... .................... .................... .................... ....................

82491 A Chromotography, quant, sing ........................................................... .................... .................... .................... .................... ....................

82492 A Chromotography, quant, mult .......................................................... .................... .................... .................... .................... ....................

82495 A Assay of chromium .......................................................................... .................... .................... .................... .................... ....................

82507 A Assay of citrate ................................................................................ .................... .................... .................... .................... ....................

82520 A Assay of cocaine .............................................................................. .................... .................... .................... .................... ....................

82523 A Collagen crosslinks .......................................................................... .................... .................... .................... .................... ....................

82525 A Assay of copper ............................................................................... .................... .................... .................... .................... ....................

82528 A Assay of corticosterone .................................................................... .................... .................... .................... .................... ....................

82530 A Cortisol, free ..................................................................................... .................... .................... .................... .................... ....................

82533 A Total cortisol ..................................................................................... .................... .................... .................... .................... ....................

82540 A Assay of creatine ............................................................................. .................... .................... .................... .................... ....................

82541 A Column chromotography, qual ......................................................... .................... .................... .................... .................... ....................

82542 A Column chromotography, quant ....................................................... .................... .................... .................... .................... ....................

82543 A Column chromotograph/isotope ....................................................... .................... .................... .................... .................... ....................

82544 A Column chromotograph/isotope ....................................................... .................... .................... .................... .................... ....................

82550 A Assay of ck (cpk) ............................................................................. .................... .................... .................... .................... ....................

82552 A Assay of cpk in blood ....................................................................... .................... .................... .................... .................... ....................

82553 A Creatine, MB fraction ....................................................................... .................... .................... .................... .................... ....................

82554 A Creatine, isoforms ............................................................................ .................... .................... .................... .................... ....................

82565 A Assay of creatinine ........................................................................... .................... .................... .................... .................... ....................

67922

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

82570 A Assay of urine creatinine ................................................................. .................... .................... .................... .................... ....................

82575 A Creatinine clearance test ................................................................. .................... .................... .................... .................... ....................

82585 A Assay of cryofibrinogen .................................................................... .................... .................... .................... .................... ....................

82595 A Assay of cryoglobulin ....................................................................... .................... .................... .................... .................... ....................

82600 A Assay of cyanide .............................................................................. .................... .................... .................... .................... ....................

82607 A Vitamin B-12 ..................................................................................... .................... .................... .................... .................... ....................

82608 A B-12 binding capacity ....................................................................... .................... .................... .................... .................... ....................

82615 A Test for urine cystines ...................................................................... .................... .................... .................... .................... ....................

82626 A Dehydroepiandrosterone .................................................................. .................... .................... .................... .................... ....................

82627 A Dehydroepiandrosterone .................................................................. .................... .................... .................... .................... ....................

82633 A Desoxycorticosterone ....................................................................... .................... .................... .................... .................... ....................

82634 A Deoxycortisol .................................................................................... .................... .................... .................... .................... ....................

82638 A Assay of dibucaine number ............................................................. .................... .................... .................... .................... ....................

82646 A Assay of dihydrocodeinone .............................................................. .................... .................... .................... .................... ....................

82649 A Assay of dihydromorphinone ........................................................... .................... .................... .................... .................... ....................

82651 A Assay of dihydrotestosterone ........................................................... .................... .................... .................... .................... ....................

82652 A Assay of dihydroxyvitamin d ............................................................ .................... .................... .................... .................... ....................

82654 A Assay of dimethadione ..................................................................... .................... .................... .................... .................... ....................

82657 A Enzyme cell activity .......................................................................... .................... .................... .................... .................... ....................

82658 A Enzyme cell activity, ra .................................................................... .................... .................... .................... .................... ....................

82664 A Electrophoretic test .......................................................................... .................... .................... .................... .................... ....................

82666 A Assay of epiandrosterone ................................................................ .................... .................... .................... .................... ....................

82668 A Assay of erythropoietin .................................................................... .................... .................... .................... .................... ....................

82670 A Assay of estradiol ............................................................................. .................... .................... .................... .................... ....................

82671 A Assay of estrogens .......................................................................... .................... .................... .................... .................... ....................

82672 A Assay of estrogen ............................................................................ .................... .................... .................... .................... ....................

82677 A Assay of estriol ................................................................................. .................... .................... .................... .................... ....................

82679 A Assay of estrone .............................................................................. .................... .................... .................... .................... ....................

82690 A Assay of ethchlorvynol ..................................................................... .................... .................... .................... .................... ....................

82693 A Assay of ethylene glycol .................................................................. .................... .................... .................... .................... ....................

82696 A Assay of etiocholanolone ................................................................. .................... .................... .................... .................... ....................

82705 A Fats/lipids, feces, qual ..................................................................... .................... .................... .................... .................... ....................

82710 A Fats/lipids, feces, quant ................................................................... .................... .................... .................... .................... ....................

82715 A Assay of fecal fat ............................................................................. .................... .................... .................... .................... ....................

82725 A Assay of blood fatty acids ................................................................ .................... .................... .................... .................... ....................

82726 A Long chain fatty acids ...................................................................... .................... .................... .................... .................... ....................

82728 A Assay of ferritin ................................................................................ .................... .................... .................... .................... ....................

82731 A Assay of fetal fibronectin .................................................................. .................... .................... .................... .................... ....................

82735 A Assay of fluoride .............................................................................. .................... .................... .................... .................... ....................

82742 A Assay of flurazepam ........................................................................ .................... .................... .................... .................... ....................

82746 A Blood folic acid serum ...................................................................... .................... .................... .................... .................... ....................

82747 A Assay of folic acid, rbc ..................................................................... .................... .................... .................... .................... ....................

82757 A Assay of semen fructose ................................................................. .................... .................... .................... .................... ....................

82759 A Assay of rbc galactokinase .............................................................. .................... .................... .................... .................... ....................

82760 A Assay of galactose ........................................................................... .................... .................... .................... .................... ....................

82775 A Assay galactose transferase ............................................................ .................... .................... .................... .................... ....................

82776 A Galactose transferase test ............................................................... .................... .................... .................... .................... ....................

82784 A Assay of gammaglobulin igm ........................................................... .................... .................... .................... .................... ....................

82785 A Assay of gammaglobulin ige ............................................................ .................... .................... .................... .................... ....................

82787 A Igg 1, 2, 3 and 4 .............................................................................. .................... .................... .................... .................... ....................

82800 A Blood pH .......................................................................................... .................... .................... .................... .................... ....................

82803 A Blood gases: pH, pO2 & pCO2 ....................................................... .................... .................... .................... .................... ....................

82805 A Blood gases W/O2 saturation .......................................................... .................... .................... .................... .................... ....................

82810 A Blood gases, O2 sat only ................................................................. .................... .................... .................... .................... ....................

82820 A Hemoglobin-oxygen affinity .............................................................. .................... .................... .................... .................... ....................

82926 A Assay of gastric acid ........................................................................ .................... .................... .................... .................... ....................

82928 A Assay of gastric acid ........................................................................ .................... .................... .................... .................... ....................

82938 A Gastrin test ....................................................................................... .................... .................... .................... .................... ....................

82941 A Assay of gastrin ............................................................................... .................... .................... .................... .................... ....................

82943 A Assay of glucagon ............................................................................ .................... .................... .................... .................... ....................

*82945 A Glucose, body fluid other than blood ............................................... .................... .................... .................... .................... ....................

82946 A Glucagon tolerance test ................................................................... .................... .................... .................... .................... ....................

82947 A Assay of glucose, quant ................................................................... .................... .................... .................... .................... ....................

82948 A Reagent strip/blood glucose ............................................................ .................... .................... .................... .................... ....................

82950 A Glucose test ..................................................................................... .................... .................... .................... .................... ....................

82951 A Glucose tolerance test (GTT) .......................................................... .................... .................... .................... .................... ....................

82952 A GTT-added samples ........................................................................ .................... .................... .................... .................... ....................

82953 A Glucose-tolbutamide test ................................................................. .................... .................... .................... .................... ....................

82955 A Assay of g6pd enzyme .................................................................... .................... .................... .................... .................... ....................

82960 A Test for G6PD enzyme .................................................................... .................... .................... .................... .................... ....................

82962 A Glucose blood test ........................................................................... .................... .................... .................... .................... ....................

82963 A Assay of glucosidase ....................................................................... .................... .................... .................... .................... ....................

82965 A Assay of gdh enzyme ...................................................................... .................... .................... .................... .................... ....................

82975 A Assay of glutamine ........................................................................... .................... .................... .................... .................... ....................

67923

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

82977 A Assay of GGT .................................................................................. .................... .................... .................... .................... ....................

82978 A Assay of glutathione ......................................................................... .................... .................... .................... .................... ....................

82979 A Assay, rbc glutathione ...................................................................... .................... .................... .................... .................... ....................

82980 A Assay of glutethimide ....................................................................... .................... .................... .................... .................... ....................

82985 A Glycated protein ............................................................................... .................... .................... .................... .................... ....................

83001 A Gonadotropin (FSH) ......................................................................... .................... .................... .................... .................... ....................

83002 A Gonadotropin (LH) ........................................................................... .................... .................... .................... .................... ....................

83003 A Assay, growth hormone (hgh) .......................................................... .................... .................... .................... .................... ....................

83008 A Assay of guanosine .......................................................................... .................... .................... .................... .................... ....................

83010 A Assay of haptoglobin, quant ............................................................ .................... .................... .................... .................... ....................

83012 A Assay of haptoglobins ...................................................................... .................... .................... .................... .................... ....................

83013 A H pylori breath tst analysis .............................................................. .................... .................... .................... .................... ....................

83014 A H pylori drug admin/collect .............................................................. .................... .................... .................... .................... ....................

83015 A Heavy metal screen ......................................................................... .................... .................... .................... .................... ....................

83018 A Quantitative screen, metals ............................................................. .................... .................... .................... .................... ....................

83020 A Hemoglobin electrophoresis ............................................................. .................... .................... .................... .................... ....................

83021 A Hemoglobin chromotography ........................................................... .................... .................... .................... .................... ....................

83026 A Hemoglobin, copper sulfate ............................................................. .................... .................... .................... .................... ....................

83030 A Fetal hemoglobin assay ................................................................... .................... .................... .................... .................... ....................

83033 A Fetal fecal hemoglobin assay .......................................................... .................... .................... .................... .................... ....................

83036 A Glycated hemoglobin test ................................................................ .................... .................... .................... .................... ....................

83045 A Blood methemoglobin test ............................................................... .................... .................... .................... .................... ....................

83050 A Blood methemoglobin assay ............................................................ .................... .................... .................... .................... ....................

83051 A Assay of plasma hemoglobin ........................................................... .................... .................... .................... .................... ....................

83055 A Blood sulfhemoglobin test ................................................................ .................... .................... .................... .................... ....................

83060 A Blood sulfhemoglobin assay ............................................................ .................... .................... .................... .................... ....................

83065 A Assay of hemoglobin heat ............................................................... .................... .................... .................... .................... ....................

83068 A Hemoglobin stability screen ............................................................. .................... .................... .................... .................... ....................

83069 A Assay of urine hemoglobin .............................................................. .................... .................... .................... .................... ....................

83070 A Assay of hemosiderin, qual .............................................................. .................... .................... .................... .................... ....................

83071 A Assay of hemosiderin, quant ........................................................... .................... .................... .................... .................... ....................

83080 A Assay of b hexosaminidase ............................................................. .................... .................... .................... .................... ....................

83088 A Assay of histamine ........................................................................... .................... .................... .................... .................... ....................

*83090 A Homocystine ..................................................................................... .................... .................... .................... .................... ....................

83150 A Assay of for hva ............................................................................... .................... .................... .................... .................... ....................

83491 A Assay of corticosteroids ................................................................... .................... .................... .................... .................... ....................

83497 A Assay of 5-hiaa ................................................................................ .................... .................... .................... .................... ....................

83498 A Assay of progesterone ..................................................................... .................... .................... .................... .................... ....................

83499 A Assay of progesterone ..................................................................... .................... .................... .................... .................... ....................

83500 A Assay, free hydroxyproline ............................................................... .................... .................... .................... .................... ....................

83505 A Assay, total hydroxyproline .............................................................. .................... .................... .................... .................... ....................

83516 A Immunoassay, nonantibody ............................................................. .................... .................... .................... .................... ....................

83518 A Immunoassay, dipstick ..................................................................... .................... .................... .................... .................... ....................

83519 A Immunoassay, nonantibody ............................................................. .................... .................... .................... .................... ....................

83520 A Immunoassay, RIA ........................................................................... .................... .................... .................... .................... ....................

83525 A Assay of insulin ................................................................................ .................... .................... .................... .................... ....................

83527 A Assay of insulin ................................................................................ .................... .................... .................... .................... ....................

83528 A Assay of intrinsic factor .................................................................... .................... .................... .................... .................... ....................

83540 A Assay of iron .................................................................................... .................... .................... .................... .................... ....................

83550 A Iron binding test ............................................................................... .................... .................... .................... .................... ....................

83570 A Assay of idh enzyme ........................................................................ .................... .................... .................... .................... ....................

83582 A Assay of ketogenic steroids ............................................................. .................... .................... .................... .................... ....................

83586 A Assay 17- ketosteroids ..................................................................... .................... .................... .................... .................... ....................

83593 A Fractionation, ketosteroids ............................................................... .................... .................... .................... .................... ....................

83605 A Assay of lactic acid .......................................................................... .................... .................... .................... .................... ....................

83615 A Lactate (LD) (LDH) enzyme ............................................................. .................... .................... .................... .................... ....................

83625 A Assay of ldh enzymes ...................................................................... .................... .................... .................... .................... ....................

83632 A Placental lactogen ............................................................................ .................... .................... .................... .................... ....................

83633 A Test urine for lactose ....................................................................... .................... .................... .................... .................... ....................

83634 A Assay of urine for lactose ................................................................ .................... .................... .................... .................... ....................

83655 A Assay of lead ................................................................................... .................... .................... .................... .................... ....................

83661 A Assay of l/s ratio .............................................................................. .................... .................... .................... .................... ....................

83662 A L/S ratio, foam stability .................................................................... .................... .................... .................... .................... ....................

*83663 A Fetal lung maturity, fluor polar ......................................................... .................... .................... .................... .................... ....................

*83664 A Fetal lung maturity, lam body dens ................................................. .................... .................... .................... .................... ....................

83670 A Assay of lap enzyme ........................................................................ .................... .................... .................... .................... ....................

83690 A Assay of lipase ................................................................................. .................... .................... .................... .................... ....................

83715 A Assay of blood lipoproteins .............................................................. .................... .................... .................... .................... ....................

83716 A Assay of blood lipoproteins .............................................................. .................... .................... .................... .................... ....................

83718 A Assay of lipoprotein .......................................................................... .................... .................... .................... .................... ....................

83719 A Assay of blood lipoprotein ................................................................ .................... .................... .................... .................... ....................

83721 A Assay of blood lipoprotein ................................................................ .................... .................... .................... .................... ....................

83727 A Assay of lrh hormone ....................................................................... .................... .................... .................... .................... ....................

83735 A Assay of magnesium ........................................................................ .................... .................... .................... .................... ....................

67924

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

83775 A Assay of md enzyme ....................................................................... .................... .................... .................... .................... ....................

83785 A Assay of manganese ....................................................................... .................... .................... .................... .................... ....................

83788 A Mass spectrometry qual ................................................................... .................... .................... .................... .................... ....................

83789 A Mass spectrometry quant ................................................................. .................... .................... .................... .................... ....................

83805 A Assay of meprobamate .................................................................... .................... .................... .................... .................... ....................

83825 A Assay of mercury ............................................................................. .................... .................... .................... .................... ....................

83835 A Assay of metanephrines .................................................................. .................... .................... .................... .................... ....................

83840 A Assay of methadone ........................................................................ .................... .................... .................... .................... ....................

83857 A Assay of methemalbumin ................................................................. .................... .................... .................... .................... ....................

83858 A Assay of methsuximide .................................................................... .................... .................... .................... .................... ....................

83864 A Mucopolysaccharides ....................................................................... .................... .................... .................... .................... ....................

83866 A Mucopolysaccharides screen ........................................................... .................... .................... .................... .................... ....................

83872 A Assay synovial fluid mucin ............................................................... .................... .................... .................... .................... ....................

83873 A Assay of csf protein ......................................................................... .................... .................... .................... .................... ....................

83874 A Assay of myoglobin .......................................................................... .................... .................... .................... .................... ....................

83883 A Assay, nephelometry not spec ......................................................... .................... .................... .................... .................... ....................

83885 A Assay of nickel ................................................................................. .................... .................... .................... .................... ....................

83887 A Assay of nicotine .............................................................................. .................... .................... .................... .................... ....................

83890 A Molecule isolate ............................................................................... .................... .................... .................... .................... ....................

83891 A Molecule isolate nucleic ................................................................... .................... .................... .................... .................... ....................

83892 A Molecular diagnostics ....................................................................... .................... .................... .................... .................... ....................

83893 A Molecule dot/slot/blot ....................................................................... .................... .................... .................... .................... ....................

83894 A Molecule gel electrophor .................................................................. .................... .................... .................... .................... ....................

83896 A Molecular diagnostics ....................................................................... .................... .................... .................... .................... ....................

83897 A Molecule nucleic transfer ................................................................. .................... .................... .................... .................... ....................

83898 A Molecule nucleic ampli ..................................................................... .................... .................... .................... .................... ....................

83901 A Molecule nucleic ampli ..................................................................... .................... .................... .................... .................... ....................

83902 A Molecular diagnostics ....................................................................... .................... .................... .................... .................... ....................

83903 A Molecule mutation scan ................................................................... .................... .................... .................... .................... ....................

83904 A Molecule mutation identify ............................................................... .................... .................... .................... .................... ....................

83905 A Molecule mutation identify ............................................................... .................... .................... .................... .................... ....................

83906 A Molecule mutation identify ............................................................... .................... .................... .................... .................... ....................

83912 A Genetic examination ........................................................................ .................... .................... .................... .................... ....................

83915 A Assay of nucleotidase ...................................................................... .................... .................... .................... .................... ....................

83916 A Oligoclonal bands ............................................................................. .................... .................... .................... .................... ....................

83918 A Assay, organic acids quant .............................................................. .................... .................... .................... .................... ....................

83919 A Assay, organic acids qual ................................................................ .................... .................... .................... .................... ....................

*83921 A Assay, organic acid, single, quant ................................................... .................... .................... .................... .................... ....................

83925 A Assay of opiates ............................................................................... .................... .................... .................... .................... ....................

83930 A Assay of blood osmolality ................................................................ .................... .................... .................... .................... ....................

83935 A Assay of urine osmolality ................................................................. .................... .................... .................... .................... ....................

83937 A Assay of osteocalcin ........................................................................ .................... .................... .................... .................... ....................

83945 A Assay of oxalate ............................................................................... .................... .................... .................... .................... ....................

83970 A Assay of parathormone .................................................................... .................... .................... .................... .................... ....................

83986 A Assay of body fluid acidity ............................................................... .................... .................... .................... .................... ....................

83992 A Assay for phencyclidine ................................................................... .................... .................... .................... .................... ....................

84022 A Assay of phenothiazine .................................................................... .................... .................... .................... .................... ....................

84030 A Assay of blood pku .......................................................................... .................... .................... .................... .................... ....................

84035 A Assay of phenylketones ................................................................... .................... .................... .................... .................... ....................

84060 A Assay acid phosphatase .................................................................. .................... .................... .................... .................... ....................

84061 A Phosphatase, forensic exam ............................................................ .................... .................... .................... .................... ....................

84066 A Assay prostate phosphatase ............................................................ .................... .................... .................... .................... ....................

84075 A Assay alkaline phosphatase ............................................................ .................... .................... .................... .................... ....................

84078 A Assay alkaline phosphatase ............................................................ .................... .................... .................... .................... ....................

84080 A Assay alkaline phosphatases ........................................................... .................... .................... .................... .................... ....................

84081 A Amniotic fluid enzyme test ............................................................... .................... .................... .................... .................... ....................

84085 A Assay of rbc pg6d enzyme .............................................................. .................... .................... .................... .................... ....................

84087 A Assay phosphohexose enzymes ..................................................... .................... .................... .................... .................... ....................

84100 A Assay of phosphorus ....................................................................... .................... .................... .................... .................... ....................

84105 A Assay of urine phosphorus .............................................................. .................... .................... .................... .................... ....................

84106 A Test for porphobilinogen .................................................................. .................... .................... .................... .................... ....................

84110 A Assay of porphobilinogen ................................................................. .................... .................... .................... .................... ....................

84119 A Test urine for porphyrins .................................................................. .................... .................... .................... .................... ....................

84120 A Assay of urine porphyrins ................................................................ .................... .................... .................... .................... ....................

84126 A Assay of feces porphyrins ................................................................ .................... .................... .................... .................... ....................

84127 A Assay of feces porphyrins ................................................................ .................... .................... .................... .................... ....................

84132 A Assay of serum potassium ............................................................... .................... .................... .................... .................... ....................

84133 A Assay of urine potassium ................................................................. .................... .................... .................... .................... ....................

84134 A Assay of prealbumin ........................................................................ .................... .................... .................... .................... ....................

84135 A Assay of pregnanediol ..................................................................... .................... .................... .................... .................... ....................

84138 A Assay of pregnanetriol ..................................................................... .................... .................... .................... .................... ....................

84140 A Assay of pregnenolone .................................................................... .................... .................... .................... .................... ....................

84143 A Assay of 17-hydroxypregneno ......................................................... .................... .................... .................... .................... ....................

84144 A Assay of progesterone ..................................................................... .................... .................... .................... .................... ....................

67925

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

84146 A Assay of prolactin ............................................................................. .................... .................... .................... .................... ....................

84150 A Assay of prostaglandin ..................................................................... .................... .................... .................... .................... ....................

*84152 A PSA, complexed ............................................................................... .................... .................... .................... .................... ....................

84153 A Assay of psa, total ........................................................................... .................... .................... .................... .................... ....................

84154 A Assay of psa, free ............................................................................ .................... .................... .................... .................... ....................

84155 A Assay of protein ............................................................................... .................... .................... .................... .................... ....................

84160 A Assay of serum protein .................................................................... .................... .................... .................... .................... ....................

84165 A Assay of serum proteins .................................................................. .................... .................... .................... .................... ....................

84181 A Western blot test .............................................................................. .................... .................... .................... .................... ....................

84182 A Protein, western blot test ................................................................. .................... .................... .................... .................... ....................

84202 A Assay RBC protoporphyrin .............................................................. .................... .................... .................... .................... ....................

84203 A Test RBC protoporphyrin ................................................................. .................... .................... .................... .................... ....................

84206 A Assay of proinsulin ........................................................................... .................... .................... .................... .................... ....................

84207 A Assay of vitamin b-6 ........................................................................ .................... .................... .................... .................... ....................

84210 A Assay of pyruvate ............................................................................ .................... .................... .................... .................... ....................

84220 A Assay of pyruvate kinase ................................................................. .................... .................... .................... .................... ....................

84228 A Assay of quinine ............................................................................... .................... .................... .................... .................... ....................

84233 A Assay of estrogen ............................................................................ .................... .................... .................... .................... ....................

84234 A Assay of progesterone ..................................................................... .................... .................... .................... .................... ....................

84235 A Assay of endocrine hormone ........................................................... .................... .................... .................... .................... ....................

84238 A Assay, nonendocrine receptor ......................................................... .................... .................... .................... .................... ....................

84244 A Assay of renin .................................................................................. .................... .................... .................... .................... ....................

84252 A Assay of vitamin b-2 ........................................................................ .................... .................... .................... .................... ....................

84255 A Assay of selenium ............................................................................ .................... .................... .................... .................... ....................

84260 A Assay of serotonin ........................................................................... .................... .................... .................... .................... ....................

84270 A Assay of sex hormone globul .......................................................... .................... .................... .................... .................... ....................

84275 A Assay of sialic acid .......................................................................... .................... .................... .................... .................... ....................

84285 A Assay of silica .................................................................................. .................... .................... .................... .................... ....................

84295 A Assay of serum sodium ................................................................... .................... .................... .................... .................... ....................

84300 A Assay of urine sodium ..................................................................... .................... .................... .................... .................... ....................

84305 A Assay of somatomedin ..................................................................... .................... .................... .................... .................... ....................

84307 A Assay of somatostatin ...................................................................... .................... .................... .................... .................... ....................

84311 A Spectrophotometry ........................................................................... .................... .................... .................... .................... ....................

84315 A Body fluid specific gravity ................................................................ .................... .................... .................... .................... ....................

84375 A Chromatogram assay, sugars .......................................................... .................... .................... .................... .................... ....................

84376 A Sugars, single, qual ......................................................................... .................... .................... .................... .................... ....................

84377 A Sugars, multiple, qual ...................................................................... .................... .................... .................... .................... ....................

84378 A Sugars single quant ......................................................................... .................... .................... .................... .................... ....................

84379 A Sugars multiple quant ...................................................................... .................... .................... .................... .................... ....................

84392 A Assay of urine sulfate ...................................................................... .................... .................... .................... .................... ....................

84402 A Assay of testosterone ...................................................................... .................... .................... .................... .................... ....................

84403 A Assay of total testosterone .............................................................. .................... .................... .................... .................... ....................

84425 A Assay of vitamin b-1 ........................................................................ .................... .................... .................... .................... ....................

84430 A Assay of thiocyanate ........................................................................ .................... .................... .................... .................... ....................

84432 A Assay of thyroglobulin ...................................................................... .................... .................... .................... .................... ....................

84436 A Assay of total thyroxine .................................................................... .................... .................... .................... .................... ....................

84437 A Assay of neonatal thyroxine ............................................................. .................... .................... .................... .................... ....................

84439 A Assay of free thyroxine .................................................................... .................... .................... .................... .................... ....................

84442 A Assay of thyroid activity ................................................................... .................... .................... .................... .................... ....................

84443 A Assay thyroid stim hormone ............................................................ .................... .................... .................... .................... ....................

84445 A Assay of tsi ....................................................................................... .................... .................... .................... .................... ....................

84446 A Assay of vitamin e ............................................................................ .................... .................... .................... .................... ....................

84449 A Assay of transcortin ......................................................................... .................... .................... .................... .................... ....................

84450 A Transferase (AST) (SGOT) .............................................................. .................... .................... .................... .................... ....................

84460 A Alanine amino (ALT) (SGPT) ........................................................... .................... .................... .................... .................... ....................

84466 A Assay of transferrin .......................................................................... .................... .................... .................... .................... ....................

84478 A Assay of triglycerides ....................................................................... .................... .................... .................... .................... ....................

84479 A Assay of thyroid (t3 or t4) ................................................................ .................... .................... .................... .................... ....................

84480 A Assay, triiodothyronine (t3) .............................................................. .................... .................... .................... .................... ....................

84481 A Free assay (FT-3) ............................................................................ .................... .................... .................... .................... ....................

84482 A T3 reverse ........................................................................................ .................... .................... .................... .................... ....................

84484 A Assay of troponin, quant .................................................................. .................... .................... .................... .................... ....................

84485 A Assay duodenal fluid trypsin ............................................................ .................... .................... .................... .................... ....................

84488 A Test feces for trypsin ....................................................................... .................... .................... .................... .................... ....................

84490 A Assay of feces for trypsin ................................................................ .................... .................... .................... .................... ....................

84510 A Assay of tyrosine .............................................................................. .................... .................... .................... .................... ....................

84512 A Assay of troponin, qual .................................................................... .................... .................... .................... .................... ....................

84520 A Assay of urea nitrogen ..................................................................... .................... .................... .................... .................... ....................

84525 A Urea nitrogen semi-quant ................................................................ .................... .................... .................... .................... ....................

84540 A Assay of urine/urea-n ....................................................................... .................... .................... .................... .................... ....................

84545 A Urea-N clearance test ...................................................................... .................... .................... .................... .................... ....................

84550 A Assay of blood/uric acid ................................................................... .................... .................... .................... .................... ....................

84560 A Assay of urine/uric acid .................................................................... .................... .................... .................... .................... ....................

84577 A Assay of feces/urobilinogen ............................................................. .................... .................... .................... .................... ....................

67926

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

84578 A Test urine urobilinogen .................................................................... .................... .................... .................... .................... ....................

84580 A Assay of urine urobilinogen ............................................................. .................... .................... .................... .................... ....................

84583 A Assay of urine urobilinogen ............................................................. .................... .................... .................... .................... ....................

84585 A Assay of urine vma .......................................................................... .................... .................... .................... .................... ....................

84586 A Assay of vip ...................................................................................... .................... .................... .................... .................... ....................

84588 A Assay of vasopressin ....................................................................... .................... .................... .................... .................... ....................

84590 A Assay of vitamin a ............................................................................ .................... .................... .................... .................... ....................

*84591 A Vitamin, NOS ................................................................................... .................... .................... .................... .................... ....................

84597 A Assay of vitamin k ............................................................................ .................... .................... .................... .................... ....................

84600 A Assay of volatiles ............................................................................. .................... .................... .................... .................... ....................

84620 A Xylose tolerance test ........................................................................ .................... .................... .................... .................... ....................

84630 A Assay of zinc .................................................................................... .................... .................... .................... .................... ....................

84681 A Assay of c-peptide ........................................................................... .................... .................... .................... .................... ....................

84702 A Chorionic gonadotropin test ............................................................. .................... .................... .................... .................... ....................

84703 A Chorionic gonadotropin assay ......................................................... .................... .................... .................... .................... ....................

84830 A Ovulation tests ................................................................................. .................... .................... .................... .................... ....................

84999 X Clinical chemistry test ...................................................................... 0349 0.48 $23.65 $4.73 $4.73

85002 A Bleeding time test ............................................................................ .................... .................... .................... .................... ....................

85007 A Differential WBC count ..................................................................... .................... .................... .................... .................... ....................

85008 A Nondifferential WBC count ............................................................... .................... .................... .................... .................... ....................

85009 A Differential WBC count ..................................................................... .................... .................... .................... .................... ....................

85013 A Hematocrit ........................................................................................ .................... .................... .................... .................... ....................

85014 A Hematocrit ........................................................................................ .................... .................... .................... .................... ....................

85018 A Hemoglobin ...................................................................................... .................... .................... .................... .................... ....................

85021 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85022 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85023 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85024 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85025 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85027 A Automated hemogram ...................................................................... .................... .................... .................... .................... ....................

85031 A Manual hemogram, cbc ................................................................... .................... .................... .................... .................... ....................

85041 A Red blood cell (RBC) count ............................................................. .................... .................... .................... .................... ....................

85044 A Reticulocyte count ............................................................................ .................... .................... .................... .................... ....................

85045 A Reticulocyte count ............................................................................ .................... .................... .................... .................... ....................

85046 A Reticyte/hgb concentrate ................................................................. .................... .................... .................... .................... ....................

85048 A White blood cell (WBC) count .......................................................... .................... .................... .................... .................... ....................

85060 X Blood smear interpretation ............................................................... 0342 0.26 $12.90 $8.03 $2.58

85095 T Bone marrow aspiration ................................................................... 0003 0.98 $48.61 $27.99 $9.72

85097 X Bone marrow interpretation .............................................................. 0344 0.79 $39.18 $23.63 $7.84

85102 T Bone marrow biopsy ........................................................................ 0003 0.98 $48.61 $27.99 $9.72

85130 A Chromogenic substrate assay ......................................................... .................... .................... .................... .................... ....................

85170 A Blood clot retraction ......................................................................... .................... .................... .................... .................... ....................

85175 A Blood clot lysis time ......................................................................... .................... .................... .................... .................... ....................

85210 A Blood clot factor II test ..................................................................... .................... .................... .................... .................... ....................

85220 A Blood clot factor V test ..................................................................... .................... .................... .................... .................... ....................

85230 A Blood clot factor VII test ................................................................... .................... .................... .................... .................... ....................

85240 A Blood clot factor VIII test .................................................................. .................... .................... .................... .................... ....................

85244 A Blood clot factor VIII test .................................................................. .................... .................... .................... .................... ....................

85245 A Blood clot factor VIII test .................................................................. .................... .................... .................... .................... ....................

85246 A Blood clot factor VIII test .................................................................. .................... .................... .................... .................... ....................

85247 A Blood clot factor VIII test .................................................................. .................... .................... .................... .................... ....................

85250 A Blood clot factor IX test .................................................................... .................... .................... .................... .................... ....................

85260 A Blood clot factor X test ..................................................................... .................... .................... .................... .................... ....................

85270 A Blood clot factor XI test .................................................................... .................... .................... .................... .................... ....................

85280 A Blood clot factor XII test ................................................................... .................... .................... .................... .................... ....................

85290 A Blood clot factor XIII test .................................................................. .................... .................... .................... .................... ....................

85291 A Blood clot factor XIII test .................................................................. .................... .................... .................... .................... ....................

85292 A Blood clot factor assay ..................................................................... .................... .................... .................... .................... ....................

85293 A Blood clot factor assay ..................................................................... .................... .................... .................... .................... ....................

85300 A Antithrombin III test .......................................................................... .................... .................... .................... .................... ....................

85301 A Antithrombin III test .......................................................................... .................... .................... .................... .................... ....................

85302 A Blood clot inhibitor antigen ............................................................... .................... .................... .................... .................... ....................

85303 A Blood clot inhibitor test ..................................................................... .................... .................... .................... .................... ....................

85305 A Blood clot inhibitor assay ................................................................. .................... .................... .................... .................... ....................

85306 A Blood clot inhibitor test ..................................................................... .................... .................... .................... .................... ....................

*85307 A Activated protein C resistance ......................................................... .................... .................... .................... .................... ....................

85335 A Factor inhibitor test .......................................................................... .................... .................... .................... .................... ....................

85337 A Thrombomodulin .............................................................................. .................... .................... .................... .................... ....................

85345 A Coagulation time .............................................................................. .................... .................... .................... .................... ....................

85347 A Coagulation time .............................................................................. .................... .................... .................... .................... ....................

85348 A Coagulation time .............................................................................. .................... .................... .................... .................... ....................

85360 A Euglobulin lysis ................................................................................ .................... .................... .................... .................... ....................

85362 A Fibrin degradation products ............................................................. .................... .................... .................... .................... ....................

85366 A Fibrinogen test ................................................................................. .................... .................... .................... .................... ....................

67927

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

85370 A Fibrinogen test ................................................................................. .................... .................... .................... .................... ....................

85378 A Fibrin degradation ............................................................................ .................... .................... .................... .................... ....................

85379 A Fibrin degradation ............................................................................ .................... .................... .................... .................... ....................

85384 A Fibrinogen ........................................................................................ .................... .................... .................... .................... ....................

85385 A Fibrinogen ........................................................................................ .................... .................... .................... .................... ....................

85390 A Fibrinolysins screen ......................................................................... .................... .................... .................... .................... ....................

85400 A Fibrinolytic plasmin ........................................................................... .................... .................... .................... .................... ....................

85410 A Fibrinolytic antiplasmin ..................................................................... .................... .................... .................... .................... ....................

85415 A Fibrinolytic plasminogen ................................................................... .................... .................... .................... .................... ....................

85420 A Fibrinolytic plasminogen ................................................................... .................... .................... .................... .................... ....................

85421 A Fibrinolytic plasminogen ................................................................... .................... .................... .................... .................... ....................

85441 A Heinz bodies, direct ......................................................................... .................... .................... .................... .................... ....................

85445 A Heinz bodies, induced ...................................................................... .................... .................... .................... .................... ....................

85460 A Hemoglobin, fetal ............................................................................. .................... .................... .................... .................... ....................

85461 A Hemoglobin, fetal ............................................................................. .................... .................... .................... .................... ....................

85475 A Hemolysin ......................................................................................... .................... .................... .................... .................... ....................

85520 A Heparin assay .................................................................................. .................... .................... .................... .................... ....................

85525 A Heparin ............................................................................................. .................... .................... .................... .................... ....................

85530 A Heparin-protamine tolerance ............................................................ .................... .................... .................... .................... ....................

85535 A Iron stain, blood cells ....................................................................... .................... .................... .................... .................... ....................

*85536 A Iron stain, peripheral blood .............................................................. .................... .................... .................... .................... ....................

85540 A Wbc alkaline phosphatase ............................................................... .................... .................... .................... .................... ....................

85547 A RBC mechanical fragility .................................................................. .................... .................... .................... .................... ....................

85549 A Muramidase ...................................................................................... .................... .................... .................... .................... ....................

85555 A RBC osmotic fragility ........................................................................ .................... .................... .................... .................... ....................

85557 A RBC osmotic fragility ........................................................................ .................... .................... .................... .................... ....................

85576 A Blood platelet aggregation ............................................................... .................... .................... .................... .................... ....................

85585 A Blood platelet estimation .................................................................. .................... .................... .................... .................... ....................

85590 A Platelet count, manual ..................................................................... .................... .................... .................... .................... ....................

85595 A Platelet count, automated ................................................................ .................... .................... .................... .................... ....................

85597 A Platelet neutralization ....................................................................... .................... .................... .................... .................... ....................

85610 A Prothrombin time .............................................................................. .................... .................... .................... .................... ....................

85611 A Prothrombin test ............................................................................... .................... .................... .................... .................... ....................

85612 A Viper venom prothrombin time ......................................................... .................... .................... .................... .................... ....................

85613 A Russell viper venom, diluted ............................................................ .................... .................... .................... .................... ....................

85635 A Reptilase test ................................................................................... .................... .................... .................... .................... ....................

85651 A Rbc sed rate, nonautomated ........................................................... .................... .................... .................... .................... ....................

85652 A Rbc sed rate, automated ................................................................. .................... .................... .................... .................... ....................

85660 A RBC sickle cell test .......................................................................... .................... .................... .................... .................... ....................

85670 A Thrombin time, plasma .................................................................... .................... .................... .................... .................... ....................

85675 A Thrombin time, titer .......................................................................... .................... .................... .................... .................... ....................

85705 A Thromboplastin inhibition ................................................................. .................... .................... .................... .................... ....................

85730 A Thromboplastin time, partial ............................................................. .................... .................... .................... .................... ....................

85732 A Thromboplastin time, partial ............................................................. .................... .................... .................... .................... ....................

85810 A Blood viscosity examination ............................................................. .................... .................... .................... .................... ....................

85999 X Hematology procedure ..................................................................... 0349 0.48 $23.65 $4.73 $4.73

86000 A Agglutinins, febrile ............................................................................ .................... .................... .................... .................... ....................

*86001 A Allergen specific IgE, quant/semiquant ............................................ .................... .................... .................... .................... ....................

86003 A Allergen specific IgE ........................................................................ .................... .................... .................... .................... ....................

86005 A Allergen specific IgE ........................................................................ .................... .................... .................... .................... ....................

86021 A WBC antibody identification ............................................................. .................... .................... .................... .................... ....................

86022 A Platelet antibodies ............................................................................ .................... .................... .................... .................... ....................

86023 A Immunoglobulin assay ..................................................................... .................... .................... .................... .................... ....................

86038 A Antinuclear antibodies ...................................................................... .................... .................... .................... .................... ....................

86039 A Antinuclear antibodies (ANA) ........................................................... .................... .................... .................... .................... ....................

86060 A Antistreptolysin o, titer ...................................................................... .................... .................... .................... .................... ....................

86063 A Antistreptolysin o, screen ................................................................. .................... .................... .................... .................... ....................

86077 X Physician blood bank service .......................................................... 0343 0.45 $22.32 $12.16 $4.46

86078 X Physician blood bank service .......................................................... 0344 0.79 $39.18 $23.63 $7.84

86079 X Physician blood bank service .......................................................... 0344 0.79 $39.18 $23.63 $7.84

86140 A C-reactive protein ............................................................................. .................... .................... .................... .................... ....................

*86146 A Beta 2 glycoprotein I antibody ......................................................... .................... .................... .................... .................... ....................

86147 A Cardiolipin antibody .......................................................................... .................... .................... .................... .................... ....................

86148 A Phospholipid antibody ...................................................................... .................... .................... .................... .................... ....................

86155 A Chemotaxis assay ............................................................................ .................... .................... .................... .................... ....................

86156 A Cold agglutinin, screen .................................................................... .................... .................... .................... .................... ....................

86157 A Cold agglutinin, titer ......................................................................... .................... .................... .................... .................... ....................

86160 A Complement, antigen ....................................................................... .................... .................... .................... .................... ....................

86161 A Complement/function activity ........................................................... .................... .................... .................... .................... ....................

86162 A Complement, total (CH50) ............................................................... .................... .................... .................... .................... ....................

86171 A Complement fixation, each .............................................................. .................... .................... .................... .................... ....................

86185 A Counterimmunoelectrophoresis ....................................................... .................... .................... .................... .................... ....................

86215 A Deoxyribonuclease, antibody ........................................................... .................... .................... .................... .................... ....................

86225 A DNA antibody ................................................................................... .................... .................... .................... .................... ....................

67928

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

86226 A DNA antibody, single strand ............................................................ .................... .................... .................... .................... ....................

86235 A Nuclear antigen antibody ................................................................. .................... .................... .................... .................... ....................

86243 A Fc receptor ....................................................................................... .................... .................... .................... .................... ....................

86255 A Fluorescent antibody, screen ........................................................... .................... .................... .................... .................... ....................

86256 A Fluorescent antibody, titer ................................................................ .................... .................... .................... .................... ....................

86277 A Growth hormone antibody ................................................................ .................... .................... .................... .................... ....................

86280 A Hemagglutination inhibition .............................................................. .................... .................... .................... .................... ....................

*86294 A Tumor antigen, qual or semiquant ................................................... .................... .................... .................... .................... ....................

*86300 A Tumor antigen, quant; CA 15-3 ....................................................... .................... .................... .................... .................... ....................

*86301 A Tumor antigen, quant; CA 19-9 ....................................................... .................... .................... .................... .................... ....................

*86304 A Tumor antigen, quant; CA 125 ........................................................ .................... .................... .................... .................... ....................

86308 A Heterophile antibodies ..................................................................... .................... .................... .................... .................... ....................

86309 A Heterophile antibodies ..................................................................... .................... .................... .................... .................... ....................

86310 A Heterophile antibodies ..................................................................... .................... .................... .................... .................... ....................

86316 A Immunoassay, tumor antigen ........................................................... .................... .................... .................... .................... ....................

86317 A Immunoassay,infectious agent ......................................................... .................... .................... .................... .................... ....................

86318 A Immunoassay,infectious agent ......................................................... .................... .................... .................... .................... ....................

86320 A Serum immunoelectrophoresis ........................................................ .................... .................... .................... .................... ....................

86325 A Other immunoelectrophoresis .......................................................... .................... .................... .................... .................... ....................

86327 A Immunoelectrophoresis assay ......................................................... .................... .................... .................... .................... ....................

86329 A Immunodiffusion ............................................................................... .................... .................... .................... .................... ....................

86331 A Immunodiffusion ouchterlony ........................................................... .................... .................... .................... .................... ....................

86332 A Immune complex assay ................................................................... .................... .................... .................... .................... ....................

86334 A Immunofixation procedure ................................................................ .................... .................... .................... .................... ....................

86337 A Insulin antibodies ............................................................................. .................... .................... .................... .................... ....................

86340 A Intrinsic factor antibody .................................................................... .................... .................... .................... .................... ....................

86341 A Islet cell antibody ............................................................................. .................... .................... .................... .................... ....................

86343 A Leukocyte histamine release ........................................................... .................... .................... .................... .................... ....................

86344 A Leukocyte phagocytosis ................................................................... .................... .................... .................... .................... ....................

86353 A Lymphocyte transformation .............................................................. .................... .................... .................... .................... ....................

86359 A T cells, total count ............................................................................ .................... .................... .................... .................... ....................

86360 A T cell, absolute count/ratio ............................................................... .................... .................... .................... .................... ....................

86361 A T cell, absolute count ....................................................................... .................... .................... .................... .................... ....................

86376 A Microsomal antibody ........................................................................ .................... .................... .................... .................... ....................

86378 A Migration inhibitory factor ................................................................. .................... .................... .................... .................... ....................

86382 A Neutralization test, viral .................................................................... .................... .................... .................... .................... ....................

86384 A Nitroblue tetrazolium dye ................................................................. .................... .................... .................... .................... ....................

86403 A Particle agglutination test ................................................................. .................... .................... .................... .................... ....................

86406 A Particle agglutination test ................................................................. .................... .................... .................... .................... ....................

86430 A Rheumatoid factor test ..................................................................... .................... .................... .................... .................... ....................

86431 A Rheumatoid factor, quant ................................................................. .................... .................... .................... .................... ....................

86485 X Skin test, candida ............................................................................. 0341 0.13 $6.44 $3.67 $1.29

86490 X Coccidioidomycosis skin test ........................................................... 0341 0.13 $6.44 $3.67 $1.29

86510 X Histoplasmosis skin test ................................................................... 0341 0.13 $6.44 $3.67 $1.29

86580 X TB intradermal test ........................................................................... 0341 0.13 $6.44 $3.67 $1.29

86585 X TB tine test ....................................................................................... 0341 0.13 $6.44 $3.67 $1.29

86586 X Skin test, unlisted ............................................................................. 0341 0.13 $6.44 $3.67 $1.29

86590 A Streptokinase, antibody .................................................................... .................... .................... .................... .................... ....................

86592 A Blood serology, qualitative ............................................................... .................... .................... .................... .................... ....................

86593 A Blood serology, quantitative ............................................................. .................... .................... .................... .................... ....................

86602 A Antinomyces antibody ...................................................................... .................... .................... .................... .................... ....................

86603 A Adenovirus antibody ......................................................................... .................... .................... .................... .................... ....................

86606 A Aspergillus antibody ......................................................................... .................... .................... .................... .................... ....................

86609 A Bacterium antibody .......................................................................... .................... .................... .................... .................... ....................

*86611 A Bartonella antibody .......................................................................... .................... .................... .................... .................... ....................

86612 A Blastomyces antibody ...................................................................... .................... .................... .................... .................... ....................

86615 A Bordetella antibody .......................................................................... .................... .................... .................... .................... ....................

86617 A Lyme disease antibody .................................................................... .................... .................... .................... .................... ....................

86618 A Lyme disease antibody .................................................................... .................... .................... .................... .................... ....................

86619 A Borrelia antibody .............................................................................. .................... .................... .................... .................... ....................

86622 A Brucella antibody .............................................................................. .................... .................... .................... .................... ....................

86625 A Campylobacter antibody .................................................................. .................... .................... .................... .................... ....................

86628 A Candida antibody ............................................................................. .................... .................... .................... .................... ....................

86631 A Chlamydia antibody .......................................................................... .................... .................... .................... .................... ....................

86632 A Chlamydia igm antibody ................................................................... .................... .................... .................... .................... ....................

86635 A Coccidioides antibody ...................................................................... .................... .................... .................... .................... ....................

86638 A Q fever antibody ............................................................................... .................... .................... .................... .................... ....................

86641 A Cryptococcus antibody ..................................................................... .................... .................... .................... .................... ....................

86644 A CMV antibody ................................................................................... .................... .................... .................... .................... ....................

86645 A CMV antibody, IgM .......................................................................... .................... .................... .................... .................... ....................

86648 A Diphtheria antibody .......................................................................... .................... .................... .................... .................... ....................

86651 A Encephalitis antibody ....................................................................... .................... .................... .................... .................... ....................

86652 A Encephalitis antibody ....................................................................... .................... .................... .................... .................... ....................

86653 A Encephalitis antibody ....................................................................... .................... .................... .................... .................... ....................

67929

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

86654 A Encephalitis antibody ....................................................................... .................... .................... .................... .................... ....................

86658 A Enterovirus antibody ........................................................................ .................... .................... .................... .................... ....................

86663 A Epstein-barr antibody ....................................................................... .................... .................... .................... .................... ....................

86664 A Epstein-barr antibody ....................................................................... .................... .................... .................... .................... ....................

86665 A Epstein-barr antibody ....................................................................... .................... .................... .................... .................... ....................

*86666 A Erlichia antibody ............................................................................... .................... .................... .................... .................... ....................

86668 A Francisella tularensis ....................................................................... .................... .................... .................... .................... ....................

86671 A Fungus antibody ............................................................................... .................... .................... .................... .................... ....................

86674 A Giardia lamblia antibody .................................................................. .................... .................... .................... .................... ....................

86677 A Helicobacter pylori ............................................................................ .................... .................... .................... .................... ....................

86682 A Helminth antibody ............................................................................ .................... .................... .................... .................... ....................

*86683 A Fecal hgb antibody ........................................................................... .................... .................... .................... .................... ....................

86684 A Hemophilus influenza ....................................................................... .................... .................... .................... .................... ....................

86687 A Htlv-i antibody .................................................................................. .................... .................... .................... .................... ....................

86688 A Htlv-ii antibody .................................................................................. .................... .................... .................... .................... ....................

86689 A HTLV/HIV confirmatory test ............................................................. .................... .................... .................... .................... ....................

86692 A Hepatitis, delta agent ....................................................................... .................... .................... .................... .................... ....................

*86696 A Herpes simplex type 2 antibody ...................................................... .................... .................... .................... .................... ....................

86694 A Herpes simplex test ......................................................................... .................... .................... .................... .................... ....................

86695 A Herpes simplex test ......................................................................... .................... .................... .................... .................... ....................

86698 A Histoplasma ...................................................................................... .................... .................... .................... .................... ....................

86701 A HIV-1 ................................................................................................ .................... .................... .................... .................... ....................

86702 A HIV-2 ................................................................................................ .................... .................... .................... .................... ....................

86703 A HIV-1/HIV-2, single assay ................................................................ .................... .................... .................... .................... ....................

86704 A Hep b core antibody, igg/igm ........................................................... .................... .................... .................... .................... ....................

86705 A Hep b core antibody, igm ................................................................. .................... .................... .................... .................... ....................

86706 A Hep b surface antibody .................................................................... .................... .................... .................... .................... ....................

86707 A Hep be antibody ............................................................................... .................... .................... .................... .................... ....................

86708 A Hep a antibody, igg/igm ................................................................... .................... .................... .................... .................... ....................

86709 A Hep a antibody, igm ......................................................................... .................... .................... .................... .................... ....................

86710 A Influenza virus antibody ................................................................... .................... .................... .................... .................... ....................

86713 A Legionella antibody .......................................................................... .................... .................... .................... .................... ....................

86717 A Leishmania antibody ........................................................................ .................... .................... .................... .................... ....................

86720 A Leptospira antibody .......................................................................... .................... .................... .................... .................... ....................

86723 A Listeria monocytogenes ab .............................................................. .................... .................... .................... .................... ....................

86727 A Lymph choriomeningitis ab .............................................................. .................... .................... .................... .................... ....................

86729 A Lympho venereum antibody ............................................................. .................... .................... .................... .................... ....................

86732 A Mucormycosis antibody .................................................................... .................... .................... .................... .................... ....................

86735 A Mumps antibody ............................................................................... .................... .................... .................... .................... ....................

86738 A Mycoplasma antibody ...................................................................... .................... .................... .................... .................... ....................

86741 A Neisseria meningitidis ...................................................................... .................... .................... .................... .................... ....................

86744 A Nocardia antibody ............................................................................ .................... .................... .................... .................... ....................

86747 A Parvovirus antibody .......................................................................... .................... .................... .................... .................... ....................

86750 A Malaria antibody ............................................................................... .................... .................... .................... .................... ....................

86753 A Protozoa antibody nos ..................................................................... .................... .................... .................... .................... ....................

86756 A Respiratory virus antibody ............................................................... .................... .................... .................... .................... ....................

*86757 A Rickettsia antibody ........................................................................... .................... .................... .................... .................... ....................

86759 A Rotavirus antibody ........................................................................... .................... .................... .................... .................... ....................

86762 A Rubella antibody .............................................................................. .................... .................... .................... .................... ....................

86765 A Rubeola antibody ............................................................................. .................... .................... .................... .................... ....................

86768 A Salmonella antibody ......................................................................... .................... .................... .................... .................... ....................

86771 A Shigella antibody .............................................................................. .................... .................... .................... .................... ....................

86774 A Tetanus antibody .............................................................................. .................... .................... .................... .................... ....................

86777 A Toxoplasma antibody ....................................................................... .................... .................... .................... .................... ....................

86778 A Toxoplasma antibody, igm ............................................................... .................... .................... .................... .................... ....................

86781 A Treponema pallidum, confirm .......................................................... .................... .................... .................... .................... ....................

86784 A Trichinella antibody .......................................................................... .................... .................... .................... .................... ....................

86787 A Varicella-zoster antibody .................................................................. .................... .................... .................... .................... ....................

86790 A Virus antibody nos ........................................................................... .................... .................... .................... .................... ....................

86793 A Yersinia antibody .............................................................................. .................... .................... .................... .................... ....................

86800 A Thyroglobulin antibody ..................................................................... .................... .................... .................... .................... ....................

86803 A Hepatitis c ab test ............................................................................ .................... .................... .................... .................... ....................

86804 A Hep c ab test, confirm ...................................................................... .................... .................... .................... .................... ....................

86805 A Lymphocytotoxicity assay ................................................................ .................... .................... .................... .................... ....................

86806 A Lymphocytotoxicity assay ................................................................ .................... .................... .................... .................... ....................

86807 A Cytotoxic antibody screening ........................................................... .................... .................... .................... .................... ....................

86808 A Cytotoxic antibody screening ........................................................... .................... .................... .................... .................... ....................

86812 A HLA typing, A, B, or C ..................................................................... .................... .................... .................... .................... ....................

86813 A HLA typing, A, B, or C ..................................................................... .................... .................... .................... .................... ....................

86816 A HLA typing, DR/DQ .......................................................................... .................... .................... .................... .................... ....................

86817 A HLA typing, DR/DQ .......................................................................... .................... .................... .................... .................... ....................

86821 A Lymphocyte culture, mixed .............................................................. .................... .................... .................... .................... ....................

86822 A Lymphocyte culture, primed ............................................................. .................... .................... .................... .................... ....................

86849 X Immunology procedure .................................................................... 0349 0.48 $23.65 $4.73 $4.73

67930

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

86850 X RBC antibody screen ....................................................................... 0346 0.51 $25.49 $12.03 $5.10

86860 X RBC antibody elution ....................................................................... 0345 0.22 $10.92 $5.37 $2.18

86870 X RBC antibody identification .............................................................. 0347 0.84 $41.90 $20.13 $8.38

86880 A Coombs test ..................................................................................... .................... .................... .................... .................... ....................

86885 A Coombs test ..................................................................................... .................... .................... .................... .................... ....................

86886 A Coombs test ..................................................................................... .................... .................... .................... .................... ....................

86890 X Autologous blood process ................................................................ 0347 0.84 $41.90 $20.13 $8.38

86891 X Autologous blood, op salvage .......................................................... 0345 0.22 $10.92 $5.37 $2.18

86900 A Blood typing, ABO ............................................................................ .................... .................... .................... .................... ....................

86901 X Blood typing, Rh (D) ........................................................................ 0345 0.22 $10.92 $5.37 $2.18

86903 A Blood typing, antigen screen ........................................................... .................... .................... .................... .................... ....................

86904 A Blood typing, patient serum ............................................................. .................... .................... .................... .................... ....................

86905 A Blood typing, RBC antigens ............................................................. .................... .................... .................... .................... ....................

86906 A Blood typing, Rh phenotype ............................................................. .................... .................... .................... .................... ....................

86910 E Blood typing, paternity test .............................................................. .................... .................... .................... .................... ....................

86911 E Blood typing, antigen system ........................................................... .................... .................... .................... .................... ....................

86915 X Bone marrow/stem cell prep ............................................................ 0347 0.84 $41.90 $20.13 $8.38

86920 X Compatibility test .............................................................................. 0346 0.51 $25.49 $12.03 $5.10

86921 X Compatibility test .............................................................................. 0346 0.51 $25.49 $12.03 $5.10

86922 X Compatibility test .............................................................................. 0346 0.51 $25.49 $12.03 $5.10

86927 X Plasma, fresh frozen ........................................................................ 0347 0.84 $41.90 $20.13 $8.38

86930 X Frozen blood prep ............................................................................ 0347 0.84 $41.90 $20.13 $8.38

86931 X Frozen blood thaw ........................................................................... 0347 0.84 $41.90 $20.13 $8.38

86932 X Frozen blood freeze/thaw ................................................................ 0347 0.84 $41.90 $20.13 $8.38

86940 A Hemolysins/agglutinins, auto ........................................................... .................... .................... .................... .................... ....................

86941 A Hemolysins/agglutinins ..................................................................... .................... .................... .................... .................... ....................

86945 X Blood product/irradiation .................................................................. 0346 0.51 $25.49 $12.03 $5.10

86950 X Leukacyte transfusion ...................................................................... 0347 0.84 $41.90 $20.13 $8.38

86965 X Pooling blood platelets ..................................................................... 0346 0.51 $25.49 $12.03 $5.10

86970 X RBC pretreatment ............................................................................ 0345 0.22 $10.92 $5.37 $2.18

86971 X RBC pretreatment ............................................................................ 0346 0.51 $25.49 $12.03 $5.10

86972 X RBC pretreatment ............................................................................ 0345 0.22 $10.92 $5.37 $2.18

86975 X RBC pretreatment, serum ................................................................ 0346 0.51 $25.49 $12.03 $5.10

86976 X RBC pretreatment, serum ................................................................ 0347 0.84 $41.90 $20.13 $8.38

86977 X RBC pretreatment, serum ................................................................ 0346 0.51 $25.49 $12.03 $5.10

86978 X RBC pretreatment, serum ................................................................ 0345 0.22 $10.92 $5.37 $2.18

86985 X Split blood or products ..................................................................... 0347 0.84 $41.90 $20.13 $8.38

86999 X Transfusion procedure ..................................................................... 0346 0.51 $25.49 $12.03 $5.10

87001 A Small animal inoculation .................................................................. .................... .................... .................... .................... ....................

87003 A Small animal inoculation .................................................................. .................... .................... .................... .................... ....................

87015 A Specimen concentration ................................................................... .................... .................... .................... .................... ....................

87040 A Blood culture for bacteria ................................................................. .................... .................... .................... .................... ....................

87045 A Stool culture for bacteria .................................................................. .................... .................... .................... .................... ....................

*87046 A Stool culture for bacteria .................................................................. .................... .................... .................... .................... ....................

87060D A Nose/throat culture, bact .................................................................. .................... .................... .................... .................... ....................

87070 A Culture specimen, bacteria .............................................................. .................... .................... .................... .................... ....................

*87071 A Culture specimen, bacteria .............................................................. .................... .................... .................... .................... ....................

87072D A Culture of specimen by kit ............................................................... .................... .................... .................... .................... ....................

*87073 A Culture specimen, bacteria .............................................................. .................... .................... .................... .................... ....................

87075 A Culture specimen, bacteria .............................................................. .................... .................... .................... .................... ....................

87076 A Bacteria identification ....................................................................... .................... .................... .................... .................... ....................

*87077 A Culture specimen, bacteria .............................................................. .................... .................... .................... .................... ....................

87081 A Bacteria culture screen .................................................................... .................... .................... .................... .................... ....................

87082 A Culture of specimen by kit ............................................................... .................... .................... .................... .................... ....................

87083D A Culture of specimen by kit ............................................................... .................... .................... .................... .................... ....................

87084 A Culture of specimen by kit ............................................................... .................... .................... .................... .................... ....................

87085D A Culture of specimen by kit ............................................................... .................... .................... .................... .................... ....................

87086 A Urine culture/colony count ............................................................... .................... .................... .................... .................... ....................

87087D A Urine bacteria culture ....................................................................... .................... .................... .................... .................... ....................

87088 A Urine bacteria culture ....................................................................... .................... .................... .................... .................... ....................

87101 A Skin fungus culture .......................................................................... .................... .................... .................... .................... ....................

87102 A Fungus isolation culture ................................................................... .................... .................... .................... .................... ....................

87103 A Blood fungus culture ........................................................................ .................... .................... .................... .................... ....................

87106 A Fungus identification ........................................................................ .................... .................... .................... .................... ....................

*87107 A Culture specimen, fungi ................................................................... .................... .................... .................... .................... ....................

87109 A Mycoplasma culture ......................................................................... .................... .................... .................... .................... ....................

87110 A Culture, chlamydia ........................................................................... .................... .................... .................... .................... ....................

87116 A Mycobacteria culture ........................................................................ .................... .................... .................... .................... ....................

87117D A Mycobacteria culture ........................................................................ .................... .................... .................... .................... ....................

87118 A Mycobacteria identification ............................................................... .................... .................... .................... .................... ....................

87140 A Culture typing, fluorescent ............................................................... .................... .................... .................... .................... ....................

87143 A Culture typing, GLC method ............................................................ .................... .................... .................... .................... ....................

87145D A Culture typing, phage method .......................................................... .................... .................... .................... .................... ....................

87147 A Culture typing, serologic .................................................................. .................... .................... .................... .................... ....................

67931

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*87149 A Culture typing ................................................................................... .................... .................... .................... .................... ....................

87151D A Culture typing, serologic .................................................................. .................... .................... .................... .................... ....................

*87152 A Culture typing ................................................................................... .................... .................... .................... .................... ....................

87155D A Culture typing, precipitin .................................................................. .................... .................... .................... .................... ....................

87158 A Culture typing, added method .......................................................... .................... .................... .................... .................... ....................

87163D A Special microbiology culture ............................................................ .................... .................... .................... .................... ....................

87164 A Dark field examination ..................................................................... .................... .................... .................... .................... ....................

87166 A Dark field examination ..................................................................... .................... .................... .................... .................... ....................

*87168 A Macroscopic exam, arthropod .......................................................... .................... .................... .................... .................... ....................

*87169 A Macroscopic exam, arthropod .......................................................... .................... .................... .................... .................... ....................

*87172 A Pinworm exam ................................................................................. .................... .................... .................... .................... ....................

87174D A Endotoxin, bacterial .......................................................................... .................... .................... .................... .................... ....................

87175D A Assay, endotoxin, bacterial .............................................................. .................... .................... .................... .................... ....................

87176 A Endotoxin, bacterial .......................................................................... .................... .................... .................... .................... ....................

87177 A Ova and parasites smears ............................................................... .................... .................... .................... .................... ....................

87181 A Antibiotic sensitivity, each ................................................................ .................... .................... .................... .................... ....................

87184 A Antibiotic sensitivity, each ................................................................ .................... .................... .................... .................... ....................

*87185 A Susceptibility study ........................................................................... .................... .................... .................... .................... ....................

87186 A Antibiotic sensitivity, MIC ................................................................. .................... .................... .................... .................... ....................

87187 A Antibiotic sensitivity, MBC ................................................................ .................... .................... .................... .................... ....................

87188 A Antibiotic sensitivity, each ................................................................ .................... .................... .................... .................... ....................

87190 A TB antibiotic sensitivity ..................................................................... .................... .................... .................... .................... ....................

87192D A Antibiotic sensitivity, each ................................................................ .................... .................... .................... .................... ....................

87197 A Bactericidal level, serum .................................................................. .................... .................... .................... .................... ....................

87205 A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87206 A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87207 A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87208D A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87210 A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87211D A Smear, stain & interpret ................................................................... .................... .................... .................... .................... ....................

87220 A Tissue exam for fungi ...................................................................... .................... .................... .................... .................... ....................

87230 A Assay, toxin or antitoxin ................................................................... .................... .................... .................... .................... ....................

87250 A Virus inoculation for test .................................................................. .................... .................... .................... .................... ....................

87252 A Virus inoculation for test .................................................................. .................... .................... .................... .................... ....................

87253 A Virus inoculation for test .................................................................. .................... .................... .................... .................... ....................

*87254 A Virus isolation ................................................................................... .................... .................... .................... .................... ....................

87260 A Adenovirus ag, dfa ........................................................................... .................... .................... .................... .................... ....................

87265 A Pertussis ag, dfa .............................................................................. .................... .................... .................... .................... ....................

87270 A Chylmd trach ag, dfa ........................................................................ .................... .................... .................... .................... ....................

87272 A Cryptosporidum ag, dfa .................................................................... .................... .................... .................... .................... ....................

*87273 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87274 A Herpes simplex ag, dfa .................................................................... .................... .................... .................... .................... ....................

*87275 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87276 A Influenza ag, dfa .............................................................................. .................... .................... .................... .................... ....................

*87277 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87278 A Legion pneumo ag, dfa .................................................................... .................... .................... .................... .................... ....................

*87279 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87280 A Resp syncytial ag, dfa ...................................................................... .................... .................... .................... .................... ....................

*87281 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

*87283 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87285 A Trepon pallidum ag, dfa ................................................................... .................... .................... .................... .................... ....................

87290 A Varicella ag, dfa ............................................................................... .................... .................... .................... .................... ....................

87299 A Ag detection nos, dfa ....................................................................... .................... .................... .................... .................... ....................

*87300 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87301 A Adenovirus ag, eia ........................................................................... .................... .................... .................... .................... ....................

87320 A Chylmd trach ag, eia ........................................................................ .................... .................... .................... .................... ....................

87324 A Clostridium ag, eia ........................................................................... .................... .................... .................... .................... ....................

*87327 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87328 A Cryptospor ag, eia ............................................................................ .................... .................... .................... .................... ....................

87332 A Cytomegalovirus ag, eia .................................................................. .................... .................... .................... .................... ....................

87335 A E coli 0157 ag, eia ........................................................................... .................... .................... .................... .................... ....................

*87336 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

*87337 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87338 A Hpylori, stool, eia ............................................................................. .................... .................... .................... .................... ....................

*87339 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87340 A Hepatitis b surface ag, eia ............................................................... .................... .................... .................... .................... ....................

*87341 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87350 A Hepatitis be ag, eia .......................................................................... .................... .................... .................... .................... ....................

87380 A Hepatitis delta ag, eia ...................................................................... .................... .................... .................... .................... ....................

87385 A Histoplasma capsul ag, eia .............................................................. .................... .................... .................... .................... ....................

87390 A Hiv-1 ag, eia ..................................................................................... .................... .................... .................... .................... ....................

87391 A Hiv-2 ag, eia ..................................................................................... .................... .................... .................... .................... ....................

*87400 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87420 A Resp syncytial ag, eia ...................................................................... .................... .................... .................... .................... ....................

67932

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

87425 A Rotavirus ag, eia .............................................................................. .................... .................... .................... .................... ....................

*87427 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87430 A Strep a ag, eia ................................................................................. .................... .................... .................... .................... ....................

87449 A Ag detect nos, eia, mult ................................................................... .................... .................... .................... .................... ....................

87450 A Ag detect nos, eia, single ................................................................ .................... .................... .................... .................... ....................

*87451 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87470 A Bartonella, dna, dir probe ................................................................ .................... .................... .................... .................... ....................

87471 A Bartonella, dna, amp probe ............................................................. .................... .................... .................... .................... ....................

87472 A Bartonella, dna, quant ...................................................................... .................... .................... .................... .................... ....................

87475 A Lyme dis, dna, dir probe .................................................................. .................... .................... .................... .................... ....................

87476 A Lyme dis, dna, amp probe ............................................................... .................... .................... .................... .................... ....................

87477 A Lyme dis, dna, quant ....................................................................... .................... .................... .................... .................... ....................

87480 A Candida, dna, dir probe ................................................................... .................... .................... .................... .................... ....................

87481 A Candida, dna, amp probe ................................................................ .................... .................... .................... .................... ....................

87482 A Candida, dna, quant ......................................................................... .................... .................... .................... .................... ....................

87485 A Chylmd pneum, dna, dir probe ........................................................ .................... .................... .................... .................... ....................

87486 A Chylmd pneum, dna, amp probe ..................................................... .................... .................... .................... .................... ....................

87487 A Chylmd pneum, dna, quant .............................................................. .................... .................... .................... .................... ....................

87490 A Chylmd trach, dna, dir probe ........................................................... .................... .................... .................... .................... ....................

87491 A Chylmd trach, dna, amp probe ........................................................ .................... .................... .................... .................... ....................

87492 A Chylmd trach, dna, quant ................................................................. .................... .................... .................... .................... ....................

87495 A Cytomeg, dna, dir probe .................................................................. .................... .................... .................... .................... ....................

87496 A Cytomeg, dna, amp probe ............................................................... .................... .................... .................... .................... ....................

87497 A Cytomeg, dna, quant ........................................................................ .................... .................... .................... .................... ....................

87510 A Gardner vag, dna, dir probe ............................................................ .................... .................... .................... .................... ....................

87511 A Gardner vag, dna, amp probe ......................................................... .................... .................... .................... .................... ....................

87512 A Gardner vag, dna, quant .................................................................. .................... .................... .................... .................... ....................

87515 A Hepatitis b, dna, dir probe ............................................................... .................... .................... .................... .................... ....................

87516 A Hepatitis b , dna, amp probe ........................................................... .................... .................... .................... .................... ....................

87517 A Hepatitis b , dna, quant .................................................................... .................... .................... .................... .................... ....................

87520 A Hepatitis c , rna, dir probe ............................................................... .................... .................... .................... .................... ....................

87521 A Hepatitis c , rna, amp probe ............................................................ .................... .................... .................... .................... ....................

87522 A Hepatitis c, rna, quant ...................................................................... .................... .................... .................... .................... ....................

87525 A Hepatitis g , dna, dir probe .............................................................. .................... .................... .................... .................... ....................

87526 A Hepatitis g, dna, amp probe ............................................................ .................... .................... .................... .................... ....................

87527 A Hepatitis g, dna, quant ..................................................................... .................... .................... .................... .................... ....................

87528 A Hsv, dna, dir probe .......................................................................... .................... .................... .................... .................... ....................

87529 A Hsv, dna, amp probe ....................................................................... .................... .................... .................... .................... ....................

87530 A Hsv, dna, quant ................................................................................ .................... .................... .................... .................... ....................

87531 A Hhv-6, dna, dir probe ....................................................................... .................... .................... .................... .................... ....................

87532 A Hhv-6, dna, amp probe .................................................................... .................... .................... .................... .................... ....................

87533 A Hhv-6, dna, quant ............................................................................ .................... .................... .................... .................... ....................

87534 A Hiv-1, dna, dir probe ........................................................................ .................... .................... .................... .................... ....................

87535 A Hiv-1, dna, amp probe ..................................................................... .................... .................... .................... .................... ....................

87536 A Hiv-1, dna, quant .............................................................................. .................... .................... .................... .................... ....................

87537 A Hiv-2, dna, dir probe ........................................................................ .................... .................... .................... .................... ....................

87538 A Hiv-2, dna, amp probe ..................................................................... .................... .................... .................... .................... ....................

87539 A Hiv-2, dna, quant .............................................................................. .................... .................... .................... .................... ....................

87540 A Legion pneumo, dna, dir prob .......................................................... .................... .................... .................... .................... ....................

87541 A Legion pneumo, dna, amp prob ....................................................... .................... .................... .................... .................... ....................

87542 A Legion pneumo, dna, quant ............................................................. .................... .................... .................... .................... ....................

87550 A Mycobacteria, dna, dir probe ........................................................... .................... .................... .................... .................... ....................

87551 A Mycobacteria, dna, amp probe ........................................................ .................... .................... .................... .................... ....................

87552 A Mycobacteria, dna, quant ................................................................. .................... .................... .................... .................... ....................

87555 A M.tuberculo, dna, dir probe .............................................................. .................... .................... .................... .................... ....................

87556 A M.tuberculo, dna, amp probe ........................................................... .................... .................... .................... .................... ....................

87557 A M.tuberculo, dna, quant ................................................................... .................... .................... .................... .................... ....................

87560 A M.avium-intra, dna, dir prob ............................................................. .................... .................... .................... .................... ....................

87561 A M.avium-intra, dna, amp prob .......................................................... .................... .................... .................... .................... ....................

87562 A M.avium-intra, dna, quant ................................................................ .................... .................... .................... .................... ....................

87580 A M.pneumon, dna, dir probe .............................................................. .................... .................... .................... .................... ....................

87581 A M.pneumon, dna, amp probe ........................................................... .................... .................... .................... .................... ....................

87582 A M.pneumon, dna, quant ................................................................... .................... .................... .................... .................... ....................

87590 A N.gonorrhoeae, dna, dir prob ........................................................... .................... .................... .................... .................... ....................

87591 A N.gonorrhoeae, dna, amp prob ........................................................ .................... .................... .................... .................... ....................

87592 A N.gonorrhoeae, dna, quant .............................................................. .................... .................... .................... .................... ....................

87620 A Hpv, dna, dir probe .......................................................................... .................... .................... .................... .................... ....................

87621 A Hpv, dna, amp probe ....................................................................... .................... .................... .................... .................... ....................

87622 A Hpv, dna, quant ................................................................................ .................... .................... .................... .................... ....................

87650 A Strep a, dna, dir probe ..................................................................... .................... .................... .................... .................... ....................

87651 A Strep a, dna, amp probe .................................................................. .................... .................... .................... .................... ....................

87652 A Strep a, dna, quant .......................................................................... .................... .................... .................... .................... ....................

87797 A Detect agent nos, dna, dir ............................................................... .................... .................... .................... .................... ....................

87798 A Detect agent nos, dna, amp ............................................................ .................... .................... .................... .................... ....................

67933

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

87799 A Detect agent nos, dna, quant .......................................................... .................... .................... .................... .................... ....................

*87800 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

*87801 A Identify infectious agent ................................................................... .................... .................... .................... .................... ....................

87810 A Chylmd trach assay w/optic ............................................................. .................... .................... .................... .................... ....................

87850 A N. gonorrhoeae assay w/optic ......................................................... .................... .................... .................... .................... ....................

87880 A Strep a assay w/optic ....................................................................... .................... .................... .................... .................... ....................

87899 A Agent nos assay w/optic .................................................................. .................... .................... .................... .................... ....................

*87901 A Infectious agent genotype ................................................................ .................... .................... .................... .................... ....................

*87903 A Infectious agent phenotype .............................................................. .................... .................... .................... .................... ....................

*87904 A Infectious agent phenotype .............................................................. .................... .................... .................... .................... ....................

87999 X Microbiology procedure .................................................................... 0349 0.48 $23.65 $4.73 $4.73

88000 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88005 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88007 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88012 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88014 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88016 E Autopsy (necropsy), gross ............................................................... .................... .................... .................... .................... ....................

88020 E Autopsy (necropsy), complete ......................................................... .................... .................... .................... .................... ....................

88025 E Autopsy (necropsy), complete ......................................................... .................... .................... .................... .................... ....................

88027 E Autopsy (necropsy), complete ......................................................... .................... .................... .................... .................... ....................

88028 E Autopsy (necropsy), complete ......................................................... .................... .................... .................... .................... ....................

88029 E Autopsy (necropsy), complete ......................................................... .................... .................... .................... .................... ....................

88036 E Limited autopsy ................................................................................ .................... .................... .................... .................... ....................

88037 E Limited autopsy ................................................................................ .................... .................... .................... .................... ....................

88040 E Forensic autopsy (necropsy) ............................................................ .................... .................... .................... .................... ....................

88045 E Coroner’s autopsy (necropsy) .......................................................... .................... .................... .................... .................... ....................

88099 E Necropsy (autopsy) procedure ......................................................... .................... .................... .................... .................... ....................

88104 X Cytopathology, fluids ........................................................................ 0343 0.45 $22.32 $12.16 $4.46

88106 X Cytopathology, fluids ........................................................................ 0343 0.45 $22.32 $12.16 $4.46

88107 X Cytopathology, fluids ........................................................................ 0343 0.45 $22.32 $12.16 $4.46

88108 X Cytopath, concentrate tech .............................................................. 0343 0.45 $22.32 $12.16 $4.46

88125 X Forensic cytopathology .................................................................... 0343 0.45 $22.32 $12.16 $4.46

88130 A Sex chromatin identification ............................................................. .................... .................... .................... .................... ....................

88140 A Sex chromatin identification ............................................................. .................... .................... .................... .................... ....................

88141 N Cytopath, c/v, interpret ..................................................................... .................... .................... .................... .................... ....................

88142 A Cytopath, c/v, thin layer ................................................................... .................... .................... .................... .................... ....................

88143 A Cytopath c/v thin layer redo ............................................................. .................... .................... .................... .................... ....................

88144 A Cytopath, c/v thin lyr redo ................................................................ .................... .................... .................... .................... ....................

88145 A Cytopath, c/v thin lyr sel .................................................................. .................... .................... .................... .................... ....................

88147 A Cytopath, c/v, automated ................................................................. .................... .................... .................... .................... ....................

88148 A Cytopath, c/v, auto rescreen ............................................................ .................... .................... .................... .................... ....................

88150 A Cytopath, c/v, manual ...................................................................... .................... .................... .................... .................... ....................

88152 A Cytopath, c/v, auto redo ................................................................... .................... .................... .................... .................... ....................

88153 A Cytopath, c/v, redo ........................................................................... .................... .................... .................... .................... ....................

88154 A Cytopath, c/v, select ......................................................................... .................... .................... .................... .................... ....................

88155 A Cytopath, c/v, index add-on ............................................................. .................... .................... .................... .................... ....................

88160 X Cytopath smear, other source ......................................................... 0342 0.26 $12.90 $8.03 $2.58

88161 X Cytopath smear, other source ......................................................... 0343 0.45 $22.32 $12.16 $4.46

88162 X Cytopath smear, other source ......................................................... 0343 0.45 $22.32 $12.16 $4.46

88164 A Cytopath tbs, c/v, manual ................................................................ .................... .................... .................... .................... ....................

88165 A Cytopath tbs, c/v, redo ..................................................................... .................... .................... .................... .................... ....................

88166 A Cytopath tbs, c/v, auto redo ............................................................. .................... .................... .................... .................... ....................

88167 A Cytopath tbs, c/v, select ................................................................... .................... .................... .................... .................... ....................

88170 T Fine needle aspiration ...................................................................... 0002 0.62 $30.75 $17.66 $6.15

88171 T Fine needle aspiration ...................................................................... 0002 0.62 $30.75 $17.66 $6.15

88172 X Evaluation of smear ......................................................................... 0343 0.45 $22.32 $12.16 $4.46

88173 X Interpretation of smear ..................................................................... 0343 0.45 $22.32 $12.16 $4.46

88180 X Cell marker study ............................................................................. 0344 0.79 $39.18 $23.63 $7.84

88182 X Cell marker study ............................................................................. 0344 0.79 $39.18 $23.63 $7.84

88199 X Cytopathology procedure ................................................................. 0349 0.48 $23.65 $4.73 $4.73

88230 A Tissue culture, lymphocyte .............................................................. .................... .................... .................... .................... ....................

88233 A Tissue culture, skin/biopsy ............................................................... .................... .................... .................... .................... ....................

88235 A Tissue culture, placenta ................................................................... .................... .................... .................... .................... ....................

88237 A Tissue culture, bone marrow ........................................................... .................... .................... .................... .................... ....................

88239 A Tissue culture, tumor ....................................................................... .................... .................... .................... .................... ....................

88240 A Cell cryopreserve/storage ................................................................ .................... .................... .................... .................... ....................

88241 A Frozen cell preparation .................................................................... .................... .................... .................... .................... ....................

88245 A Chromosome analysis, 20-25 .......................................................... .................... .................... .................... .................... ....................

88248 A Chromosome analysis, 50-100 ........................................................ .................... .................... .................... .................... ....................

88249 A Chromosome analysis, 100 ............................................................. .................... .................... .................... .................... ....................

88261 A Chromosome analysis, 5 ................................................................. .................... .................... .................... .................... ....................

88262 A Chromosome analysis, 15-20 .......................................................... .................... .................... .................... .................... ....................

88263 A Chromosome analysis, 45 ............................................................... .................... .................... .................... .................... ....................

88264 A Chromosome analysis, 20-25 .......................................................... .................... .................... .................... .................... ....................

67934

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

88267 A Chromosome analys, placenta ........................................................ .................... .................... .................... .................... ....................

88269 A Chromosome analys, amniotic ......................................................... .................... .................... .................... .................... ....................

88271 A Cytogenetics, dna probe .................................................................. .................... .................... .................... .................... ....................

88272 A Cytogenetics, 3-5 ............................................................................. .................... .................... .................... .................... ....................

88273 A Cytogenetics, 10-30 ......................................................................... .................... .................... .................... .................... ....................

88274 A Cytogenetics, 25-99 ......................................................................... .................... .................... .................... .................... ....................

88275 A Cytogenetics, 100-300 ..................................................................... .................... .................... .................... .................... ....................

88280 A Chromosome karyotype study ......................................................... .................... .................... .................... .................... ....................

88283 A Chromosome banding study ............................................................ .................... .................... .................... .................... ....................

88285 A Chromosome count, additional ........................................................ .................... .................... .................... .................... ....................

88289 A Chromosome study, additional ........................................................ .................... .................... .................... .................... ....................

88291 A Cyto/molecular report ....................................................................... .................... .................... .................... .................... ....................

88299 X Cytogenetic study ............................................................................. 0342 0.26 $12.90 $8.03 $2.58

88300 X Surgical path, gross ......................................................................... 0342 0.26 $12.90 $8.03 $2.58

88302 X Tissue exam by pathologist ............................................................. 0342 0.26 $12.90 $8.03 $2.58

88304 X Tissue exam by pathologist ............................................................. 0343 0.45 $22.32 $12.16 $4.46

88305 X Tissue exam by pathologist ............................................................. 0343 0.45 $22.32 $12.16 $4.46

88307 X Tissue exam by pathologist ............................................................. 0344 0.79 $39.18 $23.63 $7.84

88309 X Tissue exam by pathologist ............................................................. 0344 0.79 $39.18 $23.63 $7.84

88311 X Decalcify tissue ................................................................................ 0342 0.26 $12.90 $8.03 $2.58

88312 X Special stains ................................................................................... 0343 0.45 $22.32 $12.16 $4.46

88313 X Special stains ................................................................................... 0342 0.26 $12.90 $8.03 $2.58

88314 X Histochemical stain .......................................................................... 0343 0.45 $22.32 $12.16 $4.46

88318 X Chemical histochemistry .................................................................. 0343 0.45 $22.32 $12.16 $4.46

88319 X Enzyme histochemistry .................................................................... 0342 0.26 $12.90 $8.03 $2.58

88321 X Microslide consultation ..................................................................... 0342 0.26 $12.90 $8.03 $2.58

88323 X Microslide consultation ..................................................................... 0343 0.45 $22.32 $12.16 $4.46

88325 X Comprehensive review of data ........................................................ 0343 0.45 $22.32 $12.16 $4.46

88329 X Pathology consult in surgery ............................................................ 0343 0.45 $22.32 $12.16 $4.46

88331 X Pathology consult in surgery ............................................................ 0343 0.45 $22.32 $12.16 $4.46

88332 X Pathology consult in surgery ............................................................ 0343 0.45 $22.32 $12.16 $4.46

88342 X Immunocytochemistry ...................................................................... 0344 0.79 $39.18 $23.63 $7.84

88346 X Immunofluorescent study ................................................................. 0343 0.45 $22.32 $12.16 $4.46

88347 X Immunofluorescent study ................................................................. 0344 0.79 $39.18 $23.63 $7.84

88348 X Electron microscopy ......................................................................... 0344 0.79 $39.18 $23.63 $7.84

88349 X Scanning electron microscopy ......................................................... 0344 0.79 $39.18 $23.63 $7.84

88355 X Analysis, skeletal muscle ................................................................. 0344 0.79 $39.18 $23.63 $7.84

88356 X Analysis, nerve ................................................................................. 0344 0.79 $39.18 $23.63 $7.84

88358 X Analysis, tumor ................................................................................. 0344 0.79 $39.18 $23.63 $7.84

88362 X Nerve teasing preparations .............................................................. 0343 0.45 $22.32 $12.16 $4.46

88365 X Tissue hybridization ......................................................................... 0344 0.79 $39.18 $23.63 $7.84

88371 A Protein, western blot tissue .............................................................. .................... .................... .................... .................... ....................

88372 A Protein analysis w/probe .................................................................. .................... .................... .................... .................... ....................

88399 X Surgical pathology procedure .......................................................... 0349 0.48 $23.65 $4.73 $4.73

*88400 A Bilirubin total, trascutaneous ............................................................ .................... .................... .................... .................... ....................

89050 A Body fluid cell count ......................................................................... .................... .................... .................... .................... ....................

89051 A Body fluid cell count ......................................................................... .................... .................... .................... .................... ....................

89060 A Exam,synovial fluid crystals ............................................................. .................... .................... .................... .................... ....................

89100 X Sample intestinal contents ............................................................... 0361 3.53 $175.07 $88.09 $35.01

89105 X Sample intestinal contents ............................................................... 0360 1.38 $68.44 $34.75 $13.69

89125 A Specimen fat stain ........................................................................... .................... .................... .................... .................... ....................

89130 X Sample stomach contents ................................................................ 0360 1.38 $68.44 $34.75 $13.69

89132 X Sample stomach contents ................................................................ 0360 1.38 $68.44 $34.75 $13.69

89135 X Sample stomach contents ................................................................ 0360 1.38 $68.44 $34.75 $13.69

89136 X Sample stomach contents ................................................................ 0360 1.38 $68.44 $34.75 $13.69

89140 X Sample stomach contents ................................................................ 0360 1.38 $68.44 $34.75 $13.69

89141 X Sample stomach contents ................................................................ 0361 3.53 $175.07 $88.09 $35.01

89160 A Exam feces for meat fibers .............................................................. .................... .................... .................... .................... ....................

89190 A Nasal smear for eosinophils ............................................................ .................... .................... .................... .................... ....................

89250 X Fertilization of oocyte ....................................................................... 0348 0.52 $25.57 $5.11 $5.11

89251 X Culture oocyte w/embryos ............................................................... 0348 0.52 $25.57 $5.11 $5.11

89252 X Assist oocyte fertilization .................................................................. 0348 0.52 $25.57 $5.11 $5.11

89253 X Embryo hatching .............................................................................. 0348 0.52 $25.57 $5.11 $5.11

89254 X Oocyte identification ......................................................................... 0348 0.52 $25.57 $5.11 $5.11

89255 X Prepare embryo for transfer ............................................................. 0348 0.52 $25.57 $5.11 $5.11

89256 X Prepare cryopreserved embryo ....................................................... 0348 0.52 $25.57 $5.11 $5.11

89257 X Sperm identification .......................................................................... 0348 0.52 $25.57 $5.11 $5.11

89258 X Cryopreservation, embryo ................................................................ 0348 0.52 $25.57 $5.11 $5.11

89259 X Cryopreservation, sperm .................................................................. 0348 0.52 $25.57 $5.11 $5.11

89260 X Sperm isolation, simple .................................................................... 0348 0.52 $25.57 $5.11 $5.11

89261 X Sperm isolation, complex ................................................................. 0348 0.52 $25.57 $5.11 $5.11

89264 X Identify sperm tissue ........................................................................ 0348 0.52 $25.57 $5.11 $5.11

89300 A Semen analysis ................................................................................ .................... .................... .................... .................... ....................

89310 A Semen analysis ................................................................................ .................... .................... .................... .................... ....................

67935

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

89320 A Semen analysis ................................................................................ .................... .................... .................... .................... ....................

*89321 A Semen analysis ................................................................................ .................... .................... .................... .................... ....................

89325 A Sperm antibody test ......................................................................... .................... .................... .................... .................... ....................

89329 A Sperm evaluation test ...................................................................... .................... .................... .................... .................... ....................

89330 A Evaluation, cervical mucus .............................................................. .................... .................... .................... .................... ....................

89350 X Sputum specimen collection ............................................................ 0344 0.79 $39.18 $23.63 $7.84

89355 A Exam feces for starch ...................................................................... .................... .................... .................... .................... ....................

89360 X Collect sweat for test ....................................................................... 0344 0.79 $39.18 $23.63 $7.84

89365 A Water load test ................................................................................. .................... .................... .................... .................... ....................

89399 X Pathology lab procedure .................................................................. 0349 0.48 $23.65 $4.73 $4.73

90281 E Human ig, im .................................................................................... .................... .................... .................... .................... ....................

90283 E Human ig, iv ..................................................................................... .................... .................... .................... .................... ....................

90287 E Botulinum antitoxin ........................................................................... .................... .................... .................... .................... ....................

90288 E Botulism ig, iv ................................................................................... .................... .................... .................... .................... ....................

90291 E Cmv ig, iv ......................................................................................... .................... .................... .................... .................... ....................

90296 K Diphtheria antitoxin .......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90371 K Hep b ig, im ...................................................................................... 0356 0.36 $17.86 $4.82 $3.57

90375 K Rabies ig, im/sc ................................................................................ 0356 0.36 $17.86 $4.82 $3.57

90376 K Rabies ig, heat treated ..................................................................... 0356 0.36 $17.86 $4.82 $3.57

90378 K Rsv ig, im ......................................................................................... 0356 0.36 $17.86 $4.82 $3.57

90379 K Rsv ig, iv .......................................................................................... 0356 0.36 $17.86 $4.82 $3.57

90384 E Rh ig, full-dose, im ........................................................................... .................... .................... .................... .................... ....................

90385 K Rh ig, minidose, im .......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90386 E Rh ig, iv ............................................................................................ .................... .................... .................... .................... ....................

90389 K Tetanus ig, im .................................................................................. 0356 0.36 $17.86 $4.82 $3.57

90393 K Vaccina ig, im ................................................................................... 0356 0.36 $17.86 $4.82 $3.57

90396 K Varicella-zoster ig, im ....................................................................... 0356 0.36 $17.86 $4.82 $3.57

90399 E Immune globulin ............................................................................... .................... .................... .................... .................... ....................

90471 N Immunization admin ......................................................................... .................... .................... .................... .................... ....................

90472 N Immunization admin, each add ........................................................ .................... .................... .................... .................... ....................

90476 K Adenovirus vaccine, type 4 .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90477 K Adenovirus vaccine, type 7 .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90581 K Anthrax vaccine, sc .......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90585 K Bcg vaccine, percut .......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90586 K Bcg vaccine, intravesical .................................................................. 0356 0.36 $17.86 $4.82 $3.57

90632 K Hep a vaccine, adult im ................................................................... 0356 0.36 $17.86 $4.82 $3.57

90633 K Hep a vacc, ped/adol, 2 dose .......................................................... 0356 0.36 $17.86 $4.82 $3.57

90634 K Hep a vacc, ped/adol, 3 dose .......................................................... 0356 0.36 $17.86 $4.82 $3.57

90636 K Hep a/hep b vacc, adult im .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90645 K Hib vaccine, hboc, im ....................................................................... 0355 0.19 $9.42 $5.05 $1.88

90646 K Hib vaccine, prp-d, im ...................................................................... 0355 0.19 $9.42 $5.05 $1.88

90647 K Hib vaccine, prp-omp, im ................................................................. 0355 0.19 $9.42 $5.05 $1.88

90648 K Hib vaccine, prp-t, im ....................................................................... 0355 0.19 $9.42 $5.05 $1.88

90657 K Flu vaccine, 6-35 mo, im ................................................................. 0354 0.13 $6.33 .................... ....................

90658 K Flu vaccine, 3 yrs, im ....................................................................... 0354 0.13 $6.33 .................... ....................

90659 K Flu vaccine, whole, im ..................................................................... 0354 0.13 $6.33 .................... ....................

90660 K Flu vaccine, nasal ............................................................................ 0354 0.13 $6.33 .................... ....................

90665 K Lyme disease vaccine, im ................................................................ 0356 0.36 $17.86 $4.82 $3.57

90669 K Pneumococcal vaccine, ped ............................................................ 0356 0.36 $17.86 $4.82 $3.57

90675 K Rabies vaccine, im ........................................................................... 0356 0.36 $17.86 $4.82 $3.57

90676 K Rabies vaccine, id ............................................................................ 0356 0.36 $17.86 $4.82 $3.57

90680 K Rotovirus vaccine, oral ..................................................................... 0356 0.36 $17.86 $4.82 $3.57

90690 K Typhoid vaccine, oral ....................................................................... 0356 0.36 $17.86 $4.82 $3.57

90691 K Typhoid vaccine, im ......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90692 K Typhoid vaccine, h-p, sc/id .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90693 K Typhoid vaccine, akd, sc ................................................................. 0356 0.36 $17.86 $4.82 $3.57

90700 K Dtap vaccine, im .............................................................................. 0355 0.19 $9.42 $5.05 $1.88

90701 K Dtp vaccine, im ................................................................................ 0356 0.36 $17.86 $4.82 $3.57

90702 K Dt vaccine, im .................................................................................. 0355 0.19 $9.42 $5.05 $1.88

90703 K Tetanus vaccine, im ......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90704 K Mumps vaccine, sc .......................................................................... 0355 0.19 $9.42 $5.05 $1.88

90705 K Measles vaccine, sc ......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90706 K Rubella vaccine, sc .......................................................................... 0356 0.36 $17.86 $4.82 $3.57

90707 K Mmr vaccine, sc ............................................................................... 0356 0.36 $17.86 $4.82 $3.57

90708 K Measles-rubella vaccine, sc ............................................................. 0356 0.36 $17.86 $4.82 $3.57

90709 K Rubella & mumps vaccine, sc ......................................................... 0356 0.36 $17.86 $4.82 $3.57

90710 K Mmrv vaccine, sc ............................................................................. 0356 0.36 $17.86 $4.82 $3.57

90712 K Oral poliovirus vaccine ..................................................................... 0356 0.36 $17.86 $4.82 $3.57

90713 K Poliovirus, ipv, sc ............................................................................. 0355 0.19 $9.42 $5.05 $1.88

90716 K Chicken pox vaccine, sc .................................................................. 0355 0.19 $9.42 $5.05 $1.88

90717 K Yellow fever vaccine, sc .................................................................. 0356 0.36 $17.86 $4.82 $3.57

90718 K Td vaccine, im .................................................................................. 0356 0.36 $17.86 $4.82 $3.57

90719 K Diphtheria vaccine, im ...................................................................... 0356 0.36 $17.86 $4.82 $3.57

90720 K Dtp/hib vaccine, im ........................................................................... 0355 0.19 $9.42 $5.05 $1.88

67936

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

90721 K Dtap/hib vaccine, im ......................................................................... 0355 0.19 $9.42 $5.05 $1.88

*90723 K DTAP-HepB-IPV vaccine ................................................................. 0356 0.36 $17.86 $4.82 $3.57

90725 K Cholera vaccine, injectable .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90727 K Plague vaccine, im ........................................................................... 0355 0.19 $9.42 $5.05 $1.88

90732 K Pneumococcal vaccine, adult .......................................................... 0354 0.13 $6.33 .................... ....................

90733 K Meningococcal vaccine, sc .............................................................. 0356 0.36 $17.86 $4.82 $3.57

90735 K Encephalitis vaccine, sc ................................................................... 0356 0.36 $17.86 $4.82 $3.57

*90740 K Hep B vaccine, 3 dose sched .......................................................... 0356 0.36 $17.86 $4.82 $3.57

*90743 K Hep B vaccine, 2 dose sched .......................................................... 0356 0.36 $17.86 $4.82 $3.57

90744 K Hep b vaccine, ped/adol, im ............................................................ 0356 0.36 $17.86 $4.82 $3.57

90746 K Hep b vaccine, adult, im .................................................................. 0356 0.36 $17.86 $4.82 $3.57

90747 K Hep b vaccine, ill pat, im ................................................................. 0356 0.36 $17.86 $4.82 $3.57

90748 K Hep b/hib vaccine, im ...................................................................... 0356 0.36 $17.86 $4.82 $3.57

90749 K Vaccine toxoid .................................................................................. 0355 0.19 $9.42 $5.05 $1.88

90780 E IV infusion therapy, 1 hour ............................................................... .................... .................... .................... .................... ....................

90781 E IV infusion, additional hour .............................................................. .................... .................... .................... .................... ....................

90782 X Injection, sc/im ................................................................................. 0359 0.96 $47.61 $9.52 $9.52

90783 X Injection, ia ....................................................................................... 0359 0.96 $47.61 $9.52 $9.52

90784 X Injection, iv ....................................................................................... 0359 0.96 $47.61 $9.52 $9.52

90788 X Injection of antibiotic ........................................................................ 0359 0.96 $47.61 $9.52 $9.52

90799 X Ther/prophylactic/dx inject ............................................................... 0359 0.96 $47.61 $9.52 $9.52

90801 S Psy dx interview ............................................................................... 0323 1.85 $91.75 $22.48 $18.35

90802 S Intac psy dx interview ...................................................................... 0323 1.85 $91.75 $22.48 $18.35

90804 S Psytx, office, 20-30 min ................................................................... 0322 1.32 $65.46 $14.22 $13.09

90805 S Psytx, off, 20-30 min w/e&m ............................................................ 0322 1.32 $65.46 $14.22 $13.09

90806 S Psytx, off, 45-50 min ........................................................................ 0323 1.85 $91.75 $22.48 $18.35

90807 S Psytx, off, 45-50 min w/e&m ............................................................ 0323 1.85 $91.75 $22.48 $18.35

90808 S Psytx, office, 75-80 min ................................................................... 0323 1.85 $91.75 $22.48 $18.35

90809 S Psytx, off, 75-80, w/e&m .................................................................. 0323 1.85 $91.75 $22.48 $18.35

90810 S Intac psytx, off, 20-30 min ............................................................... 0322 1.32 $65.46 $14.22 $13.09

90811 S Intac psytx, 20-30, w/e&m ............................................................... 0322 1.32 $65.46 $14.22 $13.09

90812 S Intac psytx, off, 45-50 min ............................................................... 0323 1.85 $91.75 $22.48 $18.35

90813 S Intac psytx, 45-50 min w/e&m ......................................................... 0323 1.85 $91.75 $22.48 $18.35

90814 S Intac psytx, off, 75-80 min ............................................................... 0323 1.85 $91.75 $22.48 $18.35

90815 S Intac psytx, 75-80 w/e&m ................................................................ 0323 1.85 $91.75 $22.48 $18.35

90816 S Psytx, hosp, 20-30 min .................................................................... 0322 1.32 $65.46 $14.22 $13.09

90817 S Psytx, hosp, 20-30 min w/e&m ........................................................ 0322 1.32 $65.46 $14.22 $13.09

90818 S Psytx, hosp, 45-50 min .................................................................... 0323 1.85 $91.75 $22.48 $18.35

90819 S Psytx, hosp, 45-50 min w/e&m ........................................................ 0323 1.85 $91.75 $22.48 $18.35

90821 S Psytx, hosp, 75-80 min .................................................................... 0323 1.85 $91.75 $22.48 $18.35

90822 S Psytx, hosp, 75-80 min w/e&m ........................................................ 0323 1.85 $91.75 $22.48 $18.35

90823 S Intac psytx, hosp, 20-30 min ............................................................ 0322 1.32 $65.46 $14.22 $13.09

90824 S Intac psytx, hsp 20-30 w/e&m ......................................................... 0322 1.32 $65.46 $14.22 $13.09

90826 S Intac psytx, hosp, 45-50 min ............................................................ 0323 1.85 $91.75 $22.48 $18.35

90827 S Intac psytx, hsp 45-50 w/e&m ......................................................... 0323 1.85 $91.75 $22.48 $18.35

90828 S Intac psytx, hosp, 75-80 min ............................................................ 0323 1.85 $91.75 $22.48 $18.35

90829 S Intac psytx, hsp 75-80 w/e&m ......................................................... 0323 1.85 $91.75 $22.48 $18.35

90845 S Psychoanalysis ................................................................................. 0323 1.85 $91.75 $22.48 $18.35

90846 S Family psytx w/o patient .................................................................. 0324 1.87 $92.74 $20.19 $18.55

90847 S Family psytx w/patient ...................................................................... 0324 1.87 $92.74 $20.19 $18.55

90849 S Multiple family group psytx .............................................................. 0325 1.55 $76.88 $19.96 $15.38

90853 S Group psychotherapy ....................................................................... 0325 1.55 $76.88 $19.96 $15.38

90857 S Intac group psytx .............................................................................. 0325 1.55 $76.88 $19.96 $15.38

90862 X Medication management .................................................................. 0374 1.17 $58.03 $13.08 $11.61

90865 S Narcosynthesis ................................................................................. 0323 1.85 $91.75 $22.48 $18.35

90870 S Electroconvulsive therapy ................................................................ 0320 3.68 $182.51 $80.06 $36.50

90871 S Electroconvulsive therapy ................................................................ 0320 3.68 $182.51 $80.06 $36.50

90875 E Psychophysiological therapy ............................................................ .................... .................... .................... .................... ....................

90876 E Psychophysiological therapy ............................................................ .................... .................... .................... .................... ....................

90880 S Hypnotherapy ................................................................................... 0323 1.85 $91.75 $22.48 $18.35

90882 E Environmental manipulation ............................................................. .................... .................... .................... .................... ....................

90885 N Psy evaluation of records ................................................................ .................... .................... .................... .................... ....................

90887 N Consultation with family ................................................................... .................... .................... .................... .................... ....................

90889 N Preparation of report ........................................................................ .................... .................... .................... .................... ....................

90899 S Psychiatric service/therapy .............................................................. 0322 1.32 $65.46 $14.22 $13.09

90901 S Biofeedback train, any meth ............................................................ 0321 1.26 $62.49 $29.25 $12.50

90911 S Biofeedback peri/uro/rectal .............................................................. 0321 1.26 $62.49 $29.25 $12.50

90918 A ESRD related services, month ......................................................... .................... .................... .................... .................... ....................

90919 A ESRD related services, month ......................................................... .................... .................... .................... .................... ....................

90920 A ESRD related services, month ......................................................... .................... .................... .................... .................... ....................

90921 A ESRD related services, month ......................................................... .................... .................... .................... .................... ....................

90922 A ESRD related services, day ............................................................. .................... .................... .................... .................... ....................

90923 A Esrd related services, day ............................................................... .................... .................... .................... .................... ....................

90924 A Esrd related services, day ............................................................... .................... .................... .................... .................... ....................

67937

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

90925 A Esrd related services, day ............................................................... .................... .................... .................... .................... ....................

90935 S Hemodialysis, one evaluation .......................................................... 0170 6.68 $331.30 $72.26 $66.26

90937 E Hemodialysis, repeated eval ............................................................ .................... .................... .................... .................... ....................

*90940 N Hemodyalysis access study ............................................................. .................... .................... .................... .................... ....................

90945 S Dialysis, one evaluation ................................................................... 0170 6.68 $331.30 $72.26 $66.26

90947 E Dialysis, repeated eval ..................................................................... .................... .................... .................... .................... ....................

90989 E Dialysis training, complete ............................................................... .................... .................... .................... .................... ....................

90993 E Dialysis training, incompl ................................................................. .................... .................... .................... .................... ....................

90997 E Hemoperfusion ................................................................................. .................... .................... .................... .................... ....................

90999 E Dialysis procedure ............................................................................ .................... .................... .................... .................... ....................

91000 X Esophageal intubation ...................................................................... 0361 3.53 $175.07 $88.09 $35.01

91010 X Esophagus motility study ................................................................. 0361 3.53 $175.07 $88.09 $35.01

91011 X Esophagus motility study ................................................................. 0361 3.53 $175.07 $88.09 $35.01

91012 X Esophagus motility study ................................................................. 0361 3.53 $175.07 $88.09 $35.01

91020 X Gastric motility .................................................................................. 0361 3.53 $175.07 $88.09 $35.01

91030 X Acid perfusion of esophagus ........................................................... 0360 1.38 $68.44 $34.75 $13.69

91032 X Esophagus, acid reflux test .............................................................. 0361 3.53 $175.07 $88.09 $35.01

91033 X Prolonged acid reflux test ................................................................ 0361 3.53 $175.07 $88.09 $35.01

91052 X Gastric analysis test ......................................................................... 0361 3.53 $175.07 $88.09 $35.01

91055 X Gastric intubation for smear ............................................................. 0360 1.38 $68.44 $34.75 $13.69

91060 X Gastric saline load test .................................................................... 0361 3.53 $175.07 $88.09 $35.01

91065 X Breath hydrogen test ........................................................................ 0360 1.38 $68.44 $34.75 $13.69

91100 X Pass intestine bleeding tube ............................................................ 0360 1.38 $68.44 $34.75 $13.69

91105 X Gastric intubation treatment ............................................................. 0360 1.38 $68.44 $34.75 $13.69

91122 T Anal pressure record ........................................................................ 0165 3.89 $192.92 $91.76 $38.58

*91132 X Electrogastrography ......................................................................... 0360 1.38 $68.44 $34.75 $13.69

*91133 X Electrogastrography ......................................................................... 0360 1.38 $68.44 $34.75 $13.69

91299 X Gastroenterology procedure ............................................................ 0360 1.38 $68.44 $34.75 $13.69

92002 V Eye exam, new patient .................................................................... 0601 1.00 $49.60 $9.92 $9.92

92004 V Eye exam, new patient .................................................................... 0602 1.66 $82.33 $16.47 $16.47

92012 V Eye exam established pat ................................................................ 0601 1.00 $49.60 $9.92 $9.92

92014 V Eye exam & treatment ..................................................................... 0602 1.66 $82.33 $16.47 $16.47

92015 E Refraction ......................................................................................... .................... .................... .................... .................... ....................

92018 S New eye exam & treatment ............................................................. 0231 2.64 $130.94 $59.87 $26.19

92019 S Eye exam & treatment ..................................................................... 0231 2.64 $130.94 $59.87 $26.19

92020 S Special eye evaluation ..................................................................... 0230 0.98 $48.61 $22.48 $9.72

92060 S Special eye evaluation ..................................................................... 0230 0.98 $48.61 $22.48 $9.72

92065 S Orthoptic/pleoptic training ................................................................ 0230 0.98 $48.61 $22.48 $9.72

92070 N Fitting of contact lens ....................................................................... .................... .................... .................... .................... ....................

92081 S Visual field examination(s) ............................................................... 0230 0.98 $48.61 $22.48 $9.72

92082 S Visual field examination(s) ............................................................... 0230 0.98 $48.61 $22.48 $9.72

92083 S Visual field examination(s) ............................................................... 0230 0.98 $48.61 $22.48 $9.72

92100 N Serial tonometry exam(s) ................................................................. .................... .................... .................... .................... ....................

92120 S Tonography & eye evaluation .......................................................... 0230 0.98 $48.61 $22.48 $9.72

92130 S Water provocation tonography ......................................................... 0230 0.98 $48.61 $22.48 $9.72

92135 S Opthalmic dx imaging ...................................................................... 0231 2.64 $130.94 $59.87 $26.19

92140 S Glaucoma provocative tests ............................................................. 0231 2.64 $130.94 $59.87 $26.19

92225 S Special eye exam, initial .................................................................. 0230 0.98 $48.61 $22.48 $9.72

92226 S Special eye exam, subsequent ........................................................ 0231 2.64 $130.94 $59.87 $26.19

92230 S Eye exam with photos ...................................................................... 0231 2.64 $130.94 $59.87 $26.19

92235 S Eye exam with photos ...................................................................... 0231 2.64 $130.94 $59.87 $26.19

92240 S Icg angiography ................................................................................ 0231 2.64 $130.94 $59.87 $26.19

92250 S Eye exam with photos ...................................................................... 0230 0.98 $48.61 $22.48 $9.72

92260 S Ophthalmoscopy/dynamometry ........................................................ 0230 0.98 $48.61 $22.48 $9.72

92265 S Eye muscle evaluation ..................................................................... 0230 0.98 $48.61 $22.48 $9.72

92270 S Electro-oculography ......................................................................... 0230 0.98 $48.61 $22.48 $9.72

92275 S Electroretinography .......................................................................... 0216 2.87 $142.34 $64.69 $28.47

92283 S Color vision examination .................................................................. 0230 0.98 $48.61 $22.48 $9.72

92284 S Dark adaptation eye exam ............................................................... 0231 2.64 $130.94 $59.87 $26.19

92285 S Eye photography .............................................................................. 0230 0.98 $48.61 $22.48 $9.72

92286 S Internal eye photography ................................................................. 0231 2.64 $130.94 $59.87 $26.19

92287 S Internal eye photography ................................................................. 0231 2.64 $130.94 $59.87 $26.19

92310 E Contact lens fitting ........................................................................... .................... .................... .................... .................... ....................

92311 X Contact lens fitting ........................................................................... 0362 0.51 $25.30 $9.63 $5.06

92312 X Contact lens fitting ........................................................................... 0362 0.51 $25.30 $9.63 $5.06

92313 X Contact lens fitting ........................................................................... 0362 0.51 $25.30 $9.63 $5.06

92314 E Prescription of contact lens .............................................................. .................... .................... .................... .................... ....................

92315 X Prescription of contact lens .............................................................. 0362 0.51 $25.30 $9.63 $5.06

92316 X Prescription of contact lens .............................................................. 0362 0.51 $25.30 $9.63 $5.06

92317 X Prescription of contact lens .............................................................. 0362 0.51 $25.30 $9.63 $5.06

92325 X Modification of contact lens ............................................................. 0362 0.51 $25.30 $9.63 $5.06

92326 X Replacement of contact lens ........................................................... 0362 0.51 $25.30 $9.63 $5.06

92330 S Fitting of artificial eye ....................................................................... 0230 0.98 $48.61 $22.48 $9.72

92335 N Fitting of artificial eye ....................................................................... .................... .................... .................... .................... ....................

67938

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

92340 E Fitting of spectacles ......................................................................... .................... .................... .................... .................... ....................

92341 E Fitting of spectacles ......................................................................... .................... .................... .................... .................... ....................

92342 E Fitting of spectacles ......................................................................... .................... .................... .................... .................... ....................

92352 X Special spectacles fitting .................................................................. 0362 0.51 $25.30 $9.63 $5.06

92353 X Special spectacles fitting .................................................................. 0362 0.51 $25.30 $9.63 $5.06

92354 X Special spectacles fitting .................................................................. 0362 0.51 $25.30 $9.63 $5.06

92355 X Special spectacles fitting .................................................................. 0362 0.51 $25.30 $9.63 $5.06

92358 X Eye prosthesis service ..................................................................... 0362 0.51 $25.30 $9.63 $5.06

92370 E Repair & adjust spectacles .............................................................. .................... .................... .................... .................... ....................

92371 X Repair & adjust spectacles .............................................................. 0362 0.51 $25.30 $9.63 $5.06

92390 E Supply of spectacles ........................................................................ .................... .................... .................... .................... ....................

92391 E Supply of contact lenses .................................................................. .................... .................... .................... .................... ....................

92392 E Supply of low vision aids ................................................................. .................... .................... .................... .................... ....................

92393 E Supply of artificial eye ...................................................................... .................... .................... .................... .................... ....................

92395 E Supply of spectacles ........................................................................ .................... .................... .................... .................... ....................

92396 E Supply of contact lenses .................................................................. .................... .................... .................... .................... ....................

92499 S Eye service or procedure ................................................................. 0230 0.98 $48.61 $22.48 $9.72

92502 T Ear and throat examination .............................................................. 0251 1.68 $83.32 $27.99 $16.66

92504 N Ear microscopy examination ............................................................ .................... .................... .................... .................... ....................

92506 A Speech/hearing evaluation ............................................................... .................... .................... .................... .................... ....................

92507 A Speech/hearing therapy ................................................................... .................... .................... .................... .................... ....................

92508 A Speech/hearing therapy ................................................................... .................... .................... .................... .................... ....................

92510 A Rehab for ear implant ...................................................................... .................... .................... .................... .................... ....................

92511 T Nasopharyngoscopy ......................................................................... 0071 0.55 $27.28 $14.22 $5.46

92512 X Nasal function studies ...................................................................... 0363 2.83 $140.36 $53.22 $28.07

92516 X Facial nerve function test ................................................................. 0363 2.83 $140.36 $53.22 $28.07

92520 X Laryngeal function studies ............................................................... 0363 2.83 $140.36 $53.22 $28.07

92525 E Oral function evaluation ................................................................... .................... .................... .................... .................... ....................

92526 A Oral function therapy ........................................................................ .................... .................... .................... .................... ....................

92531 N Spontaneous nystagmus study ........................................................ .................... .................... .................... .................... ....................

92532 N Positional nystagmus study ............................................................. .................... .................... .................... .................... ....................

92533 N Caloric vestibular test ....................................................................... .................... .................... .................... .................... ....................

92534 N Optokinetic nystagmus ..................................................................... .................... .................... .................... .................... ....................

92541 X Spontaneous nystagmus test ........................................................... 0363 2.83 $140.36 $53.22 $28.07

92542 X Positional nystagmus test ................................................................ 0363 2.83 $140.36 $53.22 $28.07

92543 X Caloric vestibular test ....................................................................... 0363 2.83 $140.36 $53.22 $28.07

92544 X Optokinetic nystagmus test .............................................................. 0363 2.83 $140.36 $53.22 $28.07

92545 X Oscillating tracking test .................................................................... 0363 2.83 $140.36 $53.22 $28.07

92546 X Sinusoidal rotational test .................................................................. 0363 2.83 $140.36 $53.22 $28.07

92547 X Supplemental electrical test ............................................................. 0363 2.83 $140.36 $53.22 $28.07

92548 X Posturography .................................................................................. 0363 2.83 $140.36 $53.22 $28.07

92551 E Pure tone hearing test, air ............................................................... .................... .................... .................... .................... ....................

92552 X Pure tone audiometry, air ................................................................ 0364 0.68 $33.72 $13.31 $6.74

92553 X Audiometry, air & bone .................................................................... 0364 0.68 $33.72 $13.31 $6.74

92555 X Speech threshold audiometry .......................................................... 0364 0.68 $33.72 $13.31 $6.74

92556 X Speech audiometry, complete ......................................................... 0364 0.68 $33.72 $13.31 $6.74

92557 X Comprehensive hearing test ............................................................ 0365 1.47 $72.91 $22.48 $14.58

92559 E Group audiometric testing ................................................................ .................... .................... .................... .................... ....................

92560 E Bekesy audiometry, screen .............................................................. .................... .................... .................... .................... ....................

92561 X Bekesy audiometry, diagnosis ......................................................... 0365 1.47 $72.91 $22.48 $14.58

92562 X Loudness balance test ..................................................................... 0365 1.47 $72.91 $22.48 $14.58

92563 X Tone decay hearing test .................................................................. 0365 1.47 $72.91 $22.48 $14.58

92564 X Sisi hearing test ............................................................................... 0365 1.47 $72.91 $22.48 $14.58

92565 X Stenger test, pure tone .................................................................... 0365 1.47 $72.91 $22.48 $14.58

92567 X Tympanometry ................................................................................. 0364 0.68 $33.72 $13.31 $6.74

92568 X Acoustic reflex testing ...................................................................... 0365 1.47 $72.91 $22.48 $14.58

92569 X Acoustic reflex decay test ................................................................ 0365 1.47 $72.91 $22.48 $14.58

92571 X Filtered speech hearing test ............................................................ 0365 1.47 $72.91 $22.48 $14.58

92572 X Staggered spondaic word test ......................................................... 0365 1.47 $72.91 $22.48 $14.58

92573 X Lombard test .................................................................................... 0365 1.47 $72.91 $22.48 $14.58

92575 X Sensorineural acuity test .................................................................. 0365 1.47 $72.91 $22.48 $14.58

92576 X Synthetic sentence test .................................................................... 0365 1.47 $72.91 $22.48 $14.58

92577 X Stenger test, speech ........................................................................ 0365 1.47 $72.91 $22.48 $14.58

92579 X Visual audiometry (vra) .................................................................... 0365 1.47 $72.91 $22.48 $14.58

92582 X Conditioning play audiometry ........................................................... 0365 1.47 $72.91 $22.48 $14.58

92583 X Select picture audiometry ................................................................ 0365 1.47 $72.91 $22.48 $14.58

92584 X Electrocochleography ....................................................................... 0363 2.83 $140.36 $53.22 $28.07

92585 S Auditory evoked potential ................................................................. 0216 2.87 $142.34 $64.69 $28.47

*92586 S Auditory evoked potentials, ltd ......................................................... 0971 1.55 $76.88 .................... $15.38

92587 X Evoked auditory test ........................................................................ 0363 2.83 $140.36 $53.22 $28.07

92588 X Evoked auditory test ........................................................................ 0363 2.83 $140.36 $53.22 $28.07

92589 X Auditory function test(s) ................................................................... 0365 1.47 $72.91 $22.48 $14.58

92590 E Hearing aid exam, one ear .............................................................. .................... .................... .................... .................... ....................

92591 E Hearing aid exam, both ears ........................................................... .................... .................... .................... .................... ....................

67939

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

92592 E Hearing aid check, one ear .............................................................. .................... .................... .................... .................... ....................

92593 E Hearing aid check, both ears ........................................................... .................... .................... .................... .................... ....................

92594 E Electro hearng aid test, one ............................................................. .................... .................... .................... .................... ....................

92595 E Electro hearng aid tst, both .............................................................. .................... .................... .................... .................... ....................

92596 X Ear protector evaluation ................................................................... 0365 1.47 $72.91 $22.48 $14.58

92597D E Voice prosthetic evaluation .............................................................. .................... .................... .................... .................... ....................

92598D E Voice prosthetic modification ........................................................... .................... .................... .................... .................... ....................

92599 X ENT procedure/service .................................................................... 0364 0.68 $33.72 $13.31 $6.74

92950 S Heart/lung resuscitation cpr ............................................................. 0094 4.51 $223.68 $105.29 $44.74

92953 S Temporary external pacing .............................................................. 0094 4.51 $223.68 $105.29 $44.74

92960 S Cardioversion electric, ext ................................................................ 0094 4.51 $223.68 $105.29 $44.74

92961 S Cardioversion, electric, int ................................................................ 0094 4.51 $223.68 $105.29 $44.74

92970 C Cardioassist, internal ........................................................................ .................... .................... .................... .................... ....................

92971 C Cardioassist, external ....................................................................... .................... .................... .................... .................... ....................

92975 C Dissolve clot, heart vessel ............................................................... .................... .................... .................... .................... ....................

92977 T Dissolve clot, heart vessel ............................................................... 0120 1.66 $82.33 $42.67 $16.47

92978 S Intravasc us, heart add-on ............................................................... 0267 2.72 $134.90 $80.06 $26.98

92979 S Intravasc us, heart add-on ............................................................... 0267 2.72 $134.90 $80.06 $26.98

92980 T Insert intracoronary stent ................................................................. 0104 14.94 $740.96 $339.51 $148.19

92981 T Insert intracoronary stent ................................................................. 0104 14.94 $740.96 $339.51 $148.19

92982 T Coronary artery dilation .................................................................... 0082 51.01 $2,529.89 $1,351.74 $505.98

92984 T Coronary artery dilation .................................................................... 0082 51.01 $2,529.89 $1,351.74 $505.98

92986 C Revision of aortic valve .................................................................... .................... .................... .................... .................... ....................

92987 C Revision of mitral valve .................................................................... .................... .................... .................... .................... ....................

92990 C Revision of pulmonary valve ............................................................ .................... .................... .................... .................... ....................

92992 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

92993 C Revision of heart chamber ............................................................... .................... .................... .................... .................... ....................

92995 T Coronary atherectomy ...................................................................... 0083 29.70 $1,473.00 $794.30 $294.60

92996 T Coronary atherectomy add-on ......................................................... 0083 29.70 $1,473.00 $794.30 $294.60

92997 C Pul art balloon repr, percut .............................................................. .................... .................... .................... .................... ....................

92998 C Pul art balloon repr, percut .............................................................. .................... .................... .................... .................... ....................

93000 E Electrocardiogram, complete ........................................................... .................... .................... .................... .................... ....................

93005 X Electrocardiogram, tracing ............................................................... 0099 0.38 $18.85 $14.68 $3.77

93010 E Electrocardiogram report .................................................................. .................... .................... .................... .................... ....................

93012 X Transmission of ecg ......................................................................... 0097 1.62 $80.35 $62.40 $16.07

93014 E Report on transmitted ecg ............................................................... .................... .................... .................... .................... ....................

93015 E Cardiovascular stress test ................................................................ .................... .................... .................... .................... ....................

93016 E Cardiovascular stress test ................................................................ .................... .................... .................... .................... ....................

93017 X Cardiovascular stress test ................................................................ 0100 1.70 $84.32 $71.57 $16.86

93018 E Cardiovascular stress test ................................................................ .................... .................... .................... .................... ....................

93024 X Cardiac drug stress test ................................................................... 0100 1.70 $84.32 $71.57 $16.86

93040 E Rhythm ECG with report .................................................................. .................... .................... .................... .................... ....................

93041 X Rhythm ECG, tracing ....................................................................... 0099 0.38 $18.85 $14.68 $3.77

93042 E Rhythm ECG, report ........................................................................ .................... .................... .................... .................... ....................

93224 E ECG monitor/report, 24 hrs .............................................................. .................... .................... .................... .................... ....................

93225 X ECG monitor/record, 24 hrs ............................................................. 0100 1.70 $84.32 $71.57 $16.86

93226 X ECG monitor/report, 24 hrs .............................................................. 0100 1.70 $84.32 $71.57 $16.86

93227 E ECG monitor/review, 24 hrs ............................................................. .................... .................... .................... .................... ....................

93230 E ECG monitor/report, 24 hrs .............................................................. .................... .................... .................... .................... ....................

93231 X Ecg monitor/record, 24 hrs .............................................................. 0100 1.70 $84.32 $71.57 $16.86

93232 X ECG monitor/report, 24 hrs .............................................................. 0100 1.70 $84.32 $71.57 $16.86

93233 E ECG monitor/review, 24 hrs ............................................................. .................... .................... .................... .................... ....................

93235 E ECG monitor/report, 24 hrs .............................................................. .................... .................... .................... .................... ....................

93236 X ECG monitor/report, 24 hrs .............................................................. 0100 1.70 $84.32 $71.57 $16.86

93237 E ECG monitor/review, 24 hrs ............................................................. .................... .................... .................... .................... ....................

93268 E ECG record/review ........................................................................... .................... .................... .................... .................... ....................

93270 X ECG recording ................................................................................. 0097 1.62 $80.35 $62.40 $16.07

93271 X Ecg/monitoring and analysis ............................................................ 0097 1.62 $80.35 $62.40 $16.07

93272 E Ecg/review,interpret only .................................................................. .................... .................... .................... .................... ....................

93278 X ECG/signal-averaged ....................................................................... 0099 0.38 $18.85 $14.68 $3.77

93303 S Echo transthoracic ........................................................................... 0269 4.40 $218.22 $114.01 $43.64

93304 S Echo transthoracic ........................................................................... 0269 4.40 $218.22 $114.01 $43.64

93307 S Echo exam of heart .......................................................................... 0269 4.40 $218.22 $114.01 $43.64

93308 S Echo exam of heart .......................................................................... 0269 4.40 $218.22 $114.01 $43.64

93312 S Echo transesophageal ..................................................................... 0270 5.55 $275.25 $150.26 $55.05

93313 S Echo transesophageal ..................................................................... 0270 5.55 $275.25 $150.26 $55.05

93314 N Echo transesophageal ..................................................................... .................... .................... .................... .................... ....................

93315 S Echo transesophageal ..................................................................... 0270 5.55 $275.25 $150.26 $55.05

93316 S Echo transesophageal ..................................................................... 0270 5.55 $275.25 $150.26 $55.05

93317 N Echo transesophageal ..................................................................... .................... .................... .................... .................... ....................

*93318 S Echo transesophageal ..................................................................... 0270 5.55 $275.25 $150.26 $55.05

93320 S Doppler echo exam, heart ............................................................... 0269 4.40 $218.22 $114.01 $43.64

93321 S Doppler echo exam, heart ............................................................... 0269 4.40 $218.22 $114.01 $43.64

93325 S Doppler color flow add-on ................................................................ 0269 4.40 $218.22 $114.01 $43.64

67940

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

93350 S Echo transthoracic ........................................................................... 0269 4.40 $218.22 $114.01 $43.64

93501 T Right heart catheterization ............................................................... 0080 31.55 $1,564.75 $838.92 $312.95

93503 T Insert/place heart catheter ............................................................... 0103 13.09 $649.21 $295.70 $129.84

93505 T Biopsy of heart lining ....................................................................... 0103 13.09 $649.21 $295.70 $129.84

93508 N Cath placement, angiography .......................................................... .................... .................... .................... .................... ....................

93510 T Left heart catheterization ................................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93511 T Left heart catheterization ................................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93514 T Left heart catheterization ................................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93524 T Left heart catheterization ................................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93526 T Rt & Lt heart catheters ..................................................................... 0080 31.55 $1,564.75 $838.92 $312.95

93527 T Rt & Lt heart catheters ..................................................................... 0080 31.55 $1,564.75 $838.92 $312.95

93528 T Rt & Lt heart catheters ..................................................................... 0080 31.55 $1,564.75 $838.92 $312.95

93529 T Rt, Lt heart catheterization ............................................................... 0080 31.55 $1,564.75 $838.92 $312.95

93530 T Rt heart cath, congenital .................................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93531 T R & l heart cath, congenital ............................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93532 T R & l heart cath, congenital ............................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93533 T R & l heart cath, congenital ............................................................. 0080 31.55 $1,564.75 $838.92 $312.95

93536 T Insert circulation assi ....................................................................... 0103 13.09 $649.21 $295.70 $129.84

93539 N Injection, cardiac cath ...................................................................... .................... .................... .................... .................... ....................

93540 N Injection, cardiac cath ...................................................................... .................... .................... .................... .................... ....................

93541 N Injection for lung angiogram ............................................................ .................... .................... .................... .................... ....................

93542 N Injection for heart x-rays .................................................................. .................... .................... .................... .................... ....................

93543 N Injection for heart x-rays .................................................................. .................... .................... .................... .................... ....................

93544 N Injection for aortography .................................................................. .................... .................... .................... .................... ....................

93545 N Inject for coronary x-rays ................................................................. .................... .................... .................... .................... ....................

93555 N Imaging, cardiac cath ....................................................................... .................... .................... .................... .................... ....................

93556 N Imaging, cardiac cath ....................................................................... .................... .................... .................... .................... ....................

93561 N Cardiac output measurement ........................................................... .................... .................... .................... .................... ....................

93562 N Cardiac output measurement ........................................................... .................... .................... .................... .................... ....................

93571 N Heart flow reserve measure ............................................................. .................... .................... .................... .................... ....................

93572 N Heart flow reserve measure ............................................................. .................... .................... .................... .................... ....................

93600 S Bundle of His recording ................................................................... 0087 9.53 $472.65 $214.72 $94.53

93602 S Intra-atrial recording ......................................................................... 0087 9.53 $472.65 $214.72 $94.53

93603 S Right ventricular recording ............................................................... 0087 9.53 $472.65 $214.72 $94.53

93607 S Left ventricular recording ................................................................. 0087 9.53 $472.65 $214.72 $94.53

93609 S Mapping of tachycardia .................................................................... 0087 9.53 $472.65 $214.72 $94.53

93610 S Intra-atrial pacing ............................................................................. 0087 9.53 $472.65 $214.72 $94.53

93612 S Intraventricular pacing ...................................................................... 0087 9.53 $472.65 $214.72 $94.53

93615 S Esophageal recording ...................................................................... 0087 9.53 $472.65 $214.72 $94.53

93616 S Esophageal recording ...................................................................... 0087 9.53 $472.65 $214.72 $94.53

93618 S Heart rhythm pacing ......................................................................... 0087 9.53 $472.65 $214.72 $94.53

93619 S Electrophysiology evaluation ............................................................ 0085 27.06 $1,342.07 $654.48 $268.41

93620 S Electrophysiology evaluation ............................................................ 0085 27.06 $1,342.07 $654.48 $268.41

93621 S Electrophysiology evaluation ............................................................ 0085 27.06 $1,342.07 $654.48 $268.41

93622 S Electrophysiology evaluation ............................................................ 0085 27.06 $1,342.07 $654.48 $268.41

93623 S Stimulation, pacing heart ................................................................. 0087 9.53 $472.65 $214.72 $94.53

93624 S Electrophysiologic study ................................................................... 0087 9.53 $472.65 $214.72 $94.53

93631 S Heart pacing, mapping ..................................................................... 0087 9.53 $472.65 $214.72 $94.53

93640 S Evaluation heart device .................................................................... 0084 10.70 $530.68 $177.79 $106.14

93641 S Electrophysiology evaluation ............................................................ 0084 10.70 $530.68 $177.79 $106.14

93642 S Electrophysiology evaluation ............................................................ 0084 10.70 $530.68 $177.79 $106.14

93650 S Ablate heart dysrhythm focus .......................................................... 0086 47.62 $2,361.76 $1,265.37 $472.35

93651 S Ablate heart dysrhythm focus .......................................................... 0086 47.62 $2,361.76 $1,265.37 $472.35

93652 S Ablate heart dysrhythm focus .......................................................... 0086 47.62 $2,361.76 $1,265.37 $472.35

93660 S Tilt table evaluation .......................................................................... 0101 4.47 $221.70 $128.84 $44.34

*93662 S Intracardiac ECG .............................................................................. 0270 5.55 $275.25 $150.26 $55.05

*93668 E Peripheral vascular rehab ................................................................ .................... .................... .................... .................... ....................

93720 E Total body plethysmography ............................................................ .................... .................... .................... .................... ....................

93721 S Plethysmography tracing .................................................................. 0096 2.06 $102.16 $61.48 $20.43

93722 E Plethysmography report ................................................................... .................... .................... .................... .................... ....................

93724 S Analyze pacemaker system ............................................................. 0102 0.45 $22.32 $12.62 $4.46

93727 S Analyze ilr system ............................................................................ 0102 0.45 $22.32 $12.62 $4.46

93731 S Analyze pacemaker system ............................................................. 0102 0.45 $22.32 $12.62 $4.46

93732 S Analyze pacemaker system ............................................................. 0102 0.45 $22.32 $12.62 $4.46

93733 S Telephone analy, pacemaker ........................................................... 0102 0.45 $22.32 $12.62 $4.46

93734 S Analyze pacemaker system ............................................................. 0102 0.45 $22.32 $12.62 $4.46

93735 S Analyze pacemaker system ............................................................. 0102 0.45 $22.32 $12.62 $4.46

93736 S Telephone analy, pacemaker ........................................................... 0102 0.45 $22.32 $12.62 $4.46

93737 S Analyze cardio/defibrillator ............................................................... 0102 0.45 $22.32 $12.62 $4.46

93738 S Analyze cardio/defibrillator ............................................................... 0102 0.45 $22.32 $12.62 $4.46

93740 S Temperature gradient studies .......................................................... 0096 2.06 $102.16 $61.48 $20.43

93741 S Analyze ht pace device sngl ............................................................ 0102 0.45 $22.32 $12.62 $4.46

93742 S Analyze ht pace device sngl ............................................................ 0102 0.45 $22.32 $12.62 $4.46

93743 S Analyze ht pace device dual ............................................................ 0102 0.45 $22.32 $12.62 $4.46

67941

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

93744 S Analyze ht pace device dual ............................................................ 0102 0.45 $22.32 $12.62 $4.46

93760 E Cephalic thermogram ....................................................................... .................... .................... .................... .................... ....................

93762 E Peripheral thermogram .................................................................... .................... .................... .................... .................... ....................

93770 N Measure venous pressure ............................................................... .................... .................... .................... .................... ....................

93784 E Ambulatory BP monitoring ............................................................... .................... .................... .................... .................... ....................

93786 E Ambulatory BP recording ................................................................. .................... .................... .................... .................... ....................

93788 E Ambulatory BP analysis ................................................................... .................... .................... .................... .................... ....................

93790 E Review/report BP recording ............................................................. .................... .................... .................... .................... ....................

93797 S Cardiac rehab ................................................................................... 0095 0.64 $31.74 $16.98 $6.35

93798 S Cardiac rehab/monitor ...................................................................... 0095 0.64 $31.74 $16.98 $6.35

93799 S Cardiovascular procedure ................................................................ 0096 2.06 $102.16 $61.48 $20.43

93875 S Extracranial study ............................................................................. 0096 2.06 $102.16 $61.48 $20.43

93880 S Extracranial study ............................................................................. 0267 2.72 $134.90 $80.06 $26.98

93882 S Extracranial study ............................................................................. 0267 2.72 $134.90 $80.06 $26.98

93886 S Intracranial study .............................................................................. 0267 2.72 $134.90 $80.06 $26.98

93888 S Intracranial study .............................................................................. 0267 2.72 $134.90 $80.06 $26.98

93922 S Extremity study ................................................................................. 0096 2.06 $102.16 $61.48 $20.43

93923 S Extremity study ................................................................................. 0096 2.06 $102.16 $61.48 $20.43

93924 S Extremity study ................................................................................. 0096 2.06 $102.16 $61.48 $20.43

93925 S Lower extremity study ...................................................................... 0267 2.72 $134.90 $80.06 $26.98

93926 S Lower extremity study ...................................................................... 0267 2.72 $134.90 $80.06 $26.98

93930 S Upper extremity study ...................................................................... 0267 2.72 $134.90 $80.06 $26.98

93931 S Upper extremity study ...................................................................... 0267 2.72 $134.90 $80.06 $26.98

93965 S Extremity study ................................................................................. 0096 2.06 $102.16 $61.48 $20.43

93970 S Extremity study ................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93971 S Extremity study ................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93975 S Vascular study .................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93976 S Vascular study .................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93978 S Vascular study .................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93979 S Vascular study .................................................................................. 0267 2.72 $134.90 $80.06 $26.98

93980 S Penile vascular study ....................................................................... 0267 2.72 $134.90 $80.06 $26.98

93981 S Penile vascular study ....................................................................... 0267 2.72 $134.90 $80.06 $26.98

93990 S Doppler flow testing ......................................................................... 0267 2.72 $134.90 $80.06 $26.98

94010 X Breathing capacity test ..................................................................... 0367 0.83 $41.16 $20.65 $8.23

94014 X Patient recorded spirometry ............................................................. 0369 2.34 $116.06 $58.50 $23.21

94015 X Patient recorded spirometry ............................................................. 0369 2.34 $116.06 $58.50 $23.21

94016 X Review patient spirometry ................................................................ 0369 2.34 $116.06 $58.50 $23.21

94060 X Evaluation of wheezing .................................................................... 0368 1.66 $82.33 $42.44 $16.47

94070 X Evaluation of wheezing .................................................................... 0369 2.34 $116.06 $58.50 $23.21

94150 N Vital capacity test ............................................................................. .................... .................... .................... .................... ....................

94200 X Lung function test (MBC/MVV) ........................................................ 0367 0.83 $41.16 $20.65 $8.23

94240 X Residual lung capacity ..................................................................... 0368 1.66 $82.33 $42.44 $16.47

94250 X Expired gas collection ...................................................................... 0367 0.83 $41.16 $20.65 $8.23

94260 X Thoracic gas volume ........................................................................ 0368 1.66 $82.33 $42.44 $16.47

94350 X Lung nitrogen washout curve ........................................................... 0368 1.66 $82.33 $42.44 $16.47

94360 X Measure airflow resistance .............................................................. 0368 1.66 $82.33 $42.44 $16.47

94370 X Breath airway closing volume .......................................................... 0368 1.66 $82.33 $42.44 $16.47

94375 X Respiratory flow volume loop ........................................................... 0367 0.83 $41.16 $20.65 $8.23

94400 X CO2 breathing response curve ........................................................ 0367 0.83 $41.16 $20.65 $8.23

94450 X Hypoxia response curve .................................................................. 0367 0.83 $41.16 $20.65 $8.23

94620 X Pulmonary stress test/simple ........................................................... 0368 1.66 $82.33 $42.44 $16.47

94621 X Pulm stress test/complex ................................................................. 0369 2.34 $116.06 $58.50 $23.21

94640 S Airway inhalation treatment .............................................................. 0077 0.43 $21.33 $12.62 $4.27

94642 S Aerosol inhalation treatment ............................................................ 0078 1.34 $66.46 $29.13 $13.29

94650 S Pressure breathing (IPPB) ............................................................... 0077 0.43 $21.33 $12.62 $4.27

94651 S Pressure breathing (IPPB) ............................................................... 0077 0.43 $21.33 $12.62 $4.27

94652 C Pressure breathing (IPPB) ............................................................... .................... .................... .................... .................... ....................

94656 S Initial ventilator mgmt ....................................................................... 0079 3.18 $157.72 $107.70 $31.54

94657 S Continued ventilator mgmt ............................................................... 0079 3.18 $157.72 $107.70 $31.54

94660 S Pos airway pressure, CPAP ............................................................ 0079 3.18 $157.72 $107.70 $31.54

94662 S Neg press ventilation, cnp ............................................................... 0079 3.18 $157.72 $107.70 $31.54

94664 S Aerosol or vapor inhalations ............................................................ 0077 0.43 $21.33 $12.62 $4.27

94665 S Aerosol or vapor inhalations ............................................................ 0077 0.43 $21.33 $12.62 $4.27

94667 S Chest wall manipulation ................................................................... 0077 0.43 $21.33 $12.62 $4.27

94668 S Chest wall manipulation ................................................................... 0077 0.43 $21.33 $12.62 $4.27

94680 X Exhaled air analysis, o2 ................................................................... 0367 0.83 $41.16 $20.65 $8.23

94681 X Exhaled air analysis, o2/co2 ............................................................ 0368 1.66 $82.33 $42.44 $16.47

94690 X Exhaled air analysis ......................................................................... 0367 0.83 $41.16 $20.65 $8.23

94720 X Monoxide diffusing capacity ............................................................. 0367 0.83 $41.16 $20.65 $8.23

94725 X Membrane diffusion capacity ........................................................... 0368 1.66 $82.33 $42.44 $16.47

94750 X Pulmonary compliance study ........................................................... 0368 1.66 $82.33 $42.44 $16.47

94760 N Measure blood oxygen level ............................................................ .................... .................... .................... .................... ....................

94761 N Measure blood oxygen level ............................................................ .................... .................... .................... .................... ....................

94762 N Measure blood oxygen level ............................................................ .................... .................... .................... .................... ....................

67942

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

94770 X Exhaled carbon dioxide test ............................................................. 0367 0.83 $41.16 $20.65 $8.23

94772 X Breath recording, infant .................................................................... 0369 2.34 $116.06 $58.50 $23.21

94799 X Pulmonary service/procedure .......................................................... 0367 0.83 $41.16 $20.65 $8.23

95004 X Allergy skin tests .............................................................................. 0370 0.57 $28.27 $11.81 $5.65

95010 X Sensitivity skin tests ......................................................................... 0370 0.57 $28.27 $11.81 $5.65

95015 X Sensitivity skin tests ......................................................................... 0370 0.57 $28.27 $11.81 $5.65

95024 X Allergy skin tests .............................................................................. 0370 0.57 $28.27 $11.81 $5.65

95027 X Skin end point titration ..................................................................... 0370 0.57 $28.27 $11.81 $5.65

95028 X Allergy skin tests .............................................................................. 0370 0.57 $28.27 $11.81 $5.65

95044 X Allergy patch tests ............................................................................ 0370 0.57 $28.27 $11.81 $5.65

95052 X Photo patch test ............................................................................... 0370 0.57 $28.27 $11.81 $5.65

95056 X Photosensitivity tests ........................................................................ 0370 0.57 $28.27 $11.81 $5.65

95060 X Eye allergy tests ............................................................................... 0370 0.57 $28.27 $11.81 $5.65

95065 X Nose allergy test .............................................................................. 0370 0.57 $28.27 $11.81 $5.65

95070 X Bronchial allergy tests ...................................................................... 0369 2.34 $116.06 $58.50 $23.21

95071 X Bronchial allergy tests ...................................................................... 0369 2.34 $116.06 $58.50 $23.21

95075 X Ingestion challenge test ................................................................... 0361 3.53 $175.07 $88.09 $35.01

95078 X Provocative testing ........................................................................... 0370 0.57 $28.27 $11.81 $5.65

95115 X Immunotherapy, one injection .......................................................... 0371 0.32 $15.87 $3.67 $3.17

95117 X Immunotherapy injections ................................................................ 0371 0.32 $15.87 $3.67 $3.17

95120 E Immunotherapy, one injection .......................................................... .................... .................... .................... .................... ....................

95125 E Immunotherapy, many antigens ....................................................... .................... .................... .................... .................... ....................

95130 E Immunotherapy, insect venom ......................................................... .................... .................... .................... .................... ....................

95131 E Immunotherapy, insect venoms ....................................................... .................... .................... .................... .................... ....................

95132 E Immunotherapy, insect venoms ....................................................... .................... .................... .................... .................... ....................

95133 E Immunotherapy, insect venoms ....................................................... .................... .................... .................... .................... ....................

95134 E Immunotherapy, insect venoms ....................................................... .................... .................... .................... .................... ....................

95144 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95145 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95146 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95147 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95148 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95149 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95165 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95170 X Antigen therapy services .................................................................. 0371 0.32 $15.87 $3.67 $3.17

95180 X Rapid desensitization ....................................................................... 0370 0.57 $28.27 $11.81 $5.65

95199 X Allergy immunology services ........................................................... 0370 0.57 $28.27 $11.81 $5.65

95805 S Multiple sleep latency test ................................................................ 0213 11.15 $553.00 $290.42 $110.60

95806 S Sleep study, unattended .................................................................. 0213 11.15 $553.00 $290.42 $110.60

95807 S Sleep study, attended ...................................................................... 0213 11.15 $553.00 $290.42 $110.60

95808 S Polysomnography, 1-3 ..................................................................... 0213 11.15 $553.00 $290.42 $110.60

95810 S Polysomnography, 4 or more ........................................................... 0213 11.15 $553.00 $290.42 $110.60

95811 S Polysomnography w/cpap ................................................................ 0213 11.15 $553.00 $290.42 $110.60

95812 S Electroencephalogram (EEG) .......................................................... 0213 11.15 $553.00 $290.42 $110.60

95813 S Electroencephalogram (EEG) .......................................................... 0213 11.15 $553.00 $290.42 $110.60

95816 S Electroencephalogram (EEG) .......................................................... 0214 2.32 $115.06 $58.50 $23.01

95819 S Electroencephalogram (EEG) .......................................................... 0214 2.32 $115.06 $58.50 $23.01

95822 S Sleep electroencephalogram ........................................................... 0214 2.32 $115.06 $58.50 $23.01

95824 S Electroencephalography ................................................................... 0214 2.32 $115.06 $58.50 $23.01

95827 S Night electroencephalogram ............................................................ 0213 11.15 $553.00 $290.42 $110.60

95829 S Surgery electrocorticogram .............................................................. 0214 2.32 $115.06 $58.50 $23.01

95830 E Insert electrodes for EEG ................................................................ .................... .................... .................... .................... ....................

95831 N Limb muscle testing, manual ........................................................... .................... .................... .................... .................... ....................

95832 N Hand muscle testing, manual .......................................................... .................... .................... .................... .................... ....................

95833 N Body muscle testing, manual ........................................................... .................... .................... .................... .................... ....................

95834 N Body muscle testing, manual ........................................................... .................... .................... .................... .................... ....................

95851 N Range of motion measurements ...................................................... .................... .................... .................... .................... ....................

95852 N Range of motion measurements ...................................................... .................... .................... .................... .................... ....................

95857 S Tensilon test ..................................................................................... 0215 1.15 $57.04 $30.05 $11.41

95858 S Tensilon test & myogram ................................................................. 0215 1.15 $57.04 $30.05 $11.41

95860 S Muscle test, one limb ....................................................................... 0215 1.15 $57.04 $30.05 $11.41

95861 S Muscle test, two limbs ...................................................................... 0215 1.15 $57.04 $30.05 $11.41

95863 S Muscle test, 3 limbs ......................................................................... 0216 2.87 $142.34 $64.69 $28.47

95864 S Muscle test, 4 limbs ......................................................................... 0215 1.15 $57.04 $30.05 $11.41

95867 S Muscle test, head or neck ................................................................ 0216 2.87 $142.34 $64.69 $28.47

95868 S Muscle test, head or neck ................................................................ 0216 2.87 $142.34 $64.69 $28.47

95869 S Muscle test, thor paraspinal ............................................................. 0215 1.15 $57.04 $30.05 $11.41

95870 S Muscle test, nonparaspinal .............................................................. 0215 1.15 $57.04 $30.05 $11.41

95872 S Muscle test, one fiber ....................................................................... 0215 1.15 $57.04 $30.05 $11.41

95875 S Limb exercise test ............................................................................ 0217 5.87 $291.13 $156.68 $58.23

95900 S Motor nerve conduction test ............................................................ 0215 1.15 $57.04 $30.05 $11.41

95903 S Motor nerve conduction test ............................................................ 0215 1.15 $57.04 $30.05 $11.41

95904 S Sense/mixed n conduction tst .......................................................... 0215 1.15 $57.04 $30.05 $11.41

95920 S Intraop nerve test add-on ................................................................. 0216 2.87 $142.34 $64.69 $28.47

67943

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

95921 S Autonomic nerv function test ........................................................... 0216 2.87 $142.34 $64.69 $28.47

95922 S Autonomic nerv function test ........................................................... 0216 2.87 $142.34 $64.69 $28.47

95923 S Autonomic nerv function test ........................................................... 0216 2.87 $142.34 $64.69 $28.47

95925 S Somatosensory testing ..................................................................... 0216 2.87 $142.34 $64.69 $28.47

95926 S Somatosensory testing ..................................................................... 0216 2.87 $142.34 $64.69 $28.47

95927 S Somatosensory testing ..................................................................... 0216 2.87 $142.34 $64.69 $28.47

95930 S Visual evoked potential test ............................................................. 0216 2.87 $142.34 $64.69 $28.47

95933 S Blink reflex test ................................................................................. 0215 1.15 $57.04 $30.05 $11.41

95934 S H-reflex test ...................................................................................... 0215 1.15 $57.04 $30.05 $11.41

95936 S H-reflex test ...................................................................................... 0216 2.87 $142.34 $64.69 $28.47

95937 S Neuromuscular junction test ............................................................ 0215 1.15 $57.04 $30.05 $11.41

95950 S Ambulatory eeg monitoring .............................................................. 0217 5.87 $291.13 $156.68 $58.23

95951 S EEG monitoring/videorecord ............................................................ 0213 11.15 $553.00 $290.42 $110.60

95953 S EEG monitoring/computer ................................................................ 0213 11.15 $553.00 $290.42 $110.60

95954 S EEG monitoring/giving drugs ........................................................... 0213 11.15 $553.00 $290.42 $110.60

95955 S EEG during surgery ......................................................................... 0214 2.32 $115.06 $58.50 $23.01

95956 N Eeg monitoring, cable/radio ............................................................. .................... .................... .................... .................... ....................

95957 N EEG digital analysis ......................................................................... .................... .................... .................... .................... ....................

95958 S EEG monitoring/function test ........................................................... 0213 11.15 $553.00 $290.42 $110.60

95961 S Electrode stimulation, brain .............................................................. 0216 2.87 $142.34 $64.69 $28.47

95962 S Electrode stim, brain add-on ............................................................ 0216 2.87 $142.34 $64.69 $28.47

95970 S Analyze neurostim, no prog ............................................................. 0102 0.45 $22.32 $12.62 $4.46

95971 S Analyze neurostim, simple ............................................................... 0102 0.45 $22.32 $12.62 $4.46

95972 S Analyze neurostim, complex ............................................................ 0102 0.45 $22.32 $12.62 $4.46

95973 S Analyze neurostim, complex ............................................................ 0102 0.45 $22.32 $12.62 $4.46

95974 S Cranial neurostim, complex ............................................................. 0102 0.45 $22.32 $12.62 $4.46

95975 S Cranial neurostim, complex ............................................................. 0102 0.45 $22.32 $12.62 $4.46

95999 N Neurological procedure .................................................................... .................... .................... .................... .................... ....................

96100 X Psychological testing ........................................................................ 0373 3.21 $159.20 $44.96 $31.84

96105 X Assessment of aphasia .................................................................... 0373 3.21 $159.20 $44.96 $31.84

96110 X Developmental test, lim .................................................................... 0373 3.21 $159.20 $44.96 $31.84

96111 X Developmental test, extend ............................................................. 0373 3.21 $159.20 $44.96 $31.84

96115 X Neurobehavior status exam ............................................................. 0373 3.21 $159.20 $44.96 $31.84

96117 X Neuropsych test battery ................................................................... 0373 3.21 $159.20 $44.96 $31.84

96400 E Chemotherapy, sc/im ....................................................................... .................... .................... .................... .................... ....................

96405 E Intralesional chemo admin ............................................................... .................... .................... .................... .................... ....................

96406 E Intralesional chemo admin ............................................................... .................... .................... .................... .................... ....................

96408 E Chemotherapy, push technique ....................................................... .................... .................... .................... .................... ....................

96410 E Chemotherapy,infusion method ....................................................... .................... .................... .................... .................... ....................

96412 E Chemo, infuse method add-on ........................................................ .................... .................... .................... .................... ....................

96414 E Chemo, infuse method add-on ........................................................ .................... .................... .................... .................... ....................

96420 E Chemotherapy, push technique ....................................................... .................... .................... .................... .................... ....................

96422 E Chemotherapy,infusion method ....................................................... .................... .................... .................... .................... ....................

96423 E Chemo, infuse method add-on ........................................................ .................... .................... .................... .................... ....................

96425 E Chemotherapy,infusion method ....................................................... .................... .................... .................... .................... ....................

96440 E Chemotherapy, intracavitary ............................................................ .................... .................... .................... .................... ....................

96445 E Chemotherapy, intracavitary ............................................................ .................... .................... .................... .................... ....................

96450 E Chemotherapy, into CNS ................................................................. .................... .................... .................... .................... ....................

96520 E Pump refilling, maintenance ............................................................. .................... .................... .................... .................... ....................

96530 E Pump refilling, maintenance ............................................................. .................... .................... .................... .................... ....................

96542 E Chemotherapy injection ................................................................... .................... .................... .................... .................... ....................

96545 E Provide chemotherapy agent ........................................................... .................... .................... .................... .................... ....................

96549 E Chemotherapy, unspecified ............................................................. .................... .................... .................... .................... ....................

96570 T Photodynamic tx, 30 min ................................................................. 0973 5.16 $255.91 .................... $51.18

96571 T Photodynamic tx, addl 15 min ......................................................... 0973 5.16 $255.91 .................... $51.18

96900 S Ultraviolet light therapy .................................................................... 0001 0.47 $23.31 $8.49 $4.66

96902 N Trichogram ....................................................................................... .................... .................... .................... .................... ....................

96910 S Photochemotherapy with UV-B ........................................................ 0001 0.47 $23.31 $8.49 $4.66

96912 S Photochemotherapy with UV-A ........................................................ 0001 0.47 $23.31 $8.49 $4.66

96913 S Photochemotherapy, UV-A or B ...................................................... 0001 0.47 $23.31 $8.49 $4.66

96999 S Dermatological procedure ................................................................ 0001 0.47 $23.31 $8.49 $4.66

97001 A Pt evaluation .................................................................................... .................... .................... .................... .................... ....................

97002 A Pt re-evaluation ................................................................................ .................... .................... .................... .................... ....................

97003 A Ot evaluation .................................................................................... .................... .................... .................... .................... ....................

97004 A Ot re-evaluation ................................................................................ .................... .................... .................... .................... ....................

97010 A Hot or cold packs therapy ................................................................ .................... .................... .................... .................... ....................

97012 A Mechanical traction therapy ............................................................. .................... .................... .................... .................... ....................

97014 A Electric stimulation therapy .............................................................. .................... .................... .................... .................... ....................

97016 A Vasopneumatic device therapy ........................................................ .................... .................... .................... .................... ....................

97018 A Paraffin bath therapy ........................................................................ .................... .................... .................... .................... ....................

97020 A Microwave therapy ........................................................................... .................... .................... .................... .................... ....................

97022 A Whirlpool therapy ............................................................................. .................... .................... .................... .................... ....................

97024 A Diathermy treatment ......................................................................... .................... .................... .................... .................... ....................

97026 A Infrared therapy ................................................................................ .................... .................... .................... .................... ....................

67944

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

97028 A Ultraviolet therapy ............................................................................ .................... .................... .................... .................... ....................

97032 A Electrical stimulation ........................................................................ .................... .................... .................... .................... ....................

97033 A Electric current therapy .................................................................... .................... .................... .................... .................... ....................

97034 A Contrast bath therapy ...................................................................... .................... .................... .................... .................... ....................

97035 A Ultrasound therapy ........................................................................... .................... .................... .................... .................... ....................

97036 A Hydrotherapy .................................................................................... .................... .................... .................... .................... ....................

97039 A Physical therapy treatment .............................................................. .................... .................... .................... .................... ....................

97110 A Therapeutic exercises ...................................................................... .................... .................... .................... .................... ....................

97112 A Neuromuscular reeducation ............................................................. .................... .................... .................... .................... ....................

97113 A Aquatic therapy/exercises ................................................................ .................... .................... .................... .................... ....................

97116 A Gait training therapy ......................................................................... .................... .................... .................... .................... ....................

97124 A Massage therapy .............................................................................. .................... .................... .................... .................... ....................

97139 A Physical medicine procedure ........................................................... .................... .................... .................... .................... ....................

97140 A Manual therapy ................................................................................ .................... .................... .................... .................... ....................

97150 A Group therapeutic procedures ......................................................... .................... .................... .................... .................... ....................

97504 A Orthotic training ................................................................................ .................... .................... .................... .................... ....................

97520 A Prosthetic training ............................................................................ .................... .................... .................... .................... ....................

97530 A Therapeutic activities ....................................................................... .................... .................... .................... .................... ....................

*97532 A Cognitive skills development ............................................................ .................... .................... .................... .................... ....................

*97533 A Sensory integration .......................................................................... .................... .................... .................... .................... ....................

97535 A Self care mngment training .............................................................. .................... .................... .................... .................... ....................

97537 A Community/work reintegration ......................................................... .................... .................... .................... .................... ....................

97542 A Wheelchair mngment training .......................................................... .................... .................... .................... .................... ....................

97545 A Work hardening ................................................................................ .................... .................... .................... .................... ....................

97546 A Work hardening add-on ................................................................... .................... .................... .................... .................... ....................

*97601 A Wound care selective ....................................................................... .................... .................... .................... .................... ....................

*97602 N Wound care non-selective ............................................................... .................... .................... .................... .................... ....................

97703 A Prosthetic checkout .......................................................................... .................... .................... .................... .................... ....................

97750 A Physical performance test ................................................................ .................... .................... .................... .................... ....................

97770D A Cognitive skills development ............................................................ .................... .................... .................... .................... ....................

97780 E Acupuncture w/o stimul .................................................................... .................... .................... .................... .................... ....................

97781 E Acupuncture w/stimul ....................................................................... .................... .................... .................... .................... ....................

97799 A Physical medicine procedure ........................................................... .................... .................... .................... .................... ....................

*97802 E Medical nutrition ............................................................................... .................... .................... .................... .................... ....................

*97803 E Medical nutrition ............................................................................... .................... .................... .................... .................... ....................

*97804 E Medical nutrition ............................................................................... .................... .................... .................... .................... ....................

98925 S Osteopathic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98926 S Osteopathic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98927 S Osteopathic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98928 S Osteopathic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98929 S Osteopathic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98940 S Chiropractic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98941 S Chiropractic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98942 S Chiropractic manipulation ................................................................. 0060 0.77 $38.19 $7.80 $7.64

98943 E Chiropractic manipulation ................................................................. .................... .................... .................... .................... ....................

99000 E Specimen handling ........................................................................... .................... .................... .................... .................... ....................

99001 E Specimen handling ........................................................................... .................... .................... .................... .................... ....................

99002 E Device handling ................................................................................ .................... .................... .................... .................... ....................

99024 E Postop follow-up visit ....................................................................... .................... .................... .................... .................... ....................

99025 E Initial surgical evaluation .................................................................. .................... .................... .................... .................... ....................

99050 E Medical services after hrs ................................................................ .................... .................... .................... .................... ....................

99052 E Medical services at night ................................................................. .................... .................... .................... .................... ....................

99054 E Medical servcs, unusual hrs ............................................................ .................... .................... .................... .................... ....................

99056 E Non-office medical services ............................................................. .................... .................... .................... .................... ....................

99058 E Office emergency care ..................................................................... .................... .................... .................... .................... ....................

99070 E Special supplies ............................................................................... .................... .................... .................... .................... ....................

99071 E Patient education materials .............................................................. .................... .................... .................... .................... ....................

99075 E Medical testimony ............................................................................ .................... .................... .................... .................... ....................

99078 E Group health education .................................................................... .................... .................... .................... .................... ....................

99080 E Special reports or forms ................................................................... .................... .................... .................... .................... ....................

99082 E Unusual physician travel .................................................................. .................... .................... .................... .................... ....................

99090 E Computer data analysis ................................................................... .................... .................... .................... .................... ....................

99100 E Special anesthesia service .............................................................. .................... .................... .................... .................... ....................

99116 E Anesthesia with hypothermia ........................................................... .................... .................... .................... .................... ....................

99135 E Special anesthesia procedure .......................................................... .................... .................... .................... .................... ....................

99140 E Emergency anesthesia ..................................................................... .................... .................... .................... .................... ....................

99141 N Sedation, iv/im or inhalant ............................................................... .................... .................... .................... .................... ....................

99142 N Sedation, oral/rectal/nasal ................................................................ .................... .................... .................... .................... ....................

99170 T Anogenital exam, child ..................................................................... 0192 2.38 $118.04 $35.33 $23.61

*99172 E Visual function screening ................................................................. .................... .................... .................... .................... ....................

99173 E Visual screening test ........................................................................ .................... .................... .................... .................... ....................

99175 N Induction of vomiting ........................................................................ .................... .................... .................... .................... ....................

99183 E Hyperbaric oxygen therapy .............................................................. .................... .................... .................... .................... ....................

99185 N Regional hypothermia ...................................................................... .................... .................... .................... .................... ....................

67945

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

99186 N Total body hypothermia ................................................................... .................... .................... .................... .................... ....................

99190 C Special pump services ..................................................................... .................... .................... .................... .................... ....................

99191 C Special pump services ..................................................................... .................... .................... .................... .................... ....................

99192 C Special pump services ..................................................................... .................... .................... .................... .................... ....................

99195 X Phlebotomy ...................................................................................... 0372 0.43 $21.33 $10.09 $4.27

99199 E Special service/proc/report ............................................................... .................... .................... .................... .................... ....................

99201 V Office/outpatient visit, new ............................................................... 0600 0.98 $48.61 $9.72 $9.72

99202 V Office/outpatient visit, new ............................................................... 0600 0.98 $48.61 $9.72 $9.72

99203 V Office/outpatient visit, new ............................................................... 0601 1.00 $49.60 $9.92 $9.92

99204 V Office/outpatient visit, new ............................................................... 0602 1.66 $82.33 $16.47 $16.47

99205 V Office/outpatient visit, new ............................................................... 0602 1.66 $82.33 $16.47 $16.47

99211 V Office/outpatient visit, est ................................................................. 0600 0.98 $48.61 $9.72 $9.72

99212 V Office/outpatient visit, est ................................................................. 0600 0.98 $48.61 $9.72 $9.72

99213 V Office/outpatient visit, est ................................................................. 0601 1.00 $49.60 $9.92 $9.92

99214 V Office/outpatient visit, est ................................................................. 0602 1.66 $82.33 $16.47 $16.47

99215 V Office/outpatient visit, est ................................................................. 0602 1.66 $82.33 $16.47 $16.47

99217 N Observation care discharge ............................................................. .................... .................... .................... .................... ....................

99218 N Observation care .............................................................................. .................... .................... .................... .................... ....................

99219 N Observation care .............................................................................. .................... .................... .................... .................... ....................

99220 N Observation care .............................................................................. .................... .................... .................... .................... ....................

99221 E Initial hospital care ........................................................................... .................... .................... .................... .................... ....................

99222 E Initial hospital care ........................................................................... .................... .................... .................... .................... ....................

99223 E Initial hospital care ........................................................................... .................... .................... .................... .................... ....................

99231 E Subsequent hospital care ................................................................ .................... .................... .................... .................... ....................

99232 E Subsequent hospital care ................................................................ .................... .................... .................... .................... ....................

99233 E Subsequent hospital care ................................................................ .................... .................... .................... .................... ....................

99234 N Observ/hosp same date ................................................................... .................... .................... .................... .................... ....................

99235 N Observ/hosp same date ................................................................... .................... .................... .................... .................... ....................

99236 N Observ/hosp same date ................................................................... .................... .................... .................... .................... ....................

99238 E Hospital discharge day ..................................................................... .................... .................... .................... .................... ....................

99239 E Hospital discharge day ..................................................................... .................... .................... .................... .................... ....................

99241 V Office consultation ............................................................................ 0600 0.98 $48.61 $9.72 $9.72

99242 V Office consultation ............................................................................ 0600 0.98 $48.61 $9.72 $9.72

99243 V Office consultation ............................................................................ 0601 1.00 $49.60 $9.92 $9.92

99244 V Office consultation ............................................................................ 0602 1.66 $82.33 $16.47 $16.47

99245 V Office consultation ............................................................................ 0602 1.66 $82.33 $16.47 $16.47

99251 C Initial inpatient consult ...................................................................... .................... .................... .................... .................... ....................

99252 C Initial inpatient consult ...................................................................... .................... .................... .................... .................... ....................

99253 C Initial inpatient consult ...................................................................... .................... .................... .................... .................... ....................

99254 C Initial inpatient consult ...................................................................... .................... .................... .................... .................... ....................

99255 C Initial inpatient consult ...................................................................... .................... .................... .................... .................... ....................

99261 C Follow-up inpatient consult .............................................................. .................... .................... .................... .................... ....................

99262 C Follow-up inpatient consult .............................................................. .................... .................... .................... .................... ....................

99263 C Follow-up inpatient consult .............................................................. .................... .................... .................... .................... ....................

99271 V Confirmatory consultation ................................................................ 0600 0.98 $48.61 $9.72 $9.72

99272 V Confirmatory consultation ................................................................ 0600 0.98 $48.61 $9.72 $9.72

99273 V Confirmatory consultation ................................................................ 0601 1.00 $49.60 $9.92 $9.92

99274 V Confirmatory consultation ................................................................ 0602 1.66 $82.33 $16.47 $16.47

99275 V Confirmatory consultation ................................................................ 0602 1.66 $82.33 $16.47 $16.47

99281 V Emergency dept visit ........................................................................ 0610 1.34 $66.46 $20.65 $13.29

99282 V Emergency dept visit ........................................................................ 0610 1.34 $66.46 $20.65 $13.29

99283 V Emergency dept visit ........................................................................ 0611 2.11 $104.65 $36.47 $20.93

99284 V Emergency dept visit ........................................................................ 0612 3.19 $158.21 $54.14 $31.64

99285 V Emergency dept visit ........................................................................ 0612 3.19 $158.21 $54.14 $31.64

99288 E Direct advanced life support ............................................................ .................... .................... .................... .................... ....................

99291 S Critical care, first hour ...................................................................... 0620 8.60 $426.53 $152.78 $85.31

99292 N Critical care, addl 30 min ................................................................. .................... .................... .................... .................... ....................

99295 C Neonatal critical care ....................................................................... .................... .................... .................... .................... ....................

99296 C Neonatal critical care ....................................................................... .................... .................... .................... .................... ....................

99297 C Neonatal critical care ....................................................................... .................... .................... .................... .................... ....................

99298 C Neonatal critical care ....................................................................... .................... .................... .................... .................... ....................

99301 E Nursing facility care .......................................................................... .................... .................... .................... .................... ....................

99302 E Nursing facility care .......................................................................... .................... .................... .................... .................... ....................

99303 E Nursing facility care .......................................................................... .................... .................... .................... .................... ....................

99311 E Nursing fac care, subseq ................................................................. .................... .................... .................... .................... ....................

99312 E Nursing fac care, subseq ................................................................. .................... .................... .................... .................... ....................

99313 E Nursing fac care, subseq ................................................................. .................... .................... .................... .................... ....................

99315 E Nursing fac discharge day ............................................................... .................... .................... .................... .................... ....................

99316 E Nursing fac discharge day ............................................................... .................... .................... .................... .................... ....................

99321 E Rest home visit, new patient ............................................................ .................... .................... .................... .................... ....................

99322 E Rest home visit, new patient ............................................................ .................... .................... .................... .................... ....................

99323 E Rest home visit, new patient ............................................................ .................... .................... .................... .................... ....................

99331 E Rest home visit, est pat ................................................................... .................... .................... .................... .................... ....................

99332 E Rest home visit, est pat ................................................................... .................... .................... .................... .................... ....................

67946

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

99333 E Rest home visit, est pat ................................................................... .................... .................... .................... .................... ....................

99341 E Home visit, new patient .................................................................... .................... .................... .................... .................... ....................

99342 E Home visit, new patient .................................................................... .................... .................... .................... .................... ....................

99343 E Home visit, new patient .................................................................... .................... .................... .................... .................... ....................

99344 E Home visit, new patient .................................................................... .................... .................... .................... .................... ....................

99345 E Home visit, new patient .................................................................... .................... .................... .................... .................... ....................

99347 E Home visit, est patient ..................................................................... .................... .................... .................... .................... ....................

99348 E Home visit, est patient ..................................................................... .................... .................... .................... .................... ....................

99349 E Home visit, est patient ..................................................................... .................... .................... .................... .................... ....................

99350 E Home visit, est patient ..................................................................... .................... .................... .................... .................... ....................

99354 N Prolonged service, office .................................................................. .................... .................... .................... .................... ....................

99355 N Prolonged service, office .................................................................. .................... .................... .................... .................... ....................

99356 C Prolonged service, inpatient ............................................................. .................... .................... .................... .................... ....................

99357 C Prolonged service, inpatient ............................................................. .................... .................... .................... .................... ....................

99358 N Prolonged serv, w/o contact ............................................................ .................... .................... .................... .................... ....................

99359 N Prolonged serv, w/o contact ............................................................ .................... .................... .................... .................... ....................

99360 E Physician standby services .............................................................. .................... .................... .................... .................... ....................

99361 E Physician/team conference .............................................................. .................... .................... .................... .................... ....................

99362 E Physician/team conference .............................................................. .................... .................... .................... .................... ....................

99371 E Physician phone consultation .......................................................... .................... .................... .................... .................... ....................

99372 E Physician phone consultation .......................................................... .................... .................... .................... .................... ....................

99373 E Physician phone consultation .......................................................... .................... .................... .................... .................... ....................

99374 E Home health care supervision ......................................................... .................... .................... .................... .................... ....................

99375D E Home health care supervision ......................................................... .................... .................... .................... .................... ....................

99377 E Hospice care supervision ................................................................. .................... .................... .................... .................... ....................

99378D E Hospice care supervision ................................................................. .................... .................... .................... .................... ....................

99379 E Nursing fac care supervision ........................................................... .................... .................... .................... .................... ....................

99380 E Nursing fac care supervision ........................................................... .................... .................... .................... .................... ....................

99381 E Prev visit, new, infant ....................................................................... .................... .................... .................... .................... ....................

99382 E Prev visit, new, age 1-4 ................................................................... .................... .................... .................... .................... ....................

99383 E Prev visit, new, age 5-11 ................................................................. .................... .................... .................... .................... ....................

99384 E Prev visit, new, age 12-17 ............................................................... .................... .................... .................... .................... ....................

99385 E Prev visit, new, age 18-39 ............................................................... .................... .................... .................... .................... ....................

99386 E Prev visit, new, age 40-64 ............................................................... .................... .................... .................... .................... ....................

99387 E Prev visit, new, 65 & over ................................................................ .................... .................... .................... .................... ....................

99391 E Prev visit, est, infant ......................................................................... .................... .................... .................... .................... ....................

99392 E Prev visit, est, age 1-4 ..................................................................... .................... .................... .................... .................... ....................

99393 E Prev visit, est, age 5-11 ................................................................... .................... .................... .................... .................... ....................

99394 E Prev visit, est, age 12-17 ................................................................. .................... .................... .................... .................... ....................

99395 E Prev visit, est, age 18-39 ................................................................. .................... .................... .................... .................... ....................

99396 E Prev visit, est, age 40-64 ................................................................. .................... .................... .................... .................... ....................

99397 E Prev visit, est, 65 & over .................................................................. .................... .................... .................... .................... ....................

99401 E Preventive counseling, indiv ............................................................ .................... .................... .................... .................... ....................

99402 E Preventive counseling, indiv ............................................................ .................... .................... .................... .................... ....................

99403 E Preventive counseling, indiv ............................................................ .................... .................... .................... .................... ....................

99404 E Preventive counseling, indiv ............................................................ .................... .................... .................... .................... ....................

99411 E Preventive counseling, group ........................................................... .................... .................... .................... .................... ....................

99412 E Preventive counseling, group ........................................................... .................... .................... .................... .................... ....................

99420 E Health risk assessment test ............................................................. .................... .................... .................... .................... ....................

99429 E Unlisted preventive service .............................................................. .................... .................... .................... .................... ....................

99431 N Initial care, normal newborn ............................................................. .................... .................... .................... .................... ....................

99432 N Newborn care, not in hosp ............................................................... .................... .................... .................... .................... ....................

99433 C Normal newborn care/hospital ......................................................... .................... .................... .................... .................... ....................

99435 E Newborn discharge day hosp .......................................................... .................... .................... .................... .................... ....................

99436 N Attendance, birth .............................................................................. .................... .................... .................... .................... ....................

99440 S Newborn resuscitation ...................................................................... 0094 4.51 $223.68 $105.29 $44.74

99450 E Life/disability evaluation ................................................................... .................... .................... .................... .................... ....................

99455 E Disability examination ...................................................................... .................... .................... .................... .................... ....................

99456 E Disability examination ...................................................................... .................... .................... .................... .................... ....................

99499 E Unlisted e&m service ....................................................................... .................... .................... .................... .................... ....................

A0021 E Outside state ambulance serv ......................................................... .................... .................... .................... .................... ....................

A0030D A Air ambulance service ...................................................................... .................... .................... .................... .................... ....................

A0040D A Helicopter ambulance service .......................................................... .................... .................... .................... .................... ....................

A0050D A Water amb service emergency ........................................................ .................... .................... .................... .................... ....................

A0080 E Noninterest escort in non er ............................................................ .................... .................... .................... .................... ....................

A0090 E Interest escort in non er ................................................................... .................... .................... .................... .................... ....................

A0100 E Nonemergency transport taxi ........................................................... .................... .................... .................... .................... ....................

A0110 E Nonemergency transport bus ........................................................... .................... .................... .................... .................... ....................

A0120 E Noner transport mini-bus ................................................................. .................... .................... .................... .................... ....................

A0130 E Noner transport wheelch van ........................................................... .................... .................... .................... .................... ....................

A0140 E Nonemergency transport air ............................................................ .................... .................... .................... .................... ....................

A0160 E Noner transport case worker ........................................................... .................... .................... .................... .................... ....................

A0170 E Noner transport parking fees ........................................................... .................... .................... .................... .................... ....................

A0180 E Noner transport lodgng recip ........................................................... .................... .................... .................... .................... ....................

67947

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A0190 E Noner transport meals recip ............................................................ .................... .................... .................... .................... ....................

A0200 E Noner transport lodgng escrt ........................................................... .................... .................... .................... .................... ....................

A0210 E Noner transport meals escort .......................................................... .................... .................... .................... .................... ....................

A0225 A Neonatal emergency transport ......................................................... .................... .................... .................... .................... ....................

A0300D A Ambulance basic non-emer all ........................................................ .................... .................... .................... .................... ....................

A0302D A Ambulance basic emergeny all ........................................................ .................... .................... .................... .................... ....................

A0304D A Amb adv non-er no serv all ............................................................. .................... .................... .................... .................... ....................

A0306D A Amb adv non-er spec serv all .......................................................... .................... .................... .................... .................... ....................

A0308D A Amb adv er no spec serv all ............................................................ .................... .................... .................... .................... ....................

A0310D A Amb adv er spec serv all ................................................................. .................... .................... .................... .................... ....................

A0320D A Amb basic non-er + supplies ........................................................... .................... .................... .................... .................... ....................

A0322D A Amb basic emerg + supplies ........................................................... .................... .................... .................... .................... ....................

A0324D A Adv non-er serv sep mileage ........................................................... .................... .................... .................... .................... ....................

A0326D A Adv non-er no serv sep mile ............................................................ .................... .................... .................... .................... ....................

A0328D A Adv er no serv sep mileage ............................................................. .................... .................... .................... .................... ....................

A0330D A Adv er spec serv sep mile ............................................................... .................... .................... .................... .................... ....................

A0340D A Amb basic non-er + mileage ............................................................ .................... .................... .................... .................... ....................

A0342D A Ambul basic emer + mileage ........................................................... .................... .................... .................... .................... ....................

A0344D A Amb adv non-er no serv +mile ........................................................ .................... .................... .................... .................... ....................

A0346D A Amb adv non-er serv + mile ............................................................ .................... .................... .................... .................... ....................

A0348D A Adv emer no spec serv + mile ......................................................... .................... .................... .................... .................... ....................

A0350D A Adv emer spec serv + mileage ........................................................ .................... .................... .................... .................... ....................

A0360D A Basic non-er sep mile & supp .......................................................... .................... .................... .................... .................... ....................

A0362D A Basic emer sep mile & supply ......................................................... .................... .................... .................... .................... ....................

A0364D A Adv non-er no serv sep mi&su ........................................................ .................... .................... .................... .................... ....................

A0366D A Adv non-er serv sep mil&supp ......................................................... .................... .................... .................... .................... ....................

A0368 A Adv er no serv sep mile&supp ......................................................... .................... .................... .................... .................... ....................

A0370D A Adv er spec serv sep mi&supp ........................................................ .................... .................... .................... .................... ....................

A0380D A Basic life support mileage ................................................................ .................... .................... .................... .................... ....................

A0382 A Basic support routine suppls ............................................................ .................... .................... .................... .................... ....................

A0384 A Bls defibrillation supplies .................................................................. .................... .................... .................... .................... ....................

A0390D A Advanced life support mileag ........................................................... .................... .................... .................... .................... ....................

A0392 A Als defibrillation supplies .................................................................. .................... .................... .................... .................... ....................

A0394 A Als IV drug therapy supplies ............................................................ .................... .................... .................... .................... ....................

A0396 A Als esophageal intub suppls ............................................................ .................... .................... .................... .................... ....................

A0398 A Als routine disposble suppls ............................................................ .................... .................... .................... .................... ....................

A0420 A Ambulance waiting 1/2 hr ................................................................ .................... .................... .................... .................... ....................

A0422 A Ambulance O2 life sustaining .......................................................... .................... .................... .................... .................... ....................

A0424 A Extra ambulance attendant .............................................................. .................... .................... .................... .................... ....................

A0425 A Ground mileage ................................................................................ .................... .................... .................... .................... ....................

A0426 A Als 1 ................................................................................................. .................... .................... .................... .................... ....................

A0427 A ALS1-emergency .............................................................................. .................... .................... .................... .................... ....................

A0428 A bls ..................................................................................................... .................... .................... .................... .................... ....................

A0429 A BLS-emergency ................................................................................ .................... .................... .................... .................... ....................

A0430 A Fixed wing air transport ................................................................... .................... .................... .................... .................... ....................

A0431 A Rotary wing air transport .................................................................. .................... .................... .................... .................... ....................

A0432 A PI volunteer ambulance co .............................................................. .................... .................... .................... .................... ....................

A0433 A als 2 .................................................................................................. .................... .................... .................... .................... ....................

A0434 A Specialty care transport ................................................................... .................... .................... .................... .................... ....................

A0435 A Fixed wing air mileage ..................................................................... .................... .................... .................... .................... ....................

A0436 A Rotary wing air mileage ................................................................... .................... .................... .................... .................... ....................

A0888 E Noncovered ambulance mileage ..................................................... .................... .................... .................... .................... ....................

A0999 A Unlisted ambulance service ............................................................. .................... .................... .................... .................... ....................

A4206 E 1 CC sterile syringe&needle ............................................................ .................... .................... .................... .................... ....................

A4207 E 2 CC sterile syringe&needle ............................................................ .................... .................... .................... .................... ....................

A4208 E 3 CC sterile syringe&needle ............................................................ .................... .................... .................... .................... ....................

A4209 E 5+ CC sterile syringe&needle .......................................................... .................... .................... .................... .................... ....................

A4210 E Nonneedle injection device .............................................................. .................... .................... .................... .................... ....................

A4211 E Supp for self-adm injections ............................................................ .................... .................... .................... .................... ....................

A4212 E Non coring needle or stylet .............................................................. .................... .................... .................... .................... ....................

A4213 E 20+ CC syringe only ........................................................................ .................... .................... .................... .................... ....................

A4214 A 30 CC sterile water/saline ................................................................ .................... .................... .................... .................... ....................

A4215 E Sterile needle ................................................................................... .................... .................... .................... .................... ....................

A4220 E Infusion pump refill kit ...................................................................... .................... .................... .................... .................... ....................

A4221 A Maint drug infus cath per wk ........................................................... .................... .................... .................... .................... ....................

A4222 A Drug infusion pump supplies ........................................................... .................... .................... .................... .................... ....................

A4230 A Infus insulin pump non needl ........................................................... .................... .................... .................... .................... ....................

A4231 A Infusion insulin pump needle ........................................................... .................... .................... .................... .................... ....................

A4232 A Syringe w/needle insulin 3cc ........................................................... .................... .................... .................... .................... ....................

A4244 E Alcohol or peroxide per pint ............................................................. .................... .................... .................... .................... ....................

A4245 E Alcohol wipes per box ...................................................................... .................... .................... .................... .................... ....................

A4246 E Betadine/phisohex solution .............................................................. .................... .................... .................... .................... ....................

A4247 E Betadine/iodine swabs/wipes ........................................................... .................... .................... .................... .................... ....................

A4250 E Urine reagent strips/tablets .............................................................. .................... .................... .................... .................... ....................

67948

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A4253 A Blood glucose/reagent strips ............................................................ .................... .................... .................... .................... ....................

A4254 A Battery for glucose monitor .............................................................. .................... .................... .................... .................... ....................

A4255 A Glucose monitor platforms ............................................................... .................... .................... .................... .................... ....................

A4256 A Calibrator solution/chips ................................................................... .................... .................... .................... .................... ....................

A4258 A Lancet device each .......................................................................... .................... .................... .................... .................... ....................

A4259 A Lancets per box ............................................................................... .................... .................... .................... .................... ....................

A4260 E Levonorgestrel implant ..................................................................... .................... .................... .................... .................... ....................

A4261 E Cervical cap contraceptive ............................................................... .................... .................... .................... .................... ....................

A4262 N Temporary tear duct plug ................................................................. .................... .................... .................... .................... ....................

A4263 N Permanent tear duct plug ................................................................ .................... .................... .................... .................... ....................

A4265 A Paraffin ............................................................................................. .................... .................... .................... .................... ....................

A4270 A Disposable endoscope sheath ......................................................... .................... .................... .................... .................... ....................

A4280 A Brst prsths adhsv attchmnt .............................................................. .................... .................... .................... .................... ....................

A4290 N Sacral nerve stim test lead .............................................................. .................... .................... .................... .................... ....................

A4300 A Cath impl vasc access portal ........................................................... .................... .................... .................... .................... ....................

A4301 A Implantable access syst perc ........................................................... .................... .................... .................... .................... ....................

A4305 A Drug delivery system >=50 ML ........................................................ .................... .................... .................... .................... ....................

A4306 A Drug delivery system <=5 ML .......................................................... .................... .................... .................... .................... ....................

A4310 A Insert tray w/o bag/cath ................................................................... .................... .................... .................... .................... ....................

A4311 A Catheter w/o bag 2-way latex .......................................................... .................... .................... .................... .................... ....................

A4312 A Cath w/o bag 2-way silicone ............................................................ .................... .................... .................... .................... ....................

A4313 A Catheter w/bag 3-way ...................................................................... .................... .................... .................... .................... ....................

A4314 A Cath w/drainage 2-way latex ........................................................... .................... .................... .................... .................... ....................

A4315 A Cath w/drainage 2-way silcne .......................................................... .................... .................... .................... .................... ....................

A4316 A Cath w/drainage 3-way .................................................................... .................... .................... .................... .................... ....................

A4319 A Sterile H2O irrigation solut ............................................................... .................... .................... .................... .................... ....................

A4320 A Irrigation tray .................................................................................... .................... .................... .................... .................... ....................

A4321 A Cath therapeutic irrig agent ............................................................. .................... .................... .................... .................... ....................

A4322 A Irrigation syringe ............................................................................... .................... .................... .................... .................... ....................

A4323 A Saline irrigation solution ................................................................... .................... .................... .................... .................... ....................

A4324 A Male ext cath w/adh coating ............................................................ .................... .................... .................... .................... ....................

A4325 A Male ext cath w/adh strip ................................................................. .................... .................... .................... .................... ....................

A4326 A Male external catheter ..................................................................... .................... .................... .................... .................... ....................

A4327 A Fem urinary collect dev cup ............................................................. .................... .................... .................... .................... ....................

A4328 A Fem urinary collect pouch ................................................................ .................... .................... .................... .................... ....................

A4329 A External catheter start set ................................................................ .................... .................... .................... .................... ....................

A4330 A Stool collection pouch ...................................................................... .................... .................... .................... .................... ....................

A4331 A Extension drainage tubing ............................................................... .................... .................... .................... .................... ....................

A4332 A Lubricant for cath insertion .............................................................. .................... .................... .................... .................... ....................

A4333 A Urinary cath anchor device .............................................................. .................... .................... .................... .................... ....................

A4334 A Urinary cath leg strap ....................................................................... .................... .................... .................... .................... ....................

A4335 A Incontinence supply ......................................................................... .................... .................... .................... .................... ....................

A4338 A Indwelling catheter latex .................................................................. .................... .................... .................... .................... ....................

A4340 A Indwelling catheter special ............................................................... .................... .................... .................... .................... ....................

A4344 A Cath indw foley 2 way silicn ............................................................ .................... .................... .................... .................... ....................

A4346 A Cath indw foley 3 way ...................................................................... .................... .................... .................... .................... ....................

A4347 A Male external catheter ..................................................................... .................... .................... .................... .................... ....................

A4348 A Male ext cath extended wear ........................................................... .................... .................... .................... .................... ....................

A4351 A Straight tip urine catheter ................................................................. .................... .................... .................... .................... ....................

A4352 A Coude tip urinary catheter ............................................................... .................... .................... .................... .................... ....................

A4353 A Intermittent urinary cath ................................................................... .................... .................... .................... .................... ....................

A4354 A Cath insertion tray w/bag ................................................................. .................... .................... .................... .................... ....................

A4355 A Bladder irrigation tubing ................................................................... .................... .................... .................... .................... ....................

A4356 A Ext ureth clmp or compr dvc ............................................................ .................... .................... .................... .................... ....................

A4357 A Bedside drainage bag ...................................................................... .................... .................... .................... .................... ....................

A4358 A Urinary leg bag ................................................................................. .................... .................... .................... .................... ....................

A4359 A Urinary suspensory w/o leg b .......................................................... .................... .................... .................... .................... ....................

A4361 A Ostomy face plate ............................................................................ .................... .................... .................... .................... ....................

A4362 A Solid skin barrier .............................................................................. .................... .................... .................... .................... ....................

A4364 A Ostomy/cath adhesive ...................................................................... .................... .................... .................... .................... ....................

A4365 A Ostomy adhesive remover wipe ...................................................... .................... .................... .................... .................... ....................

A4367 A Ostomy belt ...................................................................................... .................... .................... .................... .................... ....................

A4368 A Ostomy filter ..................................................................................... .................... .................... .................... .................... ....................

A4369 A Skin barrier liquid per oz .................................................................. .................... .................... .................... .................... ....................

A4370 A Skin barrier paste per oz ................................................................. .................... .................... .................... .................... ....................

A4371 A Skin barrier powder per oz .............................................................. .................... .................... .................... .................... ....................

A4372 A Skin barrier solid 4x4 equiv ............................................................. .................... .................... .................... .................... ....................

A4373 A Skin barrier with flange .................................................................... .................... .................... .................... .................... ....................

A4374 A Skin barrier extended wear .............................................................. .................... .................... .................... .................... ....................

A4375 A Drainable plastic pch w fcpl ............................................................. .................... .................... .................... .................... ....................

A4376 A Drainable rubber pch w fcplt ............................................................ .................... .................... .................... .................... ....................

A4377 A Drainable plstic pch w/o fp ............................................................... .................... .................... .................... .................... ....................

A4378 A Drainable rubber pch w/o fp ............................................................ .................... .................... .................... .................... ....................

A4379 A Urinary plastic pouch w fcpl ............................................................. .................... .................... .................... .................... ....................

67949

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A4380 A Urinary rubber pouch w fcplt ............................................................ .................... .................... .................... .................... ....................

A4381 A Urinary plastic pouch w/o fp ............................................................ .................... .................... .................... .................... ....................

A4382 A Urinary hvy plstc pch w/o fp ............................................................ .................... .................... .................... .................... ....................

A4383 A Urinary rubber pouch w/o fp ............................................................ .................... .................... .................... .................... ....................

A4384 A Ostomy faceplt/silicone ring ............................................................. .................... .................... .................... .................... ....................

A4385 A Ost skn barrier sld ext wear ............................................................. .................... .................... .................... .................... ....................

A4386 A Ost skn barrier w flng ex wr ............................................................. .................... .................... .................... .................... ....................

A4387 A Ost clsd pouch w att st barr ............................................................. .................... .................... .................... .................... ....................

A4388 A Drainable pch w ex wear barr .......................................................... .................... .................... .................... .................... ....................

A4389 A Drainable pch w st wear barr ........................................................... .................... .................... .................... .................... ....................

A4390 A Drainable pch ex wear convex ........................................................ .................... .................... .................... .................... ....................

A4391 A Urinary pouch w ex wear barr ......................................................... .................... .................... .................... .................... ....................

A4392 A Urinary pouch w st wear barr .......................................................... .................... .................... .................... .................... ....................

A4393 A Urine pch w ex wear bar conv ......................................................... .................... .................... .................... .................... ....................

A4394 A Ostomy pouch liq deodorant ............................................................ .................... .................... .................... .................... ....................

A4395 A Ostomy pouch solid deodorant ........................................................ .................... .................... .................... .................... ....................

A4396 A Peristomal hernia supprt blt ............................................................. .................... .................... .................... .................... ....................

A4397 A Irrigation supply sleeve .................................................................... .................... .................... .................... .................... ....................

A4398 A Ostomy irrigation bag ....................................................................... .................... .................... .................... .................... ....................

A4399 A Ostomy irrig cone/cath w brs ........................................................... .................... .................... .................... .................... ....................

A4400 A Ostomy irrigation set ........................................................................ .................... .................... .................... .................... ....................

A4402 A Lubricant per ounce ......................................................................... .................... .................... .................... .................... ....................

A4404 A Ostomy ring each ............................................................................. .................... .................... .................... .................... ....................

A4421 A Ostomy supply misc ......................................................................... .................... .................... .................... .................... ....................

A4454 A Tape all types all sizes .................................................................... .................... .................... .................... .................... ....................

A4455 A Adhesive remover per ounce ........................................................... .................... .................... .................... .................... ....................

A4460 A Elastic compression bandage .......................................................... .................... .................... .................... .................... ....................

A4462 A Abdmnl drssng holder/binder ........................................................... .................... .................... .................... .................... ....................

A4464 A Joint support device/garment ........................................................... .................... .................... .................... .................... ....................

A4465 A Non-elastic extremity binder ............................................................ .................... .................... .................... .................... ....................

A4470 A Gravlee jet washer ........................................................................... .................... .................... .................... .................... ....................

A4480 A Vabra aspirator ................................................................................. .................... .................... .................... .................... ....................

A4481 A Tracheostoma filter .......................................................................... .................... .................... .................... .................... ....................

A4483 A Moisture exchanger .......................................................................... .................... .................... .................... .................... ....................

A4490 E Above knee surgical stocking .......................................................... .................... .................... .................... .................... ....................

A4495 E Thigh length surg stocking ............................................................... .................... .................... .................... .................... ....................

A4500 E Below knee surgical stocking ........................................................... .................... .................... .................... .................... ....................

A4510 E Full length surg stocking .................................................................. .................... .................... .................... .................... ....................

A4550 E Surgical trays ................................................................................... .................... .................... .................... .................... ....................

A4554 E Disposable underpads ..................................................................... .................... .................... .................... .................... ....................

A4556 A Electrodes, pair ................................................................................ .................... .................... .................... .................... ....................

A4557 A Lead wires, pair ................................................................................ .................... .................... .................... .................... ....................

A4558 A Conductive paste or gel ................................................................... .................... .................... .................... .................... ....................

A4560D A Pessary ............................................................................................ .................... .................... .................... .................... ....................

A4561 N Pessary rubber, any type ................................................................. .................... .................... .................... .................... ....................

A4562 N Pessary, non rubber,any type .......................................................... .................... .................... .................... .................... ....................

A4565 A Slings ................................................................................................ .................... .................... .................... .................... ....................

A4570 N Splint ................................................................................................ .................... .................... .................... .................... ....................

A4572 A Rib belt ............................................................................................. .................... .................... .................... .................... ....................

A4575 E Hyperbaric o2 chamber disps .......................................................... .................... .................... .................... .................... ....................

A4580 N Cast supplies (plaster) ..................................................................... .................... .................... .................... .................... ....................

A4590 N Special casting material ................................................................... .................... .................... .................... .................... ....................

A4595 A TENS suppl 2 lead per month ......................................................... .................... .................... .................... .................... ....................

A4608 A Transtracheal oxygen cath ............................................................... .................... .................... .................... .................... ....................

A4611 A Heavy duty battery ........................................................................... .................... .................... .................... .................... ....................

A4612 A Battery cables .................................................................................. .................... .................... .................... .................... ....................

A4613 A Battery charger ................................................................................. .................... .................... .................... .................... ....................

A4614 A Hand-held PEFR meter .................................................................... .................... .................... .................... .................... ....................

A4615 A Cannula nasal .................................................................................. .................... .................... .................... .................... ....................

A4616 A Tubing (oxygen) per foot .................................................................. .................... .................... .................... .................... ....................

A4617 A Mouth piece ...................................................................................... .................... .................... .................... .................... ....................

A4618 A Breathing circuits .............................................................................. .................... .................... .................... .................... ....................

A4619 A Face tent .......................................................................................... .................... .................... .................... .................... ....................

A4620 A Variable concentration mask ............................................................ .................... .................... .................... .................... ....................

A4621 A Tracheotomy mask or collar ............................................................ .................... .................... .................... .................... ....................

A4622 A Tracheostomy or larngectomy ......................................................... .................... .................... .................... .................... ....................

A4623 A Tracheostomy inner cannula ............................................................ .................... .................... .................... .................... ....................

A4624 A Tracheal suction tube ....................................................................... .................... .................... .................... .................... ....................

A4625 A Trach care kit for new trach ............................................................. .................... .................... .................... .................... ....................

A4626 A Tracheostomy cleaning brush .......................................................... .................... .................... .................... .................... ....................

A4627 E Spacer bag/reservoir ........................................................................ .................... .................... .................... .................... ....................

A4628 A Oropharyngeal suction cath ............................................................. .................... .................... .................... .................... ....................

A4629 A Tracheostomy care kit ...................................................................... .................... .................... .................... .................... ....................

A4630 A Repl bat t.e.n.s. own by pt ............................................................... .................... .................... .................... .................... ....................

67950

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A4631 A Wheelchair battery ........................................................................... .................... .................... .................... .................... ....................

A4635 A Underarm crutch pad ....................................................................... .................... .................... .................... .................... ....................

A4636 A Handgrip for cane etc ...................................................................... .................... .................... .................... .................... ....................

A4637 A Repl tip cane/crutch/walker .............................................................. .................... .................... .................... .................... ....................

A4640 A Alternating pressure pad .................................................................. .................... .................... .................... .................... ....................

A4641 N Diagnostic imaging agent ................................................................. .................... .................... .................... .................... ....................

A4642 G Satumomab pendetide per dose ...................................................... 0704 .................... $712.50 .................... $86.93

A4643 N High dose contrast MRI ................................................................... .................... .................... .................... .................... ....................

A4644 N Contrast 100-199 MGs iodine .......................................................... .................... .................... .................... .................... ....................

A4645 N Contrast 200-299 MGs iodine .......................................................... .................... .................... .................... .................... ....................

A4646 N Contrast 300-399 MGs iodine .......................................................... .................... .................... .................... .................... ....................

A4647 N Supp- paramagnetic contr mat ........................................................ .................... .................... .................... .................... ....................

A4649 A Surgical supplies .............................................................................. .................... .................... .................... .................... ....................

A4650 A Supp esrd centrifuge ........................................................................ .................... .................... .................... .................... ....................

A4655 A Esrd syringe/needle ......................................................................... .................... .................... .................... .................... ....................

A4660 A Esrd blood pressure device ............................................................. .................... .................... .................... .................... ....................

A4663 A Esrd blood pressure cuff .................................................................. .................... .................... .................... .................... ....................

A4670 E Auto blood pressure monitor ............................................................ .................... .................... .................... .................... ....................

A4680 A Activated carbon filters ..................................................................... .................... .................... .................... .................... ....................

A4690 A Dialyzers ........................................................................................... .................... .................... .................... .................... ....................

A4700 A Standard dialysate solution .............................................................. .................... .................... .................... .................... ....................

A4705 A Bicarb dialysate solution .................................................................. .................... .................... .................... .................... ....................

A4712 A Sterile water ..................................................................................... .................... .................... .................... .................... ....................

A4714 A Treated water for dialysis ................................................................. .................... .................... .................... .................... ....................

A4730 A Fistula cannulation set dial .............................................................. .................... .................... .................... .................... ....................

A4735 A Local/topical anesthetics .................................................................. .................... .................... .................... .................... ....................

A4740 A Esrd shunt accessory ....................................................................... .................... .................... .................... .................... ....................

A4750 A Arterial or venous tubing .................................................................. .................... .................... .................... .................... ....................

A4755 A Arterial and venous tubing ............................................................... .................... .................... .................... .................... ....................

A4760 A Standard testing solution ................................................................. .................... .................... .................... .................... ....................

A4765 A Dialysate concentrate ....................................................................... .................... .................... .................... .................... ....................

A4770 A Blood testing supplies ...................................................................... .................... .................... .................... .................... ....................

A4771 A Blood clotting time tube ................................................................... .................... .................... .................... .................... ....................

A4772 A Dextrostick/glucose strips ................................................................ .................... .................... .................... .................... ....................

A4773 A Hemostix .......................................................................................... .................... .................... .................... .................... ....................

A4774 A Ammonia test paper ......................................................................... .................... .................... .................... .................... ....................

A4780 A Esrd sterilizing agent ........................................................................ .................... .................... .................... .................... ....................

A4790 A Esrd cleansing agents ...................................................................... .................... .................... .................... .................... ....................

A4800 A Heparin/antidote dialysis .................................................................. .................... .................... .................... .................... ....................

A4820 A Supplies hemodialysis kit ................................................................. .................... .................... .................... .................... ....................

A4850 A Rubber tipped hemostats ................................................................. .................... .................... .................... .................... ....................

A4860 A Disposable catheter caps ................................................................. .................... .................... .................... .................... ....................

A4870 A Plumbing/electrical work .................................................................. .................... .................... .................... .................... ....................

A4880 A Water storage tanks ......................................................................... .................... .................... .................... .................... ....................

A4890 A Contracts/repair/maintenance .......................................................... .................... .................... .................... .................... ....................

A4900 A Capd supply kit ................................................................................ .................... .................... .................... .................... ....................

A4901 A Ccpd supply kit ................................................................................. .................... .................... .................... .................... ....................

A4905 A Ipd supply kit .................................................................................... .................... .................... .................... .................... ....................

A4910 A Esrd nonmedical supplies ................................................................ .................... .................... .................... .................... ....................

A4912 A Gomco drain bottle ........................................................................... .................... .................... .................... .................... ....................

A4913 A Esrd supply ...................................................................................... .................... .................... .................... .................... ....................

A4914 A Preparation kit .................................................................................. .................... .................... .................... .................... ....................

A4918 A Venous pressure clamp ................................................................... .................... .................... .................... .................... ....................

A4919 A Supp dialysis dialyzer holde ............................................................ .................... .................... .................... .................... ....................

A4920 A Harvard pressure clamp ................................................................... .................... .................... .................... .................... ....................

A4921 A Measuring cylinder ........................................................................... .................... .................... .................... .................... ....................

A4927 A Gloves .............................................................................................. .................... .................... .................... .................... ....................

A5051 A Pouch clsd w barr attached ............................................................. .................... .................... .................... .................... ....................

A5052 A Clsd ostomy pouch w/o barr ............................................................ .................... .................... .................... .................... ....................

A5053 A Clsd ostomy pouch faceplate ........................................................... .................... .................... .................... .................... ....................

A5054 A Clsd ostomy pouch w/flange ............................................................ .................... .................... .................... .................... ....................

A5055 A Stoma cap ........................................................................................ .................... .................... .................... .................... ....................

A5061 A Pouch drainable w barrier at ............................................................ .................... .................... .................... .................... ....................

A5062 A Drnble ostomy pouch w/o barr ......................................................... .................... .................... .................... .................... ....................

A5063 A Drain ostomy pouch w/flange .......................................................... .................... .................... .................... .................... ....................

A5064 E Drain ostomy pouch w/fceplte .......................................................... .................... .................... .................... .................... ....................

A5065D E Drain ostomy pouch w/fceplte .......................................................... .................... .................... .................... .................... ....................

A5071 A Urinary pouch w/barrier .................................................................... .................... .................... .................... .................... ....................

A5072 A Urinary pouch w/o barrier ................................................................ .................... .................... .................... .................... ....................

A5073 A Urinary pouch on barr w/flng ........................................................... .................... .................... .................... .................... ....................

A5074 E Urinary pouch w/faceplate ............................................................... .................... .................... .................... .................... ....................

A5075 E Urinary pouch on faceplate .............................................................. .................... .................... .................... .................... ....................

A5081 A Continent stoma plug ....................................................................... .................... .................... .................... .................... ....................

A5082 A Continent stoma catheter ................................................................. .................... .................... .................... .................... ....................

67951

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A5093 A Ostomy accessory convex inse ....................................................... .................... .................... .................... .................... ....................

A5102 A Bedside drain btl w/wo tube ............................................................. .................... .................... .................... .................... ....................

A5105 A Urinary suspensory .......................................................................... .................... .................... .................... .................... ....................

A5112 A Urinary leg bag ................................................................................. .................... .................... .................... .................... ....................

A5113 A Latex leg strap ................................................................................. .................... .................... .................... .................... ....................

A5114 A Foam/fabric leg strap ....................................................................... .................... .................... .................... .................... ....................

A5119 A Skin barrier wipes box pr 50 ............................................................ .................... .................... .................... .................... ....................

A5121 A Solid skin barrier 6x6 ....................................................................... .................... .................... .................... .................... ....................

A5122 A Solid skin barrier 8x8 ....................................................................... .................... .................... .................... .................... ....................

A5123 A Skin barrier with flange .................................................................... .................... .................... .................... .................... ....................

A5126 A Disk/foam pad +or- adhesive ........................................................... .................... .................... .................... .................... ....................

A5131 A Appliance cleaner ............................................................................. .................... .................... .................... .................... ....................

A5149D A Incontinence/ostomy supply ............................................................. .................... .................... .................... .................... ....................

A5200 A Percutaneous catheter anchor ......................................................... .................... .................... .................... .................... ....................

A5500 A Diab shoe for density insert ............................................................. .................... .................... .................... .................... ....................

A5501 A Diabetic custom molded shoe .......................................................... .................... .................... .................... .................... ....................

A5502 A Diabetic shoe density insert ............................................................. .................... .................... .................... .................... ....................

A5503 A Diabetic shoe w/roller/rockr .............................................................. .................... .................... .................... .................... ....................

A5504 A Diabetic shoe with wedge ................................................................ .................... .................... .................... .................... ....................

A5505 A Diab shoe w/metatarsal bar ............................................................. .................... .................... .................... .................... ....................

A5506 A Diabetic shoe w/off set heel ............................................................. .................... .................... .................... .................... ....................

A5507 A Modification diabetic shoe ................................................................ .................... .................... .................... .................... ....................

A5508 A Diabetic deluxe shoe ........................................................................ .................... .................... .................... .................... ....................

A6020 A Collagen wound dressing ................................................................. .................... .................... .................... .................... ....................

A6021 A Collagen dressing <=16 sq in .......................................................... .................... .................... .................... .................... ....................

A6022 A Collagen drsg>6<=48 sq in .............................................................. .................... .................... .................... .................... ....................

A6023 A Collagen dressing >48 sq in ............................................................ .................... .................... .................... .................... ....................

A6024 A Collagen dsg wound filler ................................................................. .................... .................... .................... .................... ....................

A6025 E Silicone gel sheet, each ................................................................... .................... .................... .................... .................... ....................

A6154 A Wound pouch each .......................................................................... .................... .................... .................... .................... ....................

A6196 A Alginate dressing <=16 sq in ........................................................... .................... .................... .................... .................... ....................

A6197 A Alginate drsg >16 <=48 sq in ........................................................... .................... .................... .................... .................... ....................

A6198 A alginate dressing > 48 sq in ............................................................. .................... .................... .................... .................... ....................

A6199 A Alginate drsg wound filler ................................................................. .................... .................... .................... .................... ....................

A6200 A Compos drsg <=16 no border .......................................................... .................... .................... .................... .................... ....................

A6201 A Compos drsg >16<=48 no bdr ......................................................... .................... .................... .................... .................... ....................

A6202 A Compos drsg >48 no border ............................................................ .................... .................... .................... .................... ....................

A6203 A Composite drsg <= 16 sq in ............................................................ .................... .................... .................... .................... ....................

A6204 A Composite drsg >16<=48 sq in ........................................................ .................... .................... .................... .................... ....................

A6205 A Composite drsg > 48 sq in ............................................................... .................... .................... .................... .................... ....................

A6206 A Contact layer <= 16 sq in ................................................................ .................... .................... .................... .................... ....................

A6207 A Contact layer >16<= 48 sq in .......................................................... .................... .................... .................... .................... ....................

A6208 A Contact layer > 48 sq in ................................................................... .................... .................... .................... .................... ....................

A6209 A Foam drsg <=16 sq in w/o bdr ........................................................ .................... .................... .................... .................... ....................

A6210 A Foam drg >16<=48 sq in w/o b ....................................................... .................... .................... .................... .................... ....................

A6211 A Foam drg > 48 sq in w/o brdr .......................................................... .................... .................... .................... .................... ....................

A6212 A Foam drg <=16 sq in w/border ........................................................ .................... .................... .................... .................... ....................

A6213 A Foam drg >16<=48 sq in w/bdr ....................................................... .................... .................... .................... .................... ....................

A6214 A Foam drg > 48 sq in w/border ......................................................... .................... .................... .................... .................... ....................

A6215 A Foam dressing wound filler .............................................................. .................... .................... .................... .................... ....................

A6216 A Non-sterile gauze<=16 sq in ............................................................ .................... .................... .................... .................... ....................

A6217 A Non-sterile gauze>16<=48 sq .......................................................... .................... .................... .................... .................... ....................

A6218 A Non-sterile gauze > 48 sq in ............................................................ .................... .................... .................... .................... ....................

A6219 A Gauze <= 16 sq in w/border ............................................................ .................... .................... .................... .................... ....................

A6220 A Gauze >16 <=48 sq in w/bordr ........................................................ .................... .................... .................... .................... ....................

A6221 A Gauze > 48 sq in w/border .............................................................. .................... .................... .................... .................... ....................

A6222 A Gauze <=16 in no w/sal w/o b ......................................................... .................... .................... .................... .................... ....................

A6223 A Gauze >16<=48 no w/sal w/o b ....................................................... .................... .................... .................... .................... ....................

A6224 A Gauze > 48 in no w/sal w/o b .......................................................... .................... .................... .................... .................... ....................

A6228 A Gauze <= 16 sq in water/sal ............................................................ .................... .................... .................... .................... ....................

A6229 A Gauze >16<=48 sq in watr/sal ......................................................... .................... .................... .................... .................... ....................

A6230 A Gauze > 48 sq in water/salne .......................................................... .................... .................... .................... .................... ....................

A6231 A Hydrogel dsg<=16 sq in ................................................................... .................... .................... .................... .................... ....................

A6232 A Hydrogel dsg>16<=48 sq in ............................................................. .................... .................... .................... .................... ....................

A6233 A Hydrogel dressing >48 sq in ............................................................ .................... .................... .................... .................... ....................

A6234 A Hydrocolld drg <=16 w/o bdr ........................................................... .................... .................... .................... .................... ....................

A6235 A Hydrocolld drg >16<=48 w/o b ......................................................... .................... .................... .................... .................... ....................

A6236 A Hydrocolld drg > 48 in w/o b ............................................................ .................... .................... .................... .................... ....................

A6237 A Hydrocolld drg <=16 in w/bdr ........................................................... .................... .................... .................... .................... ....................

A6238 A Hydrocolld drg >16<=48 w/bdr ......................................................... .................... .................... .................... .................... ....................

A6239 A Hydrocolld drg > 48 in w/bdr ............................................................ .................... .................... .................... .................... ....................

A6240 A Hydrocolld drg filler paste ................................................................ .................... .................... .................... .................... ....................

A6241 A Hydrocolloid drg filler dry ................................................................. .................... .................... .................... .................... ....................

A6242 A Hydrogel drg <=16 in w/o bdr .......................................................... .................... .................... .................... .................... ....................

67952

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A6243 A Hydrogel drg >16<=48 w/o bdr ........................................................ .................... .................... .................... .................... ....................

A6244 A Hydrogel drg >48 in w/o bdr ............................................................ .................... .................... .................... .................... ....................

A6245 A Hydrogel drg <= 16 in w/bdr ............................................................ .................... .................... .................... .................... ....................

A6246 A Hydrogel drg >16<=48 in w/b .......................................................... .................... .................... .................... .................... ....................

A6247 A Hydrogel drg > 48 sq in w/b ............................................................ .................... .................... .................... .................... ....................

A6248 A Hydrogel drsg gel filler ..................................................................... .................... .................... .................... .................... ....................

A6250 A Skin seal protect moisturizr .............................................................. .................... .................... .................... .................... ....................

A6251 A Absorpt drg <=16 sq in w/o b .......................................................... .................... .................... .................... .................... ....................

A6252 A Absorpt drg >16 <=48 w/o bdr ......................................................... .................... .................... .................... .................... ....................

A6253 A Absorpt drg > 48 sq in w/o b ........................................................... .................... .................... .................... .................... ....................

A6254 A Absorpt drg <=16 sq in w/bdr .......................................................... .................... .................... .................... .................... ....................

A6255 A Absorpt drg >16<=48 in w/bdr ......................................................... .................... .................... .................... .................... ....................

A6256 A Absorpt drg > 48 sq in w/bdr ........................................................... .................... .................... .................... .................... ....................

A6257 A Transparent film <= 16 sq in ............................................................ .................... .................... .................... .................... ....................

A6258 A Transparent film >16<=48 in ............................................................ .................... .................... .................... .................... ....................

A6259 A Transparent film > 48 sq in .............................................................. .................... .................... .................... .................... ....................

A6260 A Wound cleanser any type/size ......................................................... .................... .................... .................... .................... ....................

A6261 A Wound filler gel/paste /oz ................................................................ .................... .................... .................... .................... ....................

A6262 A Wound filler dry form / gram ............................................................ .................... .................... .................... .................... ....................

A6263 A Non-sterile elastic gauze/yd ............................................................. .................... .................... .................... .................... ....................

A6264 A Non-sterile no elastic gauze ............................................................ .................... .................... .................... .................... ....................

A6265 A Tape per 18 sq inches ..................................................................... .................... .................... .................... .................... ....................

A6266 A Impreg gauze no h2O/sal/yard ........................................................ .................... .................... .................... .................... ....................

A6402 A Sterile gauze <= 16 sq in ................................................................. .................... .................... .................... .................... ....................

A6403 A Sterile gauze>16 <= 48 sq in ........................................................... .................... .................... .................... .................... ....................

A6404 A Sterile gauze > 48 sq in ................................................................... .................... .................... .................... .................... ....................

A6405 A Sterile elastic gauze /yd ................................................................... .................... .................... .................... .................... ....................

A6406 A Sterile non-elastic gauze/yd ............................................................. .................... .................... .................... .................... ....................

A7000 A Disposable canister for pump .......................................................... .................... .................... .................... .................... ....................

A7001 A Nondisposable pump canister .......................................................... .................... .................... .................... .................... ....................

A7002 A Tubing used w suction pump ........................................................... .................... .................... .................... .................... ....................

A7003 A Nebulizer administration set ............................................................. .................... .................... .................... .................... ....................

A7004 A Disposable nebulizer sml vol ........................................................... .................... .................... .................... .................... ....................

A7005 A Nondisposable nebulizer set ............................................................ .................... .................... .................... .................... ....................

A7006 A Filtered nebulizer admin set ............................................................. .................... .................... .................... .................... ....................

A7007 A Lg vol nebulizer disposable ............................................................. .................... .................... .................... .................... ....................

A7008 A Disposable nebulizer prefill .............................................................. .................... .................... .................... .................... ....................

A7009 A Nebulizer reservoir bottle ................................................................. .................... .................... .................... .................... ....................

A7010 A Disposable corrugated tubing .......................................................... .................... .................... .................... .................... ....................

A7011 A Nondispos corrugated tubing ........................................................... .................... .................... .................... .................... ....................

A7012 A Nebulizer water collec devic ............................................................ .................... .................... .................... .................... ....................

A7013 A Disposable compressor filter ............................................................ .................... .................... .................... .................... ....................

A7014 A Compressor nondispos filter ............................................................ .................... .................... .................... .................... ....................

A7015 A Aerosol mask used w nebulize ........................................................ .................... .................... .................... .................... ....................

A7016 A Nebulizer dome & mouthpiece ......................................................... .................... .................... .................... .................... ....................

A7017 A Nebulizer not used w oxygen .......................................................... .................... .................... .................... .................... ....................

A7018 A Water distilled w/nebulizer ............................................................... .................... .................... .................... .................... ....................

A7019 A Saline solution dispenser ................................................................. .................... .................... .................... .................... ....................

A7020 A Sterile H2O or NSS w lgv neb ......................................................... .................... .................... .................... .................... ....................

A7501 A Tracheostoma valve w diaphra ........................................................ .................... .................... .................... .................... ....................

A7502 A Replacement diaphragm/fplate ........................................................ .................... .................... .................... .................... ....................

A7503 A HMES filter holder or cap ................................................................ .................... .................... .................... .................... ....................

A7504 A Tracheostoma HMES filter ............................................................... .................... .................... .................... .................... ....................

A7505 A HMES or trach valve housing .......................................................... .................... .................... .................... .................... ....................

A7506 A HMES/trachvalve adhesivedisk ........................................................ .................... .................... .................... .................... ....................

A7507 A Integrated filter & holder .................................................................. .................... .................... .................... .................... ....................

A7508 A Housing & Integrated Adhesiv ......................................................... .................... .................... .................... .................... ....................

A7509 A Heat & moisture exchange sys ........................................................ .................... .................... .................... .................... ....................

A9150 E Misc/exper non-prescript dru ........................................................... .................... .................... .................... .................... ....................

A9160 E Podiatrist non-covered servi ............................................................ .................... .................... .................... .................... ....................

A9170 E Chiropractor non-covered ser .......................................................... .................... .................... .................... .................... ....................

A9190 E Misc/expe personal comfort i ........................................................... .................... .................... .................... .................... ....................

A9270 E Non-covered item or service ............................................................ .................... .................... .................... .................... ....................

A9300 E Exercise equipment .......................................................................... .................... .................... .................... .................... ....................

*A9500 G Technetium TC 99m sestamibi ........................................................ 1600 .................... $109.25 .................... $13.33

A9502 G Technetium TC99M tetrofosmin ....................................................... 0705 .................... $136.80 .................... $16.69

*A9503 G Technetium TC 99m medronate ...................................................... 1601 .................... $38.38 .................... $4.68

*A9504 G Technetium tc 99m apcitide ............................................................. 1602 .................... $47.50 .................... $5.80

*A9505 G Thallous chloride TL 201/mci ........................................................... 1603 .................... $28.50 .................... $3.48

*A9507 G Indium/111 capromab pendetid ....................................................... 1604 .................... $1,008.90 .................... $135.19

A9508 G Iobenguane sulfate I-131 ................................................................. 1045 .................... $1,140.00 .................... $139.08

A9510 G Technetium TC99m Disofenin ......................................................... 1205 .................... $427.50 .................... $57.29

A9600 G Strontium-89 chloride ....................................................................... 0701 .................... $783.75 .................... $95.62

A9605 G Samarium sm153 lexidronamm ....................................................... 0702 .................... $942.09 .................... $134.87

67953

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

A9700 N Echocardiography Contrast .............................................................. .................... .................... .................... .................... ....................

A9900 E Supply/accessory/service ................................................................. .................... .................... .................... .................... ....................

A9901 E Delivery/set up/dispensing ............................................................... .................... .................... .................... .................... ....................

B4034 A Enter feed supkit syr by day ............................................................ .................... .................... .................... .................... ....................

B4035 A Enteral feed supp pump per d ......................................................... .................... .................... .................... .................... ....................

B4036 A Enteral feed sup kit grav by ............................................................. .................... .................... .................... .................... ....................

B4081 A Enteral ng tubing w/ stylet ............................................................... .................... .................... .................... .................... ....................

B4082 A Enteral ng tubing w/o stylet ............................................................. .................... .................... .................... .................... ....................

B4083 A Enteral stomach tube levine ............................................................ .................... .................... .................... .................... ....................

B4084 A Gastrostomy/jejunostomy tubi .......................................................... .................... .................... .................... .................... ....................

B4085 A Gastrostomy tube w/ring each ......................................................... .................... .................... .................... .................... ....................

B4150 A Enteral formulae category i .............................................................. .................... .................... .................... .................... ....................

B4151 A Enteral formulae category i- ............................................................. .................... .................... .................... .................... ....................

B4152 A Enteral formulae category ii ............................................................. .................... .................... .................... .................... ....................

B4153 A Enteral formulae category ii ............................................................. .................... .................... .................... .................... ....................

B4154 A Enteral formulae category IV ........................................................... .................... .................... .................... .................... ....................

B4155 A Enteral formulae category v ............................................................. .................... .................... .................... .................... ....................

B4156 A Enteral formulae category vi ............................................................ .................... .................... .................... .................... ....................

B4164 A Parenteral 50% dextrose solu .......................................................... .................... .................... .................... .................... ....................

B4168 A Parenteral sol amino acid 3. ............................................................ .................... .................... .................... .................... ....................

B4172 A Parenteral sol amino acid 5. ............................................................ .................... .................... .................... .................... ....................

B4176 A Parenteral sol amino acid 7- ............................................................ .................... .................... .................... .................... ....................

B4178 A Parenteral sol amino acid > ............................................................. .................... .................... .................... .................... ....................

B4180 A Parenteral sol carb > 50% ............................................................... .................... .................... .................... .................... ....................

B4184 A Parenteral sol lipids 10% ................................................................. .................... .................... .................... .................... ....................

B4186 A Parenteral sol lipids 20% ................................................................. .................... .................... .................... .................... ....................

B4189 A Parenteral sol amino acid & ............................................................. .................... .................... .................... .................... ....................

B4193 A Parenteral sol 52-73 gm prot ........................................................... .................... .................... .................... .................... ....................

B4197 A Parenteral sol 74-100 gm pro .......................................................... .................... .................... .................... .................... ....................

B4199 A Parenteral sol > 100gm prote .......................................................... .................... .................... .................... .................... ....................

B4216 A Parenteral nutrition additiv ............................................................... .................... .................... .................... .................... ....................

B4220 A Parenteral supply kit premix ............................................................ .................... .................... .................... .................... ....................

B4222 A Parenteral supply kit homemi .......................................................... .................... .................... .................... .................... ....................

B4224 A Parenteral administration ki ............................................................. .................... .................... .................... .................... ....................

B5000 A Parenteral sol renal-amirosy ............................................................ .................... .................... .................... .................... ....................

B5100 A Parenteral sol hepatic-fream ............................................................ .................... .................... .................... .................... ....................

B5200 A Parenteral sol stres-brnch c ............................................................. .................... .................... .................... .................... ....................

B9000 A Enter infusion pump w/o alrm .......................................................... .................... .................... .................... .................... ....................

B9002 A Enteral infusion pump w/ ala ........................................................... .................... .................... .................... .................... ....................

B9004 A Parenteral infus pump portab .......................................................... .................... .................... .................... .................... ....................

B9006 A Parenteral infus pump statio ............................................................ .................... .................... .................... .................... ....................

B9998 A Enteral supp not otherwise c ........................................................... .................... .................... .................... .................... ....................

B9999 A Parenteral supp not othrws c ........................................................... .................... .................... .................... .................... ....................

C1000 H PerclosClosr ProstarArt Vas ............................................................ 1000 .................... .................... .................... ....................

C1001 H AcuNav-diagnstic ultrsnd ca ............................................................ 1001 .................... .................... .................... ....................

C1003 H Cath, ablation, Livewire TC .............................................................. 1003 .................... .................... .................... ....................

C1004 H Fast-Cath,Swartz,SAFL,CSTA ......................................................... 1004 .................... .................... .................... ....................

C1005D E Sensar IOL ....................................................................................... .................... .................... .................... .................... ....................

C1006 H ARRAY post chamb IOL .................................................................. 1006 .................... .................... .................... ....................

C1007 H Ams 700 penile prosthesis ............................................................... 1007 .................... .................... .................... ....................

C1008 H Urolume-implt uretheral stent ........................................................... 1008 .................... .................... .................... ....................

C1009 K Plasma, cryoprecipitate-reduced, unit .............................................. 1009 0.86 $42.76 .................... $8.55

C1010 K Blood, L/R, CMV-neg ....................................................................... 1010 2.88 $142.84 .................... $28.57

C1011 K Platelets, L/R, CMV-neg, unit .......................................................... 1011 11.86 $588.15 .................... $117.63

C1012 K Platelet concentrate, L/R, irradiated, unit ........................................ 1012 1.92 $95.23 .................... $19.05

C1013 K Platelet concentrate, L/R, unit .......................................................... 1013 1.18 $58.30 .................... $11.66

C1014 K Platelets, aph/pher, L/R, unit ........................................................... 1014 8.93 $443.11 .................... $88.62

C1016 K Blood, L/R, froz/deglycerol/washed ................................................. 1016 7.15 $354.68 .................... $70.94

C1017 K Platelets, aph/pher, L/R, CMV-neg, unit .......................................... 1017 9.33 $462.54 .................... $92.51

C1018 K Blood, L/R, irradiated ....................................................................... 1018 3.13 $155.48 .................... $31.10

C1019 K Platelets, aph/pher, L/R, irradiated, unit .......................................... 1019 9.64 $478.09 .................... $95.62

C1024 J Quinupristin 150 mg/dalfopriston 350 mg ........................................ 1024 .................... $159.60 .................... $20.50

C1025 H Marinr CS Cath ................................................................................ 1025 .................... .................... .................... ....................

C1026 H RF Perfrmr cath 5F RF Marinr ......................................................... 1026 .................... .................... .................... ....................

C1027 H Magic x/short, Radius14mm ............................................................ 1027 .................... .................... .................... ....................

C1028 H Prcis Twst trnsvg anch sys .............................................................. 1028 .................... .................... .................... ....................

C1029 H CRE guided balloon dil cath ............................................................ 1029 .................... .................... .................... ....................

C1030 H Cthtr:Mrshal,Blu Max Utr Dmnd ....................................................... 1030 .................... .................... .................... ....................

C1031D E MR Comp/mod LeVeen ned elect ................................................... .................... .................... .................... .................... ....................

C1033 H Sonicath mdl 37-410 ........................................................................ 1033 .................... .................... .................... ....................

C1034 H SURPASS, Long30 SURPASS-cath ................................................ 1034 .................... .................... .................... ....................

C1035 H Cath, Ultra ICE ................................................................................. 1035 .................... .................... .................... ....................

C1036 H R port/reservoir impl dev .................................................................. 1036 .................... .................... .................... ....................

C1037 H Vaxcelchronic dialysis cath .............................................................. 1037 .................... .................... .................... ....................

67954

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

C1038 H UltraCross Imaging Cath .................................................................. 1038 .................... .................... .................... ....................

C1039 H Wallstent, tracheobronchial .............................................................. 1039 .................... .................... .................... ....................

C1040 H WALLSTENT: TIPS (shunt) ............................................................. 1040 .................... .................... .................... ....................

C1042 H Wallstent, biliary ............................................................................... 1042 .................... .................... .................... ....................

C1043 H Atherectomy sys, coronary .............................................................. 1043 .................... .................... .................... ....................

C1045 G I-131 MIBG (ioben-sulfate) O.5mCi ................................................. 1045 .................... $1,140.00 .................... $139.08

C1047 H Noga/Navi-Star cath ......................................................................... 1047 .................... .................... .................... ....................

C1048 H NeuroCyberneticPros: gen ............................................................... 1048 .................... .................... .................... ....................

C1050 H Prosorba column .............................................................................. 1410 .................... .................... .................... ....................

C1051 H Oasis Thrombectomy Cath .............................................................. 1051 .................... .................... .................... ....................

C1053 H EnSite 3000 catheter ....................................................................... 1053 .................... .................... .................... ....................

C1054 H Hydrolyser Thromb Cath 6/7F ......................................................... 1054 .................... .................... .................... ....................

C1055 H Transesoph 210, 210-S Cath ........................................................... 1055 .................... .................... .................... ....................

C1056 H Thermachoice II Cath ....................................................................... 1056 .................... .................... .................... ....................

C1057 H Micromark Tissue Marker ................................................................ 1057 .................... .................... .................... ....................

C1059 G Carticel,auto cult-chndr cyte ............................................................ 1059 .................... $14,250.00 .................... $2,010.00

C1060 H ACS multi-link tristor/ultra ................................................................ 1060 .................... .................... .................... ....................

*C1061 H ACS Viking Guiding cath ................................................................. 1061 .................... .................... .................... ....................

*C1063 H EndoTak Endurance EZ, RX lead ................................................... 1063 .................... .................... .................... ....................

*C1067 H Megalink biliary stent ....................................................................... 1067 .................... .................... .................... ....................

*C1068 H Pulsar DDD pmkr ............................................................................. 1068 .................... .................... .................... ....................

*C1069 H Discovery DR, pmaker ..................................................................... 1069 .................... .................... .................... ....................

*C1071 H Pulsar Max, Pulsar SR pmkr ........................................................... 1071 .................... .................... .................... ....................

*C1072 H Guidant: blln dil cath ........................................................................ 1072 .................... .................... .................... ....................

*C1073 H Morcellator ........................................................................................ 1073 .................... .................... .................... ....................

*C1074 H RX/OTW Viatrac-peri dil cath ........................................................... 1074 .................... .................... .................... ....................

*C1075 H Guidant: lead .................................................................................... 1075 .................... .................... .................... ....................

*C1076 H Ventak mini sc defib ......................................................................... 1076 .................... .................... .................... ....................

*C1077 H Ventak VR Prizm VR, sc defib ......................................................... 1077 .................... .................... .................... ....................

*C1078 H Ventak: Prizm, AVIIIDR defib ........................................................... 1078 .................... .................... .................... ....................

*C1079 G CO 57/58 0.5 mCi ............................................................................ 1079 .................... $264.10 .................... $32.22

*C1084 G Denileukin diftitox, 300 mcg ............................................................. 1084 .................... $942.88 .................... $126.35

*C1086 G Temozolomide, 5 mg ....................................................................... 1086 .................... $5.70 .................... $.76

*C1087 G I-123 per uCi capsule ....................................................................... 1087 .................... $.84 .................... $.10

*C1088 T LaserOptic tx sys ............................................................................. 0980 38.67 $1,917.89 .................... $383.58

*C1089 G CO 57, 0.5 mCi ................................................................................ 1089 .................... $91.20 .................... $11.13

*C1090 G IN 111 Chloride, per mCi ................................................................. 1090 .................... $152.00 .................... $18.54

*C1091 G IN 111 Oxyquinoline, per 5 mCi ...................................................... 1091 .................... $508.25 .................... $62.01

*C1092 G IN 111 Pentetate, per 1.5 mCi ......................................................... 1092 .................... $769.50 .................... $93.88

*C1094 J TC 99M Albumin aggr, per vial ........................................................ 1094 .................... $102.05 .................... $13.67

*C1095 G TC 99M Depreotide, per vial ............................................................ 1095 .................... $760.00 .................... $101.84

*C1096 G TC 99M Exametazime, per dose ..................................................... 1096 .................... $34.20 .................... $4.17

*C1097 G TC 99M Mebrofenin, per vial ........................................................... 1097 .................... $445.31 .................... $63.75

*C1098 G TC 99M Pentetate, per vial .............................................................. 1098 .................... $46.76 .................... $5.71

*C1099 J TC 99M Pyrophosphate, per vial ..................................................... 1099 .................... $42.75 .................... $5.22

*C1100 H Medtronic AVE GT1 guidewire ........................................................ 1100 .................... .................... .................... ....................

*C1101 H MedtronicAVE Zuma guidecath ....................................................... 1101 .................... .................... .................... ....................

*C1102 H Syngergy Neurostim Genrtr ............................................................. 1102 .................... .................... .................... ....................

*C1103 H Micro Jewel Defibrillator ................................................................... 1103 .................... .................... .................... ....................

*C1104 H RF Conductor Ablative Cath ............................................................ 1104 .................... .................... .................... ....................

*C1105 H Sigma 300VDD pacmker ................................................................. 1105 .................... .................... .................... ....................

*C1106 H SynergyEZ Pt Progrmr ..................................................................... 1106 .................... .................... .................... ....................

*C1107 H Torqr, Solist cath .............................................................................. 1107 .................... .................... .................... ....................

*C1109 H Implantable anchor: Ethicon ............................................................ 1109 .................... .................... .................... ....................

*C1110 H Stable Mapper, cath electrd ............................................................. 1110 .................... .................... .................... ....................

*C1111 H AneuRxAort-Uni-Ilicstnt&cath ........................................................... 1111 .................... .................... .................... ....................

*C1112 H AneuRx Stent graft/del.cath ............................................................. 1112 .................... .................... .................... ....................

*C1113 H Tlnt Endo Sprng Stnt Grft Sys ......................................................... 1113 .................... .................... .................... ....................

*C1114 H TalntSprgStnt+Graf endo pros ......................................................... 1114 .................... .................... .................... ....................

*C1115 H 5038S,5038,5038L pace lead .......................................................... 1115 .................... .................... .................... ....................

*C1116 H CapSureSP pacing Lead ................................................................. 1116 .................... .................... .................... ....................

*C1117 H Ancure Endograft Del Sys ............................................................... 1117 .................... .................... .................... ....................

*C1118 H Sigma300DR LegIIDR,pacemkr ....................................................... 1118 .................... .................... .................... ....................

*C1119 H Sprint6932,6943 defib lead .............................................................. 1119 .................... .................... .................... ....................

*C1120 H Sprint6942,6945 defib lead .............................................................. 1120 .................... .................... .................... ....................

*C1121 H Gem defibrillator ............................................................................... 1121 .................... .................... .................... ....................

*C1122 G TC 99M arcitumomab per dose ....................................................... 1122 .................... $22.80 .................... $2.78

*C1123 H Gem II VR defibrillator ..................................................................... 1123 .................... .................... .................... ....................

*C1124 H InterStim Test Stim Kit ..................................................................... 1124 .................... .................... .................... ....................

*C1125 H Kappa 400SR,Ttopaz II SR pmkr .................................................... 1125 .................... .................... .................... ....................

*C1126 H Kappa 700 DR pacemakr ................................................................ 1126 .................... .................... .................... ....................

*C1127 H Kappa 700SR,pmkr sgl chamber ..................................................... 1127 .................... .................... .................... ....................

*C1128 H Kappa 700D,Ruby IID pmkr ............................................................. 1128 .................... .................... .................... ....................

*C1129 H Kappa 700VDD,pacmkr ................................................................... 1129 .................... .................... .................... ....................

67955

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C1130 H Sigm200D,LGCY IID sc pmkr .......................................................... 1130 .................... .................... .................... ....................

*C1131 H Sigma 200DR, pmker ....................................................................... 1131 .................... .................... .................... ....................

*C1132 H Sigma300,200SR Leg II:sc pac ....................................................... 1132 .................... .................... .................... ....................

*C1133 H Sigma SR, Vita SR, pmaker ............................................................ 1133 .................... .................... .................... ....................

*C1134 H Sigma 300D pmker .......................................................................... 1134 .................... .................... .................... ....................

*C1135 H Entity DR 5326L/R ........................................................................... 1135 .................... .................... .................... ....................

*C1136 H Affinity DR 5330L/R ......................................................................... 1136 .................... .................... .................... ....................

*C1137 H CardioSEAL implant syst ................................................................. 1137 .................... .................... .................... ....................

*C1143 H AddVent mod 2060BL,VDD ............................................................. 1143 .................... .................... .................... ....................

*C1144 H Afnty SR 5130,Integrity SR,pmkr ..................................................... 1144 .................... .................... .................... ....................

*C1145 H Angio-Seal 6fr, 8fr ............................................................................ 1145 .................... .................... .................... ....................

C1146D E VETT tube ........................................................................................ .................... .................... .................... .................... ....................

*C1147 H AV Plus DX 1368: lead .................................................................... 1147 .................... .................... .................... ....................

*C1148 H Contour MD sc defib ........................................................................ 1148 .................... .................... .................... ....................

*C1149 H Entity DC 5226R, 5226 pmkr ........................................................... 1149 .................... .................... .................... ....................

*C1151 H Passiveplus DX lead, 10mdls .......................................................... 1151 .................... .................... .................... ....................

*C1152 H LifeSite Access System ................................................................... 1152 .................... .................... .................... ....................

*C1153 H Regency SC+ 2402L pmker ............................................................. 1153 .................... .................... .................... ....................

*C1154 H SPL:SPOI,02,04- defib lead ............................................................. 1154 .................... .................... .................... ....................

*C1155 H Repliform 8 sq cm ............................................................................ 1155 .................... .................... .................... ....................

*C1156 H Tr 1102TrSR+ 2260L,2264L,5131 ................................................... 1156 .................... .................... .................... ....................

*C1157 H Trilogy DCT 2318L pmkr .................................................................. 1157 .................... .................... .................... ....................

*C1158 H TVL lead SV01,SV02,SV04 ............................................................. 1158 .................... .................... .................... ....................

*C1159 H TVL RV02,RV06,RV07: lead ............................................................ 1159 .................... .................... .................... ....................

*C1160 H TVL-ADX 1559: lead ........................................................................ 1160 .................... .................... .................... ....................

*C1161 H Tendril DX, 1388 pacing lead .......................................................... 1161 .................... .................... .................... ....................

*C1162 H TempoDr, TrilogyDR+DC pmkr ........................................................ 1162 .................... .................... .................... ....................

*C1163 H Tendril SDX, 1488T pacing lead ...................................................... 1163 .................... .................... .................... ....................

*C1164 H Iodine-125 brachytx seed ................................................................. 1164 .................... .................... .................... ....................

*C1166 G Cytarabine liposomal, 10 mg ........................................................... 1166 .................... $371.45 .................... $49.77

*C1167 J Epirubicin hcl, 2 mg ......................................................................... 1167 .................... $24.94 .................... $3.34

C1170D E ABBI disp biopsy device .................................................................. .................... .................... .................... .................... ....................

*C1171 H Autosuture site marker stple ............................................................ 1171 .................... .................... .................... ....................

*C1172 H Spacemaker dissect ballon .............................................................. 1172 .................... .................... .................... ....................

*C1173 H Cor stnt S540, S670, o-wire stn ...................................................... 1173 .................... .................... .................... ....................

*C1174 H Bard brachytx needle ....................................................................... 1174 .................... .................... .................... ....................

C1175D E Biopsy device, MIBB Device ............................................................ .................... .................... .................... .................... ....................

C1176D E Mammotome HH Probe w/Vac Sys ................................................. .................... .................... .................... .................... ....................

C1177D E 11-G Mammotome Probe ................................................................ .................... .................... .................... .................... ....................

*C1178 G Busulfan IV, 6 mg ............................................................................ 1178 .................... $26.48 .................... $3.55

C1179D E 14-G Mammotome Probe ................................................................ .................... .................... .................... .................... ....................

*C1180 H Vigor SR, SC, pmkr ......................................................................... 1180 .................... .................... .................... ....................

*C1181 H Meridian SSI, SC, pmkr ................................................................... 1181 .................... .................... .................... ....................

*C1182 H Pulsar SSI, SC, pmkr ....................................................................... 1182 .................... .................... .................... ....................

*C1183 H Jade IIS, Sigma 300S,SC, pmkr ...................................................... 1183 .................... .................... .................... ....................

*C1184 H Sigma 200S, SC, pmkr .................................................................... 1184 .................... .................... .................... ....................

*C1188 G I 131, per mCi .................................................................................. 1188 .................... $5.86 .................... $.75

*C1200 G TC 99M Sodium Glucoheptonate, per vial ...................................... 1200 .................... $113.05 .................... $13.79

*C1201 G TC 99M succimer, per vial ............................................................... 1201 .................... $135.66 .................... $16.55

*C1202 G TC 99M Sulfur Colloid, per dose ..................................................... 1202 .................... $38.00 .................... $4.64

*C1203 G Verteporfin for Injection .................................................................... 1203 .................... $1,458.25 .................... $195.41

*C1205 G TC 99M Disofenin, per vial .............................................................. 1205 .................... $427.50 .................... $57.29

*C1207 G Octreotide acetate depot 1mg ......................................................... 1207 .................... $135.10 .................... $16.48

*C1300 S Hyperbaric O2 per 30 min under pressure ...................................... 0971 1.55 $76.88 .................... $15.38

*C1302 H Lead, defibrillator, TVL SQ01 .......................................................... 1302 .................... .................... .................... ....................

*C1303 H CapSure Fix 6940/4068-110, lead ................................................... 1303 .................... .................... .................... ....................

*C1304 H Sonicath mdl 37-416,-418 ................................................................ 1304 .................... .................... .................... ....................

*C1305 G Apligraf ............................................................................................. 1305 .................... $1,157.81 .................... $163.31

*C1306 H NeuroCyberneticPros: lead .............................................................. 1306 .................... .................... .................... ....................

*C1311 H Trilogy DR+/DAO pmkr .................................................................... 1311 .................... .................... .................... ....................

*C1312 H Magic WALLSTENTstent-Mini ......................................................... 1312 .................... .................... .................... ....................

*C1313 H Magic medium, Radius 31mm ......................................................... 1313 .................... .................... .................... ....................

*C1314 H Magic WALLSTENT stent-Long ....................................................... 1314 .................... .................... .................... ....................

*C1315 H Vigor DR, Meridian DR pmkr ........................................................... 1315 .................... .................... .................... ....................

*C1316 H Meridian DDD pmkr ......................................................................... 1316 .................... .................... .................... ....................

*C1317 H Discovery SR, pmkr ......................................................................... 1317 .................... .................... .................... ....................

*C1318 H Meridian SR pmakr .......................................................................... 1318 .................... .................... .................... ....................

*C1319 H WALLSTENT: enteral ....................................................................... 1319 .................... .................... .................... ....................

*C1320 H WALLSTENT:iliac ............................................................................. 1320 .................... .................... .................... ....................

C1321D E Palate/Base of Tongue electr .......................................................... .................... .................... .................... .................... ....................

C1322D E Turbinate Somnoplasty electr .......................................................... .................... .................... .................... .................... ....................

C1323D E VAPR/T disp electrode ..................................................................... .................... .................... .................... .................... ....................

C1324D E Ligasure disposable electrode ......................................................... .................... .................... .................... .................... ....................

*C1325 H Pallidium -103 seed ......................................................................... 1325 .................... .................... .................... ....................

67956

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C1326 H Angio-jet rheolytic thromb cath ........................................................ 1326 .................... .................... .................... ....................

*C1328 H ANS Renew NS trnsmtr ................................................................... 1328 .................... .................... .................... ....................

C1329D E Versapoint disp electrode ................................................................ .................... .................... .................... .................... ....................

*C1333 H PALMAZ Corinthian bill stent ........................................................... 1333 .................... .................... .................... ....................

*C1334 H Crown,Mini-crown,CrossLC .............................................................. 1334 .................... .................... .................... ....................

*C1335 H Mesh, Prolene .................................................................................. 1335 .................... .................... .................... ....................

*C1336 H Constant Flow Imp Pump ................................................................ 1336 .................... .................... .................... ....................

*C1337 H IsoMed 8472-20/35/60 ..................................................................... 1337 .................... .................... .................... ....................

*C1348 G I 131 per mCi solution ...................................................................... 1348 .................... $146.57 .................... $17.88

*C1350 H ProstaSeed, I125, per source .......................................................... 1350 .................... .................... .................... ....................

*C1351 H CapSure Fix lead ............................................................................. 1351 .................... .................... .................... ....................

*C1352 H Gem II defib ..................................................................................... 1352 .................... .................... .................... ....................

*C1353 H Itrel Interstm neurostim+ext ............................................................. 1353 .................... .................... .................... ....................

*C1354 H Kappa 400DR,Diamond II 820DR .................................................... 1354 .................... .................... .................... ....................

*C1355 H Kappa 600DR, Vita DR .................................................................... 1355 .................... .................... .................... ....................

*C1356 H Profile MD V-186HV3 sc defib ......................................................... 1356 .................... .................... .................... ....................

*C1357 H Angstrom MD V-190HV3 sc defib .................................................... 1357 .................... .................... .................... ....................

*C1358 H Affinity DC 5230R, 5230 pmkr ......................................................... 1358 .................... .................... .................... ....................

*C1359 H Pulsar,Pulsar Max DR,pmkr ............................................................. 1359 .................... .................... .................... ....................

*C1360D T Ocular photodynamic therapy .......................................................... 0235 2.94 $145.81 $78.91 $29.16

*C1361 H Reveal Cardiac Recorder ................................................................. 1108 .................... .................... .................... ....................

*C1362 H Herculink,OTW SDS bil stent ........................................................... 1411 .................... .................... .................... ....................

*C1363 H Gem DR, DC, defib .......................................................................... 1363 .................... .................... .................... ....................

*C1364 H Photon DR V-230HV3 DC defib ...................................................... 1364 .................... .................... .................... ....................

*C1365 H Guidewire, Hi-Torque14/18/35 ......................................................... 1365 .................... .................... .................... ....................

*C1366 H Guidewire,PTCA, Hi-Torque ............................................................ 1366 .................... .................... .................... ....................

*C1367 H Guidewire, Hi-Torque CrossIt .......................................................... 1367 .................... .................... .................... ....................

C1368D E On-Q Pain Mgt Sys .......................................................................... .................... .................... .................... .................... ....................

*C1369 H ANS Renew Stim Sys recvr ............................................................. 1369 .................... .................... .................... ....................

*C1370 H Tension-Free Vaginal Tape ............................................................. 1370 .................... .................... .................... ....................

*C1371 H Symp Nitinol Transhep Bil Sys ........................................................ 1371 .................... .................... .................... ....................

*C1372 H Cordis Nitinol bil stent ...................................................................... 1372 .................... .................... .................... ....................

*C1375 H Stent, coronary, NIR ........................................................................ 1375 .................... .................... .................... ....................

*C1376 H ANS Renew Stim Sys lead/ex ......................................................... 1376 .................... .................... .................... ....................

*C1377 H Specify 3988 neuro lead .................................................................. 1377 .................... .................... .................... ....................

*C1378 H InterStim Tx 3080/3886 lead ............................................................ 1378 .................... .................... .................... ....................

*C1379 H Pisces-Quad 3887 lead .................................................................... 1379 .................... .................... .................... ....................

*C1420 H StapleTac2 Bone w/Dermis ............................................................. 1420 .................... .................... .................... ....................

*C1421 H StapleTac2 Bone wo Dermis ........................................................... 1421 .................... .................... .................... ....................

*C1450 H Orthosphere Arthroplasty ................................................................. 1450 .................... .................... .................... ....................

*C1451 H Orthosphere Arthroplasty Kit ............................................................ 1451 .................... .................... .................... ....................

*C1500 H Atherectomy sys, peripheral ............................................................ 1500 .................... .................... .................... ....................

*C1700 H Authen Mick TP brachy needle ........................................................ 1700 .................... .................... .................... ....................

*C1701 H Medtec MT-BT-5201 -25 ndl ............................................................ 1701 .................... .................... .................... ....................

*C1702 H WWMT brachytx needle ................................................................... 1702 .................... .................... .................... ....................

*C1703 H Mentor Prostate Brachy ................................................................... 1703 .................... .................... .................... ....................

*C1704 H MT-BT-5001-25/5051-25 .................................................................. 1704 .................... .................... .................... ....................

*C1705 H Best Flexi Brachy Needle ................................................................ 1705 .................... .................... .................... ....................

*C1706 H Indigo Prostate Seeding Ndl ............................................................ 1706 .................... .................... .................... ....................

*C1707 H Varisource Implt Ndl ......................................................................... 1707 .................... .................... .................... ....................

*C1708 H UroMed Prostate Seed Ndl .............................................................. 1708 .................... .................... .................... ....................

*C1709 H Remington Brachytx Needle ............................................................ 1709 .................... .................... .................... ....................

*C1710 H US Biopsy Prostate Needle ............................................................. 1710 .................... .................... .................... ....................

*C1711 H MD Tech brachytx needle ................................................................ 1711 .................... .................... .................... ....................

*C1712 H Imagyn brachytx needle ................................................................... 1712 .................... .................... .................... ....................

*C1790 H Iridium 192 HDR .............................................................................. 1790 .................... .................... .................... ....................

*C1791 H OncoSeed, Rapid Strand I-125 ........................................................ 1791 .................... .................... .................... ....................

*C1792 H UroMed I-125 Brachy seed .............................................................. 1792 .................... .................... .................... ....................

*C1793 H Bard InterSource P-103 seed .......................................................... 1793 .................... .................... .................... ....................

*C1794 H Bard IsoSeed P-103 seed ................................................................ 1794 .................... .................... .................... ....................

*C1795 H Bard BrachySource I-125 ................................................................. 1795 .................... .................... .................... ....................

*C1796 H SourceTech Med I-125 .................................................................... 1796 .................... .................... .................... ....................

*C1797 H Draximage I-125 seed ...................................................................... 1797 .................... .................... .................... ....................

*C1798 H Syncor I-125 PharmaSeed ............................................................... 1798 .................... .................... .................... ....................

*C1799 H I-Plant I-125 Brachytx seed ............................................................. 1799 .................... .................... .................... ....................

*C1800 H Pd-103 brachytx seed ...................................................................... 1800 .................... .................... .................... ....................

*C1801 H IoGold I-125 brachytx seed .............................................................. 1801 .................... .................... .................... ....................

*C1802 H Brachytherapy seed, Iridium 192 ..................................................... 1802 .................... .................... .................... ....................

*C1803 H Best Iodine 125 brachytx sds .......................................................... 1803 .................... .................... .................... ....................

*C1804 H Best Palladium 103 seeds ............................................................... 1804 .................... .................... .................... ....................

*C1805 H IsoStar Iodine-125 seeds ................................................................. 1805 .................... .................... .................... ....................

*C1806 H Gold 198 brachy seeds .................................................................... 1806 .................... .................... .................... ....................

*C1810 H D114S Dilatation Cath ..................................................................... 1810 .................... .................... .................... ....................

*C1811 H Surgical Dynamics Anchors ............................................................. 1811 .................... .................... .................... ....................

67957

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C1812 H OBL Anchors .................................................................................... 1812 .................... .................... .................... ....................

*C1850 H Repliform 14/21 sq cm ..................................................................... 1850 .................... .................... .................... ....................

*C1851 H Repliform 24/28 sq cm ..................................................................... 1851 .................... .................... .................... ....................

*C1852 H TransCyte, per 247 sq cm ............................................................... 1852 .................... .................... .................... ....................

*C1853 H Suspend, per 8/14 sq cm ................................................................. 1853 .................... .................... .................... ....................

*C1854 H Suspend, per 24/28 sq cm ............................................................... 1854 .................... .................... .................... ....................

*C1855 H Suspend, per 36 sq cm .................................................................... 1855 .................... .................... .................... ....................

*C1856 H Suspend, per 48 sq cm .................................................................... 1856 .................... .................... .................... ....................

*C1857 H Suspend, per 84 sq cm .................................................................... 1857 .................... .................... .................... ....................

*C1858 H DuraDerm, per 8/14 sq cm .............................................................. 1858 .................... .................... .................... ....................

*C1859 H DuraDerm, per 21/24/28 sq cm ....................................................... 1859 .................... .................... .................... ....................

*C1860 H DuraDerm, per 48 sq cm ................................................................. 1860 .................... .................... .................... ....................

*C1861 H DuraDerm, per 36 sq cm ................................................................. 1861 .................... .................... .................... ....................

*C1862 H DuraDerm, per 72 sq cm ................................................................. 1862 .................... .................... .................... ....................

*C1863 H DuraDerm, per 84 sq cm ................................................................. 1863 .................... .................... .................... ....................

*C1864 H SpermaTex,per 13.44 sq cm ........................................................... 1864 .................... .................... .................... ....................

*C1865 H FasLata, per 8/14 sq cm .................................................................. 1865 .................... .................... .................... ....................

*C1866 H FasLata, per 24/28 sq cm ................................................................ 1866 .................... .................... .................... ....................

*C1867 H FasLata, per 36/48 sq cm ................................................................ 1867 .................... .................... .................... ....................

*C1868 H FasLata, per 96 sq cm ..................................................................... 1868 .................... .................... .................... ....................

*C1869 H Gore Thyroplasty Dev ...................................................................... 1869 .................... .................... .................... ....................

*C1870 H DermMatrix, per 16 sq cm ............................................................... 1870 .................... .................... .................... ....................

*C1871 H DermMatrix, 32 or 64 sq cm ............................................................ 1871 .................... .................... .................... ....................

*C1872 H Dermagraft, per 37.5 sq cm ............................................................. 1872 .................... .................... .................... ....................

*C1873 H Bard 3DMax Mesh ........................................................................... 1873 .................... .................... .................... ....................

*C1929 H Maverick PTCA Cath ....................................................................... 1929 .................... .................... .................... ....................

*C1930 H Coyote Dil Cath,20/30/40mm ........................................................... 1930 .................... .................... .................... ....................

*C1931 H Talon Dil Cath .................................................................................. 1931 .................... .................... .................... ....................

*C1932 H Scimed Remedy Dil Cath ................................................................. 1932 .................... .................... .................... ....................

*C1933 H Opti-Plast XL/Centurion Cath ........................................................... 1933 .................... .................... .................... ....................

*C1934 H Ultraverse 3.5F Bal Dil Cath ............................................................ 1934 .................... .................... .................... ....................

*C1935 H Workhorse PTA Bal Cath ................................................................. 1935 .................... .................... .................... ....................

*C1936 H Uromax Ultra Bal Dil Cath ............................................................... 1936 .................... .................... .................... ....................

*C1937 H Synergy Balloon Dil Cath ................................................................. 1937 .................... .................... .................... ....................

*C1938 H UroForce Bal Dil Cath ...................................................................... 1938 .................... .................... .................... ....................

*C1939 H Raptor, Ninja PTCA Dil Cath ........................................................... 1939 .................... .................... .................... ....................

*C1940 H PowerFlex,OPTA 5/LP Bal Cath ...................................................... 1940 .................... .................... .................... ....................

*C1941 H Jupiter PTA Dil Cath ........................................................................ 1941 .................... .................... .................... ....................

*C1942 H Cordis Maxi LD PTA Bal Cath ......................................................... 1942 .................... .................... .................... ....................

*C1943 H RXCrossSail OTW OpenSail ........................................................... 1943 .................... .................... .................... ....................

*C1944 H Rapid Exchange Bil Dil Cath ........................................................... 1944 .................... .................... .................... ....................

*C1945 H Savvy PTA Dil Cath ......................................................................... 1945 .................... .................... .................... ....................

*C1946 H R1s Rapid Dil Cath .......................................................................... 1946 .................... .................... .................... ....................

*C1947 H Gazelle Bal Dil Cath ......................................................................... 1947 .................... .................... .................... ....................

*C1948 H Pursuit Balloon Cath ........................................................................ 1948 .................... .................... .................... ....................

*C1949 H Oracle Megasonics Cath .................................................................. 1949 .................... .................... .................... ....................

*C1979 H Visions PV/Avanar US Cath ............................................................ 1979 .................... .................... .................... ....................

*C1980 H Atlantis SR Coronary Cath ............................................................... 1980 .................... .................... .................... ....................

*C1981 H PTCA Catheters ............................................................................... 1981 .................... .................... .................... ....................

*C2000 H Orbiter ST Steerable Cath ............................................................... 2000 .................... .................... .................... ....................

*C2001 H Constellation Diag Cath ................................................................... 2001 .................... .................... .................... ....................

*C2002 H Irvine 5F Inquiry Diag EP Cath ........................................................ 2002 .................... .................... .................... ....................

*C2003 H Irvine 6F Inquiry Diag EP Cath ........................................................ 2003 .................... .................... .................... ....................

*C2004 H Biosense EP Cath--Octapolar .......................................................... 2004 .................... .................... .................... ....................

*C2005 H Biosense EP Cath--Hexapolar ......................................................... 2005 .................... .................... .................... ....................

*C2006 H Biosense EP Cath--Decapolar ......................................................... 2006 .................... .................... .................... ....................

*C2007 H Irvine 6F Luma-Cath EP Cath ......................................................... 2007 .................... .................... .................... ....................

*C2008 H Luma-Cath EP Cath 81910-15 ........................................................ 2008 .................... .................... .................... ....................

*C2009 H Irvine 7F Luma-Cath EP Cath ......................................................... 2009 .................... .................... .................... ....................

*C2010 H Fixed Curve EP Cath ....................................................................... 2010 .................... .................... .................... ....................

*C2011 H Deflectable Tip Cath--Quad ............................................................. 2011 .................... .................... .................... ....................

*C2012 H Celsius Abln Cath ............................................................................ 2012 .................... .................... .................... ....................

*C2013 H Celsius Large Abln Cath .................................................................. 2013 .................... .................... .................... ....................

*C2014 H Celsius II Asym Abln Cath ............................................................... 2014 .................... .................... .................... ....................

*C2015 H Celsius II Sym Abln Cath ................................................................. 2015 .................... .................... .................... ....................

*C2016 H Navi-Star DS, Navi-Star Ther .......................................................... 2016 .................... .................... .................... ....................

*C2017 H Navi-Star Abln Cath ......................................................................... 2017 .................... .................... .................... ....................

*C2018 H Polaris T Ablation Cath .................................................................... 2018 .................... .................... .................... ....................

*C2019 H EP Deflectable Cath ......................................................................... 2019 .................... .................... .................... ....................

*C2020 H Catheter, ablation, Blazer II XP ....................................................... 2020 .................... .................... .................... ....................

*C2021 H SilverFlex EP Cath ........................................................................... 2021 .................... .................... .................... ....................

*C2022 H CP Chilli Cooled Abln Cath .............................................................. 2022 .................... .................... .................... ....................

*C2023 H Chilli Cld AblnCath-std, lg ................................................................ 2023 .................... .................... .................... ....................

*C2100 H CP CS Reference Cath .................................................................... 2100 .................... .................... .................... ....................

67958

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C2101 H CP RV Reference Cath .................................................................... 2101 .................... .................... .................... ....................

*C2102 H CP Radii 7F EP Cath ....................................................................... 2102 .................... .................... .................... ....................

*C2103 H CP Radii 7F EP Cath w/Track ......................................................... 2103 .................... .................... .................... ....................

*C2104 H Lasso Deflectable Cath .................................................................... 2104 .................... .................... .................... ....................

*C2151 H Veripath Guiding Cath ...................................................................... 2151 .................... .................... .................... ....................

*C2152 H Cordis Vista Brite Tip Cath .............................................................. 2152 .................... .................... .................... ....................

*C2153 H Bard Viking Cath .............................................................................. 2153 .................... .................... .................... ....................

*C2200 H Arrow-Trerotola PTD Cath ............................................................... 2200 .................... .................... .................... ....................

*C2300 H Varisource Stnd Catheters ............................................................... 2300 .................... .................... .................... ....................

*C2597 H CliniCath/kit 16/18 sgl/dbl ................................................................ 2597 .................... .................... .................... ....................

*C2598 H CliniCath 18/20/24G-single .............................................................. 2598 .................... .................... .................... ....................

*C2599 H CliniCath 16/18G-double .................................................................. 2599 .................... .................... .................... ....................

C2600D E Gold Probe Catheter ........................................................................ .................... .................... .................... .................... ....................

*C2601 H Bard DL Ureteral Cath ..................................................................... 2601 .................... .................... .................... ....................

*C2602 H Vitesse Laser Cath 1.4/1.7mm ........................................................ 2602 .................... .................... .................... ....................

*C2603 H Vitesse Laser Cath 2.0mm .............................................................. 2603 .................... .................... .................... ....................

*C2604 H Vitesse E Laser Cath 2.0mm ........................................................... 2604 .................... .................... .................... ....................

*C2605 H Extreme Laser Catheter ................................................................... 2605 .................... .................... .................... ....................

*C2606 H SpineCath XL Catheter .................................................................... 2606 .................... .................... .................... ....................

*C2607 H SpineCath Intradiscal Cath .............................................................. 2607 .................... .................... .................... ....................

*C2608 H Scimed 6F Wiseguide Cath ............................................................. 2608 .................... .................... .................... ....................

*C2609 H Flexima Bil Drainage Cath ............................................................... 2609 .................... .................... .................... ....................

*C2610 H FlexTipPlus Intraspinal Cath ............................................................ 2610 .................... .................... .................... ....................

*C2611 H AlgoLine Intraspinal Cath ................................................................. 2611 .................... .................... .................... ....................

*C2612 H InDura Catheter ................................................................................ 2612 .................... .................... .................... ....................

*C2676 E Response CV Catheter .................................................................... .................... .................... .................... .................... ....................

*C2700 H MycroPhylax Plus SC defib ............................................................. 2700 .................... .................... .................... ....................

*C2701 H Phylax XM SC defib ......................................................................... 2701 .................... .................... .................... ....................

*C2702 H Ventak Prizm 2 VR Defib ................................................................. 2702 .................... .................... .................... ....................

*C2703 H Ventak Prizm VR HE Defib .............................................................. 2703 .................... .................... .................... ....................

*C2704 H Ventak Mini IV+ Defib ...................................................................... 2704 .................... .................... .................... ....................

*C2801 H Defender IV DR 612 DC defib ......................................................... 2801 .................... .................... .................... ....................

*C2802 H Phylax AV DC defib ......................................................................... 2802 .................... .................... .................... ....................

*C2803 H Ventak Prizm DR HE Defib .............................................................. 2803 .................... .................... .................... ....................

*C2804 H Ventak Prizm 2 DR Defib ................................................................. 2804 .................... .................... .................... ....................

*C2805 H Jewel AF 7250 Defib ........................................................................ 2805 .................... .................... .................... ....................

*C2806 H GEM VR 7227 Defib ........................................................................ 2806 .................... .................... .................... ....................

*C2807 H Contak CD 1823 .............................................................................. 2807 .................... .................... .................... ....................

*C2808 H Contak TR 1241 ............................................................................... 2808 .................... .................... .................... ....................

*C3001 H Kainox SL/RV defib lead .................................................................. 3001 .................... .................... .................... ....................

*C3002 H EasyTrak Defib Lead ....................................................................... 3002 .................... .................... .................... ....................

*C3003 H Endotak SQ Array XP lead .............................................................. 3003 .................... .................... .................... ....................

*C3004 H Intervene Defib Lead ........................................................................ 3004 .................... .................... .................... ....................

*C3400 H Siltex Spectrum,Contour Prof .......................................................... 3400 .................... .................... .................... ....................

*C3401 H Saline-Filled Spectrum ..................................................................... 3401 .................... .................... .................... ....................

*C3500 H Mentor Alpha I Inf Penile Pros ......................................................... 3500 .................... .................... .................... ....................

*C3510 H AMS 800 Urinary Pros ..................................................................... 3510 .................... .................... .................... ....................

*C3551 H Choice/PT Graphix/Luge/Trooper .................................................... 3551 .................... .................... .................... ....................

*C3552 H Hi-Torque Whisper ........................................................................... 3552 .................... .................... .................... ....................

*C3553 H Cordis guidewires ............................................................................. 3553 .................... .................... .................... ....................

*C3554 H Jindo guidewire ................................................................................ 3554 .................... .................... .................... ....................

*C3555 H Wholey Hi-Torque Plus GW ............................................................. 3555 .................... .................... .................... ....................

*C3556 H Wave/FlowWire Guidewire ............................................................... 3556 .................... .................... .................... ....................

*C3557 H HyTek guidewire .............................................................................. 3557 .................... .................... .................... ....................

*C3800 H SynchroMed EL infusion pump ........................................................ 3800 .................... .................... .................... ....................

*C3801 H Arrow/MicroJect PCA Sys ................................................................ 3801 .................... .................... .................... ....................

*C3851 H Elastic UV IOL AA-4203T/TF/TL ...................................................... 3851 .................... .................... .................... ....................

*C4000 H Opus G 4621, 4624 SC pmkr .......................................................... 4000 .................... .................... .................... ....................

*C4001 H Opus S 4121/4124 SC pmkr ............................................................ 4001 .................... .................... .................... ....................

*C4002 H Talent 113 SC pmkr ......................................................................... 4002 .................... .................... .................... ....................

*C4003 H Kairos SR SC pmkr .......................................................................... 4003 .................... .................... .................... ....................

*C4004 H Actros SR, Actros SLR SC pmkr ..................................................... 4004 .................... .................... .................... ....................

*C4005 H Philos SR/SR-B SC pmkr ................................................................ 4005 .................... .................... .................... ....................

*C4006 H Pulsar Max II SR pmkr ..................................................................... 4006 .................... .................... .................... ....................

*C4007 H Marathon SR pmkr ........................................................................... 4007 .................... .................... .................... ....................

*C4008 H Discovery II SSI pmkr ...................................................................... 4008 .................... .................... .................... ....................

*C4009 H Discovery II SR pmkr ....................................................................... 4009 .................... .................... .................... ....................

*C4300 H Integrity AFx DR 5342 pmkr ............................................................ 4300 .................... .................... .................... ....................

*C4301 H Integrity AFx DR 5346 pmkr ............................................................ 4301 .................... .................... .................... ....................

*C4302 H Affinity VDR 5430 pmkr ................................................................... 4302 .................... .................... .................... ....................

*C4303 H Brio 112 DC pmkr ............................................................................ 4303 .................... .................... .................... ....................

*C4304 H Brio 212, Talent 213/223 DC pmkr .................................................. 4304 .................... .................... .................... ....................

*C4305 H Brio 222 DC pmkr ............................................................................ 4305 .................... .................... .................... ....................

*C4306 H Brio 220 DC pmkr ............................................................................ 4306 .................... .................... .................... ....................

67959

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C4307 H Kairos DR DC pmkr ......................................................................... 4307 .................... .................... .................... ....................

*C4308 H Inos2, Inos2+ DC pmkr .................................................................... 4308 .................... .................... .................... ....................

*C4309 H Actros DR,D,DR-A,SLR DC pmkr .................................................... 4309 .................... .................... .................... ....................

*C4310 H Actros DR-B DC pmkr ...................................................................... 4310 .................... .................... .................... ....................

*C4311 H Philos DR/DR-B/SLR DC pmkr ........................................................ 4311 .................... .................... .................... ....................

*C4312 H Pulsar Max II DR pmkr .................................................................... 4312 .................... .................... .................... ....................

*C4313 H Marathon DR pmkr ........................................................................... 4313 .................... .................... .................... ....................

*C4314 H Momentum DR pmkr ........................................................................ 4314 .................... .................... .................... ....................

*C4315 H Selection AFm pmkr ......................................................................... 4315 .................... .................... .................... ....................

*C4316 H Discovery II DR ................................................................................ 4316 .................... .................... .................... ....................

*C4317 H Discovery II DDD ............................................................................. 4317 .................... .................... .................... ....................

*C4600 H Snynox,Polyrox,Elox,Retrox ............................................................. 4600 .................... .................... .................... ....................

*C4601 E Aescula LV pmkr lead ...................................................................... .................... .................... .................... .................... ....................

*C4602 H Tendril SDX, 1488K pmkr lead ........................................................ 4602 .................... .................... .................... ....................

*C4603 H Oscor/Flexion pmkr lead .................................................................. 4603 .................... .................... .................... ....................

*C4604 H CrystallineActFix,CapsureFix ........................................................... 4604 .................... .................... .................... ....................

*C4605 H CapSure Epi pmkr lead .................................................................... 4605 .................... .................... .................... ....................

*C4606 H Flextend pmkr lead .......................................................................... 4606 .................... .................... .................... ....................

*C4607 H FinelineII/EZ, ThinlineII/EZ ............................................................... 4607 .................... .................... .................... ....................

*C5000 H BX Velocity w/Hepacoat ................................................................... 5000 .................... .................... .................... ....................

*C5001 H Memotherm Bil Stent, sm, med ....................................................... 5001 .................... .................... .................... ....................

*C5002 H Memotherm Bil Stent, large ............................................................. 5002 .................... .................... .................... ....................

*C5003 H Memotherm Bil Stent, x-large .......................................................... 5003 .................... .................... .................... ....................

*C5004 H PalmazCorinthian IQ Bil Stent ......................................................... 5004 .................... .................... .................... ....................

*C5005 H PalmazCorinthian IQ Trans/Bil ......................................................... 5005 .................... .................... .................... ....................

*C5006 H PalmazTrans Bil Stent Sys-Med ...................................................... 5006 .................... .................... .................... ....................

*C5007 H PalmazTrans XL Bil Stent--40mm ................................................... 5007 .................... .................... .................... ....................

*C5008 H PalmazTrans XL Bil Stent--50mm ................................................... 5008 .................... .................... .................... ....................

*C5009 H Stent, biliary, Biliary VistaFlex Stent ................................................ 5009 .................... .................... .................... ....................

*C5010 H Rapid Exchange Bil Stent Sys ......................................................... 5010 .................... .................... .................... ....................

*C5011 H Stent, biliary, IntraStent, IntraStent LP ............................................ 5011 .................... .................... .................... ....................

*C5012 H Stent, biliary, IntraStent DoubleStrut LD .......................................... 5012 .................... .................... .................... ....................

*C5013 H IntraStent DoubleStrut, XS ............................................................... 5013 .................... .................... .................... ....................

*C5014 H AVE Bridge Stent Sys-10/17/28 ....................................................... 5014 .................... .................... .................... ....................

*C5015 H AVE/X3 Bridge Sys, 40-100 ............................................................. 5015 .................... .................... .................... ....................

*C5016 H Biliary stent single use cov .............................................................. 5016 .................... .................... .................... ....................

*C5017 H WallstentRP Bil--20/40/60/68mm ..................................................... 5017 .................... .................... .................... ....................

*C5018 H WallstentRP Bil--80/94mm ............................................................... 5018 .................... .................... .................... ....................

*C5019 H Flexima Bil Stent Sys ....................................................................... 5019 .................... .................... .................... ....................

*C5020 H Smart Nitinol Stent--20mm ............................................................... 5020 .................... .................... .................... ....................

*C5021 H Smart Nitinol Stent--40/60mm .......................................................... 5021 .................... .................... .................... ....................

*C5022 H Smart Nitinol Stent--80mm ............................................................... 5022 .................... .................... .................... ....................

*C5023 H BX Velocity Stent--8/13mm .............................................................. 5023 .................... .................... .................... ....................

*C5024 H BX Velocity Stent--18mm ................................................................. 5024 .................... .................... .................... ....................

*C5025 H BX Velocity Stent--23mm ................................................................. 5025 .................... .................... .................... ....................

*C5026 H BX Velocity Stent--28/33mm ............................................................ 5026 .................... .................... .................... ....................

*C5027 H BX Velocity w/Hep--8/13mm ............................................................ 5027 .................... .................... .................... ....................

*C5028 H BX Velocity w/Hep--18mm ............................................................... 5028 .................... .................... .................... ....................

*C5029 H BX Velocity w/Hep--23mm ............................................................... 5029 .................... .................... .................... ....................

*C5030 H Stent, coronary, S660 9/12mm ........................................................ 5030 .................... .................... .................... ....................

*C5031 H Stent,coronary, S660 15/18mm ....................................................... 5031 .................... .................... .................... ....................

*C5032 H Stent,coronary, S660 24/30mm ....................................................... 5032 .................... .................... .................... ....................

*C5033 H Niroyal Stent Sys, 9mm ................................................................... 5033 .................... .................... .................... ....................

*C5034 H Niroyal Stent Sys, 12/15mm ............................................................ 5034 .................... .................... .................... ....................

*C5035 H Niroyal Stent Sys, 18mm ................................................................. 5035 .................... .................... .................... ....................

*C5036 H Niroyal Stent Sys, 25mm ................................................................. 5036 .................... .................... .................... ....................

*C5037 H Niroyal Stent Sys, 31mm ................................................................. 5037 .................... .................... .................... ....................

*C5038 H BX Velocity Stent w/Raptor .............................................................. 5038 .................... .................... .................... ....................

*C5039 H IntraCoil Periph Stent--40mm .......................................................... 5039 .................... .................... .................... ....................

*C5040 H IntraCoil Periph Stent--60mm .......................................................... 5040 .................... .................... .................... ....................

*C5041 H BeStent Over-the-Wire 24/30mm ..................................................... 5041 .................... .................... .................... ....................

*C5042 H BeStent Over-the-Wire 18mm .......................................................... 5042 .................... .................... .................... ....................

*C5043 H BeStent Over-the-Wire 15mm .......................................................... 5043 .................... .................... .................... ....................

*C5044 H BeStent Over-the-Wire 9/12mm ....................................................... 5044 .................... .................... .................... ....................

*C5045 H Multilink Tetra Cor Stent Sys ........................................................... 5045 .................... .................... .................... ....................

*C5046 H Radius 20mm cor stent .................................................................... 5046 .................... .................... .................... ....................

*C5047 H Niroyal Elite Cor Stent Sys .............................................................. 5047 .................... .................... .................... ....................

*C5048 H GR II Coronary Stent ....................................................................... 5048 .................... .................... .................... ....................

*C5130 H Wilson-Cook Colonic Z-Stent ........................................................... 5130 .................... .................... .................... ....................

*C5131 H Bard Colorectal Stent-60mm ............................................................ 5131 .................... .................... .................... ....................

*C5132 H Bard Colorectal Stent-80mm ............................................................ 5132 .................... .................... .................... ....................

*C5133 H Bard Colorectal Stent-100mm .......................................................... 5133 .................... .................... .................... ....................

*C5134 H Enteral Wallstent--90mm .................................................................. 5134 .................... .................... .................... ....................

*C5279 H Contour/Percuflex Stent ................................................................... 5279 .................... .................... .................... ....................

67960

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C5280 H Inlay Dbl Ureteral Stent .................................................................... 5280 .................... .................... .................... ....................

*C5281 H Wallgraft Trach Sys 70mm .............................................................. 5281 .................... .................... .................... ....................

*C5282 H Wallgraft Trach Sys 20/30/50 .......................................................... 5282 .................... .................... .................... ....................

*C5283 H Wallstent/RP TIPS --80mm .............................................................. 5283 .................... .................... .................... ....................

*C5284 H Wallstent TrachUltraFlex .................................................................. 5284 .................... .................... .................... ....................

*C5600 H Closure dev, VasoSeal ES .............................................................. 5600 .................... .................... .................... ....................

*C5601 H VasoSeal Model 1000 ...................................................................... 5601 .................... .................... .................... ....................

*C6001 H Composix Mesh 8/21 in ................................................................... 6001 .................... .................... .................... ....................

*C6002 H Composix Mesh 32 in ...................................................................... 6002 .................... .................... .................... ....................

*C6003 H Composix Mesh 48 in ...................................................................... 6003 .................... .................... .................... ....................

*C6004 H Composix Mesh 80 in ...................................................................... 6004 .................... .................... .................... ....................

*C6005 H Composix Mesh 140 in .................................................................... 6005 .................... .................... .................... ....................

*C6006 H Composix Mesh 144 in .................................................................... 6006 .................... .................... .................... ....................

*C6012 H Pelvicol Collagen 8/14 sq cm .......................................................... 6012 .................... .................... .................... ....................

*C6013 H Pelvicol Collagen 21/24/28 sq cm ................................................... 6013 .................... .................... .................... ....................

*C6014 H Pelvicol Collagen 40sq cm ............................................................... 6014 .................... .................... .................... ....................

*C6015 H Pelvicol Collagen 48 sq cm ............................................................. 6015 .................... .................... .................... ....................

*C6016 H Pelvicol Collagen 96 sq cm ............................................................. 6016 .................... .................... .................... ....................

*C6017 H Gore-Tex DualMesh 75/96 sq cm .................................................... 6017 .................... .................... .................... ....................

*C6018 H Gore-Tex DualMesh 150 sq cm ....................................................... 6018 .................... .................... .................... ....................

*C6019 H Gore-Tex DualMesh 285 sq cm ....................................................... 6019 .................... .................... .................... ....................

*C6020 H Gore-Tex DualMesh 432 sq cm ....................................................... 6020 .................... .................... .................... ....................

*C6021 H Gore-Tex DualMesh 600 sq cm ....................................................... 6021 .................... .................... .................... ....................

*C6022 H Gore-Tex DualMesh 884 sq cm ....................................................... 6022 .................... .................... .................... ....................

*C6023 H Gore-TexPlus 1mm, 75/96sq cm ..................................................... 6023 .................... .................... .................... ....................

*C6024 H Gore-TexPlus 1mm, 150sq cm ........................................................ 6024 .................... .................... .................... ....................

*C6025 H Gore-TexPlus 1mm, 285sq cm ........................................................ 6025 .................... .................... .................... ....................

*C6026 H Gore-TexPlus 1mm, 432sq cm ........................................................ 6026 .................... .................... .................... ....................

*C6027 H Gore-TexPlus 1mm, 600sq cm ........................................................ 6027 .................... .................... .................... ....................

*C6028 H Gore-TexPlus 1mm, 884 sq cm ....................................................... 6028 .................... .................... .................... ....................

*C6029 H Gore-TexPlus 2mm, 150 sq cm ....................................................... 6029 .................... .................... .................... ....................

*C6030 H Gore-TexPlus 2mm, 285 sq cm ....................................................... 6030 .................... .................... .................... ....................

*C6031 H Gore-TexPlus 2mm, 432 sq cm ....................................................... 6031 .................... .................... .................... ....................

*C6032 H Gore-TexPlus 2mm, 600 sq cm ....................................................... 6032 .................... .................... .................... ....................

*C6033 H Gore-TexPlus 2mm, 884 sq cm ....................................................... 6033 .................... .................... .................... ....................

*C6034 H Bard ePTFE: 15 sq cm--2mm .......................................................... 6034 .................... .................... .................... ....................

*C6035 H Bard ePTFE150sqcm-1mm,75-2mm ............................................... 6035 .................... .................... .................... ....................

*C6036 H Bard ePTFE: 50/75sqcm-1,2mm ..................................................... 6036 .................... .................... .................... ....................

*C6037 H Bard ePTFE: 300sq cm-1,2mm ....................................................... 6037 .................... .................... .................... ....................

*C6038 H Bard ePTFE: 600sq cm-1mm .......................................................... 6038 .................... .................... .................... ....................

*C6039 H Bard ePTFE: 884sq cm-1mm .......................................................... 6039 .................... .................... .................... ....................

*C6040 H Bard ePTFE: 600sq cm-2mm .......................................................... 6040 .................... .................... .................... ....................

*C6041 H Bard ePTFE: 884sq cm-2mm .......................................................... 6041 .................... .................... .................... ....................

*C6050 H Female Sling Sys w/wo Matrl .......................................................... 6050 .................... .................... .................... ....................

*C6051 H Stratasis Urethral Sling, 20/40 cm ................................................... 6051 .................... .................... .................... ....................

*C6052 H Stratasis Urethral Sling, 60 cm ........................................................ 6052 .................... .................... .................... ....................

*C6053 H Surgisis Soft Graft ............................................................................ 6053 .................... .................... .................... ....................

*C6054 H Surgisis Enhanced Graft .................................................................. 6054 .................... .................... .................... ....................

*C6055 H Surgisis Enhanced Tissue ............................................................... 6055 .................... .................... .................... ....................

*C6056 H Surgisis Soft Tissue Graft ................................................................ 6056 .................... .................... .................... ....................

*C6057 H Surgisis Hernia Graft ........................................................................ 6057 .................... .................... .................... ....................

*C6058 H SurgiPro Hernia Plug, med/lg .......................................................... 6058 .................... .................... .................... ....................

*C6080 H Male Sling Sys w/wo Matrl ............................................................... 6080 .................... .................... .................... ....................

*C6200 H Exxcel Sft ePTFE vas graft .............................................................. 6200 .................... .................... .................... ....................

*C6201 H Impra Venaflo--10/20cm ................................................................... 6201 .................... .................... .................... ....................

*C6202 H Impra Venaflo-30/40cm .................................................................... 6202 .................... .................... .................... ....................

*C6203 H Impra Venaflo-50cm,vt45 ................................................................. 6203 .................... .................... .................... ....................

*C6204 H Impra Venaflo-stepped ..................................................................... 6204 .................... .................... .................... ....................

*C6205 H Impra Carboflo--10cm ...................................................................... 6205 .................... .................... .................... ....................

*C6206 H Impra Carboflo--20cm ...................................................................... 6206 .................... .................... .................... ....................

*C6207 H Impra Carboflo--30/35/40cm ............................................................ 6207 .................... .................... .................... ....................

*C6208 H Impra Carboflo--40/50cm ................................................................. 6208 .................... .................... .................... ....................

*C6209 H Impra Carboflo--ctrflex ..................................................................... 6209 .................... .................... .................... ....................

*C6210 H Exxcel ePTFE vas graft ................................................................... 6210 .................... .................... .................... ....................

*C6300 H Vanguard III Endovas Graft ............................................................. 6300 .................... .................... .................... ....................

*C6500 H Preface Guiding Sheath ................................................................... 6500 .................... .................... .................... ....................

*C6501 H Sheath, Soft Tip Sheaths ................................................................. 6501 .................... .................... .................... ....................

*C6502 H Perry Exchange Dilator .................................................................... 6502 .................... .................... .................... ....................

*C6525 H Spectranetics Laser Sheath ............................................................. 6525 .................... .................... .................... ....................

*C6600 H Micro Litho Flex Probes ................................................................... 6600 .................... .................... .................... ....................

*C6650 H Fast-Cath Guiding Introducer ........................................................... 6650 .................... .................... .................... ....................

*C6651 H Seal-AwayGuiding Introducer .......................................................... 6651 .................... .................... .................... ....................

*C6652 H Bard Excalibur Introducer ................................................................ 6652 .................... .................... .................... ....................

*C6700 H Focal Seal-L ..................................................................................... 6700 .................... .................... .................... ....................

67961

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

*C8099 H Spectranetics Lead Lock Dev .......................................................... 8099 .................... .................... .................... ....................

C8100 H Adhesion barrier, ADCON-L ............................................................ 8100 .................... .................... .................... ....................

*C8102 H SurgiVision Esoph Coil .................................................................... 8102 .................... .................... .................... ....................

C8103D E Capio Capturing Dev ........................................................................ .................... .................... .................... .................... ....................

*C8500 X Atherocath-GTO ............................................................................... 0991 .................... $1,278.59 .................... $255.72

*C8501 X Pacemaker, single chamber, Vigor SSI ........................................... 0992 .................... $1,790.03 .................... $358.01

*C8502 X Livewire Steerable EP Cath ............................................................. 0988 .................... $383.58 .................... $76.72

*C8503 X SyncroMed Vas Cath ....................................................................... 0988 .................... $383.58 .................... $76.72

*C8504 X VasoSeal Hemostasis Dev .............................................................. 0987 .................... $127.86 .................... $25.57

*C8505 X SynchroMed Infusion Pump ............................................................. 0997 .................... $8,182.98 .................... $1,636.60

*C8506 X Pmkr leads 4057M,4058M ............................................................... 0990 .................... $895.01 .................... $179.00

*C8507 X 6721L/M/S,6939 lead ....................................................................... 0990 .................... $895.01 .................... $179.00

*C8508 X Lead, defibrillator, CapSure 4965 .................................................... 0990 .................... $895.01 .................... $179.00

*C8509 X Transvene 6933/6937 lead .............................................................. 0990 .................... $895.01 .................... $179.00

*C8510 X Lead, defibrillator, DP-3238 ............................................................. 0990 .................... $895.01 .................... $179.00

*C8511 X Lead, defibrillator, EndoTak DSP .................................................... 0996 .................... $6,137.23 .................... $1,227.45

*C8512 X On-Point,Pisces-Quad lead .............................................................. 0990 .................... $895.01 .................... $179.00

*C8513 X Pisces,Resume II lead ..................................................................... 0990 .................... $895.01 .................... $179.00

*C8514 X Dura II Penile Pros ........................................................................... 0993 .................... $2,557.18 .................... $511.44

*C8515D X Alpha 1 narrow base prosthesis ...................................................... 0995 .................... $4,602.92 .................... $920.58

*C8516 X Mentor Acu-Form/Mal Pros .............................................................. 0992 .................... $1,790.03 .................... $358.01

*C8517D X Ambicor prosthesis ........................................................................... 0994 .................... $3,580.05 .................... $716.01

*C8518 X Pacemaker, dual chamber, Vigor DDD ........................................... 0994 .................... $3,580.05 .................... $716.01

*C8519 X Pacemaker, dual chamber, Vista DDD ............................................ 0994 .................... $3,580.05 .................... $716.01

*C8520 X Pacemaker, single chamber, Legacy II S ........................................ 0992 .................... $1,790.03 .................... $358.01

*C8521 X Medtronic Mattrix rcvr/trmr ............................................................... 0997 .................... $8,182.98 .................... $1,636.60

*C8522 X Palmaz Bal Stent ............................................................................. 0990 .................... $895.01 .................... $179.00

*C8523 X Wallstent Trans Bil ........................................................................... 0991 .................... $1,278.59 .................... $255.72

*C8524 X Wallstent Esop ................................................................................. 0991 .................... $1,278.59 .................... $255.72

*C8525 X Esoph stent--double ......................................................................... 0992 .................... $1,790.03 .................... $358.01

*C8526 X OptiPlast XT 5F PTA Cath ............................................................... 0987 .................... $127.86 .................... $25.57

*C8528 X MS Classique Balloon Dilation Catheter .......................................... 0987 .................... $127.86 .................... $25.57

*C8529 X Crista Cath II Def 20-Pole ................................................................ 0990 .................... $895.01 .................... $179.00

*C8530 X Gel-Filled/Smooth Mammary Pros ................................................... 0989 .................... $639.30 .................... $127.86

*C8531 X Wilson-Cook Esoph Z-Stent ............................................................. 0989 .................... $639.30 .................... $127.86

*C8532 X UltraFlex Esoph ................................................................................ 0991 .................... $1,278.59 .................... $255.72

*C8533 X SynchroMed Vas Cath 8700A/V ...................................................... 0988 .................... $383.58 .................... $76.72

*C8534 X AMS Malleable 650 Penile Prosthesis ............................................. 0992 .................... $1,790.03 .................... $358.01

*C8535 X Za/Spiral Z Bil Stent ......................................................................... 0990 .................... $895.01 .................... $179.00

*C8536 X Esoph Z Metal Stent ........................................................................ 0991 .................... $1,278.59 .................... $255.72

*C8539 X Quantum Dil Balloon ........................................................................ 0987 .................... $127.86 .................... $25.57

*C8540 X Flex-EZ Bal Dilator ........................................................................... 0988 .................... $383.58 .................... $76.72

*C8541 X Carson/Passprt Dil ........................................................................... 0988 .................... $383.58 .................... $76.72

*C8542 X UrethraMax Dil Cath ........................................................................ 0987 .................... $127.86 .................... $25.57

*C8543 X Amplatz Renal Dil ............................................................................ 0987 .................... $127.86 .................... $25.57

*C8550 X Livewire 5F, 7F EP Cath .................................................................. 0989 .................... $639.30 .................... $127.86

*C8551 X Livewire 7F Duo-Decapolar ............................................................. 0990 .................... $895.01 .................... $179.00

*C8552 X Santuro Fixed Curve Cath ............................................................... 0989 .................... $639.30 .................... $127.86

*C8597 X Wisdom ST guidewire ...................................................................... 0987 .................... $127.86 .................... $25.57

*C8598 X SV Guidewire-5/8/14cm ................................................................... 0987 .................... $127.86 .................... $25.57

*C8599 X Stabilizer XS guidewire .................................................................... 0987 .................... $127.86 .................... $25.57

*C8600 X Shinobi Plus guidewire ..................................................................... 0987 .................... $127.86 .................... $25.57

*C8650 X XL Check-Flo Introducer .................................................................. 0987 .................... $127.86 .................... $25.57

*C8724 X Octad neuro lead ............................................................................. 0991 .................... $1,278.59 .................... $255.72

*C8725 X SymMix neuro lead .......................................................................... 0990 .................... $895.01 .................... $179.00

*C8748 X Endotak SQ Patch defib lead .......................................................... 0990 .................... $895.01 .................... $179.00

*C8749 X Endotak SQ Array defib lead ........................................................... 0993 .................... $2,557.18 .................... $511.44

*C8750 X Unity VDDR dc pmkr ........................................................................ 0994 .................... $3,580.05 .................... $716.01

*C8775 X 2188 Cor pmkr lead ......................................................................... 0991 .................... $1,278.59 .................... $255.72

*C8776 X Innomedica pmkr lead ...................................................................... 0990 .................... $895.01 .................... $179.00

*C8777 X Unipass pmkr lead ........................................................................... 0991 .................... $1,278.59 .................... $255.72

*C8800 X Lg Palmaz Bil Stent ......................................................................... 0990 .................... $895.01 .................... $179.00

*C8801 X Gianturco Bil Z Stent ........................................................................ 0989 .................... $639.30 .................... $127.86

*C8802 X Oasis Stent Intro Sys ....................................................................... 0987 .................... $127.86 .................... $25.57

*C8830 X Gianturco-Roubin Cor Snt ................................................................ 0991 .................... $1,278.59 .................... $255.72

*C8890 X Perfluoron, per 2ml .......................................................................... 0987 .................... $127.86 .................... $25.57

*C8891 X Perfluoron, per 5/7ml ....................................................................... 0988 .................... $383.58 .................... $76.72

C9000 G Na chromate Cr51, per 0.25mCi ...................................................... 9000 .................... $259.36 .................... $34.75

C9001 J Linezolid inj, 200mg ......................................................................... 9001 .................... $34.14 .................... $4.57

C9002 J Tenecteplase, 50mg/vial .................................................................. 9002 .................... $2,612.50 .................... $350.08

C9003 J Palivizumab, per 50mg .................................................................... 9003 .................... $664.49 .................... $89.04

C9004 J Gemtuzumab ozogamicin inj,5mg .................................................... 9004 .................... $1,929.69 .................... $258.58

C9005 G reteplase, 18.1 mg (one single-use vial) ......................................... 9005 .................... $1,306.25 .................... $175.04

C9006 J Tacrolimus inj, per 5mg (1 amp) ...................................................... 9006 .................... $109.83 .................... $14.72

67962

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

C9007 G Baclofen Intrathecal kit-1amp .......................................................... 9007 .................... $79.80 .................... $10.69

C9008 G Baclofen Refill Kit--500mcg .............................................................. 9008 .................... $222.30 .................... $29.79

C9009 G Baclofen Refill Kit--2000mcg ............................................................ 9009 .................... $467.40 .................... $62.63

C9010 G Baclofen Refill Kit--4000mcg ............................................................ 9010 .................... $820.80 .................... $109.99

C9011 G Caffeine Citrate, inj, 1ml .................................................................. 9011 .................... $12.22 .................... $1.57

*C9100 G Iodinated I-131 Albumin ................................................................... 9100 .................... $246.05 .................... $30.02

C9102 G 51 Na chromate, 50uCi .................................................................... 9102 .................... $216.60 .................... $26.43

C9103 G Na Iothalamate I-125, 10uCi ............................................................ 9103 .................... $12.27 .................... $1.50

C9104 G Anti-thymocyte globulin,25mg .......................................................... 9104 .................... $251.75 .................... $33.73

C9105 G Hep B imm glob, per 1 ml ................................................................ 9105 .................... $152.00 .................... $20.37

C9106 J Sirolimus 1mg/ml .............................................................................. 9106 .................... $6.51 .................... $.87

*C9107 J Tinzaparin sodium, 2ml vial ............................................................. 9107 .................... $159.60 .................... $20.50

C9108 G Thyrotropin alfa, 1.1 mg ................................................................... 9108 .................... $494.00 .................... $70.72

C9109 G Tirofiban hcl, 6.25 mg ...................................................................... 9109 .................... $199.50 .................... $28.56

C9500 K Platelets, irradiated, each unit ......................................................... 9500 1.77 $87.97 .................... $17.59

C9501 K Platelets, pheresis, each unit ........................................................... 9501 9.69 $480.75 .................... $96.15

C9502 K Platelets, pheresis, irradiated, each unit .......................................... 9502 10.52 $521.66 .................... $104.33

C9503 K Fresh frzn plasma, donor retested, unit ........................................... 9503 1.65 $81.83 .................... $16.37

C9504 K Red blood cells, deglycerolized, unit ............................................... 9504 4.35 $215.83 .................... $43.17

C9505 K Red blood cells, irradiated, each unit .............................................. 9505 2.58 $127.86 .................... $25.57

*C9700 T Water-induced thermotherapy .......................................................... 0977 23.20 $1,150.63 .................... $230.13

*C9701 S Stretta Procedure ............................................................................. 0976 18.05 $895.21 .................... $179.04

*C9702 S Chkmate Intra Brachytx Sys ............................................................ 0981 46.40 $2,301.26 .................... $460.25

D0120 E Periodic oral evaluation .................................................................... .................... .................... .................... .................... ....................

D0140 E Limit oral eval problm focus ............................................................. .................... .................... .................... .................... ....................

D0150 S Comprehensve oral evaluation ........................................................ 0330 1.51 $74.89 $14.98 $14.98

D0160 E Extensv oral eval prob focus ........................................................... .................... .................... .................... .................... ....................

D0170 E Re-eval,est pt,problem focus ........................................................... .................... .................... .................... .................... ....................

D0210 E Intraor complete film series .............................................................. .................... .................... .................... .................... ....................

D0220 E Intraoral periapical first f .................................................................. .................... .................... .................... .................... ....................

D0230 E Intraoral periapical ea add ............................................................... .................... .................... .................... .................... ....................

D0240 S Intraoral occlusal film ....................................................................... 0330 1.51 $74.89 $14.98 $14.98

D0250 S Extraoral first film ............................................................................. 0330 1.51 $74.89 $14.98 $14.98

D0260 S Extraoral ea additional film .............................................................. 0330 1.51 $74.89 $14.98 $14.98

D0270 S Dental bitewing single film ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D0272 S Dental bitewings two films ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D0274 S Dental bitewings four films ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D0277 S Vert bitewings-sev to eight ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D0290 E Dental film skull/facial bon ............................................................... .................... .................... .................... .................... ....................

D0310 E Dental saliography ........................................................................... .................... .................... .................... .................... ....................

D0320 E Dental tmj arthrogram incl i .............................................................. .................... .................... .................... .................... ....................

D0321 E Dental other tmj films ....................................................................... .................... .................... .................... .................... ....................

D0322 E Dental tomographic survey .............................................................. .................... .................... .................... .................... ....................

D0330 E Dental panoramic film ...................................................................... .................... .................... .................... .................... ....................

D0340 E Dental cephalometric film ................................................................. .................... .................... .................... .................... ....................

D0350 E Oral/facial images ............................................................................ .................... .................... .................... .................... ....................

D0415 E Bacteriologic study ........................................................................... .................... .................... .................... .................... ....................

D0425 E Caries susceptibility test .................................................................. .................... .................... .................... .................... ....................

D0460 S Pulp vitality test ................................................................................ 0330 1.51 $74.89 $14.98 $14.98

D0470 E Diagnostic casts ............................................................................... .................... .................... .................... .................... ....................

D0472 S Gross exam, prep & report .............................................................. 0330 1.51 $74.89 $14.98 $14.98

D0473 S Micro exam, prep & report ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D0474 S Micro w exam of surg margins ........................................................ 0330 1.51 $74.89 $14.98 $14.98

D0480 S Cytopath smear prep & report ......................................................... 0330 1.51 $74.89 $14.98 $14.98

D0501 S Histopathologic examinations .......................................................... 0330 1.51 $74.89 $14.98 $14.98

D0502 S Other oral pathology procedu .......................................................... 0330 1.51 $74.89 $14.98 $14.98

D0999 S Unspecified diagnostic proce ........................................................... 0330 1.51 $74.89 $14.98 $14.98

D1110 E Dental prophylaxis adult ................................................................... .................... .................... .................... .................... ....................

D1120 E Dental prophylaxis child ................................................................... .................... .................... .................... .................... ....................

D1201 E Topical fluor w prophy child ............................................................. .................... .................... .................... .................... ....................

D1203 E Topical fluor w/o prophy chi ............................................................. .................... .................... .................... .................... ....................

D1204 E Topical fluor w/o prophy adu ........................................................... .................... .................... .................... .................... ....................

D1205 E Topical fluoride w/ prophy a ............................................................. .................... .................... .................... .................... ....................

D1310 E Nutri counsel-control caries ............................................................. .................... .................... .................... .................... ....................

D1320 E Tobacco counseling ......................................................................... .................... .................... .................... .................... ....................

D1330 E Oral hygiene instruction ................................................................... .................... .................... .................... .................... ....................

D1351 E Dental sealant per tooth ................................................................... .................... .................... .................... .................... ....................

D1510 S Space maintainer fxd unilat ............................................................. 0330 1.51 $74.89 $14.98 $14.98

D1515 S Fixed bilat space maintainer ............................................................ 0330 1.51 $74.89 $14.98 $14.98

D1520 S Remove unilat space maintain ......................................................... 0330 1.51 $74.89 $14.98 $14.98

D1525 S Remove bilat space maintain ........................................................... 0330 1.51 $74.89 $14.98 $14.98

D1550 S Recement space maintainer ............................................................ 0330 1.51 $74.89 $14.98 $14.98

D2110 E Amalgam one surface primary ......................................................... .................... .................... .................... .................... ....................

D2120 E Amalgam two surfaces primary ....................................................... .................... .................... .................... .................... ....................

67963

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D2130 E Amalgam three surfaces prima ........................................................ .................... .................... .................... .................... ....................

D2131 E Amalgam four/more surf prima ........................................................ .................... .................... .................... .................... ....................

D2140 E Amalgam one surface permanen ..................................................... .................... .................... .................... .................... ....................

D2150 E Amalgam two surfaces permane ..................................................... .................... .................... .................... .................... ....................

D2160 E Amalgam three surfaces perma ....................................................... .................... .................... .................... .................... ....................

D2161 E Amalgam 4 or > surfaces perm ....................................................... .................... .................... .................... .................... ....................

D2330 E Resin one surface-anterior ............................................................... .................... .................... .................... .................... ....................

D2331 E Resin two surfaces-anterior ............................................................. .................... .................... .................... .................... ....................

D2332 E Resin three surfaces-anterio ............................................................ .................... .................... .................... .................... ....................

D2335 E Resin 4/> surf or w incis an ............................................................. .................... .................... .................... .................... ....................

D2336 E Composite resin crown .................................................................... .................... .................... .................... .................... ....................

D2337 E Compo resin crown ant-perm .......................................................... .................... .................... .................... .................... ....................

D2380 E Resin one surf poster primar ........................................................... .................... .................... .................... .................... ....................

D2381 E Resin two surf poster primar ............................................................ .................... .................... .................... .................... ....................

D2382 E Resin three/more surf post p ........................................................... .................... .................... .................... .................... ....................

D2385 E Resin one surf poster perman ......................................................... .................... .................... .................... .................... ....................

D2386 E Resin two surf poster perman .......................................................... .................... .................... .................... .................... ....................

D2387 E Resin three/more surf post p ........................................................... .................... .................... .................... .................... ....................

D2388 E Resin four/more, post perm ............................................................. .................... .................... .................... .................... ....................

D2410 E Dental gold foil one surface ............................................................. .................... .................... .................... .................... ....................

D2420 E Dental gold foil two surface ............................................................. .................... .................... .................... .................... ....................

D2430 E Dental gold foil three surfa ............................................................... .................... .................... .................... .................... ....................

D2510 E Dental inlay metalic 1 surf ............................................................... .................... .................... .................... .................... ....................

D2520 E Dental inlay metallic 2 surf ............................................................... .................... .................... .................... .................... ....................

D2530 E Dental inlay metl 3/more sur ............................................................ .................... .................... .................... .................... ....................

D2542 E Dental onlay metallic 2 surf ............................................................. .................... .................... .................... .................... ....................

D2543 E Dental onlay metallic 3 surf ............................................................. .................... .................... .................... .................... ....................

D2544 E Dental onlay metl 4/more sur ........................................................... .................... .................... .................... .................... ....................

D2610 E Inlay porcelain/ceramic 1 su ............................................................ .................... .................... .................... .................... ....................

D2620 E Inlay porcelain/ceramic 2 su ............................................................ .................... .................... .................... .................... ....................

D2630 E Dental onlay porc 3/more sur .......................................................... .................... .................... .................... .................... ....................

D2642 E Dental onlay porcelin 2 surf ............................................................. .................... .................... .................... .................... ....................

D2643 E Dental onlay porcelin 3 surf ............................................................. .................... .................... .................... .................... ....................

D2644 E Dental onlay porc 4/more sur .......................................................... .................... .................... .................... .................... ....................

D2650 E Inlay composite/resin one su ........................................................... .................... .................... .................... .................... ....................

D2651 E Inlay composite/resin two su ............................................................ .................... .................... .................... .................... ....................

D2652 E Dental inlay resin 3/mre sur ............................................................. .................... .................... .................... .................... ....................

D2662 E Dental onlay resin 2 surface ............................................................ .................... .................... .................... .................... ....................

D2663 E Dental onlay resin 3 surface ............................................................ .................... .................... .................... .................... ....................

D2664 E Dental onlay resin 4/mre sur ............................................................ .................... .................... .................... .................... ....................

D2710 E Crown resin laboratory ..................................................................... .................... .................... .................... .................... ....................

D2720 E Crown resin w/ high noble me ......................................................... .................... .................... .................... .................... ....................

D2721 E Crown resin w/ base metal .............................................................. .................... .................... .................... .................... ....................

D2722 E Crown resin w/ noble metal ............................................................. .................... .................... .................... .................... ....................

D2740 E Crown porcelain/ceramic subs ......................................................... .................... .................... .................... .................... ....................

D2750 E Crown porcelain w/ h noble m ......................................................... .................... .................... .................... .................... ....................

D2751 E Crown porcelain fused base m ........................................................ .................... .................... .................... .................... ....................

D2752 E Crown porcelain w/ noble met ......................................................... .................... .................... .................... .................... ....................

D2780 E Crown 3/4 cast hi noble met ............................................................ .................... .................... .................... .................... ....................

D2781 E Crown 3/4 cast base metal .............................................................. .................... .................... .................... .................... ....................

D2782 E Crown 3/4 cast noble metal ............................................................. .................... .................... .................... .................... ....................

D2783 E Crown 3/4 porcelain/ceramic ........................................................... .................... .................... .................... .................... ....................

D2790 E Crown full cast high noble m ........................................................... .................... .................... .................... .................... ....................

D2791 E Crown full cast base metal .............................................................. .................... .................... .................... .................... ....................

D2792 E Crown full cast noble metal ............................................................. .................... .................... .................... .................... ....................

D2799 E Provisional crown ............................................................................. .................... .................... .................... .................... ....................

D2910 E Dental recement inlay ...................................................................... .................... .................... .................... .................... ....................

D2920 E Dental recement crown .................................................................... .................... .................... .................... .................... ....................

D2930 E Prefab stnlss steel crwn pri .............................................................. .................... .................... .................... .................... ....................

D2931 E Prefab stnlss steel crown pe ............................................................ .................... .................... .................... .................... ....................

D2932 E Prefabricated resin crown ................................................................ .................... .................... .................... .................... ....................

D2933 E Prefab stainless steel crown ............................................................ .................... .................... .................... .................... ....................

D2940 E Dental sedative filling ....................................................................... .................... .................... .................... .................... ....................

D2950 E Core build-up incl any pins .............................................................. .................... .................... .................... .................... ....................

D2951 E Tooth pin retention ........................................................................... .................... .................... .................... .................... ....................

D2952 E Post and core cast + crown ............................................................. .................... .................... .................... .................... ....................

D2953 E Each addtnl cast post ...................................................................... .................... .................... .................... .................... ....................

D2954 E Prefab post/core + crown ................................................................. .................... .................... .................... .................... ....................

D2955 E Post removal .................................................................................... .................... .................... .................... .................... ....................

D2957 E Each addtnl prefab post ................................................................... .................... .................... .................... .................... ....................

D2960 E Laminate labial veneer ..................................................................... .................... .................... .................... .................... ....................

D2961 E Lab labial veneer resin ..................................................................... .................... .................... .................... .................... ....................

D2962 E Lab labial veneer porcelain .............................................................. .................... .................... .................... .................... ....................

D2970 S Temporary- fractured tooth .............................................................. 0330 1.51 $74.89 $14.98 $14.98

67964

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D2980 E Crown repair ..................................................................................... .................... .................... .................... .................... ....................

D2999 S Dental unspec restorative pr ............................................................ 0330 1.51 $74.89 $14.98 $14.98

D3110 E Pulp cap direct ................................................................................. .................... .................... .................... .................... ....................

D3120 E Pulp cap indirect .............................................................................. .................... .................... .................... .................... ....................

D3220 E Therapeutic pulpotomy ..................................................................... .................... .................... .................... .................... ....................

D3221 E Gross pulpal debridement ................................................................ .................... .................... .................... .................... ....................

D3230 E Pulpal therapy anterior prim ............................................................. .................... .................... .................... .................... ....................

D3240 E Pulpal therapy posterior pri .............................................................. .................... .................... .................... .................... ....................

D3310 E Anterior ............................................................................................. .................... .................... .................... .................... ....................

D3320 E Root canal therapy 2 canals ............................................................ .................... .................... .................... .................... ....................

D3330 E Root canal therapy 3 canals ............................................................ .................... .................... .................... .................... ....................

D3331 E Non-surg tx root canal obs .............................................................. .................... .................... .................... .................... ....................

D3332 E Incomplete endodontic tx ................................................................. .................... .................... .................... .................... ....................

D3333 E Internal root repair ............................................................................ .................... .................... .................... .................... ....................

D3346 E Retreat root canal anterior ............................................................... .................... .................... .................... .................... ....................

D3347 E Retreat root canal bicuspid .............................................................. .................... .................... .................... .................... ....................

D3348 E Retreat root canal molar .................................................................. .................... .................... .................... .................... ....................

D3351 E Apexification/recalc initial ................................................................. .................... .................... .................... .................... ....................

D3352 E Apexification/recalc interim .............................................................. .................... .................... .................... .................... ....................

D3353 E Apexification/recalc final ................................................................... .................... .................... .................... .................... ....................

D3410 E Apicoect/perirad surg anter .............................................................. .................... .................... .................... .................... ....................

D3421 E Root surgery bicuspid ...................................................................... .................... .................... .................... .................... ....................

D3425 E Root surgery molar .......................................................................... .................... .................... .................... .................... ....................

D3426 E Root surgery ea add root ................................................................. .................... .................... .................... .................... ....................

D3430 E Retrograde filling .............................................................................. .................... .................... .................... .................... ....................

D3450 E Root amputation ............................................................................... .................... .................... .................... .................... ....................

D3460 S Endodontic endosseous implan ....................................................... 0330 1.51 $74.89 $14.98 $14.98

D3470 E Intentional replantation ..................................................................... .................... .................... .................... .................... ....................

D3910 E Isolation- tooth w rubb dam ............................................................. .................... .................... .................... .................... ....................

D3920 E Tooth splitting ................................................................................... .................... .................... .................... .................... ....................

D3950 E Canal prep/fitting of dowel ............................................................... .................... .................... .................... .................... ....................

D3999 S Endodontic procedure ...................................................................... 0330 1.51 $74.89 $14.98 $14.98

D4210 E Gingivectomy/plasty per quad .......................................................... .................... .................... .................... .................... ....................

D4211 E Gingivectomy/plasty per toot ............................................................ .................... .................... .................... .................... ....................

D4220 E Gingival curettage per quadr ........................................................... .................... .................... .................... .................... ....................

D4240 E Gingival flap proc w/ planin .............................................................. .................... .................... .................... .................... ....................

D4245 E Apically positioned flap .................................................................... .................... .................... .................... .................... ....................

D4249 E Crown lengthen hard tissue ............................................................. .................... .................... .................... .................... ....................

D4260 S Osseous surgery per quadrant ........................................................ 0330 1.51 $74.89 $14.98 $14.98

D4263 S Bone replce graft first site ................................................................ 0330 1.51 $74.89 $14.98 $14.98

D4264 S Bone replce graft each add ............................................................. 0330 1.51 $74.89 $14.98 $14.98

D4266 E Guided tiss regen resorble ............................................................... .................... .................... .................... .................... ....................

D4267 E Guided tiss regen nonresorb ........................................................... .................... .................... .................... .................... ....................

D4268 S Surgical revision procedure ............................................................. 0330 1.51 $74.89 $14.98 $14.98

D4270 S Pedicle soft tissue graft pr ............................................................... 0330 1.51 $74.89 $14.98 $14.98

D4271 S Free soft tissue graft proc ................................................................ 0330 1.51 $74.89 $14.98 $14.98

D4273 S Subepithelial tissue graft .................................................................. 0330 1.51 $74.89 $14.98 $14.98

D4274 E Distal/proximal wedge proc .............................................................. .................... .................... .................... .................... ....................

D4320 E Provision splnt intracoronal .............................................................. .................... .................... .................... .................... ....................

D4321 E Provisional splint extracoro .............................................................. .................... .................... .................... .................... ....................

D4341 E Periodontal scaling & root ................................................................ .................... .................... .................... .................... ....................

D4355 S Full mouth debridement ................................................................... 0330 1.51 $74.89 $14.98 $14.98

D4381 S Localized chemo delivery ................................................................. 0330 1.51 $74.89 $14.98 $14.98

D4910 E Periodontal maint procedures .......................................................... .................... .................... .................... .................... ....................

D4920 E Unscheduled dressing change ......................................................... .................... .................... .................... .................... ....................

D4999 E Unspecified periodontal proc ........................................................... .................... .................... .................... .................... ....................

D5110 E Dentures complete maxillary ............................................................ .................... .................... .................... .................... ....................

D5120 E Dentures complete mandible ........................................................... .................... .................... .................... .................... ....................

D5130 E Dentures immediat maxillary ............................................................ .................... .................... .................... .................... ....................

D5140 E Dentures immediat mandible ........................................................... .................... .................... .................... .................... ....................

D5211 E Dentures maxill part resin ................................................................ .................... .................... .................... .................... ....................

D5212 E Dentures mand part resin ................................................................ .................... .................... .................... .................... ....................

D5213 E Dentures maxill part metal ............................................................... .................... .................... .................... .................... ....................

D5214 E Dentures mandibl part metal ............................................................ .................... .................... .................... .................... ....................

D5281 E Removable partial denture ............................................................... .................... .................... .................... .................... ....................

D5410 E Dentures adjust cmplt maxil ............................................................. .................... .................... .................... .................... ....................

D5411 E Dentures adjust cmplt mand ............................................................ .................... .................... .................... .................... ....................

D5421 E Dentures adjust part maxill .............................................................. .................... .................... .................... .................... ....................

D5422 E Dentures adjust part mandbl ............................................................ .................... .................... .................... .................... ....................

D5510 E Dentur repr broken compl bas ......................................................... .................... .................... .................... .................... ....................

D5520 E Replace denture teeth complt .......................................................... .................... .................... .................... .................... ....................

D5610 E Dentures repair resin base .............................................................. .................... .................... .................... .................... ....................

D5620 E Rep part denture cast frame ............................................................ .................... .................... .................... .................... ....................

D5630 E Rep partial denture clasp ................................................................. .................... .................... .................... .................... ....................

67965

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D5640 E Replace part denture teeth .............................................................. .................... .................... .................... .................... ....................

D5650 E Add tooth to partial denture ............................................................. .................... .................... .................... .................... ....................

D5660 E Add clasp to partial denture ............................................................. .................... .................... .................... .................... ....................

D5710 E Dentures rebase cmplt maxil ........................................................... .................... .................... .................... .................... ....................

D5711 E Dentures rebase cmplt mand ........................................................... .................... .................... .................... .................... ....................

D5720 E Dentures rebase part maxill ............................................................. .................... .................... .................... .................... ....................

D5721 E Dentures rebase part mandbl .......................................................... .................... .................... .................... .................... ....................

D5730 E Denture reln cmplt maxil ch ............................................................. .................... .................... .................... .................... ....................

D5731 E Denture reln cmplt mand chr ........................................................... .................... .................... .................... .................... ....................

D5740 E Denture reln part maxil chr .............................................................. .................... .................... .................... .................... ....................

D5741 E Denture reln part mand chr .............................................................. .................... .................... .................... .................... ....................

D5750 E Denture reln cmplt max lab .............................................................. .................... .................... .................... .................... ....................

D5751 E Denture reln cmplt mand lab ........................................................... .................... .................... .................... .................... ....................

D5760 E Denture reln part maxil lab .............................................................. .................... .................... .................... .................... ....................

D5761 E Denture reln part mand lab .............................................................. .................... .................... .................... .................... ....................

D5810 E Denture interm cmplt maxill ............................................................. .................... .................... .................... .................... ....................

D5811 E Denture interm cmplt mandbl ........................................................... .................... .................... .................... .................... ....................

D5820 E Denture interm part maxill ................................................................ .................... .................... .................... .................... ....................

D5821 E Denture interm part mandbl ............................................................. .................... .................... .................... .................... ....................

D5850 E Denture tiss conditn maxill ............................................................... .................... .................... .................... .................... ....................

D5851 E Denture tiss condtin mandbl ............................................................ .................... .................... .................... .................... ....................

D5860 E Overdenture complete ...................................................................... .................... .................... .................... .................... ....................

D5861 E Overdenture partial .......................................................................... .................... .................... .................... .................... ....................

D5862 E Precision attachment ........................................................................ .................... .................... .................... .................... ....................

D5867 E Replacement of precision att ........................................................... .................... .................... .................... .................... ....................

D5875 E Prosthesis modification .................................................................... .................... .................... .................... .................... ....................

D5899 E Removable prosthodontic proc ........................................................ .................... .................... .................... .................... ....................

D5911 S Facial moulage sectional ................................................................. 0330 1.51 $74.89 $14.98 $14.98

D5912 S Facial moulage complete ................................................................. 0330 1.51 $74.89 $14.98 $14.98

D5913 E Nasal prosthesis ............................................................................... .................... .................... .................... .................... ....................

D5914 E Auricular prosthesis .......................................................................... .................... .................... .................... .................... ....................

D5915 E Orbital prosthesis ............................................................................. .................... .................... .................... .................... ....................

D5916 E Ocular prosthesis ............................................................................. .................... .................... .................... .................... ....................

D5919 E Facial prosthesis .............................................................................. .................... .................... .................... .................... ....................

D5922 E Nasal septal prosthesis .................................................................... .................... .................... .................... .................... ....................

D5923 E Ocular prosthesis interim ................................................................. .................... .................... .................... .................... ....................

D5924 E Cranial prosthesis ............................................................................ .................... .................... .................... .................... ....................

D5925 E Facial augmentation implant ............................................................ .................... .................... .................... .................... ....................

D5926 E Replacement nasal prosthesis ......................................................... .................... .................... .................... .................... ....................

D5927 E Auricular replacement ...................................................................... .................... .................... .................... .................... ....................

D5928 E Orbital replacement .......................................................................... .................... .................... .................... .................... ....................

D5929 E Facial replacement ........................................................................... .................... .................... .................... .................... ....................

D5931 E Surgical obturator ............................................................................. .................... .................... .................... .................... ....................

D5932 E Postsurgical obturator ...................................................................... .................... .................... .................... .................... ....................

D5933 E Refitting of obturator ........................................................................ .................... .................... .................... .................... ....................

D5934 E Mandibular flange prosthesis ........................................................... .................... .................... .................... .................... ....................

D5935 E Mandibular denture prosth ............................................................... .................... .................... .................... .................... ....................

D5936 E Temp obturator prosthesis ............................................................... .................... .................... .................... .................... ....................

D5937 E Trismus appliance ............................................................................ .................... .................... .................... .................... ....................

D5951 E Feeding aid ...................................................................................... .................... .................... .................... .................... ....................

D5952 E Pediatric speech aid ......................................................................... .................... .................... .................... .................... ....................

D5953 E Adult speech aid .............................................................................. .................... .................... .................... .................... ....................

D5954 E Superimposed prosthesis ................................................................. .................... .................... .................... .................... ....................

D5955 E Palatal lift prosthesis ........................................................................ .................... .................... .................... .................... ....................

D5958 E Intraoral con def inter plt .................................................................. .................... .................... .................... .................... ....................

D5959 E Intraoral con def mod palat .............................................................. .................... .................... .................... .................... ....................

D5960 E Modify speech aid prosthesis .......................................................... .................... .................... .................... .................... ....................

D5982 E Surgical stent ................................................................................... .................... .................... .................... .................... ....................

D5983 S Radiation applicator ......................................................................... 0330 1.51 $74.89 $14.98 $14.98

D5984 S Radiation shield ................................................................................ 0330 1.51 $74.89 $14.98 $14.98

D5985 S Radiation cone locator ..................................................................... 0330 1.51 $74.89 $14.98 $14.98

D5986 E Fluoride applicator ............................................................................ .................... .................... .................... .................... ....................

D5987 S Commissure splint ............................................................................ 0330 1.51 $74.89 $14.98 $14.98

D5988 E Surgical splint ................................................................................... .................... .................... .................... .................... ....................

D5999 E Maxillofacial prosthesis .................................................................... .................... .................... .................... .................... ....................

D6010 E Odontics endosteal implant .............................................................. .................... .................... .................... .................... ....................

D6020 E Odontics abutment placement ......................................................... .................... .................... .................... .................... ....................

D6040 E Odontics eposteal implant ................................................................ .................... .................... .................... .................... ....................

D6050 E Odontics transosteal implnt .............................................................. .................... .................... .................... .................... ....................

D6055 E Implant connecting bar ..................................................................... .................... .................... .................... .................... ....................

D6056 E Prefabricated abutment .................................................................... .................... .................... .................... .................... ....................

D6057 E Custom abutment ............................................................................. .................... .................... .................... .................... ....................

D6058 E Abutment supported crown .............................................................. .................... .................... .................... .................... ....................

D6059 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

67966

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D6060 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

D6061 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

D6062 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

D6063 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

D6064 E Abutment supported mtl crown ........................................................ .................... .................... .................... .................... ....................

D6065 E Implant supported crown .................................................................. .................... .................... .................... .................... ....................

D6066 E Implant supported mtl crown ............................................................ .................... .................... .................... .................... ....................

D6067 E Implant supported mtl crown ............................................................ .................... .................... .................... .................... ....................

D6068 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6069 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6070 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6071 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6072 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6073 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6074 E Abutment supported retainer ........................................................... .................... .................... .................... .................... ....................

D6075 E Implant supported retainer ............................................................... .................... .................... .................... .................... ....................

D6076 E Implant supported retainer ............................................................... .................... .................... .................... .................... ....................

D6077 E Implant supported retainer ............................................................... .................... .................... .................... .................... ....................

D6078 E Implnt/abut suprtd fixd dent ............................................................. .................... .................... .................... .................... ....................

D6079 E Implnt/abut suprtd fixd dent ............................................................. .................... .................... .................... .................... ....................

D6080 E Implant maintenance ........................................................................ .................... .................... .................... .................... ....................

D6090 E Repair implant .................................................................................. .................... .................... .................... .................... ....................

D6095 E Odontics repr abutment ................................................................... .................... .................... .................... .................... ....................

D6100 E Removal of implant .......................................................................... .................... .................... .................... .................... ....................

D6199 E Implant procedure ............................................................................ .................... .................... .................... .................... ....................

D6210 E Prosthodont high noble metal .......................................................... .................... .................... .................... .................... ....................

D6211 E Bridge base metal cast .................................................................... .................... .................... .................... .................... ....................

D6212 E Bridge noble metal cast ................................................................... .................... .................... .................... .................... ....................

D6240 E Bridge porcelain high noble ............................................................. .................... .................... .................... .................... ....................

D6241 E Bridge porcelain base metal ............................................................ .................... .................... .................... .................... ....................

D6242 E Bridge porcelain nobel metal ........................................................... .................... .................... .................... .................... ....................

D6245 E Bridge porcelain/ceramic .................................................................. .................... .................... .................... .................... ....................

D6250 E Bridge resin w/high noble ................................................................ .................... .................... .................... .................... ....................

D6251 E Bridge resin base metal ................................................................... .................... .................... .................... .................... ....................

D6252 E Bridge resin w/noble metal .............................................................. .................... .................... .................... .................... ....................

D6519 E Inlay/onlay porce/ceramic ................................................................ .................... .................... .................... .................... ....................

D6520 E Dental retainer two surfaces ............................................................ .................... .................... .................... .................... ....................

D6530 E Retainer metallic 3+ surface ............................................................ .................... .................... .................... .................... ....................

D6543 E Dental retainr onlay 3 surf ............................................................... .................... .................... .................... .................... ....................

D6544 E Dental retainr onlay 4/more ............................................................. .................... .................... .................... .................... ....................

D6545 E Dental retainr cast metl .................................................................... .................... .................... .................... .................... ....................

D6548 E Porcelain/ceramic retainer ............................................................... .................... .................... .................... .................... ....................

D6720 E Retain crown resin w hi nble ........................................................... .................... .................... .................... .................... ....................

D6721 E Crown resin w/base metal ............................................................... .................... .................... .................... .................... ....................

D6722 E Crown resin w/noble metal .............................................................. .................... .................... .................... .................... ....................

D6740 E Crown porcelain/ceramic .................................................................. .................... .................... .................... .................... ....................

D6750 E Crown porcelain high noble ............................................................. .................... .................... .................... .................... ....................

D6751 E Crown porcelain base metal ............................................................ .................... .................... .................... .................... ....................

D6752 E Crown porcelain noble metal ........................................................... .................... .................... .................... .................... ....................

D6780 E Crown 3/4 high noble metal ............................................................. .................... .................... .................... .................... ....................

D6781 E Crown 3/4 cast based metal ............................................................ .................... .................... .................... .................... ....................

D6782 E Crown 3/4 cast noble metal ............................................................. .................... .................... .................... .................... ....................

D6783 E Crown 3/4 porcelain/ceramic ........................................................... .................... .................... .................... .................... ....................

D6790 E Crown full high noble metal ............................................................. .................... .................... .................... .................... ....................

D6791 E Crown full base metal cast .............................................................. .................... .................... .................... .................... ....................

D6792 E Crown full noble metal cast ............................................................. .................... .................... .................... .................... ....................

D6920 S Dental connector bar ........................................................................ 0330 1.51 $74.89 $14.98 $14.98

D6930 E Dental recement bridge .................................................................... .................... .................... .................... .................... ....................

D6940 E Stress breaker .................................................................................. .................... .................... .................... .................... ....................

D6950 E Precision attachment ........................................................................ .................... .................... .................... .................... ....................

D6970 E Post & core plus retainer ................................................................. .................... .................... .................... .................... ....................

D6971 E Cast post bridge retainer ................................................................. .................... .................... .................... .................... ....................

D6972 E Prefab post & core plus reta ............................................................ .................... .................... .................... .................... ....................

D6973 E Core build up for retainer ................................................................. .................... .................... .................... .................... ....................

D6975 E Coping metal .................................................................................... .................... .................... .................... .................... ....................

D6976 E Each addtnl cast post ...................................................................... .................... .................... .................... .................... ....................

D6977 E Each addtl prefab post ..................................................................... .................... .................... .................... .................... ....................

D6980 E Bridge repair ..................................................................................... .................... .................... .................... .................... ....................

D6999 E Fixed prosthodontic proc .................................................................. .................... .................... .................... .................... ....................

D7110 S Oral surgery single tooth .................................................................. 0330 1.51 $74.89 $14.98 $14.98

D7120 S Each add tooth extraction ................................................................ 0330 1.51 $74.89 $14.98 $14.98

D7130 S Tooth root removal ........................................................................... 0330 1.51 $74.89 $14.98 $14.98

D7210 S Rem imp tooth w mucoper flp .......................................................... 0330 1.51 $74.89 $14.98 $14.98

D7220 S Impact tooth remov soft tiss ............................................................. 0330 1.51 $74.89 $14.98 $14.98

67967

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D7230 S Impact tooth remov part bony .......................................................... 0330 1.51 $74.89 $14.98 $14.98

D7240 S Impact tooth remov comp bony ....................................................... 0330 1.51 $74.89 $14.98 $14.98

D7241 S Impact tooth rem bony w/comp ....................................................... 0330 1.51 $74.89 $14.98 $14.98

D7250 S Tooth root removal ........................................................................... 0330 1.51 $74.89 $14.98 $14.98

D7260 S Oral antral fistula closure ................................................................. 0330 1.51 $74.89 $14.98 $14.98

D7270 E Tooth reimplantation ........................................................................ .................... .................... .................... .................... ....................

D7272 E Tooth transplantation ....................................................................... .................... .................... .................... .................... ....................

D7280 E Exposure impact tooth orthod .......................................................... .................... .................... .................... .................... ....................

D7281 E Exposure tooth aid eruption ............................................................. .................... .................... .................... .................... ....................

D7285 E Biopsy of oral tissue hard ................................................................ .................... .................... .................... .................... ....................

D7286 E Biopsy of oral tissue soft .................................................................. .................... .................... .................... .................... ....................

D7290 E Repositioning of teeth ...................................................................... .................... .................... .................... .................... ....................

D7291 S Transseptal fiberotomy ..................................................................... 0330 1.51 $74.89 $14.98 $14.98

D7310 E Alveoplasty w/ extraction ................................................................. .................... .................... .................... .................... ....................

D7320 E Alveoplasty w/o extraction ............................................................... .................... .................... .................... .................... ....................

D7340 E Vestibuloplasty ridge extens ............................................................ .................... .................... .................... .................... ....................

D7350 E Vestibuloplasty exten graft ............................................................... .................... .................... .................... .................... ....................

D7410 E Rad exc lesion up to 1.25 cm .......................................................... .................... .................... .................... .................... ....................

D7420 E Lesion > 1.25 cm ............................................................................. .................... .................... .................... .................... ....................

D7430 E Exc benign tumor to 1.25 cm ........................................................... .................... .................... .................... .................... ....................

D7431 E Benign tumor exc > 1.25 cm ............................................................ .................... .................... .................... .................... ....................

D7440 E Malig tumor exc to 1.25 cm ............................................................. .................... .................... .................... .................... ....................

D7441 E Malig tumor > 1.25 cm ..................................................................... .................... .................... .................... .................... ....................

D7450 E Rem odontogen cyst to 1.25cm ....................................................... .................... .................... .................... .................... ....................

D7451 E Rem odontogen cyst > 1.25 cm ....................................................... .................... .................... .................... .................... ....................

D7460 E Rem nonodonto cyst to 1.25cm ....................................................... .................... .................... .................... .................... ....................

D7461 E Rem nonodonto cyst > 1.25 cm ....................................................... .................... .................... .................... .................... ....................

D7465 E Lesion destruction ............................................................................ .................... .................... .................... .................... ....................

D7471 E Rem exostosis any site .................................................................... .................... .................... .................... .................... ....................

D7480 E Partial ostectomy .............................................................................. .................... .................... .................... .................... ....................

D7490 E Mandible resection ........................................................................... .................... .................... .................... .................... ....................

D7510 E I&d absc intraoral soft tiss ............................................................... .................... .................... .................... .................... ....................

D7520 E I&d abscess extraoral ...................................................................... .................... .................... .................... .................... ....................

D7530 E Removal fb skin/areolar tiss ............................................................. .................... .................... .................... .................... ....................

D7540 E Removal of fb reaction ..................................................................... .................... .................... .................... .................... ....................

D7550 E Removal of sloughed off bone ......................................................... .................... .................... .................... .................... ....................

D7560 E Maxillary sinusotomy ........................................................................ .................... .................... .................... .................... ....................

D7610 E Maxilla open reduct simple .............................................................. .................... .................... .................... .................... ....................

D7620 E Clsd reduct simpl maxilla fx ............................................................. .................... .................... .................... .................... ....................

D7630 E Open red simpl mandible fx ............................................................. .................... .................... .................... .................... ....................

D7640 E Clsd red simpl mandible fx .............................................................. .................... .................... .................... .................... ....................

D7650 E Open red simp malar/zygom fx ........................................................ .................... .................... .................... .................... ....................

D7660 E Clsd red simp malar/zygom fx ......................................................... .................... .................... .................... .................... ....................

D7670 E Closd rductn splint alveolus ............................................................. .................... .................... .................... .................... ....................

D7680 E Reduct simple facial bone fx ............................................................ .................... .................... .................... .................... ....................

D7710 E Maxilla open reduct compound ........................................................ .................... .................... .................... .................... ....................

D7720 E Clsd reduct compd maxilla fx ........................................................... .................... .................... .................... .................... ....................

D7730 E Open reduct compd mandble fx ...................................................... .................... .................... .................... .................... ....................

D7740 E Clsd reduct compd mandble fx ........................................................ .................... .................... .................... .................... ....................

D7750 E Open red comp malar/zygma fx ...................................................... .................... .................... .................... .................... ....................

D7760 E Clsd red comp malar/zygma fx ........................................................ .................... .................... .................... .................... ....................

D7770 E Open reduc compd alveolus fx ........................................................ .................... .................... .................... .................... ....................

D7780 E Reduct compnd facial bone fx ......................................................... .................... .................... .................... .................... ....................

D7810 E Tmj open reduct-dislocation ............................................................. .................... .................... .................... .................... ....................

D7820 E Closed tmp manipulation ................................................................. .................... .................... .................... .................... ....................

D7830 E Tmj manipulation under anest ......................................................... .................... .................... .................... .................... ....................

D7840 E Removal of tmj condyle ................................................................... .................... .................... .................... .................... ....................

D7850 E Tmj meniscectomy ........................................................................... .................... .................... .................... .................... ....................

D7852 E Tmj repair of joint disc ..................................................................... .................... .................... .................... .................... ....................

D7854 E Tmj excisn of joint membrane .......................................................... .................... .................... .................... .................... ....................

D7856 E Tmj cutting of a muscle .................................................................... .................... .................... .................... .................... ....................

D7858 E Tmj reconstruction ............................................................................ .................... .................... .................... .................... ....................

D7860 E Tmj cutting into joint ......................................................................... .................... .................... .................... .................... ....................

D7865 E Tmj reshaping components .............................................................. .................... .................... .................... .................... ....................

D7870 E Tmj aspiration joint fluid ................................................................... .................... .................... .................... .................... ....................

D7871 E Lysis + lavage w catheters .............................................................. .................... .................... .................... .................... ....................

D7872 E Tmj diagnostic arthroscopy .............................................................. .................... .................... .................... .................... ....................

D7873 E Tmj arthroscopy lysis adhesn .......................................................... .................... .................... .................... .................... ....................

D7874 E Tmj arthroscopy disc reposit ............................................................ .................... .................... .................... .................... ....................

D7875 E Tmj arthroscopy synovectomy ......................................................... .................... .................... .................... .................... ....................

D7876 E Tmj arthroscopy discectomy ............................................................ .................... .................... .................... .................... ....................

D7877 E Tmj arthroscopy debridement .......................................................... .................... .................... .................... .................... ....................

D7880 E Occlusal orthotic appliance .............................................................. .................... .................... .................... .................... ....................

D7899 E Tmj unspecified therapy ................................................................... .................... .................... .................... .................... ....................

67968

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D7910 E Dent sutur recent wnd to 5cm ......................................................... .................... .................... .................... .................... ....................

D7911 E Dental suture wound to 5 cm ........................................................... .................... .................... .................... .................... ....................

D7912 E Suture complicate wnd > 5 cm ........................................................ .................... .................... .................... .................... ....................

D7920 E Dental skin graft ............................................................................... .................... .................... .................... .................... ....................

D7940 S Reshaping bone orthognathic .......................................................... 0330 1.51 $74.89 $14.98 $14.98

D7941 E Bone cutting ramus closed .............................................................. .................... .................... .................... .................... ....................

D7943 E Cutting ramus open w/graft .............................................................. .................... .................... .................... .................... ....................

D7944 E Bone cutting segmented .................................................................. .................... .................... .................... .................... ....................

D7945 E Bone cutting body mandible ............................................................ .................... .................... .................... .................... ....................

D7946 E Reconstruction maxilla total ............................................................. .................... .................... .................... .................... ....................

D7947 E Reconstruct maxilla segment ........................................................... .................... .................... .................... .................... ....................

D7948 E Reconstruct midface no graft ........................................................... .................... .................... .................... .................... ....................

D7949 E Reconstruct midface w/graft ............................................................ .................... .................... .................... .................... ....................

D7950 E Mandible graft .................................................................................. .................... .................... .................... .................... ....................

D7955 E Repair maxillofacial defects ............................................................. .................... .................... .................... .................... ....................

D7960 E Frenulectomy/frenulotomy ................................................................ .................... .................... .................... .................... ....................

D7970 E Excision hyperplastic tissue ............................................................. .................... .................... .................... .................... ....................

D7971 E Excision pericoronal gingiva ............................................................ .................... .................... .................... .................... ....................

D7980 E Sialolithotomy ................................................................................... .................... .................... .................... .................... ....................

D7981 E Excision of salivary gland ................................................................ .................... .................... .................... .................... ....................

D7982 E Sialodochoplasty .............................................................................. .................... .................... .................... .................... ....................

D7983 E Closure of salivary fistula ................................................................. .................... .................... .................... .................... ....................

D7990 E Emergency tracheotomy .................................................................. .................... .................... .................... .................... ....................

D7991 E Dental coronoidectomy .................................................................... .................... .................... .................... .................... ....................

D7995 E Synthetic graft facial bones .............................................................. .................... .................... .................... .................... ....................

D7996 E Implant mandible for augment ......................................................... .................... .................... .................... .................... ....................

D7997 E Appliance removal ............................................................................ .................... .................... .................... .................... ....................

D7999 E Oral surgery procedure .................................................................... .................... .................... .................... .................... ....................

D8010 E Limited dental tx primary .................................................................. .................... .................... .................... .................... ....................

D8020 E Limited dental tx transition ............................................................... .................... .................... .................... .................... ....................

D8030 E Limited dental tx adolescent ............................................................ .................... .................... .................... .................... ....................

D8040 E Limited dental tx adult ...................................................................... .................... .................... .................... .................... ....................

D8050 E Intercep dental tx primary ................................................................ .................... .................... .................... .................... ....................

D8060 E Intercep dental tx transitn ................................................................ .................... .................... .................... .................... ....................

D8070 E Compre dental tx transition .............................................................. .................... .................... .................... .................... ....................

D8080 E Compre dental tx adolescent ........................................................... .................... .................... .................... .................... ....................

D8090 E Compre dental tx adult ..................................................................... .................... .................... .................... .................... ....................

D8210 E Orthodontic rem appliance tx ........................................................... .................... .................... .................... .................... ....................

D8220 E Fixed appliance therapy habt ........................................................... .................... .................... .................... .................... ....................

D8660 E Preorthodontic tx visit ....................................................................... .................... .................... .................... .................... ....................

D8670 E Periodic orthodontc tx visit ............................................................... .................... .................... .................... .................... ....................

D8680 E Orthodontic retention ........................................................................ .................... .................... .................... .................... ....................

D8690 E Orthodontic treatment ...................................................................... .................... .................... .................... .................... ....................

D8691 E Repair ortho appliance ..................................................................... .................... .................... .................... .................... ....................

D8692 E Replacement retainer ....................................................................... .................... .................... .................... .................... ....................

D8999 E Orthodontic procedure ..................................................................... .................... .................... .................... .................... ....................

D9110 N Tx dental pain minor proc ................................................................ .................... .................... .................... .................... ....................

D9210 E Dent anesthesia w/o surgery ........................................................... .................... .................... .................... .................... ....................

D9211 E Regional block anesthesia ............................................................... .................... .................... .................... .................... ....................

D9212 E Trigeminal block anesthesia ............................................................ .................... .................... .................... .................... ....................

D9215 E Local anesthesia .............................................................................. .................... .................... .................... .................... ....................

D9220 E General anesthesia .......................................................................... .................... .................... .................... .................... ....................

D9221 E General anesthesia ea ad 15m ....................................................... .................... .................... .................... .................... ....................

D9230 N Analgesia .......................................................................................... .................... .................... .................... .................... ....................

D9241 E Intravenous sedation ........................................................................ .................... .................... .................... .................... ....................

D9242 E IV sedation ea ad 30 m ................................................................... .................... .................... .................... .................... ....................

D9248 N Sedation (non-iv) .............................................................................. .................... .................... .................... .................... ....................

D9310 E Dental consultation ........................................................................... .................... .................... .................... .................... ....................

D9410 E Dental house call ............................................................................. .................... .................... .................... .................... ....................

D9420 E Hospital call ...................................................................................... .................... .................... .................... .................... ....................

D9430 E Office visit during hours ................................................................... .................... .................... .................... .................... ....................

D9440 E Office visit after hours ...................................................................... .................... .................... .................... .................... ....................

D9610 E Dent therapeutic drug inject ............................................................. .................... .................... .................... .................... ....................

D9630 S Other drugs/medicaments ................................................................ 0330 1.51 $74.89 $14.98 $14.98

D9910 E Dent appl desensitizing med ............................................................ .................... .................... .................... .................... ....................

D9911 E Appl desensitizing resin ................................................................... .................... .................... .................... .................... ....................

D9920 E Behavior management ..................................................................... .................... .................... .................... .................... ....................

D9930 S Treatment of complications .............................................................. 0330 1.51 $74.89 $14.98 $14.98

D9940 S Dental occlusal guard ...................................................................... 0330 1.51 $74.89 $14.98 $14.98

D9941 E Fabrication athletic guard ................................................................. .................... .................... .................... .................... ....................

D9950 S Occlusion analysis ........................................................................... 0330 1.51 $74.89 $14.98 $14.98

D9951 S Limited occlusal adjustment ............................................................. 0330 1.51 $74.89 $14.98 $14.98

D9952 S Complete occlusal adjustment ......................................................... 0330 1.51 $74.89 $14.98 $14.98

D9970 E Enamel microabrasion ..................................................................... .................... .................... .................... .................... ....................

67969

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

D9971 E Odontoplasty 1-2 teeth ..................................................................... .................... .................... .................... .................... ....................

D9972 E Extrnl bleaching per arch ................................................................. .................... .................... .................... .................... ....................

D9973 E Extrnl bleaching per tooth ................................................................ .................... .................... .................... .................... ....................

D9974 E Intrnl bleaching per tooth ................................................................. .................... .................... .................... .................... ....................

D9999 E Adjunctive procedure ....................................................................... .................... .................... .................... .................... ....................

E0100 A Cane adjust/fixed with tip ................................................................. .................... .................... .................... .................... ....................

E0105 A Cane adjust/fixed quad/3 pro ........................................................... .................... .................... .................... .................... ....................

E0110 A Crutch forearm pair .......................................................................... .................... .................... .................... .................... ....................

E0111 A Crutch forearm each ........................................................................ .................... .................... .................... .................... ....................

E0112 A Crutch underarm pair wood ............................................................. .................... .................... .................... .................... ....................

E0113 A Crutch underarm each wood ........................................................... .................... .................... .................... .................... ....................

E0114 A Crutch underarm pair no wood ........................................................ .................... .................... .................... .................... ....................

E0116 A Crutch underarm each no wood ...................................................... .................... .................... .................... .................... ....................

E0130 A Walker rigid adjust/fixed ht ............................................................... .................... .................... .................... .................... ....................

E0135 A Walker folding adjust/fixed ............................................................... .................... .................... .................... .................... ....................

E0141 A Rigid walker wheeled wo seat ......................................................... .................... .................... .................... .................... ....................

E0142 A Walker rigid wheeled with se ........................................................... .................... .................... .................... .................... ....................

E0143 A Walker folding wheeled w/o s .......................................................... .................... .................... .................... .................... ....................

E0144 A Enclosed walker w rear seat ............................................................ .................... .................... .................... .................... ....................

E0145 A Walker whled seat/crutch att ............................................................ .................... .................... .................... .................... ....................

E0146 A Folding walker wheels w seat .......................................................... .................... .................... .................... .................... ....................

E0147 A Walker variable wheel resist ............................................................ .................... .................... .................... .................... ....................

E0148 A Heavyduty walker no wheels ........................................................... .................... .................... .................... .................... ....................

E0149 A Heavy duty wheeled walker ............................................................. .................... .................... .................... .................... ....................

E0153 A Forearm crutch platform atta ........................................................... .................... .................... .................... .................... ....................

E0154 A Walker platform attachment ............................................................. .................... .................... .................... .................... ....................

E0155 A Walker wheel attachment,pair .......................................................... .................... .................... .................... .................... ....................

E0156 A Walker seat attachment ................................................................... .................... .................... .................... .................... ....................

E0157 A Walker crutch attachment ................................................................ .................... .................... .................... .................... ....................

E0158 A Walker leg extenders set of4 ........................................................... .................... .................... .................... .................... ....................

E0159 A Brake for wheeled walker ................................................................ .................... .................... .................... .................... ....................

E0160 A Sitz type bath or equipment ............................................................. .................... .................... .................... .................... ....................

E0161 A Sitz bath/equipment w/faucet ........................................................... .................... .................... .................... .................... ....................

E0162 A Sitz bath chair .................................................................................. .................... .................... .................... .................... ....................

E0163 A Commode chair stationry fxd ........................................................... .................... .................... .................... .................... ....................

E0164 A Commode chair mobile fixed a ........................................................ .................... .................... .................... .................... ....................

E0165 A Commode chair stationry det ........................................................... .................... .................... .................... .................... ....................

E0166 A Commode chair mobile detach ........................................................ .................... .................... .................... .................... ....................

E0167 A Commode chair pail or pan ............................................................. .................... .................... .................... .................... ....................

E0168 A Heavyduty/wide commode chair ...................................................... .................... .................... .................... .................... ....................

E0175 A Commode chair foot rest ................................................................. .................... .................... .................... .................... ....................

E0176 A Air pressre pad/cushion nonp .......................................................... .................... .................... .................... .................... ....................

E0177 A Water press pad/cushion nonp ........................................................ .................... .................... .................... .................... ....................

E0178 A Gel pressre pad/cushion nonp ......................................................... .................... .................... .................... .................... ....................

E0179 A Dry pressre pad/cushion nonp ......................................................... .................... .................... .................... .................... ....................

E0180 A Press pad alternating w pump ......................................................... .................... .................... .................... .................... ....................

E0181 A Press pad alternating w/ pum .......................................................... .................... .................... .................... .................... ....................

E0182 A Pressure pad alternating pum .......................................................... .................... .................... .................... .................... ....................

E0184 A Dry pressure mattress ...................................................................... .................... .................... .................... .................... ....................

E0185 A Gel pressure mattress pad .............................................................. .................... .................... .................... .................... ....................

E0186 A Air pressure mattress ....................................................................... .................... .................... .................... .................... ....................

E0187 A Water pressure mattress .................................................................. .................... .................... .................... .................... ....................

E0188 E Synthetic sheepskin pad .................................................................. .................... .................... .................... .................... ....................

E0189 E Lambswool sheepskin pad ............................................................... .................... .................... .................... .................... ....................

E0191 A Protector heel or elbow .................................................................... .................... .................... .................... .................... ....................

E0192 A Pad wheelchr low press/posit .......................................................... .................... .................... .................... .................... ....................

E0193 A Powered air flotation bed ................................................................. .................... .................... .................... .................... ....................

E0194 A Air fluidized bed ............................................................................... .................... .................... .................... .................... ....................

E0196 A Gel pressure mattress ...................................................................... .................... .................... .................... .................... ....................

E0197 A Air pressure pad for mattres ............................................................ .................... .................... .................... .................... ....................

E0198 A Water pressure pad for mattr ........................................................... .................... .................... .................... .................... ....................

E0199 A Dry pressure pad for mattres ........................................................... .................... .................... .................... .................... ....................

E0200 A Heat lamp without stand .................................................................. .................... .................... .................... .................... ....................

E0202 A Phototherapy light w/ photom .......................................................... .................... .................... .................... .................... ....................

E0205 A Heat lamp with stand ....................................................................... .................... .................... .................... .................... ....................

E0210 A Electric heat pad standard ............................................................... .................... .................... .................... .................... ....................

E0215 A Electric heat pad moist .................................................................... .................... .................... .................... .................... ....................

E0217 A Water circ heat pad w pump ............................................................ .................... .................... .................... .................... ....................

E0218 E Water circ cold pad w pump ............................................................ .................... .................... .................... .................... ....................

E0220 A Hot water bottle ................................................................................ .................... .................... .................... .................... ....................

E0225 A Hydrocollator unit ............................................................................. .................... .................... .................... .................... ....................

E0230 A Ice cap or collar ............................................................................... .................... .................... .................... .................... ....................

E0235 A Paraffin bath unit portable ................................................................ .................... .................... .................... .................... ....................

E0236 A Pump for water circulating p ............................................................ .................... .................... .................... .................... ....................

67970

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

E0238 A Heat pad non-electric moist ............................................................. .................... .................... .................... .................... ....................

E0239 A Hydrocollator unit portable ............................................................... .................... .................... .................... .................... ....................

E0241 E Bath tub wall rail .............................................................................. .................... .................... .................... .................... ....................

E0242 E Bath tub rail floor .............................................................................. .................... .................... .................... .................... ....................

E0243 E Toilet rail ........................................................................................... .................... .................... .................... .................... ....................

E0244 E Toilet seat raised .............................................................................. .................... .................... .................... .................... ....................

E0245 E Tub stool or bench ........................................................................... .................... .................... .................... .................... ....................

E0246 E Transfer tub rail attachment ............................................................. .................... .................... .................... .................... ....................

E0249 A Pad water circulating heat u ............................................................ .................... .................... .................... .................... ....................

E0250 A Hosp bed fixed ht w/ mattres ........................................................... .................... .................... .................... .................... ....................

E0251 A Hosp bed fixd ht w/o mattres ........................................................... .................... .................... .................... .................... ....................

E0255 A Hospital bed var ht w/ mattr ............................................................. .................... .................... .................... .................... ....................

E0256 A Hospital bed var ht w/o matt ............................................................ .................... .................... .................... .................... ....................

E0260 A Hosp bed semi-electr w/ matt .......................................................... .................... .................... .................... .................... ....................

E0261 A Hosp bed semi-electr w/o mat ......................................................... .................... .................... .................... .................... ....................

E0265 A Hosp bed total electr w/ mat ............................................................ .................... .................... .................... .................... ....................

E0266 A Hosp bed total elec w/o matt ........................................................... .................... .................... .................... .................... ....................

E0270 E Hospital bed institutional t ................................................................ .................... .................... .................... .................... ....................

E0271 A Mattress innerspring ......................................................................... .................... .................... .................... .................... ....................

E0272 A Mattress foam rubber ....................................................................... .................... .................... .................... .................... ....................

E0273 E Bed board ......................................................................................... .................... .................... .................... .................... ....................

E0274 E Over-bed table ................................................................................. .................... .................... .................... .................... ....................

E0275 A Bed pan standard ............................................................................. .................... .................... .................... .................... ....................

E0276 A Bed pan fracture .............................................................................. .................... .................... .................... .................... ....................

E0277 A Powered pres-redu air mattrs .......................................................... .................... .................... .................... .................... ....................

E0280 A Bed cradle ........................................................................................ .................... .................... .................... .................... ....................

E0290 A Hosp bed fx ht w/o rails w/m ........................................................... .................... .................... .................... .................... ....................

E0291 A Hosp bed fx ht w/o rail w/o .............................................................. .................... .................... .................... .................... ....................

E0292 A Hosp bed var ht w/o rail w/o ............................................................ .................... .................... .................... .................... ....................

E0293 A Hosp bed var ht w/o rail w/ .............................................................. .................... .................... .................... .................... ....................

E0294 A Hosp bed semi-elect w/ mattr .......................................................... .................... .................... .................... .................... ....................

E0295 A Hosp bed semi-elect w/o matt ......................................................... .................... .................... .................... .................... ....................

E0296 A Hosp bed total elect w/ matt ............................................................ .................... .................... .................... .................... ....................

E0297 A Hosp bed total elect w/o mat ........................................................... .................... .................... .................... .................... ....................

E0298 A Heavyduty/xtra wide hosp bed ......................................................... .................... .................... .................... .................... ....................

E0305 A Rails bed side half length ................................................................ .................... .................... .................... .................... ....................

E0310 A Rails bed side full length .................................................................. .................... .................... .................... .................... ....................

E0315 E Bed accessory brd/tbl/supprt ........................................................... .................... .................... .................... .................... ....................

E0325 A Urinal male jug-type ......................................................................... .................... .................... .................... .................... ....................

E0326 A Urinal female jug-type ...................................................................... .................... .................... .................... .................... ....................

E0350 E Control unit bowel system ................................................................ .................... .................... .................... .................... ....................

E0352 E Disposable pack w/bowel syst ......................................................... .................... .................... .................... .................... ....................

E0370 E Air elevator for heel .......................................................................... .................... .................... .................... .................... ....................

E0371 A Nonpower mattress overlay ............................................................. .................... .................... .................... .................... ....................

E0372 A Powered air mattress overlay .......................................................... .................... .................... .................... .................... ....................

E0373 A Nonpowered pressure mattress ....................................................... .................... .................... .................... .................... ....................

E0424 A Stationary compressed gas O2 ....................................................... .................... .................... .................... .................... ....................

E0425 E Gas system stationary compre ........................................................ .................... .................... .................... .................... ....................

E0430 E Oxygen system gas portable ........................................................... .................... .................... .................... .................... ....................

E0431 A Portable gaseous O2 ....................................................................... .................... .................... .................... .................... ....................

E0434 A Portable liquid O2 ............................................................................ .................... .................... .................... .................... ....................

E0435 E Oxygen system liquid portabl ........................................................... .................... .................... .................... .................... ....................

E0439 A Stationary liquid O2 .......................................................................... .................... .................... .................... .................... ....................

E0440 E Oxygen system liquid station ........................................................... .................... .................... .................... .................... ....................

E0441 A Oxygen contents gas per/unit .......................................................... .................... .................... .................... .................... ....................

E0442 A Oxygen contents liq per/unit ............................................................ .................... .................... .................... .................... ....................

E0443 A Port O2 contents gas/unit ................................................................ .................... .................... .................... .................... ....................

E0444 A Port O2 contents liq/unit .................................................................. .................... .................... .................... .................... ....................

E0450 A Volume vent stationary/porta ........................................................... .................... .................... .................... .................... ....................

E0455 A Oxygen tent excl croup/ped t ........................................................... .................... .................... .................... .................... ....................

E0457 A Chest shell ....................................................................................... .................... .................... .................... .................... ....................

E0459 A Chest wrap ....................................................................................... .................... .................... .................... .................... ....................

E0460 A Neg press vent portabl/statn ............................................................ .................... .................... .................... .................... ....................

E0462 A Rocking bed w/ or w/o side r ........................................................... .................... .................... .................... .................... ....................

E0480 A Percussor elect/pneum home m ...................................................... .................... .................... .................... .................... ....................

E0500 A Ippb all types .................................................................................... .................... .................... .................... .................... ....................

E0550 A Humidif extens supple w ippb .......................................................... .................... .................... .................... .................... ....................

E0555 A Humidifier for use w/ regula ............................................................. .................... .................... .................... .................... ....................

E0560 A Humidifier supplemental w/ i ............................................................ .................... .................... .................... .................... ....................

E0565 A Compressor air power source .......................................................... .................... .................... .................... .................... ....................

E0570 A Nebulizer with compression ............................................................. .................... .................... .................... .................... ....................

E0571 A Aerosol compressor for svneb ......................................................... .................... .................... .................... .................... ....................

E0572 A Aerosol compressor adjust pr .......................................................... .................... .................... .................... .................... ....................

E0574 A Ultrasonic generator w svneb .......................................................... .................... .................... .................... .................... ....................

67971

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

E0575 A Nebulizer ultrasonic .......................................................................... .................... .................... .................... .................... ....................

E0580 A Nebulizer for use w/ regulat ............................................................. .................... .................... .................... .................... ....................

E0585 A Nebulizer w/ compressor & he ......................................................... .................... .................... .................... .................... ....................

E0590 A Dispensing fee dme neb drug .......................................................... .................... .................... .................... .................... ....................

E0600 A Suction pump portab hom modl ....................................................... .................... .................... .................... .................... ....................

E0601 A Cont airway pressure device ........................................................... .................... .................... .................... .................... ....................

E0602 E Breast pump ..................................................................................... .................... .................... .................... .................... ....................

E0605 A Vaporizer room type ......................................................................... .................... .................... .................... .................... ....................

E0606 A Drainage board postural .................................................................. .................... .................... .................... .................... ....................

E0607 A Blood glucose monitor home ........................................................... .................... .................... .................... .................... ....................

E0608 A Apnea monitor .................................................................................. .................... .................... .................... .................... ....................

E0609 A Blood gluc mon w/special fea .......................................................... .................... .................... .................... .................... ....................

E0610 A Pacemaker monitr audible/vis .......................................................... .................... .................... .................... .................... ....................

E0615 A Pacemaker monitr digital/vis ............................................................ .................... .................... .................... .................... ....................

E0616 N Cardiac event recorder .................................................................... .................... .................... .................... .................... ....................

E0617 A Automatic ext defibrillator ................................................................. .................... .................... .................... .................... ....................

E0621 A Patient lift sling or seat .................................................................... .................... .................... .................... .................... ....................

E0625 E Patient lift bathroom or toi ................................................................ .................... .................... .................... .................... ....................

E0627 A Seat lift incorp lift-chair .................................................................... .................... .................... .................... .................... ....................

E0628 A Seat lift for pt furn-electr .................................................................. .................... .................... .................... .................... ....................

E0629 A Seat lift for pt furn-non-el ................................................................. .................... .................... .................... .................... ....................

E0630 A Patient lift hydraulic .......................................................................... .................... .................... .................... .................... ....................

E0635 A Patient lift electric ............................................................................. .................... .................... .................... .................... ....................

E0650 A Pneuma compresor non-segment .................................................... .................... .................... .................... .................... ....................

E0651 A Pneum compressor segmental ........................................................ .................... .................... .................... .................... ....................

E0652 A Pneum compres w/cal pressure ...................................................... .................... .................... .................... .................... ....................

E0655 A Pneumatic appliance half arm ......................................................... .................... .................... .................... .................... ....................

E0660 A Pneumatic appliance full leg ............................................................ .................... .................... .................... .................... ....................

E0665 A Pneumatic appliance full arm ........................................................... .................... .................... .................... .................... ....................

E0666 A Pneumatic appliance half leg ........................................................... .................... .................... .................... .................... ....................

E0667 A Seg pneumatic appl full leg ............................................................. .................... .................... .................... .................... ....................

E0668 A Seg pneumatic appl full arm ............................................................ .................... .................... .................... .................... ....................

E0669 A Seg pneumatic appli half leg ........................................................... .................... .................... .................... .................... ....................

E0671 A Pressure pneum appl full leg ........................................................... .................... .................... .................... .................... ....................

E0672 A Pressure pneum appl full arm .......................................................... .................... .................... .................... .................... ....................

E0673 A Pressure pneum appl half leg .......................................................... .................... .................... .................... .................... ....................

E0690 A Ultraviolet cabinet ............................................................................. .................... .................... .................... .................... ....................

E0700 E Safety equipment ............................................................................. .................... .................... .................... .................... ....................

E0710 E Restraints any type .......................................................................... .................... .................... .................... .................... ....................

E0720 A Tens two lead ................................................................................... .................... .................... .................... .................... ....................

E0730 A Tens four lead .................................................................................. .................... .................... .................... .................... ....................

E0731 A Conductive garment for tens/ ........................................................... .................... .................... .................... .................... ....................

E0740 E Incontinence treatment systm .......................................................... .................... .................... .................... .................... ....................

E0744 A Neuromuscular stim for scoli ........................................................... .................... .................... .................... .................... ....................

E0745 A Neuromuscular stim for shock ......................................................... .................... .................... .................... .................... ....................

E0746 E Electromyograph biofeedback .......................................................... .................... .................... .................... .................... ....................

E0747 A Elec osteogen stim not spine ........................................................... .................... .................... .................... .................... ....................

E0748 A Elec osteogen stim spinal ................................................................ .................... .................... .................... .................... ....................

E0749 N Elec osteogen stim implanted .......................................................... .................... .................... .................... .................... ....................

E0751D N Pulse generator or receiver ............................................................. .................... .................... .................... .................... ....................

E0753 N Neurostimulator electrodes .............................................................. .................... .................... .................... .................... ....................

E0755 E Electronic salivary reflex s ............................................................... .................... .................... .................... .................... ....................

E0756 N Implantable pulse generator ............................................................ .................... .................... .................... .................... ....................

E0757 N Implantable RF receiver ................................................................... .................... .................... .................... .................... ....................

E0758 A External RF transmitter .................................................................... .................... .................... .................... .................... ....................

E0760 E Osteogen ultrasound stimltor ........................................................... .................... .................... .................... .................... ....................

E0765 A Nerve stimulator for tx n&v .............................................................. .................... .................... .................... .................... ....................

E0776 A Iv pole ............................................................................................... .................... .................... .................... .................... ....................

E0779 A Amb infusion pump mechanical ....................................................... .................... .................... .................... .................... ....................

E0780 A Mech amb infusion pump <8hrs ...................................................... .................... .................... .................... .................... ....................

E0781 A External ambulatory infus pu ........................................................... .................... .................... .................... .................... ....................

E0782 N Non-programble infusion pump ........................................................ .................... .................... .................... .................... ....................

E0783 N Programmable infusion pump .......................................................... .................... .................... .................... .................... ....................

E0784 A Ext amb infusn pump insulin ............................................................ .................... .................... .................... .................... ....................

E0785 N Replacement impl pump cathet ....................................................... .................... .................... .................... .................... ....................

E0786 N Implantable pump replacement ........................................................ .................... .................... .................... .................... ....................

E0791 A Parenteral infusion pump sta ........................................................... .................... .................... .................... .................... ....................

E0830 A Ambulatory traction device ............................................................... .................... .................... .................... .................... ....................

E0840 A Tract frame attach headboard ......................................................... .................... .................... .................... .................... ....................

E0850 A Traction stand free standing ............................................................ .................... .................... .................... .................... ....................

E0855 A Cervical traction equipment ............................................................. .................... .................... .................... .................... ....................

E0860 A Tract equip cervical tract .................................................................. .................... .................... .................... .................... ....................

E0870 A Tract frame attach footboard ........................................................... .................... .................... .................... .................... ....................

E0880 A Trac stand free stand extrem ........................................................... .................... .................... .................... .................... ....................

67972

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

E0890 A Traction frame attach pelvic ............................................................. .................... .................... .................... .................... ....................

E0900 A Trac stand free stand pelvic ............................................................ .................... .................... .................... .................... ....................

E0910 A Trapeze bar attached to bed ........................................................... .................... .................... .................... .................... ....................

E0920 A Fracture frame attached to b ........................................................... .................... .................... .................... .................... ....................

E0930 A Fracture frame free standing ........................................................... .................... .................... .................... .................... ....................

E0935 A Exercise device passive moti ........................................................... .................... .................... .................... .................... ....................

E0940 A Trapeze bar free standing ................................................................ .................... .................... .................... .................... ....................

E0941 A Gravity assisted traction de ............................................................. .................... .................... .................... .................... ....................

E0942 A Cervical head harness/halter ........................................................... .................... .................... .................... .................... ....................

E0943 A Cervical pillow .................................................................................. .................... .................... .................... .................... ....................

E0944 A Pelvic belt/harness/boot ................................................................... .................... .................... .................... .................... ....................

E0945 A Belt/harness extremity ...................................................................... .................... .................... .................... .................... ....................

E0946 A Fracture frame dual w cross ............................................................ .................... .................... .................... .................... ....................

E0947 A Fracture frame attachmnts pe .......................................................... .................... .................... .................... .................... ....................

E0948 A Fracture frame attachmnts ce .......................................................... .................... .................... .................... .................... ....................

E0950 E Tray .................................................................................................. .................... .................... .................... .................... ....................

E0951 E Loop heel ......................................................................................... .................... .................... .................... .................... ....................

E0952 E Loop tie ............................................................................................ .................... .................... .................... .................... ....................

E0953 E Pneumatic tire .................................................................................. .................... .................... .................... .................... ....................

E0954 E Wheelchair semi-pneumatic ca ........................................................ .................... .................... .................... .................... ....................

E0958 E Whlchr att- conv 1 arm drive ........................................................... .................... .................... .................... .................... ....................

E0959 E Amputee adapter .............................................................................. .................... .................... .................... .................... ....................

E0961 E Wheelchair brake extension ............................................................. .................... .................... .................... .................... ....................

E0962 A Wheelchair 1 inch cushion ............................................................... .................... .................... .................... .................... ....................

E0963 A Wheelchair 2 inch cushion ............................................................... .................... .................... .................... .................... ....................

E0964 A Wheelchair 3 inch cushion ............................................................... .................... .................... .................... .................... ....................

E0965 A Wheelchair 4 inch cushion ............................................................... .................... .................... .................... .................... ....................

E0966 E Wheelchair head rest extensi .......................................................... .................... .................... .................... .................... ....................

E0967 E Wheelchair hand rims ...................................................................... .................... .................... .................... .................... ....................

E0968 E Wheelchair commode seat .............................................................. .................... .................... .................... .................... ....................

E0969 E Wheelchair narrowing device ........................................................... .................... .................... .................... .................... ....................

E0970 E Wheelchair no. 2 footplates ............................................................. .................... .................... .................... .................... ....................

E0971 E Wheelchair anti-tipping devi ............................................................. .................... .................... .................... .................... ....................

E0972 A Transfer board or device .................................................................. .................... .................... .................... .................... ....................

E0973 E Wheelchair adjustabl height ............................................................. .................... .................... .................... .................... ....................

E0974 E Wheelchair grade-aid ....................................................................... .................... .................... .................... .................... ....................

E0975 E Wheelchair reinforced seat u ........................................................... .................... .................... .................... .................... ....................

E0976 E Wheelchair reinforced back u .......................................................... .................... .................... .................... .................... ....................

E0977 E Wheelchair wedge cushion .............................................................. .................... .................... .................... .................... ....................

E0978 E Wheelchair belt w/airplane b ............................................................ .................... .................... .................... .................... ....................

E0979 E Wheelchair belt with velcro .............................................................. .................... .................... .................... .................... ....................

E0980 E Wheelchair safety vest ..................................................................... .................... .................... .................... .................... ....................

E0990 E Whellchair elevating leg res ............................................................. .................... .................... .................... .................... ....................

E0991 E Wheelchair upholstry seat ................................................................ .................... .................... .................... .................... ....................

E0992 E Wheelchair solid seat insert ............................................................. .................... .................... .................... .................... ....................

E0993 E Wheelchair back upholstery ............................................................. .................... .................... .................... .................... ....................

E0994 E Wheelchair arm rest ......................................................................... .................... .................... .................... .................... ....................

E0995 E Wheelchair calf rest ......................................................................... .................... .................... .................... .................... ....................

E0996 E Wheelchair tire solid ......................................................................... .................... .................... .................... .................... ....................

E0997 E Wheelchair caster w/ a fork ............................................................. .................... .................... .................... .................... ....................

E0998 E Wheelchair caster w/o a fork ........................................................... .................... .................... .................... .................... ....................

E0999 E Wheelchr pneumatic tire w/wh ......................................................... .................... .................... .................... .................... ....................

E1000 E Wheelchair tire pneumatic ca .......................................................... .................... .................... .................... .................... ....................

E1001 E Wheelchair wheel ............................................................................. .................... .................... .................... .................... ....................

E1031 A Rollabout chair with casters ............................................................. .................... .................... .................... .................... ....................

E1035 A Patient transfer system .................................................................... .................... .................... .................... .................... ....................

E1050 E Whelchr fxd full length arms ............................................................ .................... .................... .................... .................... ....................

E1060 E Wheelchair detachable arms ........................................................... .................... .................... .................... .................... ....................

E1065 E Wheelchair power attachment ......................................................... .................... .................... .................... .................... ....................

E1066 E Wheelchair battery charger .............................................................. .................... .................... .................... .................... ....................

E1069 E Wheelchair deep cycle batter .......................................................... .................... .................... .................... .................... ....................

E1070 E Wheelchair detachable foot r ........................................................... .................... .................... .................... .................... ....................

E1083 E Hemi-wheelchair fixed arms ............................................................. .................... .................... .................... .................... ....................

E1084 E Hemi-wheelchair detachable a ......................................................... .................... .................... .................... .................... ....................

E1085 E Hemi-wheelchair fixed arms ............................................................. .................... .................... .................... .................... ....................

E1086 E Hemi-wheelchair detachable a ......................................................... .................... .................... .................... .................... ....................

E1087 E Wheelchair lightwt fixed arm ............................................................ .................... .................... .................... .................... ....................

E1088 E Wheelchair lightweight det a ............................................................ .................... .................... .................... .................... ....................

E1089 E Wheelchair lightwt fixed arm ............................................................ .................... .................... .................... .................... ....................

E1090 E Wheelchair lightweight det a ............................................................ .................... .................... .................... .................... ....................

E1091 E Wheelchair youth ............................................................................. .................... .................... .................... .................... ....................

E1092 E Wheelchair wide w/ leg rests ........................................................... .................... .................... .................... .................... ....................

E1093 E Wheelchair wide w/ foot rest ............................................................ .................... .................... .................... .................... ....................

E1100 E Whchr s-recl fxd arm leg res ........................................................... .................... .................... .................... .................... ....................

67973

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

E1110 E Wheelchair semi-recl detach ............................................................ .................... .................... .................... .................... ....................

E1130 E Whlchr stand fxd arm ft rest ............................................................ .................... .................... .................... .................... ....................

E1140 E Wheelchair standard detach a ......................................................... .................... .................... .................... .................... ....................

E1150 E Wheelchair standard w/ leg r ........................................................... .................... .................... .................... .................... ....................

E1160 E Wheelchair fixed arms ..................................................................... .................... .................... .................... .................... ....................

E1170 E Whlchr ampu fxd arm leg rest ......................................................... .................... .................... .................... .................... ....................

E1171 E Wheelchair amputee w/o leg r ......................................................... .................... .................... .................... .................... ....................

E1172 E Wheelchair amputee detach ar ........................................................ .................... .................... .................... .................... ....................

E1180 E Wheelchair amputee w/ foot r .......................................................... .................... .................... .................... .................... ....................

E1190 E Wheelchair amputee w/ leg re ......................................................... .................... .................... .................... .................... ....................

E1195 E Wheelchair amputee heavy dut ....................................................... .................... .................... .................... .................... ....................

E1200 E Wheelchair amputee fixed arm ........................................................ .................... .................... .................... .................... ....................

E1210 E Whlchr moto ful arm leg rest ........................................................... .................... .................... .................... .................... ....................

E1211 E Wheelchair motorized w/ det ........................................................... .................... .................... .................... .................... ....................

E1212 E Wheelchair motorized w full ............................................................. .................... .................... .................... .................... ....................

E1213 E Wheelchair motorized w/ det ........................................................... .................... .................... .................... .................... ....................

E1220 E Whlchr special size/constrc .............................................................. .................... .................... .................... .................... ....................

E1221 E Wheelchair spec size w foot ............................................................ .................... .................... .................... .................... ....................

E1222 E Wheelchair spec size w/ leg ............................................................ .................... .................... .................... .................... ....................

E1223 E Wheelchair spec size w foot ............................................................ .................... .................... .................... .................... ....................

E1224 E Wheelchair spec size w/ leg ............................................................ .................... .................... .................... .................... ....................

E1225 E Wheelchair spec sz semi-recl .......................................................... .................... .................... .................... .................... ....................

E1226 E Wheelchair spec sz full-recl ............................................................. .................... .................... .................... .................... ....................

E1227 E Wheelchair spec sz spec ht a .......................................................... .................... .................... .................... .................... ....................

E1228 E Wheelchair spec sz spec ht b .......................................................... .................... .................... .................... .................... ....................

E1230 A Power operated vehicle ................................................................... .................... .................... .................... .................... ....................

E1240 E Whchr litwt det arm leg rest ............................................................. .................... .................... .................... .................... ....................

E1250 E Wheelchair lightwt fixed arm ............................................................ .................... .................... .................... .................... ....................

E1260 E Wheelchair lightwt foot rest .............................................................. .................... .................... .................... .................... ....................

E1270 E Wheelchair lightweight leg r ............................................................. .................... .................... .................... .................... ....................

E1280 E Whchr h-duty det arm leg res .......................................................... .................... .................... .................... .................... ....................

E1285 E Wheelchair heavy duty fixed ............................................................ .................... .................... .................... .................... ....................

E1290 E Wheelchair hvy duty detach a ......................................................... .................... .................... .................... .................... ....................

E1295 E Wheelchair heavy duty fixed ............................................................ .................... .................... .................... .................... ....................

E1296 E Wheelchair special seat heig ........................................................... .................... .................... .................... .................... ....................

E1297 E Wheelchair special seat dept ........................................................... .................... .................... .................... .................... ....................

E1298 E Wheelchair spec seat depth/w ......................................................... .................... .................... .................... .................... ....................

E1300 E Whirlpool portable ............................................................................ .................... .................... .................... .................... ....................

E1310 A Whirlpool non-portable ..................................................................... .................... .................... .................... .................... ....................

E1340 A Repair for DME, per 15 min ............................................................. .................... .................... .................... .................... ....................

E1353 A Oxygen supplies regulator ............................................................... .................... .................... .................... .................... ....................

E1355 A Oxygen supplies stand/rack ............................................................. .................... .................... .................... .................... ....................

E1372 A Oxy suppl heater for nebuliz ............................................................ .................... .................... .................... .................... ....................

E1375D A Oxygen suppl nebulizer porta .......................................................... .................... .................... .................... .................... ....................

E1377D E Oxygen concentrator to 244 c ......................................................... .................... .................... .................... .................... ....................

E1378D E Oxygen concentrator to 488 c ......................................................... .................... .................... .................... .................... ....................

E1379D E Oxygen concentrator to 732 c ......................................................... .................... .................... .................... .................... ....................

E1380D E Oxygen concentrator to 976 c ......................................................... .................... .................... .................... .................... ....................

E1381D E Oxygen concentrat to 1220 cu ......................................................... .................... .................... .................... .................... ....................

E1382D E Oxygen concentrat to 1464 cu ......................................................... .................... .................... .................... .................... ....................

E1383D E Oxygen concentrat to 1708 cu ......................................................... .................... .................... .................... .................... ....................

E1384D E Oxygen concentrat to 1952 cu ......................................................... .................... .................... .................... .................... ....................

E1385D E Oxygen concentrator > 1952 c ........................................................ .................... .................... .................... .................... ....................

E1390 A Oxygen concentrator ........................................................................ .................... .................... .................... .................... ....................

E1399 A Durable medical equipment mi ........................................................ .................... .................... .................... .................... ....................

E1405 A O2/water vapor enrich w/heat .......................................................... .................... .................... .................... .................... ....................

E1406 A O2/water vapor enrich w/o he .......................................................... .................... .................... .................... .................... ....................

E1510 A Kidney dialysate delivry sys ............................................................. .................... .................... .................... .................... ....................

E1520 A Heparin infusion pump for di ............................................................ .................... .................... .................... .................... ....................

E1530 A Air bubble detector for dial ............................................................... .................... .................... .................... .................... ....................

E1540 A Pressure alarm for dialysis .............................................................. .................... .................... .................... .................... ....................

E1550 A Bath conductivity meter .................................................................... .................... .................... .................... .................... ....................

E1560 A Blood leak detector for dial .............................................................. .................... .................... .................... .................... ....................

E1570 A Adjustable chair for esrd pt .............................................................. .................... .................... .................... .................... ....................

E1575 A Transducer protector/fluid b ............................................................. .................... .................... .................... .................... ....................

E1580 A Unipuncture control system ............................................................. .................... .................... .................... .................... ....................

E1590 A Hemodialysis machine ..................................................................... .................... .................... .................... .................... ....................

E1592 A Auto interm peritoneal dialy ............................................................. .................... .................... .................... .................... ....................

E1594 A Cycler dialysis machine ................................................................... .................... .................... .................... .................... ....................

E1600 A Deliv/install equip for dial ................................................................. .................... .................... .................... .................... ....................

E1610 A Reverse osmosis water purifi ........................................................... .................... .................... .................... .................... ....................

E1615 A Deionizer water purification .............................................................. .................... .................... .................... .................... ....................

E1620 A Blood pump for dialysis .................................................................... .................... .................... .................... .................... ....................

E1625 A Water softening system ................................................................... .................... .................... .................... .................... ....................

67974

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

E1630 A Reciprocating peritoneal dia ............................................................ .................... .................... .................... .................... ....................

E1632 A Wearable artificial kidney ................................................................. .................... .................... .................... .................... ....................

E1635 A Compact travel hemodialyzer .......................................................... .................... .................... .................... .................... ....................

E1636 A Sorbent cartridges for dialy .............................................................. .................... .................... .................... .................... ....................

E1640 A Replacement components for d ....................................................... .................... .................... .................... .................... ....................

E1699 A Dialysis equipment unspecifi ............................................................ .................... .................... .................... .................... ....................

E1700 A Jaw motion rehab system ................................................................ .................... .................... .................... .................... ....................

E1701 A Repl cushions for jaw motion ........................................................... .................... .................... .................... .................... ....................

E1702 A Repl measr scales jaw motion ......................................................... .................... .................... .................... .................... ....................

E1800 A Adjust elbow ext/flex device ............................................................. .................... .................... .................... .................... ....................

E1805 A Adjust wrist ext/flex device ............................................................... .................... .................... .................... .................... ....................

E1810 A Adjust knee ext/flex device .............................................................. .................... .................... .................... .................... ....................

E1815 A Adjust ankle ext/flex device ............................................................. .................... .................... .................... .................... ....................

E1820 A Soft interface material ...................................................................... .................... .................... .................... .................... ....................

E1825 A Adjust finger ext/flex devc ................................................................ .................... .................... .................... .................... ....................

E1830 A Adjust toe ext/flex device ................................................................. .................... .................... .................... .................... ....................

E1900 A Speech communication device ........................................................ .................... .................... .................... .................... ....................

G0001 A Drawing blood for specimen ............................................................ .................... .................... .................... .................... ....................

G0002 N Temporary urinary catheter .............................................................. .................... .................... .................... .................... ....................

G0004 E ECG transm phys review & int ........................................................ .................... .................... .................... .................... ....................

G0005 X ECG 24 hour recording .................................................................... 0097 1.62 $80.35 $62.40 $16.07

G0006 X ECG transmission & analysis .......................................................... 0097 1.62 $80.35 $62.40 $16.07

G0007 N ECG phy review & interpret ............................................................. .................... .................... .................... .................... ....................

G0008 K Admin influenza virus vac ................................................................ 0354 0.13 $6.33 .................... ....................

G0009 K Admin pneumococcal vaccine ......................................................... 0354 0.13 $6.33 .................... ....................

G0010 N Admin hepatitis b vaccine ................................................................ .................... .................... .................... .................... ....................

G0015 X Post symptom ECG tracing ............................................................. 0097 1.62 $80.35 $62.40 $16.07

G0016 E Post symptom ECG md review ........................................................ .................... .................... .................... .................... ....................

G0025 X Collagen skin test kit ........................................................................ 0343 0.45 $22.32 $12.16 $4.46

G0026 A Fecal leukocyte examination ............................................................ .................... .................... .................... .................... ....................

G0027 A Semen analysis ................................................................................ .................... .................... .................... .................... ....................

G0030 S PET imaging prev PET single .......................................................... 0285 15.06 $746.92 $415.21 $149.38

G0031 S PET imaging prev PET multple ....................................................... 0285 15.06 $746.92 $415.21 $149.38

G0032 S PET follow SPECT 78464 singl ....................................................... 0285 15.06 $746.92 $415.21 $149.38

G0033 S PET follow SPECT 78464 mult ........................................................ 0285 15.06 $746.92 $415.21 $149.38

G0034 S PET follow SPECT 76865 singl ....................................................... 0285 15.06 $746.92 $415.21 $149.38

G0035 S PET follow SPECT 78465 mult ........................................................ 0285 15.06 $746.92 $415.21 $149.38

G0036 S PET follow cornry angio sing ........................................................... 0285 15.06 $746.92 $415.21 $149.38

G0037 S PET follow cornry angio mult ........................................................... 0285 15.06 $746.92 $415.21 $149.38

G0038 S PET follow myocard perf sing .......................................................... 0285 15.06 $746.92 $415.21 $149.38

G0039 S PET follow myocard perf mult .......................................................... 0285 15.06 $746.92 $415.21 $149.38

G0040 S PET follow stress echo singl ............................................................ 0285 15.06 $746.92 $415.21 $149.38

G0041 S PET follow stress echo mult ............................................................ 0285 15.06 $746.92 $415.21 $149.38

G0042 S PET follow ventriculogm sing ........................................................... 0285 15.06 $746.92 $415.21 $149.38

G0043 S PET follow ventriculogm mult .......................................................... 0285 15.06 $746.92 $415.21 $149.38

G0044 S PET following rest ECG singl .......................................................... 0285 15.06 $746.92 $415.21 $149.38

G0045 S PET following rest ECG mult ........................................................... 0285 15.06 $746.92 $415.21 $149.38

G0046 S PET follow stress ECG singl ............................................................ 0285 15.06 $746.92 $415.21 $149.38

G0047 S PET follow stress ECG mult ............................................................ 0285 15.06 $746.92 $415.21 $149.38

G0050 S Residual urine by ultrasound ........................................................... 0265 1.17 $58.03 $38.08 $11.61

G0101 V CA screen;pelvic/breast exam ......................................................... 0601 1.00 $49.60 $9.92 $9.92

G0102 N Prostate ca screening; dre ............................................................... .................... .................... .................... .................... ....................

G0103 A Psa, total screening ......................................................................... .................... .................... .................... .................... ....................

G0104 S CA screen;flexi sigmoidscope .......................................................... 0159 2.83 $140.36 .................... $35.09

G0105 S Colorectal scrn; hi risk ind ............................................................... 0158 7.98 $395.78 .................... $98.94

G0106 S Colon CA screen;barium enema ...................................................... 0157 1.79 $88.78 .................... $22.19

G0107 A CA screen; fecal blood test .............................................................. .................... .................... .................... .................... ....................

G0108 A Diab manage trn per indiv ............................................................... .................... .................... .................... .................... ....................

G0109 A Diab manage trn ind/group .............................................................. .................... .................... .................... .................... ....................

G0110 A Nett pulm-rehab educ; ind ............................................................... .................... .................... .................... .................... ....................

G0111 A Nett pulm-rehab educ; group ........................................................... .................... .................... .................... .................... ....................

G0112 A Nett;nutrition guid, initial ................................................................... .................... .................... .................... .................... ....................

G0113 A Nett;nutrition guid,subseqnt ............................................................. .................... .................... .................... .................... ....................

G0114 A Nett; psychosocial consult ............................................................... .................... .................... .................... .................... ....................

G0115 A Nett; psychological testing ............................................................... .................... .................... .................... .................... ....................

G0116 A Nett; psychosocial counsel .............................................................. .................... .................... .................... .................... ....................

G0120 S Colon ca scrn; barium enema .......................................................... 0157 1.79 $88.78 .................... $22.19

G0121 E Colon ca scrn not hi rsk ind ............................................................. .................... .................... .................... .................... ....................

G0122 S Colon ca scrn; barium enema .......................................................... 0157 1.79 $88.78 .................... $22.19

G0123 A Screen cerv/vag thin layer ............................................................... .................... .................... .................... .................... ....................

G0124 A Screen c/v thin layer by MD ............................................................ .................... .................... .................... .................... ....................

G0125 S Lung image (PET) ............................................................................ 0981 46.40 $2,301.26 .................... $460.25

G0126 S Lung image (PET) staging ............................................................... 0981 46.40 $2,301.26 .................... $460.25

G0127 T Trim nail(s) ....................................................................................... 0009 0.74 $36.70 $9.63 $7.34

67975

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

G0128 E CORF skilled nursing service .......................................................... .................... .................... .................... .................... ....................

G0129 P Partial hosp prog service ................................................................. 0033 4.17 $206.82 $48.17 $41.36

G0130 X Single energy x-ray study ................................................................ 0261 1.38 $68.44 $38.77 $13.69

G0131 S CT scan, bone density study ........................................................... 0282 2.38 $118.04 $94.51 $23.61

G0132 S CT scan, bone density study ........................................................... 0282 2.38 $118.04 $94.51 $23.61

G0141 E Scr c/v cyto,autosys and md ............................................................ .................... .................... .................... .................... ....................

G0143 A Scr c/v cyto,thinlayer,rescr ............................................................... .................... .................... .................... .................... ....................

G0144 A Scr c/v cyto,thinlayer,rescr ............................................................... .................... .................... .................... .................... ....................

G0145 A Scr c/v cyto,thinlayer,rescr ............................................................... .................... .................... .................... .................... ....................

G0147 A Scr c/v cyto, automated sys ............................................................. .................... .................... .................... .................... ....................

G0148 A Scr c/v cyto, autosys, rescr .............................................................. .................... .................... .................... .................... ....................

G0151 E HHCP-serv of pt,ea 15 min .............................................................. .................... .................... .................... .................... ....................

G0152 E HHCP-serv of ot,ea 15 min .............................................................. .................... .................... .................... .................... ....................

G0153 E HHCP-svs of s/l path,ea 15mn ........................................................ .................... .................... .................... .................... ....................

G0154 E HHCP-svs of rn,ea 15 min ............................................................... .................... .................... .................... .................... ....................

G0155 E HHCP-svs of csw,ea 15 min ............................................................ .................... .................... .................... .................... ....................

G0156 E HHCP-svs of aide,ea 15 min ........................................................... .................... .................... .................... .................... ....................

G0159D T Perc declot dialysis graft .................................................................. 0103 13.09 $649.21 $295.70 $129.84

*G0160D S Cryo. ablation, prostate .................................................................... 0981 46.40 $2,301.26 .................... $460.25

G0161D X Echo guide for cryo probes .............................................................. 0268 2.23 $110.60 $69.51 $22.12

G0163 S Pet for rec of colorectal ca ............................................................... 0981 46.40 $2,301.26 .................... $460.25

G0164 S Pet for lymphoma staging ................................................................ 0981 46.40 $2,301.26 .................... $460.25

G0165 S Pet,rec of melanoma/met ca ............................................................ 0981 46.40 $2,301.26 .................... $460.25

G0166 T Extrnl counterpulse, per tx ............................................................... 0972 3.09 $153.26 .................... $30.65

G0167 E Hyperbaric oz tx;no md reqrd .......................................................... .................... .................... .................... .................... ....................

G0168 T Wound closure by adhesive ............................................................. 0970 0.52 $25.79 .................... $5.16

G0169D T Removal tissue; no anesthsia .......................................................... 0013 0.91 $45.13 $17.66 $9.03

G0170D T Skin biograft ..................................................................................... 0025 3.74 $185.49 $70.66 $37.10

G0171D T Skin biograft add-on ......................................................................... 0025 3.74 $185.49 $70.66 $37.10

G0172D P Partial hosp prog service ................................................................. 0033 4.17 $206.82 $48.17 $41.36

G0173 S Stereotactic radiosurgery ................................................................. 0302 8.21 $407.18 $216.55 $81.44

G0174 S IMRT , per session ........................................................................... 0302 8.21 $407.18 $216.55 $81.44

G0175 V Interdisciplinary team conf ............................................................... 0602 1.66 $82.33 $16.47 $16.47

*G0176 P OPPS/PHP;activity therapy .............................................................. 0033 4.17 $206.82 $48.17 $41.36

*G0177 P OPPS/PHP; train & educ serv ......................................................... 0033 4.17 $206.82 $48.17 $41.36

*G0178 S Intensity modulated radiation ........................................................... 0302 8.21 $407.18 $216.55 $81.44

*G0179 E Phys recertification, HHA pt ............................................................. .................... .................... .................... .................... ....................

*G0180 E Phys certification, HHA pt ................................................................ .................... .................... .................... .................... ....................

*G0181 E Home health care supervision ......................................................... .................... .................... .................... .................... ....................

*G0182 E Hospice care supervision ................................................................. .................... .................... .................... .................... ....................

*G0183 T Ocular photodynamic therapy .......................................................... 0235 2.94 $145.81 $78.91 $29.16

*G0184 T Ocular photocoagulation .................................................................. 0235 33.96 $1,684.28 $852.68 $336.86

*G0185 T Transpuppillary thermotx .................................................................. 0235 6.70 $332.29 $147.96 $66.46

*G0186 T Dstry eye lesn,fdr vssl tech .............................................................. 0235 6.70 $332.29 $147.96 $66.46

*G0187 T Dstry mclr drusen,photocoag ........................................................... 0235 33.96 $1,684.28 $852.68 $336.86

*G0188 X Xray lwr extrmty-full lngth ................................................................ .................... 1.38 $68.44 $38.77 $13.69

*G0190 N Immunization administration ............................................................ .................... .................... .................... .................... ....................

*G0191 N Immunization admin,each add ......................................................... .................... .................... .................... .................... ....................

*G0192 N Immunization oral/intranasal ............................................................ .................... .................... .................... .................... ....................

*G0195 A Clinical eval, swallowing .................................................................. .................... .................... .................... .................... ....................

*G0196 A Radioisotope eval, swallowing ......................................................... .................... .................... .................... .................... ....................

*G0197 A Eval, speech generating device ....................................................... .................... .................... .................... .................... ....................

*G0198 A Trng, speech generating device ...................................................... .................... .................... .................... .................... ....................

*G0199 A Re-evaluation, speech device .......................................................... .................... .................... .................... .................... ....................

*G0200 A Eval, voice prosthetic ....................................................................... .................... .................... .................... .................... ....................

*G0201 A Trng, voice prosthetic ....................................................................... .................... .................... .................... .................... ....................

*G9001 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9002 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9003 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9004 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9005 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9006 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9007 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9008 E Coordinated care fee ....................................................................... .................... .................... .................... .................... ....................

*G9016 A Demo-smoking cessation coun ........................................................ .................... .................... .................... .................... ....................

J0120 N Tetracyclin injection .......................................................................... .................... .................... .................... .................... ....................

*J0130 G Abciximab injection .......................................................................... 1605 .................... $513.02 .................... $68.74

J0150 K Injection adenosine 6 MG ................................................................ 0917 0.36 $17.86 .................... $3.57

J0151 E Adenosine injection .......................................................................... .................... .................... .................... .................... ....................

J0170 N Adrenalin epinephrin inject ............................................................... .................... .................... .................... .................... ....................

J0190 N Inj biperiden lactate/5 mg ................................................................. .................... .................... .................... .................... ....................

J0200 N Alatrofloxacin mesylate .................................................................... .................... .................... .................... .................... ....................

J0205 G Alglucerase injection ........................................................................ 0900 .................... $37.53 .................... $5.03

J0207 G Amifostine ......................................................................................... 7000 .................... $350.31 .................... $46.94

67976

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J0210 N Methyldopate hcl injection ................................................................ .................... .................... .................... .................... ....................

J0256 G Alpha 1 proteinase inhibitor ............................................................. 0901 .................... $2.09 .................... $.28

J0270 E Alprostadil for injection ..................................................................... .................... .................... .................... .................... ....................

J0275 E Alprostadil urethral suppos .............................................................. .................... .................... .................... .................... ....................

J0280 N Aminophyllin 250 MG inj .................................................................. .................... .................... .................... .................... ....................

J0282 N Amiodarone HCl ............................................................................... .................... .................... .................... .................... ....................

J0285 N Amphotericin B ................................................................................. .................... .................... .................... .................... ....................

J0286 G Amphotericin B lipid complex ........................................................... 7001 .................... $95.00 .................... $12.73

J0290 N Ampicillin 500 MG inj ....................................................................... .................... .................... .................... .................... ....................

J0295 N Ampicillin sodium per 1.5 gm ........................................................... .................... .................... .................... .................... ....................

J0300 N Amobarbital 125 MG inj ................................................................... .................... .................... .................... .................... ....................

J0330 N Succinycholine chloride inj ............................................................... .................... .................... .................... .................... ....................

J0340 N Nandrolon phenpropionate inj .......................................................... .................... .................... .................... .................... ....................

*J0350 G Injection anistreplase 30 u ............................................................... 1606 .................... $2,693.80 .................... $360.97

J0360 N Hydralazine hcl injection .................................................................. .................... .................... .................... .................... ....................

J0380 N Inj metaraminol bitartrate ................................................................. .................... .................... .................... .................... ....................

J0390 N Chloroquine injection ........................................................................ .................... .................... .................... .................... ....................

J0395 N Arbutamine HCl injection ................................................................. .................... .................... .................... .................... ....................

J0400 N Inj trimethaphan camsylate .............................................................. .................... .................... .................... .................... ....................

J0456 N Azithromycin ..................................................................................... .................... .................... .................... .................... ....................

J0460 N Atropine sulfate injection .................................................................. .................... .................... .................... .................... ....................

J0470 N Dimecaprol injection ......................................................................... .................... .................... .................... .................... ....................

J0475 N Baclofen 10 MG injection ................................................................. .................... .................... .................... .................... ....................

J0476 E Baclofen 50 mcg intrathecal trial ..................................................... .................... .................... .................... .................... ....................

J0500 N Dicyclomine injection ........................................................................ .................... .................... .................... .................... ....................

J0510 N Benzquinamide injection .................................................................. .................... .................... .................... .................... ....................

J0515 N Inj benztropine mesylate .................................................................. .................... .................... .................... .................... ....................

J0520 N Bethanechol chloride inject .............................................................. .................... .................... .................... .................... ....................

J0530 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0540 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0550 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0560 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0570 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0580 N Penicillin g benzathine inj ................................................................ .................... .................... .................... .................... ....................

J0585 G Botulinum toxin a per unit ................................................................ 0902 .................... $4.39 .................... $.59

J0590 N Ethylnorepinephrine hcl inj ............................................................... .................... .................... .................... .................... ....................

J0600 N Edetate calcium disodium inj ........................................................... .................... .................... .................... .................... ....................

J0610 N Calcium gluconate injection ............................................................. .................... .................... .................... .................... ....................

J0620 N Calcium glycer & lact/10 ML ............................................................ .................... .................... .................... .................... ....................

J0630 N Calcitonin salmon injection .............................................................. .................... .................... .................... .................... ....................

J0635 N Calcitriol injection ............................................................................. .................... .................... .................... .................... ....................

J0640 G Leucovorin calcium injection ............................................................ 0725 .................... $49.73 .................... $6.66

J0670 N Inj mepivacaine HCL/10 ml .............................................................. .................... .................... .................... .................... ....................

J0690 N Cefazolin sodium injection ............................................................... .................... .................... .................... .................... ....................

J0694 N Cefoxitin sodium injection ................................................................ .................... .................... .................... .................... ....................

J0695 N Cefonocid sodium injection .............................................................. .................... .................... .................... .................... ....................

J0696 N Ceftriaxone sodium injection ............................................................ .................... .................... .................... .................... ....................

J0697 N Sterile cefuroxime injection .............................................................. .................... .................... .................... .................... ....................

J0698 N Cefotaxime sodium injection ............................................................ .................... .................... .................... .................... ....................

J0702 N Betamethasone acet&sod phosp ..................................................... .................... .................... .................... .................... ....................

J0704 N Betamethasone sod phosp/4 MG .................................................... .................... .................... .................... .................... ....................

J0710 N Cephapirin sodium injection ............................................................. .................... .................... .................... .................... ....................

J0713 N Inj ceftazidime per 500 mg .............................................................. .................... .................... .................... .................... ....................

J0715 N Ceftizoxime sodium / 500 MG ......................................................... .................... .................... .................... .................... ....................

J0720 N Chloramphenicol sodium injec ......................................................... .................... .................... .................... .................... ....................

J0725 N Chorionic gonadotropin/1000u ......................................................... .................... .................... .................... .................... ....................

J0730 N Chlorpheniramin maleate inj ............................................................ .................... .................... .................... .................... ....................

J0735 N Clonidine hydrochloride .................................................................... .................... .................... .................... .................... ....................

J0740 N Cidofovir injection ............................................................................. .................... .................... .................... .................... ....................

J0743 N Cilastatin sodium injection ............................................................... .................... .................... .................... .................... ....................

J0745 N Inj codeine phosphate /30 MG ......................................................... .................... .................... .................... .................... ....................

J0760 N Colchicine injection .......................................................................... .................... .................... .................... .................... ....................

J0770 N Colistimethate sodium inj ................................................................. .................... .................... .................... .................... ....................

J0780 N Prochlorperazine injection ................................................................ .................... .................... .................... .................... ....................

J0800 N Corticotropin injection ....................................................................... .................... .................... .................... .................... ....................

J0810 N Cortisone injection ............................................................................ .................... .................... .................... .................... ....................

J0835 N Inj cosyntropin per 0.25 MG ............................................................ .................... .................... .................... .................... ....................

J0850 G Cytomegalovirus imm IV /vial .......................................................... 0903 .................... $370.50 .................... $49.65

J0895 N Deferoxamine mesylate inj ............................................................... .................... .................... .................... .................... ....................

J0900 N Testosterone enanthate inj .............................................................. .................... .................... .................... .................... ....................

J0945 N Brompheniramine maleate inj .......................................................... .................... .................... .................... .................... ....................

J0970 N Estradiol valerate injection ............................................................... .................... .................... .................... .................... ....................

J1000 N Depo-estradiol cypionate inj ............................................................. .................... .................... .................... .................... ....................

J1020 N Methylprednisolone 20 MG inj ......................................................... .................... .................... .................... .................... ....................

67977

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J1030 N Methylprednisolone 40 MG inj ......................................................... .................... .................... .................... .................... ....................

J1040 N Methylprednisolone 80 MG inj ......................................................... .................... .................... .................... .................... ....................

J1050 N Medroxyprogesterone inj .................................................................. .................... .................... .................... .................... ....................

J1055 E Medrxyprogester acetate inj ............................................................. .................... .................... .................... .................... ....................

J1060 N Testosterone cypionate 1 ML .......................................................... .................... .................... .................... .................... ....................

J1070 N Testosterone cypionat 100 MG ........................................................ .................... .................... .................... .................... ....................

J1080 N Testosterone cypionat 200 MG ........................................................ .................... .................... .................... .................... ....................

J1090 N Testosterone cypionate 50 MG ........................................................ .................... .................... .................... .................... ....................

J1095 N Inj dexamethasone acetate .............................................................. .................... .................... .................... .................... ....................

J1100 N Dexamethasone sodium phos ......................................................... .................... .................... .................... .................... ....................

J1110 N Inj dihydroergotamine mesylt ........................................................... .................... .................... .................... .................... ....................

J1120 N Acetazolamid sodium injectio ........................................................... .................... .................... .................... .................... ....................

J1160 N Digoxin injection ............................................................................... .................... .................... .................... .................... ....................

J1165 N Phenytoin sodium injection .............................................................. .................... .................... .................... .................... ....................

J1170 N Hydromorphone injection ................................................................. .................... .................... .................... .................... ....................

J1180 N Dyphylline injection .......................................................................... .................... .................... .................... .................... ....................

J1190 G Dexrazoxane HCl injection ............................................................... 0726 .................... $161.11 .................... $21.59

J1200 N Diphenhydramine hcl injectio ........................................................... .................... .................... .................... .................... ....................

J1205 N Chlorothiazide sodium inj ................................................................. .................... .................... .................... .................... ....................

J1212 N Dimethyl sulfoxide 50% 50 ML ........................................................ .................... .................... .................... .................... ....................

J1230 N Methadone injection ......................................................................... .................... .................... .................... .................... ....................

J1240 N Dimenhydrinate injection .................................................................. .................... .................... .................... .................... ....................

J1245 K Dipyridamole injection ...................................................................... 0917 0.36 $17.86 .................... $3.57

J1250 N Inj dobutamine HCL/250 mg ............................................................ .................... .................... .................... .................... ....................

J1260 G Dolasetron mesylate ........................................................................ 0750 .................... $14.81 .................... $1.98

J1320 N Amitriptyline injection ....................................................................... .................... .................... .................... .................... ....................

J1325 G Epoprostenol injection ...................................................................... 7003 .................... $16.53 .................... $2.22

*J1327 G Eptifibatide injection ......................................................................... 1607 .................... $12.57 .................... $1.68

J1330 N Ergonovine maleate injection ........................................................... .................... .................... .................... .................... ....................

J1362 N Erythromycin glucep / 250 MG ........................................................ .................... .................... .................... .................... ....................

J1364 N Erythro lactobionate /500 MG .......................................................... .................... .................... .................... .................... ....................

J1380 N Estradiol valerate 10 MG inj ............................................................ .................... .................... .................... .................... ....................

J1390 N Estradiol valerate 20 MG inj ............................................................ .................... .................... .................... .................... ....................

J1410 N Inj estrogen conjugate 25 MG ......................................................... .................... .................... .................... .................... ....................

J1435 N Injection estrone per 1 MG .............................................................. .................... .................... .................... .................... ....................

J1436 G Etidronate disodium inj ..................................................................... 0727 .................... $63.65 .................... $8.53

*J1438 G Etanercept injection .......................................................................... 1608 .................... $134.42 .................... $18.01

J1440 G Filgrastim 300 mcg injection ............................................................ 0728 .................... $171.38 .................... $22.96

J1441 G Filgrastim 480 mcg injection ............................................................ 7049 .................... $273.03 .................... $35.06

J1450 N Fluconazole ...................................................................................... .................... .................... .................... .................... ....................

J1452 N Intraocular Fomivirsen na 1.65 MG ................................................. .................... .................... .................... .................... ....................

J1455 N Foscarnet sodium injection .............................................................. .................... .................... .................... .................... ....................

J1460 N Gamma globulin 1 CC inj ................................................................. .................... .................... .................... .................... ....................

J1470 E Gamma globulin 2 CC inj ................................................................. .................... .................... .................... .................... ....................

J1480 E Gamma globulin 3 CC inj ................................................................. .................... .................... .................... .................... ....................

J1490 E Gamma globulin 4 CC inj ................................................................. .................... .................... .................... .................... ....................

J1500 E Gamma globulin 5 CC inj ................................................................. .................... .................... .................... .................... ....................

J1510 E Gamma globulin 6 CC inj ................................................................. .................... .................... .................... .................... ....................

J1520 E Gamma globulin 7 CC inj ................................................................. .................... .................... .................... .................... ....................

J1530 E Gamma globulin 8 CC inj ................................................................. .................... .................... .................... .................... ....................

J1540 E Gamma globulin 9 CC inj ................................................................. .................... .................... .................... .................... ....................

J1550 E Gamma globulin 10 CC inj ............................................................... .................... .................... .................... .................... ....................

J1560 E Gamma globulin > 10 CC inj ........................................................... .................... .................... .................... .................... ....................

J1561 G Immune globulin 500 mg ................................................................. 0905 .................... $27.28 .................... $3.33

J1562D G Immune globulin 5 gms .................................................................... 7004 .................... $272.80 .................... $33.28

J1563D N IV immune globulin 1 GM ................................................................ .................... .................... .................... .................... ....................

J1565 G RSV-ivig ........................................................................................... 0906 .................... $427.73 .................... $57.32

J1570 K Ganciclovir sodium injection ............................................................ 0907 0.45 $22.26 .................... $4.45

J1580 N Garamycin gentamicin inj ................................................................. .................... .................... .................... .................... ....................

J1600 N Gold sodium thiomaleate inj ............................................................ .................... .................... .................... .................... ....................

J1610 N Glucagon hydrochloride/1 MG ......................................................... .................... .................... .................... .................... ....................

J1620 G Gonadorelin hydroch/ 100 mcg ........................................................ 7005 .................... $14.80 .................... $1.98

J1626 G Granisetron HCl injection ................................................................. 0764 .................... $1.85 .................... $.25

J1630 N Haloperidol injection ......................................................................... .................... .................... .................... .................... ....................

J1631 N Haloperidol decanoate inj ................................................................ .................... .................... .................... .................... ....................

J1642 N Inj heparin sodium per 10 u ............................................................. .................... .................... .................... .................... ....................

J1644 N Inj heparin sodium per 1000u .......................................................... .................... .................... .................... .................... ....................

J1645 N Dalteparin sodium ............................................................................ .................... .................... .................... .................... ....................

J1650 G Enoxaparin sodium 10 mg ............................................................... 9998 .................... $5.53 .................... $.79

J1670 G Tetanus immune globulin inj ............................................................ 0908 .................... $102.60 .................... $13.75

J1690 N Prednisolone tebutate inj ................................................................. .................... .................... .................... .................... ....................

J1700 N Hydrocortisone acetate inj ............................................................... .................... .................... .................... .................... ....................

J1710 N Hydrocortisone sodium ph inj .......................................................... .................... .................... .................... .................... ....................

J1720 N Hydrocortisone sodium succ i .......................................................... .................... .................... .................... .................... ....................

67978

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J1730 N Diazoxide injection ........................................................................... .................... .................... .................... .................... ....................

J1739 N Hydroxyprogesterone cap 125 ......................................................... .................... .................... .................... .................... ....................

J1741 N Hydroxyprogesterone cap 250 ......................................................... .................... .................... .................... .................... ....................

J1742 N Ibutilide fumarate injection ............................................................... .................... .................... .................... .................... ....................

J1745 G Infliximab injection ............................................................................ 7043 .................... $58.08 .................... $7.78

J1750 N Iron dextran ...................................................................................... .................... .................... .................... .................... ....................

J1785 G Injection imiglucerase /unit ............................................................... 0916 .................... $3.75 .................... $.50

J1790 N Droperidol injection .......................................................................... .................... .................... .................... .................... ....................

J1800 N Propranolol injection ......................................................................... .................... .................... .................... .................... ....................

J1810 G Droperidol/fentanyl inj ...................................................................... 7047 .................... $7.02 .................... $.90

J1820 N Insulin injection ................................................................................. .................... .................... .................... .................... ....................

J1825 G Interferon beta-1a ............................................................................. 0909 .................... $204.73 .................... $27.43

J1830 G Interferon beta-1b / .25 MG ............................................................. 0910 .................... $57.00 .................... $7.64

J1840 N Kanamycin sulfate 500 MG inj ......................................................... .................... .................... .................... .................... ....................

J1850 N Kanamycin sulfate 75 MG inj ........................................................... .................... .................... .................... .................... ....................

J1885 N Ketorolac tromethamine inj .............................................................. .................... .................... .................... .................... ....................

J1890 N Cephalothin sodium injection ........................................................... .................... .................... .................... .................... ....................

J1910 N Kutapressin injection ........................................................................ .................... .................... .................... .................... ....................

J1930 N Propiomazine injection ..................................................................... .................... .................... .................... .................... ....................

J1940 N Furosemide injection ........................................................................ .................... .................... .................... .................... ....................

J1950 G Leuprolide acetate /3.75 MG ........................................................... 0800 .................... $492.71 .................... $63.27

J1955 N Inj levocarnitine per 1 gm ................................................................ .................... .................... .................... .................... ....................

J1956 N Levofloxacin injection ....................................................................... .................... .................... .................... .................... ....................

J1960 N Levorphanol tartrate inj .................................................................... .................... .................... .................... .................... ....................

J1970 N Methotrimeprazine injection ............................................................. .................... .................... .................... .................... ....................

J1980 N Hyoscyamine sulfate inj ................................................................... .................... .................... .................... .................... ....................

J1990 N Chlordiazepoxide injection ............................................................... .................... .................... .................... .................... ....................

J2000 N Lidocaine injection ............................................................................ .................... .................... .................... .................... ....................

J2010 N Lincomycin injection ......................................................................... .................... .................... .................... .................... ....................

J2060 N Lorazepam injection ......................................................................... .................... .................... .................... .................... ....................

J2150 N Mannitol injection ............................................................................. .................... .................... .................... .................... ....................

J2175 N Meperidine hydrochl /100 MG .......................................................... .................... .................... .................... .................... ....................

J2180 N Meperidine/promethazine inj ............................................................ .................... .................... .................... .................... ....................

J2210 N Methylergonovin maleate inj ............................................................ .................... .................... .................... .................... ....................

J2240 N Metocurine iodide injection .............................................................. .................... .................... .................... .................... ....................

J2250 N Inj midazolam hydrochloride ............................................................ .................... .................... .................... .................... ....................

J2260 K Inj milrinone lactate / 5 ML .............................................................. 7007 0.47 $23.31 .................... $4.66

J2270 N Morphine sulfate injection ................................................................ .................... .................... .................... .................... ....................

J2271 N Morphine so4 injection 100mg ......................................................... .................... .................... .................... .................... ....................

J2275 G Morphine sulfate injection ................................................................ 7010 .................... $7.41 .................... $.99

J2300 N Inj nalbuphine hydrochloride ............................................................ .................... .................... .................... .................... ....................

J2310 N Inj naloxone hydrochloride ............................................................... .................... .................... .................... .................... ....................

J2320 N Nandrolone decanoate 50 MG ......................................................... .................... .................... .................... .................... ....................

J2321 N Nandrolone decanoate 100 MG ....................................................... .................... .................... .................... .................... ....................

J2322 N Nandrolone decanoate 200 MG ....................................................... .................... .................... .................... .................... ....................

J2330 N Thiothixene injection ........................................................................ .................... .................... .................... .................... ....................

J2350 N Niacinamide/niacin injection ............................................................. .................... .................... .................... .................... ....................

J2352 G Octreotide acetate injection ............................................................. 7031 .................... $115.34 .................... $15.46

J2355 G Oprelvekin injection .......................................................................... 7011 .................... $236.31 .................... $31.67

J2360 N Orphenadrine injection ..................................................................... .................... .................... .................... .................... ....................

J2370 N Phenylephrine hcl injection .............................................................. .................... .................... .................... .................... ....................

J2400 N Chloroprocaine hcl injection ............................................................. .................... .................... .................... .................... ....................

J2405 G Ondansetron hcl injection ................................................................ 0768 .................... $6.09 .................... $.82

J2410 N Oxymorphone hcl injection ............................................................... .................... .................... .................... .................... ....................

J2430 G Pamidronate disodium /30 MG ........................................................ 0730 .................... $232.51 .................... $31.16

J2440 N Papaverin hcl injection ..................................................................... .................... .................... .................... .................... ....................

J2460 N Oxytetracycline injection .................................................................. .................... .................... .................... .................... ....................

J2480 N Hydrochlorides of opium inj ............................................................. .................... .................... .................... .................... ....................

J2500 N Paricalcitol ........................................................................................ .................... .................... .................... .................... ....................

J2510 N Penicillin g procaine inj .................................................................... .................... .................... .................... .................... ....................

J2512 N Inj pentagastrin per 2 ML ................................................................. .................... .................... .................... .................... ....................

J2515 N Pentobarbital sodium inj ................................................................... .................... .................... .................... .................... ....................

J2540 N Penicillin g potassium inj .................................................................. .................... .................... .................... .................... ....................

J2543 N Piperacillin/tazobactam .................................................................... .................... .................... .................... .................... ....................

J2545 A Pentamidine isethionte/300mg ......................................................... .................... .................... .................... .................... ....................

J2550 N Promethazine hcl injection ............................................................... .................... .................... .................... .................... ....................

J2560 N Phenobarbital sodium inj .................................................................. .................... .................... .................... .................... ....................

J2590 N Oxytocin injection ............................................................................. .................... .................... .................... .................... ....................

J2597 E Inj desmopressin acetate ................................................................. .................... .................... .................... .................... ....................

J2640 N Prednisolone sodium ph inj .............................................................. .................... .................... .................... .................... ....................

J2650 N Prednisolone acetate inj ................................................................... .................... .................... .................... .................... ....................

J2670 N Totazoline hcl injection ..................................................................... .................... .................... .................... .................... ....................

J2675 N Inj progesterone per 50 MG ............................................................. .................... .................... .................... .................... ....................

J2680 N Fluphenazine decanoate 25 MG ...................................................... .................... .................... .................... .................... ....................

67979

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J2690 N Procainamide hcl injection ............................................................... .................... .................... .................... .................... ....................

J2700 N Oxacillin sodium injection ................................................................. .................... .................... .................... .................... ....................

J2710 N Neostigmine methylslfte inj .............................................................. .................... .................... .................... .................... ....................

J2720 N Inj protamine sulfate/10 MG ............................................................. .................... .................... .................... .................... ....................

J2725 N Inj protirelin per 250 mcg ................................................................. .................... .................... .................... .................... ....................

J2730 N Pralidoxime chloride inj .................................................................... .................... .................... .................... .................... ....................

J2760 N Phentolaine mesylate inj .................................................................. .................... .................... .................... .................... ....................

J2765 G Metoclopramide hcl injection ............................................................ 0754 .................... $2.00 .................... $.27

J2770 G Quinupristin/dalfopristin .................................................................... 1024 .................... $102.05 .................... $13.67

J2780 N Ranitidine hydrochloride inj .............................................................. .................... .................... .................... .................... ....................

J2790 G Rho d immune globulin inj ............................................................... 0884 .................... $35.91 .................... $4.38

*J2792 G Rho(D) immune globulin h, sd ......................................................... 1609 .................... $20.55 .................... $2.51

J2795 N Ropivacaine HCl injection ................................................................ .................... .................... .................... .................... ....................

J2800 N Methocarbamol injection .................................................................. .................... .................... .................... .................... ....................

J2810 N Inj theophylline per 40 MG ............................................................... .................... .................... .................... .................... ....................

J2820 G Sargramostim injection ..................................................................... 0731 .................... $27.42 .................... $3.67

J2860 N Secobarbital sodium inj .................................................................... .................... .................... .................... .................... ....................

J2910 N Aurothioglucose injection ................................................................. .................... .................... .................... .................... ....................

J2912 N Sodium chloride injection ................................................................. .................... .................... .................... .................... ....................

J2915 N NA Ferric Gluconate Complex ......................................................... .................... .................... .................... .................... ....................

J2920 N Methylprednisolone injection ............................................................ .................... .................... .................... .................... ....................

J2930 N Methylprednisolone injection ............................................................ .................... .................... .................... .................... ....................

J2950 N Promazine hcl injection .................................................................... .................... .................... .................... .................... ....................

J2970 N Methicillin sodium injection .............................................................. .................... .................... .................... .................... ....................

J2993 G Reteplase injection ........................................................................... 9005 .................... $1,306.25 .................... $175.04

J2994D G Reteplase double bolus ................................................................... 0914 .................... $2,612.50 .................... $350.08

J2995 K Inj streptokinase /250000 IU ............................................................ 0911 1.76 $87.25 .................... $17.45

J2996D K Alteplase recombinant inj ................................................................. 0915 3.80 $188.46 .................... $37.69

J2997 G Alteplase recombinant, 1 mg ........................................................... 7048 0.38 $18.70 .................... $3.74

J3000 N Streptomycin injection ...................................................................... .................... .................... .................... .................... ....................

J3010 G Fentanyl citrate injection .................................................................. 7014 .................... $.98 .................... $.13

J3030 N Sumatriptan succinate / 6 MG ......................................................... .................... .................... .................... .................... ....................

J3070 N Pentazocine hcl injection ................................................................. .................... .................... .................... .................... ....................

J3080 N Chlorprothixene injection .................................................................. .................... .................... .................... .................... ....................

J3105 N Terbutaline sulfate inj ....................................................................... .................... .................... .................... .................... ....................

J3120 N Testosterone enanthate inj .............................................................. .................... .................... .................... .................... ....................

J3130 N Testosterone enanthate inj .............................................................. .................... .................... .................... .................... ....................

J3140 N Testosterone suspension inj ............................................................ .................... .................... .................... .................... ....................

J3150 N Testosteron propionate inj ............................................................... .................... .................... .................... .................... ....................

J3230 N Chlorpromazine hcl injection ............................................................ .................... .................... .................... .................... ....................

*J3240 E Thyrotropin injection ......................................................................... .................... .................... .................... .................... ....................

J3245 G Tirofiban hydrochloride ..................................................................... 7041 .................... $399.00 .................... $53.47

J3250 N Trimethobenzamide hcl inj ............................................................... .................... .................... .................... .................... ....................

J3260 N Tobramycin sulfate injection ............................................................ .................... .................... .................... .................... ....................

J3265 N Injection torsemide 10 mg/ml ........................................................... .................... .................... .................... .................... ....................

J3270 N Imipramine hcl injection ................................................................... .................... .................... .................... .................... ....................

J3280 G Thiethylperazine maleate inj ............................................................ 0755 .................... $5.02 .................... $.67

J3301 N Triamcinolone acetonide inj ............................................................. .................... .................... .................... .................... ....................

J3302 N Triamcinolone diacetate inj .............................................................. .................... .................... .................... .................... ....................

J3303 N Triamcinolone hexacetonl inj ........................................................... .................... .................... .................... .................... ....................

J3305 G Inj trimetrexate glucoronate ............................................................. 7045 .................... $69.83 .................... $9.36

J3310 N Perphenazine injection ..................................................................... .................... .................... .................... .................... ....................

J3320 N Spectinomycn di-hcl inj .................................................................... .................... .................... .................... .................... ....................

J3350 N Urea injection ................................................................................... .................... .................... .................... .................... ....................

J3360 N Diazepam injection ........................................................................... .................... .................... .................... .................... ....................

J3364 N Urokinase 5000 IU injection ............................................................. .................... .................... .................... .................... ....................

J3365 K Urokinase 250,000 IU inj ................................................................. 7036 6.78 $336.29 .................... $67.26

J3370 N Vancomycin hcl injection .................................................................. .................... .................... .................... .................... ....................

J3390 N Methoxamine injection ..................................................................... .................... .................... .................... .................... ....................

J3400 N Triflupromazine hcl inj ...................................................................... .................... .................... .................... .................... ....................

J3410 N Hydroxyzine hcl injection ................................................................. .................... .................... .................... .................... ....................

J3420 N Vitamin b12 injection ........................................................................ .................... .................... .................... .................... ....................

J3430 N Vitamin k phytonadione inj ............................................................... .................... .................... .................... .................... ....................

J3450 N Mephentermine sulfate inj ................................................................ .................... .................... .................... .................... ....................

J3470 N Hyaluronidase injection .................................................................... .................... .................... .................... .................... ....................

J3475 N Inj magnesium sulfate ...................................................................... .................... .................... .................... .................... ....................

J3480 N Inj potassium chloride ...................................................................... .................... .................... .................... .................... ....................

J3485 N Zidovudine ........................................................................................ .................... .................... .................... .................... ....................

J3490 N Drugs unclassified injection ............................................................. .................... .................... .................... .................... ....................

J3520 E Edetate disodium per 150 mg .......................................................... .................... .................... .................... .................... ....................

J3530 N Nasal vaccine inhalation .................................................................. .................... .................... .................... .................... ....................

J3535 E Metered dose inhaler drug ............................................................... .................... .................... .................... .................... ....................

J3570 E Laetrile amygdalin vit B17 ................................................................ .................... .................... .................... .................... ....................

J7030 N Normal saline solution infus ............................................................. .................... .................... .................... .................... ....................

67980

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J7040 N Normal saline solution infus ............................................................. .................... .................... .................... .................... ....................

J7042 N 5% dextrose/normal saline ............................................................... .................... .................... .................... .................... ....................

J7050 N Normal saline solution infus ............................................................. .................... .................... .................... .................... ....................

J7051 N Sterile saline/water ........................................................................... .................... .................... .................... .................... ....................

J7060 N 5% dextrose/water ........................................................................... .................... .................... .................... .................... ....................

J7070 N D5w infusion ..................................................................................... .................... .................... .................... .................... ....................

J7100 N Dextran 40 infusion .......................................................................... .................... .................... .................... .................... ....................

J7110 N Dextran 75 infusion .......................................................................... .................... .................... .................... .................... ....................

J7120 N Ringers lactate infusion .................................................................... .................... .................... .................... .................... ....................

J7130 N Hypertonic saline solution ................................................................ .................... .................... .................... .................... ....................

J7190 G Factor viii .......................................................................................... 0925 .................... $.88 .................... $.12

J7191 G Factor VIII (porcine) ......................................................................... 0926 .................... $2.09 .................... $.28

J7192 G Factor viii recombinant ..................................................................... 0927 .................... $1.17 .................... $.16

J7194 G Factor ix complex ............................................................................. 0928 .................... $.71 .................... $.10

J7197 G Antithrombin iii injection ................................................................... 0930 .................... $.82 .................... $.11

J7198 G Anti-inhibitor ..................................................................................... 0929 .................... $1.43 .................... $.19

J7199 E Hemophilia clot factor noc ............................................................... .................... .................... .................... .................... ....................

J7300 E Intraut copper contraceptive ............................................................ .................... .................... .................... .................... ....................

J7310 G Ganciclovir long act implant ............................................................. 0913 .................... $4,750.00 .................... $636.50

J7315 G Sodium hyaluronate injection ........................................................... 7315 .................... $125.59 .................... $16.83

*J7320 G Hylan G-F 20 injection ..................................................................... 1611 .................... $204.87 .................... $27.45

J7330 G Cultured chondrocytes implnt .......................................................... 1059 .................... $14,250.00 .................... $2,010.00

J7500 G Azathioprine oral 50mg .................................................................... 0886 .................... $1.24 .................... $.17

J7501 G Azathioprine parenteral .................................................................... 0887 .................... $67.88 .................... $9.10

J7502 G Cyclosporine oral 100 mg ................................................................ 0888 .................... $5.80 .................... $.78

J7504 G Lymphocyte immune globulin .......................................................... 0890 .................... $249.13 .................... $30.39

J7505 G Muromonab-CD3, 5 mg ................................................................... 7038 .................... $741.00 .................... $99.29

J7506 N Prednisone oral ................................................................................ .................... .................... .................... .................... ....................

J7507 G Tacrolimus oral per 1 MG ................................................................ 0891 .................... $2.66 .................... $.36

J7508 E Tacrolimus oral per 5 MG ................................................................ .................... .................... .................... .................... ....................

J7509 N Methylprednisolone oral ................................................................... .................... .................... .................... .................... ....................

J7510 N Prednisolone oral per 5 mg ............................................................. .................... .................... .................... .................... ....................

*J7513 G Daclizumab, parenteral .................................................................... 1612 .................... $397.29 .................... $53.24

J7515 N Cyclosporine oral 25 mg .................................................................. .................... .................... .................... .................... ....................

J7516 G Cyclosporin parenteral 250mg ......................................................... 0889 .................... $15.81 .................... $2.12

J7517 N Mycophenolate mofetil oral .............................................................. .................... .................... .................... .................... ....................

J7520 G Sirolimus, oral .................................................................................. 9106 .................... $6.51 .................... $.87

J7525 E Tacrolimus injection ......................................................................... .................... .................... .................... .................... ....................

J7599 E Immunosuppressive drug noc .......................................................... .................... .................... .................... .................... ....................

J7608 A Acetylcysteine inh sol u d ................................................................ .................... .................... .................... .................... ....................

J7610D A Acetylcysteine 10% injection ............................................................ .................... .................... .................... .................... ....................

J7615D A Acetylcysteine 20% injection ............................................................ .................... .................... .................... .................... ....................

J7618 A Albuterol inh sol con ........................................................................ .................... .................... .................... .................... ....................

J7619 A Albuterol inh sol u d ......................................................................... .................... .................... .................... .................... ....................

J7620D A Albuterol sulfate .083%/ml ............................................................... .................... .................... .................... .................... ....................

J7625D A Albuterol sulfate .5% inj ................................................................... .................... .................... .................... .................... ....................

J7627D A Bitolterolmesylate inhal sol .............................................................. .................... .................... .................... .................... ....................

J7628 A Bitolterol mes inhal sol con .............................................................. .................... .................... .................... .................... ....................

J7629 A Bitolterol mes inh sol u d ................................................................. .................... .................... .................... .................... ....................

J7630D A Cromolyn sodium injection ............................................................... .................... .................... .................... .................... ....................

J7631 A Cromolyn sodium inh sol u d ........................................................... .................... .................... .................... .................... ....................

J7635 A Atropine inhal sol con ...................................................................... .................... .................... .................... .................... ....................

J7636 A Atropine inhal sol unit dose ............................................................. .................... .................... .................... .................... ....................

J7637 A Dexamethasone inhal sol con .......................................................... .................... .................... .................... .................... ....................

J7638 A Dexamethasone inhal sol u d .......................................................... .................... .................... .................... .................... ....................

J7639 A Dornase alpha inhal sol u d ............................................................. .................... .................... .................... .................... ....................

J7640D A Epinephrine injection ........................................................................ .................... .................... .................... .................... ....................

J7642 A Glycopyrrolate inhal sol con ............................................................. .................... .................... .................... .................... ....................

J7643 A Glycopyrrolate inhal sol u d ............................................................. .................... .................... .................... .................... ....................

J7644 A Ipratropium brom inh sol u d ............................................................ .................... .................... .................... .................... ....................

J7645D A Ipratropium bromide .02%/ml ........................................................... .................... .................... .................... .................... ....................

J7648 A Isoetharine hcl inh sol con ............................................................... .................... .................... .................... .................... ....................

J7649 A Isoetharine hcl inh sol u d ................................................................ .................... .................... .................... .................... ....................

J7650D A Isoetharine hcl .1% inj ...................................................................... .................... .................... .................... .................... ....................

J7651D A Isoetharine hcl .125% inj .................................................................. .................... .................... .................... .................... ....................

J7652D A Isoetharine hcl .167% inj .................................................................. .................... .................... .................... .................... ....................

J7653D A Isoetharine hcl .2%/ inj ..................................................................... .................... .................... .................... .................... ....................

J7654D A Isoetharine hcl .25% inj .................................................................... .................... .................... .................... .................... ....................

J7655D A Isoetharine hcl 1% inj ....................................................................... .................... .................... .................... .................... ....................

J7658 A Isoproterenolhcl inh sol con ............................................................. .................... .................... .................... .................... ....................

J7659 A Isoproterenol hcl inh sol ud .............................................................. .................... .................... .................... .................... ....................

J7660D A Isoproterenol hcl .5% inj .................................................................. .................... .................... .................... .................... ....................

J7665D A Isoproterenol hcl 1% inj ................................................................... .................... .................... .................... .................... ....................

J7668 A Metaproterenol inh sol con .............................................................. .................... .................... .................... .................... ....................

67981

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J7669 A Metaproterenol inh sol u d ............................................................... .................... .................... .................... .................... ....................

J7670D A Metaproterenol sulfate .4% .............................................................. .................... .................... .................... .................... ....................

J7672D A Metaproterenol sulfate .6% .............................................................. .................... .................... .................... .................... ....................

J7675D A Metaproterenol sulfate 5% ............................................................... .................... .................... .................... .................... ....................

J7680 A Terbutaline so4 inh sol con .............................................................. .................... .................... .................... .................... ....................

J7681 A Terbutaline so4 inh sol u d .............................................................. .................... .................... .................... .................... ....................

J7682 A Tobramycin inhalation sol ................................................................ .................... .................... .................... .................... ....................

J7683 A Triamcinolone inh sol con ................................................................ .................... .................... .................... .................... ....................

J7684 A Triamcinolone inh sol u d ................................................................. .................... .................... .................... .................... ....................

J7699 A Inhalation solution for DME .............................................................. .................... .................... .................... .................... ....................

J7799 A Non-inhalation drug for DME ........................................................... .................... .................... .................... .................... ....................

J8499 E Oral prescrip drug non chemo ......................................................... .................... .................... .................... .................... ....................

J8510 G Oral busulfan .................................................................................... 7015 .................... $1.73 .................... $.23

J8520 G Capecitabine, oral, 150 mg .............................................................. 7042 .................... $1.94 .................... $.26

J8521 N Capecitabine, oral, 500 mg .............................................................. .................... .................... .................... .................... ....................

J8530 G Cyclophosphamide oral 25 MG ....................................................... 0801 .................... $2.12 .................... $.28

J8560 G Etoposide oral 50 MG ...................................................................... 0802 .................... $45.95 .................... $6.16

J8600 G Melphalan oral 2 MG ....................................................................... 0803 .................... $2.07 .................... $.30

J8610 G Methotrexate oral 2.5 MG ................................................................ 0826 .................... $2.92 .................... $.39

J8700 G Temozolmide, oral 5 mg .................................................................. 1086 .................... $5.70 .................... $.76

J8999 E Oral prescription drug chemo .......................................................... .................... .................... .................... .................... ....................

J9000 G Doxorubic hcl 10 MG vl chemo ....................................................... 0847 .................... $15.79 .................... $2.12

J9001 G Doxorubicin hcl liposome inj ............................................................ 7046 .................... $311.72 .................... $41.77

J9015 G Aldesleukin/single use vial ............................................................... 0807 .................... $569.76 .................... $76.35

J9020 G Asparaginase injection ..................................................................... 0814 .................... $57.41 .................... $7.69

J9031 G Bcg live intravesical vac ................................................................... 0809 .................... $159.39 .................... $19.45

J9040 G Bleomycin sulfate injection ............................................................... 0857 .................... $294.48 .................... $39.46

J9045 G Carboplatin injection ......................................................................... 0811 .................... $98.90 .................... $13.25

J9050 G Carmus bischl nitro inj ..................................................................... 0812 .................... $103.27 .................... $13.84

J9060 G Cisplatin 10 MG injection ................................................................. 0813 .................... $42.18 .................... $5.65

J9062 E Cisplatin 50 MG injection ................................................................. .................... .................... .................... .................... ....................

J9065 G Inj cladribine per 1 MG .................................................................... 0858 .................... $53.47 .................... $7.16

J9070 G Cyclophosphamide 100 MG inj ........................................................ 0815 .................... $6.13 .................... $.82

J9080 E Cyclophosphamide 200 MG inj ........................................................ .................... .................... .................... .................... ....................

J9090 E Cyclophosphamide 500 MG inj ........................................................ .................... .................... .................... .................... ....................

J9091 E Cyclophosphamide 1.0 grm inj ........................................................ .................... .................... .................... .................... ....................

J9092 E Cyclophosphamide 2.0 grm inj ........................................................ .................... .................... .................... .................... ....................

J9093 G Cyclophosphamide lyophilized ......................................................... 0816 .................... $6.13 .................... $.82

J9094 E Cyclophosphamide lyophilized ......................................................... .................... .................... .................... .................... ....................

J9095 E Cyclophosphamide lyophilized ......................................................... .................... .................... .................... .................... ....................

J9096 E Cyclophosphamide lyophilized ......................................................... .................... .................... .................... .................... ....................

J9097 E Cyclophosphamide lyophilized ......................................................... .................... .................... .................... .................... ....................

J9100 G Cytarabine hcl 100 MG inj ............................................................... 0817 .................... $5.94 .................... $.80

J9110 E Cytarabine hcl 500 MG inj ............................................................... .................... .................... .................... .................... ....................

J9120 G Dactinomycin actinomycin d ............................................................ 0818 .................... $12.73 .................... $1.71

J9130 G Dacarbazine 10 MG inj .................................................................... 0819 .................... $1.13 .................... $.15

J9140 E Dacarbazine 200 MG inj .................................................................. .................... .................... .................... .................... ....................

J9150 G Daunorubicin .................................................................................... 0820 .................... $80.04 .................... $10.73

J9151 G Daunorubicin citrate liposom ............................................................ 0821 .................... $64.60 .................... $8.66

J9160 G Denileukin diftitox, 300 mcg ............................................................. 1084 .................... $942.88 .................... $126.35

J9165 G Diethylstilbestrol injection ................................................................. 0822 .................... $4.20 .................... $.56

J9170 G Docetaxel ......................................................................................... 0823 .................... $283.65 .................... $38.01

J9180 E Epirubicin HCl injection .................................................................... .................... .................... .................... .................... ....................

J9181 G Etoposide 10 MG inj ........................................................................ 0824 .................... $4.06 .................... $.54

J9182 E Etoposide 100 MG inj ...................................................................... .................... .................... .................... .................... ....................

J9185 G Fludarabine phosphate inj ................................................................ 0842 .................... $237.03 .................... $31.76

J9190 G Fluorouracil injection ........................................................................ 0859 .................... $2.75 .................... $.37

J9200 G Floxuridine injection ......................................................................... 0827 .................... $129.56 .................... $17.36

J9201 G Gemcitabine HCl .............................................................................. 0828 .................... $88.46 .................... $11.85

J9202 G Goserelin acetate implant ................................................................ 0810 .................... $446.49 .................... $59.83

J9206 G Irinotecan injection ........................................................................... 0830 .................... $117.81 .................... $15.79

J9208 G Ifosfomide injection .......................................................................... 0831 .................... $141.50 .................... $18.96

J9209 G Mesna injection ................................................................................ 0732 .................... $36.51 .................... $4.89

J9211 G Idarubicin hcl injection ...................................................................... 0832 .................... $341.38 .................... $45.75

J9212 G Interferon alfacon-1 .......................................................................... 0833 .................... $3.91 .................... $.52

J9213 G Interferon alfa-2a inj ......................................................................... 0834 .................... $33.22 .................... $4.45

J9214 G Interferon alfa-2b inj ......................................................................... 0836 .................... $11.28 .................... $1.51

J9215 G Interferon alfa-n3 inj ......................................................................... 0865 .................... $7.86 .................... $1.05

J9216 G Interferon gamma 1-b inj .................................................................. 0838 .................... $199.50 .................... $26.73

J9217 G Leuprolide acetate suspnsion .......................................................... 9217 .................... $592.60 .................... $79.40

J9218 G Leuprolide acetate injection ............................................................. 0861 .................... $22.90 .................... $3.07

J9219 N Leuprolide acetate implant ............................................................... .................... .................... .................... .................... ....................

J9230 G Mechlorethamine hcl inj ................................................................... 0839 .................... $11.01 .................... $1.48

J9245 G Inj melphalan hydrochl 50 MG ......................................................... 0840 .................... $363.48 .................... $48.71

67982

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

J9250 G Methotrexate sodium inj ................................................................... 0841 .................... $.45 .................... $.06

J9260 E Methotrexate sodium inj ................................................................... .................... .................... .................... .................... ....................

J9265 G Paclitaxel injection ............................................................................ 0863 .................... $173.50 .................... $23.25

J9266 G Pegaspargase/singl dose vial .......................................................... 0843 .................... $1,321.65 .................... $177.10

J9268 G Pentostatin injection ......................................................................... 0844 .................... $1,562.75 .................... $209.41

J9270 G Plicamycin (mithramycin) inj ............................................................ 0860 .................... $93.80 .................... $12.57

J9280 G Mitomycin 5 MG inj .......................................................................... 0862 .................... $121.65 .................... $16.30

J9290 E Mitomycin 20 MG inj ........................................................................ .................... .................... .................... .................... ....................

J9291 E Mitomycin 40 MG inj ........................................................................ .................... .................... .................... .................... ....................

J9293 G Mitoxantrone hydrochl / 5 MG ......................................................... 0864 .................... $223.02 .................... $29.88

J9310 G Rituximab cancer treatment ............................................................. 0849 .................... $420.29 .................... $56.32

J9320 G Streptozocin injection ....................................................................... 0850 .................... $65.79 .................... $8.82

J9340 G Thiotepa injection ............................................................................. 0851 .................... $100.30 .................... $13.44

J9350 G Topotecan ........................................................................................ 0852 .................... $573.75 .................... $76.88

*J9355 G Trastuzumab .................................................................................... 1613 .................... $48.85 .................... $6.55

*J9357 G Valrubicin, 200 mg ........................................................................... 1614 .................... $423.23 .................... $56.71

J9360 G Vinblastine sulfate inj ....................................................................... 0853 .................... $4.11 .................... $.55

J9370 G Vincristine sulfate 1 MG inj .............................................................. 0854 .................... $30.16 .................... $4.04

J9375 E Vincristine sulfate 2 MG inj .............................................................. .................... .................... .................... .................... ....................

J9380 E Vincristine sulfate 5 MG inj .............................................................. .................... .................... .................... .................... ....................

J9390 G Vinorelbine tartrate/10 mg ................................................................ 0855 .................... $75.51 .................... $10.12

J9600 G Porfimer sodium ............................................................................... 0856 .................... $2,603.67 .................... $348.89

J9999 E Chemotherapy drug ......................................................................... .................... .................... .................... .................... ....................

K0001 A Standard wheelchair ........................................................................ .................... .................... .................... .................... ....................

K0002 A Stnd hemi (low seat) whlchr ............................................................ .................... .................... .................... .................... ....................

K0003 A Lightweight wheelchair ..................................................................... .................... .................... .................... .................... ....................

K0004 A High strength ltwt whlchr .................................................................. .................... .................... .................... .................... ....................

K0005 A Ultralightweight wheelchair .............................................................. .................... .................... .................... .................... ....................

K0006 A Heavy duty wheelchair ..................................................................... .................... .................... .................... .................... ....................

K0007 A Extra heavy duty wheelchair ............................................................ .................... .................... .................... .................... ....................

K0008 A Cstm manual wheelchair/base ......................................................... .................... .................... .................... .................... ....................

K0009 A Other manual wheelchair/base ........................................................ .................... .................... .................... .................... ....................

K0010 A Stnd wt frame power whlchr ............................................................ .................... .................... .................... .................... ....................

K0011 A Stnd wt pwr whlchr w control ........................................................... .................... .................... .................... .................... ....................

K0012 A Ltwt portbl power whlchr .................................................................. .................... .................... .................... .................... ....................

K0013 A Custom power whlchr base ............................................................. .................... .................... .................... .................... ....................

K0014 A Other power whlchr base ................................................................. .................... .................... .................... .................... ....................

K0015 A Detach non-adjus hght armrst ......................................................... .................... .................... .................... .................... ....................

K0016 A Detach adjust armrst cmplete .......................................................... .................... .................... .................... .................... ....................

K0017 A Detach adjust armrest base ............................................................. .................... .................... .................... .................... ....................

K0018 A Detach adjust armrst upper ............................................................. .................... .................... .................... .................... ....................

K0019 A Arm pad each ................................................................................... .................... .................... .................... .................... ....................

K0020 A Fixed adjust armrest pair ................................................................. .................... .................... .................... .................... ....................

K0021 A Anti-tipping device each ................................................................... .................... .................... .................... .................... ....................

K0022 A Reinforced back upholstery ............................................................. .................... .................... .................... .................... ....................

K0023 A Planr back insrt foam w/strp ............................................................ .................... .................... .................... .................... ....................

K0024 A Plnr back insrt foam w/hrdwr ........................................................... .................... .................... .................... .................... ....................

K0025 A Hook-on headrest extension ............................................................ .................... .................... .................... .................... ....................

K0026 A Back upholst lgtwt whlchr ................................................................ .................... .................... .................... .................... ....................

K0027 A Back upholst other whlchr ................................................................ .................... .................... .................... .................... ....................

K0028 A Manual fully reclining back ............................................................... .................... .................... .................... .................... ....................

K0029 A Reinforced seat upholstery .............................................................. .................... .................... .................... .................... ....................

K0030 A Solid plnr seat sngl dnsfoam ........................................................... .................... .................... .................... .................... ....................

K0031 A Safety belt/pelvic strap ..................................................................... .................... .................... .................... .................... ....................

K0032 A Seat uphols lgtwt whlchr .................................................................. .................... .................... .................... .................... ....................

K0033 A Seat upholstery other whlchr ........................................................... .................... .................... .................... .................... ....................

K0034 A Heel loop each ................................................................................. .................... .................... .................... .................... ....................

K0035 A Heel loop with ankle strap ............................................................... .................... .................... .................... .................... ....................

K0036 A Toe loop each .................................................................................. .................... .................... .................... .................... ....................

K0037 A High mount flip-up footrest ............................................................... .................... .................... .................... .................... ....................

K0038 A Leg strap each ................................................................................. .................... .................... .................... .................... ....................

K0039 A Leg strap h style each ..................................................................... .................... .................... .................... .................... ....................

K0040 A Adjustable angle footplate ................................................................ .................... .................... .................... .................... ....................

K0041 A Large size footplate each ................................................................. .................... .................... .................... .................... ....................

K0042 A Standard size footplate each ........................................................... .................... .................... .................... .................... ....................

K0043 A Ftrst lower extension tube ................................................................ .................... .................... .................... .................... ....................

K0044 A Ftrst upper hanger bracket .............................................................. .................... .................... .................... .................... ....................

K0045 A Footrest complete assembly ............................................................ .................... .................... .................... .................... ....................

K0046 A Elevat legrst low extension .............................................................. .................... .................... .................... .................... ....................

K0047 A Elevat legrst up hangr brack ............................................................ .................... .................... .................... .................... ....................

K0048 A Elevate legrest complete .................................................................. .................... .................... .................... .................... ....................

K0049 A Calf pad each ................................................................................... .................... .................... .................... .................... ....................

K0050 A Ratchet assembly ............................................................................. .................... .................... .................... .................... ....................

K0051 A Cam relese assem ftrst/lgrst ............................................................ .................... .................... .................... .................... ....................

67983

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

K0052 A Swingaway detach footrest .............................................................. .................... .................... .................... .................... ....................

K0053 A Elevate footrest articulate ................................................................ .................... .................... .................... .................... ....................

K0054 A Seat wdth 10-12/15/17/20 wc .......................................................... .................... .................... .................... .................... ....................

K0055 A Seat dpth 15/17/18 ltwt wc .............................................................. .................... .................... .................... .................... ....................

K0056 A Seat ht <17 or >=21 ltwt wc ............................................................. .................... .................... .................... .................... ....................

K0057 A Seat wdth 19/20 hvy dty wc ............................................................. .................... .................... .................... .................... ....................

K0058 A Seat dpth 17/18 power wc ............................................................... .................... .................... .................... .................... ....................

K0059 A Plastic coated handrim each ............................................................ .................... .................... .................... .................... ....................

K0060 A Steel handrim each .......................................................................... .................... .................... .................... .................... ....................

K0061 A Aluminum handrim each .................................................................. .................... .................... .................... .................... ....................

K0062 A Handrim 8-10 vert/obliq proj ............................................................ .................... .................... .................... .................... ....................

K0063 A Hndrm 12-16 vert/obliq proj ............................................................. .................... .................... .................... .................... ....................

K0064 A Zero pressure tube flat free ............................................................. .................... .................... .................... .................... ....................

K0065 A Spoke protectors .............................................................................. .................... .................... .................... .................... ....................

K0066 A Solid tire any size each .................................................................... .................... .................... .................... .................... ....................

K0067 A Pneumatic tire any size each ........................................................... .................... .................... .................... .................... ....................

K0068 A Pneumatic tire tube each ................................................................. .................... .................... .................... .................... ....................

K0069 A Rear whl complete solid tire ............................................................ .................... .................... .................... .................... ....................

K0070 A Rear whl compl pneum tire .............................................................. .................... .................... .................... .................... ....................

K0071 A Front castr compl pneum tire ........................................................... .................... .................... .................... .................... ....................

K0072 A Frnt cstr cmpl sem-pneum tir ........................................................... .................... .................... .................... .................... ....................

K0073 A Caster pin lock each ........................................................................ .................... .................... .................... .................... ....................

K0074 A Pneumatic caster tire each .............................................................. .................... .................... .................... .................... ....................

K0075 A Semi-pneumatic caster tire .............................................................. .................... .................... .................... .................... ....................

K0076 A Solid caster tire each ....................................................................... .................... .................... .................... .................... ....................

K0077 A Front caster assem complete .......................................................... .................... .................... .................... .................... ....................

K0078 A Pneumatic caster tire tube ............................................................... .................... .................... .................... .................... ....................

K0079 A Wheel lock extension pair ................................................................ .................... .................... .................... .................... ....................

K0080 A Anti-rollback device pair ................................................................... .................... .................... .................... .................... ....................

K0081 A Wheel lock assembly complete ....................................................... .................... .................... .................... .................... ....................

K0082 A 22 nf deep cycl acid battery ............................................................. .................... .................... .................... .................... ....................

K0083 A 22 nf gel cell battery each ............................................................... .................... .................... .................... .................... ....................

K0084 A Grp 24 deep cycl acid battry ............................................................ .................... .................... .................... .................... ....................

K0085 A Group 24 gel cell battery ................................................................. .................... .................... .................... .................... ....................

K0086 A U-1 lead acid battery each ............................................................... .................... .................... .................... .................... ....................

K0087 A U-1 gel cell battery each .................................................................. .................... .................... .................... .................... ....................

K0088 A Battry chrgr acid/gel cell .................................................................. .................... .................... .................... .................... ....................

K0089 A Battery charger dual mode .............................................................. .................... .................... .................... .................... ....................

K0090 A Rear tire power wheelchair .............................................................. .................... .................... .................... .................... ....................

K0091 A Rear tire tube power whlchr ............................................................. .................... .................... .................... .................... ....................

K0092 A Rear assem cmplt powr whlchr ....................................................... .................... .................... .................... .................... ....................

K0093 A Rear zero pressure tire tube ............................................................ .................... .................... .................... .................... ....................

K0094 A Wheel tire for power base ................................................................ .................... .................... .................... .................... ....................

K0095 A Wheel tire tube each base ............................................................... .................... .................... .................... .................... ....................

K0096 A Wheel assem powr base complt ...................................................... .................... .................... .................... .................... ....................

K0097 A Wheel zero presure tire tube ........................................................... .................... .................... .................... .................... ....................

K0098 A Drive belt power wheelchair ............................................................. .................... .................... .................... .................... ....................

K0099 A Pwr wheelchair front caster ............................................................. .................... .................... .................... .................... ....................

K0100 A Amputee adapter pair ...................................................................... .................... .................... .................... .................... ....................

K0101 A One-arm drive attachment ............................................................... .................... .................... .................... .................... ....................

K0102 A Crutch and cane holder ................................................................... .................... .................... .................... .................... ....................

K0103 A Transfer board < 25′′ ........................................................................ .................... .................... .................... .................... ....................

K0104 A Cylinder tank carrier ......................................................................... .................... .................... .................... .................... ....................

K0105 A Iv hanger .......................................................................................... .................... .................... .................... .................... ....................

K0106 A Arm trough each .............................................................................. .................... .................... .................... .................... ....................

K0107 A Wheelchair tray ................................................................................ .................... .................... .................... .................... ....................

K0108 A W/c component-accessory NOS ...................................................... .................... .................... .................... .................... ....................

K0112 A Trunk vest supprt innr frame ............................................................ .................... .................... .................... .................... ....................

K0113 A Trunk vest suprt w/o inr frm ............................................................. .................... .................... .................... .................... ....................

K0114 A Whlchr back suprt inr frame ............................................................. .................... .................... .................... .................... ....................

K0115 A Back module orthotic system ........................................................... .................... .................... .................... .................... ....................

K0116 A Back & seat modul orthot sys .......................................................... .................... .................... .................... .................... ....................

K0182D A Water distilled w/ nebulizer .............................................................. .................... .................... .................... .................... ....................

K0183 A Nasal application device .................................................................. .................... .................... .................... .................... ....................

K0184 A Nasal pillows/seals pair .................................................................... .................... .................... .................... .................... ....................

K0185 A Pos airway pressure headgear ........................................................ .................... .................... .................... .................... ....................

K0186 A Pos airway prssure chinstrap ........................................................... .................... .................... .................... .................... ....................

K0187 A Pos airway pressure tubing ............................................................. .................... .................... .................... .................... ....................

K0188 A Pos airway pressure filter ................................................................ .................... .................... .................... .................... ....................

K0189 A Filter nondisposable w PAP ............................................................. .................... .................... .................... .................... ....................

K0195 A Elevating whlchair leg rests ............................................................. .................... .................... .................... .................... ....................

K0268 A Humidifier nonheated w PAP ........................................................... .................... .................... .................... .................... ....................

K0269D A Aerosol compressor cpap dev ......................................................... .................... .................... .................... .................... ....................

K0270D A Ultrasonic generator w nebul ........................................................... .................... .................... .................... .................... ....................

67984

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

K0280D A Extension drainage tubing ............................................................... .................... .................... .................... .................... ....................

K0281D A Lubricant catheter insertion .............................................................. .................... .................... .................... .................... ....................

K0283D A Saline solution dispenser ................................................................. .................... .................... .................... .................... ....................

K0407D A Urinary cath skin attachment ........................................................... .................... .................... .................... .................... ....................

K0408D A Urinary cath leg strap ....................................................................... .................... .................... .................... .................... ....................

K0409D A Sterile H2O irrigation solut ............................................................... .................... .................... .................... .................... ....................

K0410D A Male ext cath w/adh coating ............................................................ .................... .................... .................... .................... ....................

K0411D A Male ext cath w/adh strip ................................................................. .................... .................... .................... .................... ....................

K0415 E RX antiemetic drg, oral NOS ........................................................... .................... .................... .................... .................... ....................

K0416 E Rx antiemetic drg,rectal NOS .......................................................... .................... .................... .................... .................... ....................

K0440D A Nasal prosthesis ............................................................................... .................... .................... .................... .................... ....................

K0441D A Midfacial prosthesis .......................................................................... .................... .................... .................... .................... ....................

K0442D A Orbital prosthesis ............................................................................. .................... .................... .................... .................... ....................

K0443D A Upper facial prosthesis .................................................................... .................... .................... .................... .................... ....................

K0444D A Hemi-facial prosthesis ...................................................................... .................... .................... .................... .................... ....................

K0445D A Auricular prosthesis .......................................................................... .................... .................... .................... .................... ....................

K0446D A Partial facial prosthesis .................................................................... .................... .................... .................... .................... ....................

K0447D A Nasal septal prosthesis .................................................................... .................... .................... .................... .................... ....................

K0448D A Unspec maxillofacial prosth ............................................................. .................... .................... .................... .................... ....................

K0449D A Repair maxillofacial prosth ............................................................... .................... .................... .................... .................... ....................

K0450D A Liq adhes for facial prosth ............................................................... .................... .................... .................... .................... ....................

K0451D A Adhesive remover wipes .................................................................. .................... .................... .................... .................... ....................

K0452 A Wheelchair bearings ........................................................................ .................... .................... .................... .................... ....................

K0455 A Pump uninterrupted infusion ............................................................ .................... .................... .................... .................... ....................

K0456D A Heavyduty/xtra wide hosp bed ......................................................... .................... .................... .................... .................... ....................

K0457D A Heavyduty/wide commode chair ...................................................... .................... .................... .................... .................... ....................

K0458D A Heavyduty walker no wheels ........................................................... .................... .................... .................... .................... ....................

K0459D A Heavy duty wheeled walker ............................................................. .................... .................... .................... .................... ....................

K0460 A WC power add-on joystick ............................................................... .................... .................... .................... .................... ....................

K0461 A WC power add-on tiller cntrl ............................................................ .................... .................... .................... .................... ....................

K0462 A Temporary replacement eqpmnt ...................................................... .................... .................... .................... .................... ....................

K0501D A Aerosol compressor for svneb ......................................................... .................... .................... .................... .................... ....................

K0529D A Sterile H20 or nss w lv neb ............................................................. .................... .................... .................... .................... ....................

K0531 A Heated humidifier used w pap ......................................................... .................... .................... .................... .................... ....................

K0532 A Noninvasive assist wo backup ......................................................... .................... .................... .................... .................... ....................

K0533 A Noninvasive assist w backup ........................................................... .................... .................... .................... .................... ....................

K0534 A Invasive assist w backup ................................................................. .................... .................... .................... .................... ....................

K0535D A Gauze, impregnated hydrogel .......................................................... .................... .................... .................... .................... ....................

K0536D A Gauze, impregnated hydrogel .......................................................... .................... .................... .................... .................... ....................

K0537D A Gauze, impregnated hydrogel .......................................................... .................... .................... .................... .................... ....................

K0541 A Speech generating device ............................................................... .................... .................... .................... .................... ....................

K0542 A Speech generating device ............................................................... .................... .................... .................... .................... ....................

K0543 A Speech generating device ............................................................... .................... .................... .................... .................... ....................

K0544 A Speech generating device ............................................................... .................... .................... .................... .................... ....................

K0545 A Speech generating software ............................................................ .................... .................... .................... .................... ....................

K0546 A Accessory for sgd,mntng syst .......................................................... .................... .................... .................... .................... ....................

K0547 A Accessory for sgd,not clasfd ............................................................ .................... .................... .................... .................... ....................

L0100 A Cerv craniosten helmet mold ........................................................... .................... .................... .................... .................... ....................

L0110 A Cerv craniostenosis hel non- ........................................................... .................... .................... .................... .................... ....................

L0120 A Cerv flexible non-adjustable ............................................................. .................... .................... .................... .................... ....................

L0130 A Flex thermoplastic collar mo ............................................................ .................... .................... .................... .................... ....................

L0140 A Cervical semi-rigid adjustab ............................................................. .................... .................... .................... .................... ....................

L0150 A Cerv semi-rig adj molded chn .......................................................... .................... .................... .................... .................... ....................

L0160 A Cerv semi-rig wire occ/mand ........................................................... .................... .................... .................... .................... ....................

L0170 A Cervical collar molded to pt ............................................................. .................... .................... .................... .................... ....................

L0172 A Cerv col thermplas foam 2 pi ........................................................... .................... .................... .................... .................... ....................

L0174 A Cerv col foam 2 piece w thor ........................................................... .................... .................... .................... .................... ....................

L0180 A Cer post col occ/man sup adj .......................................................... .................... .................... .................... .................... ....................

L0190 A Cerv collar supp adj cerv ba ............................................................ .................... .................... .................... .................... ....................

L0200 A Cerv col supp adj bar & thor ............................................................ .................... .................... .................... .................... ....................

L0210 A Thoracic rib belt ............................................................................... .................... .................... .................... .................... ....................

L0220 A Thor rib belt custom fabrica ............................................................. .................... .................... .................... .................... ....................

L0300 A TLSO flex surgical support .............................................................. .................... .................... .................... .................... ....................

L0310 A Tlso flexible custom fabrica ............................................................. .................... .................... .................... .................... ....................

L0315 A Tlso flex elas rigid post pa ............................................................... .................... .................... .................... .................... ....................

L0317 A Tlso flex hypext elas post p ............................................................. .................... .................... .................... .................... ....................

L0320 A Tlso a-p contrl w apron frnt .............................................................. .................... .................... .................... .................... ....................

L0330 A Tlso ant-pos-lateral control .............................................................. .................... .................... .................... .................... ....................

L0340 A Tlso a-p-l-rotary with apron .............................................................. .................... .................... .................... .................... ....................

L0350 A Tlso flex compress jacket cu ........................................................... .................... .................... .................... .................... ....................

L0360 A Tlso flex compress jacket mo .......................................................... .................... .................... .................... .................... ....................

L0370 A Tlso a-p-l-rotary hyperexten ............................................................. .................... .................... .................... .................... ....................

L0380 A Tlso a-p-l-rot w/ pos extens ............................................................. .................... .................... .................... .................... ....................

L0390 A Tlso a-p-l control molded ................................................................. .................... .................... .................... .................... ....................

67985

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L0400 A Tlso a-p-l w interface mater ............................................................. .................... .................... .................... .................... ....................

L0410 A Tlso a-p-l two piece constr ............................................................... .................... .................... .................... .................... ....................

L0420 A Tlso a-p-l 2 piece w interfa .............................................................. .................... .................... .................... .................... ....................

L0430 A Tlso a-p-l w interface custm ............................................................. .................... .................... .................... .................... ....................

L0440 A Tlso a-p-l overlap frnt cust ............................................................... .................... .................... .................... .................... ....................

L0500 A Lso flex surgical support .................................................................. .................... .................... .................... .................... ....................

L0510 A Lso flexible custom fabricat ............................................................. .................... .................... .................... .................... ....................

L0515 A Lso flex elas w/ rig post pa .............................................................. .................... .................... .................... .................... ....................

L0520 A Lso a-p-l control with apron ............................................................. .................... .................... .................... .................... ....................

L0530 A Lso ant-pos control w apron ............................................................ .................... .................... .................... .................... ....................

L0540 A Lso lumbar flexion a-p-l ................................................................... .................... .................... .................... .................... ....................

L0550 A Lso a-p-l control molded .................................................................. .................... .................... .................... .................... ....................

L0560 A Lso a-p-l w interface ........................................................................ .................... .................... .................... .................... ....................

L0565 A Lso a-p-l control custom .................................................................. .................... .................... .................... .................... ....................

L0600 A Sacroiliac flex surg support .............................................................. .................... .................... .................... .................... ....................

L0610 A Sacroiliac flexible custm fa .............................................................. .................... .................... .................... .................... ....................

L0620 A Sacroiliac semi-rig w apron .............................................................. .................... .................... .................... .................... ....................

L0700 A Ctlso a-p-l control molded ................................................................ .................... .................... .................... .................... ....................

L0710 A Ctlso a-p-l control w/ inter ................................................................ .................... .................... .................... .................... ....................

L0810 A Halo cervical into jckt vest ............................................................... .................... .................... .................... .................... ....................

L0820 A Halo cervical into body jack ............................................................. .................... .................... .................... .................... ....................

L0830 A Halo cerv into milwaukee typ ........................................................... .................... .................... .................... .................... ....................

L0860 A Magnetic resonanc image comp ...................................................... .................... .................... .................... .................... ....................

L0900 A Torso/ptosis support ......................................................................... .................... .................... .................... .................... ....................

L0910 A Torso & ptosis supp custm fa .......................................................... .................... .................... .................... .................... ....................

L0920 A Torso/pendulous abd support .......................................................... .................... .................... .................... .................... ....................

L0930 A Pendulous abdomen supp custm .................................................... .................... .................... .................... .................... ....................

L0940 A Torso/postsurgical support ............................................................... .................... .................... .................... .................... ....................

L0950 A Post surg support custom fab .......................................................... .................... .................... .................... .................... ....................

L0960 A Post surgical support pads .............................................................. .................... .................... .................... .................... ....................

L0970 A Tlso corset front ............................................................................... .................... .................... .................... .................... ....................

L0972 A Lso corset front ................................................................................ .................... .................... .................... .................... ....................

L0974 A Tlso full corset .................................................................................. .................... .................... .................... .................... ....................

L0976 A Lso full corset ................................................................................... .................... .................... .................... .................... ....................

L0978 A Axillary crutch extension .................................................................. .................... .................... .................... .................... ....................

L0980 A Peroneal straps pair ......................................................................... .................... .................... .................... .................... ....................

L0982 A Stocking supp grips set of f ............................................................. .................... .................... .................... .................... ....................

L0984 A Protective body sock each ............................................................... .................... .................... .................... .................... ....................

L0999 A Add to spinal orthosis NOS ............................................................. .................... .................... .................... .................... ....................

L1000 A Ctlso milwauke initial model ............................................................. .................... .................... .................... .................... ....................

L1010 A Ctlso axilla sling ............................................................................... .................... .................... .................... .................... ....................

L1020 A Kyphosis pad .................................................................................... .................... .................... .................... .................... ....................

L1025 A Kyphosis pad floating ....................................................................... .................... .................... .................... .................... ....................

L1030 A Lumbar bolster pad .......................................................................... .................... .................... .................... .................... ....................

L1040 A Lumbar or lumbar rib pad ................................................................ .................... .................... .................... .................... ....................

L1050 A Sternal pad ....................................................................................... .................... .................... .................... .................... ....................

L1060 A Thoracic pad .................................................................................... .................... .................... .................... .................... ....................

L1070 A Trapezius sling ................................................................................. .................... .................... .................... .................... ....................

L1080 A Outrigger .......................................................................................... .................... .................... .................... .................... ....................

L1085 A Outrigger bil w/ vert extens .............................................................. .................... .................... .................... .................... ....................

L1090 A Lumbar sling ..................................................................................... .................... .................... .................... .................... ....................

L1100 A Ring flange plastic/leather ................................................................ .................... .................... .................... .................... ....................

L1110 A Ring flange plas/leather mol ............................................................ .................... .................... .................... .................... ....................

L1120 A Covers for upright each ................................................................... .................... .................... .................... .................... ....................

L1200 A Furnsh initial orthosis only ............................................................... .................... .................... .................... .................... ....................

L1210 A Lateral thoracic extension ................................................................ .................... .................... .................... .................... ....................

L1220 A Anterior thoracic extension .............................................................. .................... .................... .................... .................... ....................

L1230 A Milwaukee type superstructur .......................................................... .................... .................... .................... .................... ....................

L1240 A Lumbar derotation pad ..................................................................... .................... .................... .................... .................... ....................

L1250 A Anterior asis pad .............................................................................. .................... .................... .................... .................... ....................

L1260 A Anterior thoracic derotation .............................................................. .................... .................... .................... .................... ....................

L1270 A Abdominal pad ................................................................................. .................... .................... .................... .................... ....................

L1280 A Rib gusset (elastic) each ................................................................. .................... .................... .................... .................... ....................

L1290 A Lateral trochanteric pad ................................................................... .................... .................... .................... .................... ....................

L1300 A Body jacket mold to patient ............................................................. .................... .................... .................... .................... ....................

L1310 A Post-operative body jacket ............................................................... .................... .................... .................... .................... ....................

L1499 A Spinal orthosis NOS ......................................................................... .................... .................... .................... .................... ....................

L1500 A Thkao mobility frame ........................................................................ .................... .................... .................... .................... ....................

L1510 A Thkao standing frame ...................................................................... .................... .................... .................... .................... ....................

L1520 A Thkao swivel walker ......................................................................... .................... .................... .................... .................... ....................

L1600 A Abduct hip flex frejka w cvr .............................................................. .................... .................... .................... .................... ....................

L1610 A Abduct hip flex frejka covr ............................................................... .................... .................... .................... .................... ....................

L1620 A Abduct hip flex pavlik harne ............................................................. .................... .................... .................... .................... ....................

L1630 A Abduct control hip semi-flex ............................................................. .................... .................... .................... .................... ....................

67986

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L1640 A Pelv band/spread bar thigh c ........................................................... .................... .................... .................... .................... ....................

L1650 A HO abduction hip adjustable ............................................................ .................... .................... .................... .................... ....................

L1660 A HO abduction static plastic .............................................................. .................... .................... .................... .................... ....................

L1680 A Pelvic & hip control thigh c .............................................................. .................... .................... .................... .................... ....................

L1685 A Post-op hip abduct custom fa .......................................................... .................... .................... .................... .................... ....................

L1686 A HO post-op hip abduction ................................................................ .................... .................... .................... .................... ....................

L1690 A Combination bilateral HO ................................................................. .................... .................... .................... .................... ....................

L1700 A Leg perthes orth toronto typ ............................................................ .................... .................... .................... .................... ....................

L1710 A Legg perthes orth newington ........................................................... .................... .................... .................... .................... ....................

L1720 A Legg perthes orthosis trilat .............................................................. .................... .................... .................... .................... ....................

L1730 A Legg perthes orth scottish r ............................................................. .................... .................... .................... .................... ....................

L1750 A Legg perthes sling ............................................................................ .................... .................... .................... .................... ....................

L1755 A Legg perthes patten bottom t ........................................................... .................... .................... .................... .................... ....................

L1800 A Knee orthoses elas w stays ............................................................. .................... .................... .................... .................... ....................

L1810 A Ko elastic with joints ........................................................................ .................... .................... .................... .................... ....................

L1815 A Elastic with condylar pads ............................................................... .................... .................... .................... .................... ....................

L1820 A Ko elas w/ condyle pads & jo .......................................................... .................... .................... .................... .................... ....................

L1825 A Ko elastic knee cap .......................................................................... .................... .................... .................... .................... ....................

L1830 A Ko immobilizer canvas longit ........................................................... .................... .................... .................... .................... ....................

L1832 A KO adj jnt pos rigid support ............................................................. .................... .................... .................... .................... ....................

L1834 A Ko w/0 joint rigid molded to ............................................................. .................... .................... .................... .................... ....................

L1840 A Ko derot ant cruciate custom ........................................................... .................... .................... .................... .................... ....................

L1843 A KO single upright custom fit ............................................................. .................... .................... .................... .................... ....................

L1844 A Ko w/adj jt rot cntrl molded .............................................................. .................... .................... .................... .................... ....................

L1845 A Ko w/ adj flex/ext rotat cus .............................................................. .................... .................... .................... .................... ....................

L1846 A Ko w adj flex/ext rotat mold ............................................................. .................... .................... .................... .................... ....................

L1847 A KO adjustable w air chambers ......................................................... .................... .................... .................... .................... ....................

L1850 A Ko swedish type ............................................................................... .................... .................... .................... .................... ....................

L1855 A Ko plas doub upright jnt mol ............................................................ .................... .................... .................... .................... ....................

L1858 A Ko polycentric pneumatic pad .......................................................... .................... .................... .................... .................... ....................

L1860 A Ko supracondylar socket mold ......................................................... .................... .................... .................... .................... ....................

L1870 A Ko doub upright lacers molde .......................................................... .................... .................... .................... .................... ....................

L1880 A Ko doub upright cuffs/lacers ............................................................ .................... .................... .................... .................... ....................

L1885 A Knee upright w/resistance ................................................................ .................... .................... .................... .................... ....................

L1900 A Afo sprng wir drsflx calf bd .............................................................. .................... .................... .................... .................... ....................

L1902 A Afo ankle gauntlet ............................................................................ .................... .................... .................... .................... ....................

L1904 A Afo molded ankle gauntlet ............................................................... .................... .................... .................... .................... ....................

L1906 A Afo multiligamentus ankle su ........................................................... .................... .................... .................... .................... ....................

L1910 A Afo sing bar clasp attach sh ............................................................ .................... .................... .................... .................... ....................

L1920 A Afo sing upright w/ adjust s ............................................................. .................... .................... .................... .................... ....................

L1930 A Afo plastic ......................................................................................... .................... .................... .................... .................... ....................

L1940 A Afo molded to patient plasti ............................................................. .................... .................... .................... .................... ....................

L1945 A Afo molded plas rig ant tib ............................................................... .................... .................... .................... .................... ....................

L1950 A Afo spiral molded to pt plas ............................................................. .................... .................... .................... .................... ....................

L1960 A Afo pos solid ank plastic mo ............................................................ .................... .................... .................... .................... ....................

L1970 A Afo plastic molded w/ankle j ............................................................ .................... .................... .................... .................... ....................

L1980 A Afo sing solid stirrup calf .................................................................. .................... .................... .................... .................... ....................

L1990 A Afo doub solid stirrup calf ................................................................ .................... .................... .................... .................... ....................

L2000 A Kafo sing fre stirr thi/calf .................................................................. .................... .................... .................... .................... ....................

L2010 A Kafo sng solid stirrup w/o j .............................................................. .................... .................... .................... .................... ....................

L2020 A Kafo dbl solid stirrup band/ .............................................................. .................... .................... .................... .................... ....................

L2030 A Kafo dbl solid stirrup w/o j ............................................................... .................... .................... .................... .................... ....................

L2035 A KAFO plastic pediatric size .............................................................. .................... .................... .................... .................... ....................

L2036 A Kafo plas doub free knee mol .......................................................... .................... .................... .................... .................... ....................

L2037 A Kafo plas sing free knee mol ........................................................... .................... .................... .................... .................... ....................

L2038 A Kafo w/o joint multi-axis an .............................................................. .................... .................... .................... .................... ....................

L2039 A KAFO,plstic,medlat rotat con ........................................................... .................... .................... .................... .................... ....................

L2040 A Hkafo torsion bil rot straps ............................................................... .................... .................... .................... .................... ....................

L2050 A Hkafo torsion cable hip pelv ............................................................ .................... .................... .................... .................... ....................

L2060 A Hkafo torsion ball bearing j .............................................................. .................... .................... .................... .................... ....................

L2070 A Hkafo torsion unilat rot str ................................................................ .................... .................... .................... .................... ....................

L2080 A Hkafo unilat torsion cable ................................................................ .................... .................... .................... .................... ....................

L2090 A Hkafo unilat torsion ball br ............................................................... .................... .................... .................... .................... ....................

L2102 A Afo tibial fx cast plstr mol ................................................................. .................... .................... .................... .................... ....................

L2104 A Afo tib fx cast synthetic mo .............................................................. .................... .................... .................... .................... ....................

L2106 A Afo tib fx cast plaster mold .............................................................. .................... .................... .................... .................... ....................

L2108 A Afo tib fx cast molded to pt .............................................................. .................... .................... .................... .................... ....................

L2112 A Afo tibial fracture soft ....................................................................... .................... .................... .................... .................... ....................

L2114 A Afo tib fx semi-rigid .......................................................................... .................... .................... .................... .................... ....................

L2116 A Afo tibial fracture rigid ...................................................................... .................... .................... .................... .................... ....................

L2122 A Kafo fem fx cast plaster mol ............................................................ .................... .................... .................... .................... ....................

L2124 A Kafo fem fx cast synthet mol ........................................................... .................... .................... .................... .................... ....................

L2126 A Kafo fem fx cast thermoplas ............................................................ .................... .................... .................... .................... ....................

L2128 A Kafo fem fx cast molded to p ........................................................... .................... .................... .................... .................... ....................

67987

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L2132 A Kafo femoral fx cast soft .................................................................. .................... .................... .................... .................... ....................

L2134 A Kafo fem fx cast semi-rigid .............................................................. .................... .................... .................... .................... ....................

L2136 A Kafo femoral fx cast rigid ................................................................. .................... .................... .................... .................... ....................

L2180 A Plas shoe insert w ank joint ............................................................. .................... .................... .................... .................... ....................

L2182 A Drop lock knee ................................................................................. .................... .................... .................... .................... ....................

L2184 A Limited motion knee joint ................................................................. .................... .................... .................... .................... ....................

L2186 A Adj motion knee jnt lerman t ............................................................ .................... .................... .................... .................... ....................

L2188 A Quadrilateral brim ............................................................................. .................... .................... .................... .................... ....................

L2190 A Waist belt ......................................................................................... .................... .................... .................... .................... ....................

L2192 A Pelvic band & belt thigh fla .............................................................. .................... .................... .................... .................... ....................

L2200 A Limited ankle motion ea jnt .............................................................. .................... .................... .................... .................... ....................

L2210 A Dorsiflexion assist each joi .............................................................. .................... .................... .................... .................... ....................

L2220 A Dorsi & plantar flex ass/res .............................................................. .................... .................... .................... .................... ....................

L2230 A Split flat caliper stirr & p ................................................................... .................... .................... .................... .................... ....................

L2240 A Round caliper and plate atta ............................................................ .................... .................... .................... .................... ....................

L2250 A Foot plate molded stirrup at ............................................................. .................... .................... .................... .................... ....................

L2260 A Reinforced solid stirrup .................................................................... .................... .................... .................... .................... ....................

L2265 A Long tongue stirrup .......................................................................... .................... .................... .................... .................... ....................

L2270 A Varus/valgus strap padded/li ............................................................ .................... .................... .................... .................... ....................

L2275 A Plastic mod low ext pad/line ............................................................ .................... .................... .................... .................... ....................

L2280 A Molded inner boot ............................................................................ .................... .................... .................... .................... ....................

L2300 A Abduction bar jointed adjust ............................................................ .................... .................... .................... .................... ....................

L2310 A Abduction bar-straight ...................................................................... .................... .................... .................... .................... ....................

L2320 A Non-molded lacer ............................................................................. .................... .................... .................... .................... ....................

L2330 A Lacer molded to patient mode ......................................................... .................... .................... .................... .................... ....................

L2335 A Anterior swing band ......................................................................... .................... .................... .................... .................... ....................

L2340 A Pre-tibial shell molded to p .............................................................. .................... .................... .................... .................... ....................

L2350 A Prosthetic type socket molde ........................................................... .................... .................... .................... .................... ....................

L2360 A Extended steel shank ....................................................................... .................... .................... .................... .................... ....................

L2370 A Patten bottom ................................................................................... .................... .................... .................... .................... ....................

L2375 A Torsion ank & half solid sti .............................................................. .................... .................... .................... .................... ....................

L2380 A Torsion straight knee joint ................................................................ .................... .................... .................... .................... ....................

L2385 A Straight knee joint heavy du ............................................................ .................... .................... .................... .................... ....................

L2390 A Offset knee joint each ...................................................................... .................... .................... .................... .................... ....................

L2395 A Offset knee joint heavy duty ............................................................ .................... .................... .................... .................... ....................

L2397 A Suspension sleeve lower ext ........................................................... .................... .................... .................... .................... ....................

L2405 A Knee joint drop lock ea jnt ............................................................... .................... .................... .................... .................... ....................

L2415 A Knee joint cam lock each joi ............................................................ .................... .................... .................... .................... ....................

L2425 A Knee disc/dial lock/adj flex ............................................................... .................... .................... .................... .................... ....................

L2430 A Knee jnt ratchet lock ea jnt .............................................................. .................... .................... .................... .................... ....................

L2435 A Knee joint polycentric joint ............................................................... .................... .................... .................... .................... ....................

L2492 A Knee lift loop drop lock rin ............................................................... .................... .................... .................... .................... ....................

L2500 A Thi/glut/ischia wgt bearing ............................................................... .................... .................... .................... .................... ....................

L2510 A Th/wght bear quad-lat brim m .......................................................... .................... .................... .................... .................... ....................

L2520 A Th/wght bear quad-lat brim c ........................................................... .................... .................... .................... .................... ....................

L2525 A Th/wght bear nar m-l brim mo ......................................................... .................... .................... .................... .................... ....................

L2526 A Th/wght bear nar m-l brim cu .......................................................... .................... .................... .................... .................... ....................

L2530 A Thigh/wght bear lacer non-mo ......................................................... .................... .................... .................... .................... ....................

L2540 A Thigh/wght bear lacer molded ......................................................... .................... .................... .................... .................... ....................

L2550 A Thigh/wght bear high roll cu ............................................................ .................... .................... .................... .................... ....................

L2570 A Hip clevis type 2 posit jnt ................................................................. .................... .................... .................... .................... ....................

L2580 A Pelvic control pelvic sling ................................................................. .................... .................... .................... .................... ....................

L2600 A Hip clevis/thrust bearing fr ............................................................... .................... .................... .................... .................... ....................

L2610 A Hip clevis/thrust bearing lo ............................................................... .................... .................... .................... .................... ....................

L2620 A Pelvic control hip heavy dut ............................................................. .................... .................... .................... .................... ....................

L2622 A Hip joint adjustable flexion ............................................................... .................... .................... .................... .................... ....................

L2624 A Hip adj flex ext abduct cont ............................................................. .................... .................... .................... .................... ....................

L2627 A Plastic mold recipro hip & c ............................................................. .................... .................... .................... .................... ....................

L2628 A Metal frame recipro hip & ca ........................................................... .................... .................... .................... .................... ....................

L2630 A Pelvic control band & belt u ............................................................. .................... .................... .................... .................... ....................

L2640 A Pelvic control band & belt b ............................................................. .................... .................... .................... .................... ....................

L2650 A Pelv & thor control gluteal ................................................................ .................... .................... .................... .................... ....................

L2660 A Thoracic control thoracic ba ............................................................. .................... .................... .................... .................... ....................

L2670 A Thorac cont paraspinal uprig ........................................................... .................... .................... .................... .................... ....................

L2680 A Thorac cont lat support upri ............................................................. .................... .................... .................... .................... ....................

L2750 A Plating chrome/nickel pr bar ............................................................ .................... .................... .................... .................... ....................

L2755 A Carbon graphite lamination .............................................................. .................... .................... .................... .................... ....................

L2760 A Extension per extension per ............................................................ .................... .................... .................... .................... ....................

L2770 A Low ext orthosis per bar/jnt ............................................................. .................... .................... .................... .................... ....................

L2780 A Non-corrosive finish ......................................................................... .................... .................... .................... .................... ....................

L2785 A Drop lock retainer each .................................................................... .................... .................... .................... .................... ....................

L2795 A Knee control full kneecap ................................................................ .................... .................... .................... .................... ....................

L2800 A Knee cap medial or lateral p ............................................................ .................... .................... .................... .................... ....................

L2810 A Knee control condylar pad ............................................................... .................... .................... .................... .................... ....................

67988

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L2820 A Soft interface below knee se ........................................................... .................... .................... .................... .................... ....................

L2830 A Soft interface above knee se ........................................................... .................... .................... .................... .................... ....................

L2840 A Tibial length sock fx or equ .............................................................. .................... .................... .................... .................... ....................

L2850 A Femoral lgth sock fx or equa ........................................................... .................... .................... .................... .................... ....................

L2860 A Torsion mechanism knee/ankle ....................................................... .................... .................... .................... .................... ....................

L2999 A Lower extremity orthosis NOS ......................................................... .................... .................... .................... .................... ....................

L3000 E Ft insert ucb berkeley shell .............................................................. .................... .................... .................... .................... ....................

L3001 E Foot insert remov molded spe ......................................................... .................... .................... .................... .................... ....................

L3002 E Foot insert plastazote or eq ............................................................. .................... .................... .................... .................... ....................

L3003 E Foot insert silicone gel eac .............................................................. .................... .................... .................... .................... ....................

L3010 E Foot longitudinal arch suppo ............................................................ .................... .................... .................... .................... ....................

L3020 E Foot longitud/metatarsal sup ............................................................ .................... .................... .................... .................... ....................

L3030 E Foot arch support remov prem ........................................................ .................... .................... .................... .................... ....................

L3040 E Ft arch suprt premold longit ............................................................. .................... .................... .................... .................... ....................

L3050 E Foot arch supp premold metat ......................................................... .................... .................... .................... .................... ....................

L3060 E Foot arch supp longitud/meta .......................................................... .................... .................... .................... .................... ....................

L3070 E Arch suprt att to sho longit ............................................................... .................... .................... .................... .................... ....................

L3080 E Arch supp att to shoe metata .......................................................... .................... .................... .................... .................... ....................

L3090 E Arch supp att to shoe long/m ........................................................... .................... .................... .................... .................... ....................

L3100 E Hallus-valgus nght dynamic s .......................................................... .................... .................... .................... .................... ....................

L3140 E Abduction rotation bar shoe ............................................................. .................... .................... .................... .................... ....................

L3150 E Abduct rotation bar w/o shoe ........................................................... .................... .................... .................... .................... ....................

L3160 E Shoe styled positioning dev ............................................................. .................... .................... .................... .................... ....................

L3170 E Foot plastic heel stabilizer ............................................................... .................... .................... .................... .................... ....................

L3201 E Oxford w supinat/pronat inf .............................................................. .................... .................... .................... .................... ....................

L3202 E Oxford w/ supinat/pronator c ............................................................ .................... .................... .................... .................... ....................

L3203 E Oxford w/ supinator/pronator ........................................................... .................... .................... .................... .................... ....................

L3204 E Hightop w/ supp/pronator inf ............................................................ .................... .................... .................... .................... ....................

L3206 E Hightop w/ supp/pronator chi ........................................................... .................... .................... .................... .................... ....................

L3207 E Hightop w/ supp/pronator jun ........................................................... .................... .................... .................... .................... ....................

L3208 E Surgical boot each infant ................................................................. .................... .................... .................... .................... ....................

L3209 E Surgical boot each child ................................................................... .................... .................... .................... .................... ....................

L3211 E Surgical boot each junior ................................................................. .................... .................... .................... .................... ....................

L3212 E Benesch boot pair infant .................................................................. .................... .................... .................... .................... ....................

L3213 E Benesch boot pair child ................................................................... .................... .................... .................... .................... ....................

L3214 E Benesch boot pair junior .................................................................. .................... .................... .................... .................... ....................

L3215 E Orthopedic ftwear ladies oxf ............................................................ .................... .................... .................... .................... ....................

L3216 E Orthoped ladies shoes dpth i ........................................................... .................... .................... .................... .................... ....................

L3217 E Ladies shoes hightop depth i ........................................................... .................... .................... .................... .................... ....................

L3218 E Ladies surgical boot each ................................................................ .................... .................... .................... .................... ....................

L3219 E Orthopedic mens shoes oxford ........................................................ .................... .................... .................... .................... ....................

L3221 E Orthopedic mens shoes dpth i ......................................................... .................... .................... .................... .................... ....................

L3222 E Mens shoes hightop depth inl .......................................................... .................... .................... .................... .................... ....................

L3223 E Mens surgical boot each .................................................................. .................... .................... .................... .................... ....................

L3224 A Woman’s shoe oxford brace ............................................................ .................... .................... .................... .................... ....................

L3225 A Man’s shoe oxford brace ................................................................. .................... .................... .................... .................... ....................

L3230 E Custom shoes depth inlay ............................................................... .................... .................... .................... .................... ....................

L3250 E Custom mold shoe remov prost ....................................................... .................... .................... .................... .................... ....................

L3251 E Shoe molded to pt silicone s ........................................................... .................... .................... .................... .................... ....................

L3252 E Shoe molded plastazote cust ........................................................... .................... .................... .................... .................... ....................

L3253 E Shoe molded plastazote cust ........................................................... .................... .................... .................... .................... ....................

L3254 E Orth foot non-stndard size/w ............................................................ .................... .................... .................... .................... ....................

L3255 E Orth foot non-standard size/ ............................................................ .................... .................... .................... .................... ....................

L3257 E Orth foot add charge split s ............................................................. .................... .................... .................... .................... ....................

L3260 E Ambulatory surgical boot eac .......................................................... .................... .................... .................... .................... ....................

L3265 E Plastazote sandal each .................................................................... .................... .................... .................... .................... ....................

L3300 E Sho lift taper to metatarsal ............................................................... .................... .................... .................... .................... ....................

L3310 E Shoe lift elev heel/sole neo .............................................................. .................... .................... .................... .................... ....................

L3320 E Shoe lift elev heel/sole cor ............................................................... .................... .................... .................... .................... ....................

L3330 E Lifts elevation metal extens ............................................................. .................... .................... .................... .................... ....................

L3332 E Shoe lifts tapered to one-ha ............................................................ .................... .................... .................... .................... ....................

L3334 E Shoe lifts elevation heel /i ................................................................ .................... .................... .................... .................... ....................

L3340 E Shoe wedge sach ............................................................................ .................... .................... .................... .................... ....................

L3350 E Shoe heel wedge ............................................................................. .................... .................... .................... .................... ....................

L3360 E Shoe sole wedge outside sole ......................................................... .................... .................... .................... .................... ....................

L3370 E Shoe sole wedge between sole ....................................................... .................... .................... .................... .................... ....................

L3380 E Shoe clubfoot wedge ....................................................................... .................... .................... .................... .................... ....................

L3390 E Shoe outflare wedge ........................................................................ .................... .................... .................... .................... ....................

L3400 E Shoe metatarsal bar wedge ro ........................................................ .................... .................... .................... .................... ....................

L3410 E Shoe metatarsal bar between .......................................................... .................... .................... .................... .................... ....................

L3420 E Full sole/heel wedge btween ........................................................... .................... .................... .................... .................... ....................

L3430 E Sho heel count plast reinfor ............................................................. .................... .................... .................... .................... ....................

L3440 E Heel leather reinforced ..................................................................... .................... .................... .................... .................... ....................

L3450 E Shoe heel sach cushion type ........................................................... .................... .................... .................... .................... ....................

67989

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L3455 E Shoe heel new leather standa ......................................................... .................... .................... .................... .................... ....................

L3460 E Shoe heel new rubber standar ........................................................ .................... .................... .................... .................... ....................

L3465 E Shoe heel thomas with wedge ......................................................... .................... .................... .................... .................... ....................

L3470 E Shoe heel thomas extend to b ......................................................... .................... .................... .................... .................... ....................

L3480 E Shoe heel pad & depress for ........................................................... .................... .................... .................... .................... ....................

L3485 E Shoe heel pad removable for .......................................................... .................... .................... .................... .................... ....................

L3500 E Ortho shoe add leather insol ........................................................... .................... .................... .................... .................... ....................

L3510 E Orthopedic shoe add rub insl ........................................................... .................... .................... .................... .................... ....................

L3520 E O shoe add felt w leath insl ............................................................. .................... .................... .................... .................... ....................

L3530 E Ortho shoe add half sole ................................................................. .................... .................... .................... .................... ....................

L3540 E Ortho shoe add full sole ................................................................... .................... .................... .................... .................... ....................

L3550 E O shoe add standard toe tap ........................................................... .................... .................... .................... .................... ....................

L3560 E O shoe add horseshoe toe tap ........................................................ .................... .................... .................... .................... ....................

L3570 E O shoe add instep extension ........................................................... .................... .................... .................... .................... ....................

L3580 E O shoe add instep velcro clo ........................................................... .................... .................... .................... .................... ....................

L3590 E O shoe convert to sof counte .......................................................... .................... .................... .................... .................... ....................

L3595 E Ortho shoe add march bar ............................................................... .................... .................... .................... .................... ....................

L3600 E Trans shoe calip plate exist ............................................................. .................... .................... .................... .................... ....................

L3610 E Trans shoe caliper plate new ........................................................... .................... .................... .................... .................... ....................

L3620 E Trans shoe solid stirrup exi .............................................................. .................... .................... .................... .................... ....................

L3630 E Trans shoe solid stirrup new ............................................................ .................... .................... .................... .................... ....................

L3640 E Shoe dennis browne splint bo ......................................................... .................... .................... .................... .................... ....................

L3649 E Orthopedic shoe modifica NOS ....................................................... .................... .................... .................... .................... ....................

L3650 A Shlder fig 8 abduct restrain .............................................................. .................... .................... .................... .................... ....................

L3660 A Abduct restrainer canvas&web ........................................................ .................... .................... .................... .................... ....................

L3670 A Acromio/clavicular canvas&we ......................................................... .................... .................... .................... .................... ....................

L3675 A Canvas vest SO ............................................................................... .................... .................... .................... .................... ....................

L3700 A Elbow orthoses elas w stays ........................................................... .................... .................... .................... .................... ....................

L3710 A Elbow elastic with metal joi .............................................................. .................... .................... .................... .................... ....................

L3720 A Forearm/arm cuffs free motio .......................................................... .................... .................... .................... .................... ....................

L3730 A Forearm/arm cuffs ext/flex a ............................................................ .................... .................... .................... .................... ....................

L3740 A Cuffs adj lock w/ active con ............................................................. .................... .................... .................... .................... ....................

L3760 A EO withjoint, Prefabricated .............................................................. .................... .................... .................... .................... ....................

L3800 A Whfo short opponen no attach ........................................................ .................... .................... .................... .................... ....................

L3805 A Whfo long opponens no attach ........................................................ .................... .................... .................... .................... ....................

L3807 A Whfo w inflatable airchamber .......................................................... .................... .................... .................... .................... ....................

L3810 A Whfo thumb abduction bar ............................................................... .................... .................... .................... .................... ....................

L3815 A Whfo second m.p. abduction a ........................................................ .................... .................... .................... .................... ....................

L3820 A Whfo ip ext asst w/ mp ext s ........................................................... .................... .................... .................... .................... ....................

L3825 A Whfo m.p. extension stop ................................................................ .................... .................... .................... .................... ....................

L3830 A Whfo m.p. extension assist .............................................................. .................... .................... .................... .................... ....................

L3835 A Whfo m.p. spring extension a .......................................................... .................... .................... .................... .................... ....................

L3840 A Whfo spring swivel thumb ................................................................ .................... .................... .................... .................... ....................

L3845 A Whfo thumb ip ext ass w/ mp .......................................................... .................... .................... .................... .................... ....................

L3850 A Action wrist w/ dorsiflex as .............................................................. .................... .................... .................... .................... ....................

L3855 A Whfo adj m.p. flexion contro ............................................................ .................... .................... .................... .................... ....................

L3860 A Whfo adj m.p. flex ctrl & i. ............................................................... .................... .................... .................... .................... ....................

L3890 E Torsion mechanism wrist/elbo ......................................................... .................... .................... .................... .................... ....................

L3900 A Hinge extension/flex wrist/f .............................................................. .................... .................... .................... .................... ....................

L3901 A Hinge ext/flex wrist finger ................................................................. .................... .................... .................... .................... ....................

L3902 A Whfo ext power compress gas ........................................................ .................... .................... .................... .................... ....................

L3904 A Whfo electric custom fitted ............................................................... .................... .................... .................... .................... ....................

L3906 A Wrist gauntlet molded to pt .............................................................. .................... .................... .................... .................... ....................

L3907 A Whfo wrst gauntlt thmb spica .......................................................... .................... .................... .................... .................... ....................

L3908 A Wrist cock-up non-molded ............................................................... .................... .................... .................... .................... ....................

L3910 A Whfo swanson design ...................................................................... .................... .................... .................... .................... ....................

L3912 A Flex glove w/elastic finger ................................................................ .................... .................... .................... .................... ....................

L3914 A WHO wrist extension cock-up .......................................................... .................... .................... .................... .................... ....................

L3916 A Whfo wrist extens w/ outrigg ............................................................ .................... .................... .................... .................... ....................

L3918 A HFO knuckle bender ........................................................................ .................... .................... .................... .................... ....................

L3920 A Knuckle bender with outrigge .......................................................... .................... .................... .................... .................... ....................

L3922 A Knuckle bend 2 seg to flex j ............................................................ .................... .................... .................... .................... ....................

L3923 A HFO, no joint, prefabricated ............................................................. .................... .................... .................... .................... ....................

L3924 A Oppenheimer .................................................................................... .................... .................... .................... .................... ....................

L3926 A Thomas suspension ......................................................................... .................... .................... .................... .................... ....................

L3928 A Finger extension w/ clock sp ........................................................... .................... .................... .................... .................... ....................

L3930 A Finger extension with wrist .............................................................. .................... .................... .................... .................... ....................

L3932 A Safety pin spring wire ...................................................................... .................... .................... .................... .................... ....................

L3934 A Safety pin modified .......................................................................... .................... .................... .................... .................... ....................

L3936 A Palmer .............................................................................................. .................... .................... .................... .................... ....................

L3938 A Dorsal wrist ...................................................................................... .................... .................... .................... .................... ....................

L3940 A Dorsal wrist w/ outrigger at .............................................................. .................... .................... .................... .................... ....................

L3942 A Reverse knuckle bender .................................................................. .................... .................... .................... .................... ....................

L3944 A Reverse knuckle bend w/ outr ......................................................... .................... .................... .................... .................... ....................

67990

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L3946 A HFO composite elastic ..................................................................... .................... .................... .................... .................... ....................

L3948 A Finger knuckle bender ..................................................................... .................... .................... .................... .................... ....................

L3950 A Oppenheimer w/ knuckle bend ........................................................ .................... .................... .................... .................... ....................

L3952 A Oppenheimer w/ rev knuckle 2 ........................................................ .................... .................... .................... .................... ....................

L3954 A Spreading hand ................................................................................ .................... .................... .................... .................... ....................

L3956 A Add joint upper ext orthosis ............................................................. .................... .................... .................... .................... ....................

L3960 A Sewho airplan desig abdu pos ........................................................ .................... .................... .................... .................... ....................

L3962 A Sewho erbs palsey design abd ........................................................ .................... .................... .................... .................... ....................

L3963 A Molded w/ articulating elbow ............................................................ .................... .................... .................... .................... ....................

L3964 A Seo mobile arm sup att to wc .......................................................... .................... .................... .................... .................... ....................

L3965 A Arm supp att to wc rancho ty ........................................................... .................... .................... .................... .................... ....................

L3966 A Mobile arm supports reclinin ............................................................ .................... .................... .................... .................... ....................

L3968 A Friction dampening arm supp .......................................................... .................... .................... .................... .................... ....................

L3969 A Monosuspension arm/hand supp ..................................................... .................... .................... .................... .................... ....................

L3970 A Elevat proximal arm support ............................................................ .................... .................... .................... .................... ....................

L3972 A Offset/lat rocker arm w/ ela .............................................................. .................... .................... .................... .................... ....................

L3974 A Mobile arm support supinator .......................................................... .................... .................... .................... .................... ....................

L3980 A Upp ext fx orthosis humeral ............................................................. .................... .................... .................... .................... ....................

L3982 A Upper ext fx orthosis rad/ul .............................................................. .................... .................... .................... .................... ....................

L3984 A Upper ext fx orthosis wrist ............................................................... .................... .................... .................... .................... ....................

L3985 A Forearm hand fx orth w/ wr h .......................................................... .................... .................... .................... .................... ....................

L3986 A Humeral rad/ulna wrist fx or ............................................................. .................... .................... .................... .................... ....................

L3995 A Sock fracture or equal each ............................................................. .................... .................... .................... .................... ....................

L3999 A Upper limb orthosis NOS ................................................................. .................... .................... .................... .................... ....................

L4000 A Repl girdle milwaukee orth .............................................................. .................... .................... .................... .................... ....................

L4010 A Replace trilateral socket br .............................................................. .................... .................... .................... .................... ....................

L4020 A Replace quadlat socket brim ........................................................... .................... .................... .................... .................... ....................

L4030 A Replace socket brim cust fit ............................................................. .................... .................... .................... .................... ....................

L4040 A Replace molded thigh lacer ............................................................. .................... .................... .................... .................... ....................

L4045 A Replace non-molded thigh lac ......................................................... .................... .................... .................... .................... ....................

L4050 A Replace molded calf lacer ............................................................... .................... .................... .................... .................... ....................

L4055 A Replace non-molded calf lace ......................................................... .................... .................... .................... .................... ....................

L4060 A Replace high roll cuff ....................................................................... .................... .................... .................... .................... ....................

L4070 A Replace prox & dist upright ............................................................. .................... .................... .................... .................... ....................

L4080 A Repl met band kafo-afo prox ........................................................... .................... .................... .................... .................... ....................

L4090 A Repl met band kafo-afo calf/ ............................................................ .................... .................... .................... .................... ....................

L4100 A Repl leath cuff kafo prox th .............................................................. .................... .................... .................... .................... ....................

L4110 A Repl leath cuff kafo-afo cal .............................................................. .................... .................... .................... .................... ....................

L4130 A Replace pretibial shell ...................................................................... .................... .................... .................... .................... ....................

L4205 A Ortho dvc repair per 15 min ............................................................. .................... .................... .................... .................... ....................

L4210 A Orth dev repair/repl minor p ............................................................. .................... .................... .................... .................... ....................

L4350 A Pneumatic ankle cntrl splint ............................................................. .................... .................... .................... .................... ....................

L4360 A Pneumatic walking splint .................................................................. .................... .................... .................... .................... ....................

L4370 A Pneumatic full leg splint ................................................................... .................... .................... .................... .................... ....................

L4380 A Pneumatic knee splint ...................................................................... .................... .................... .................... .................... ....................

L4392 A Replace AFO soft interface .............................................................. .................... .................... .................... .................... ....................

L4394 A Replace foot drop spint .................................................................... .................... .................... .................... .................... ....................

L4396 A Static AFO ........................................................................................ .................... .................... .................... .................... ....................

L4398 A Foot drop splint recumbent .............................................................. .................... .................... .................... .................... ....................

L5000 A Sho insert w arch toe filler ............................................................... .................... .................... .................... .................... ....................

L5010 A Mold socket ank hgt w/ toe f ............................................................ .................... .................... .................... .................... ....................

L5020 A Tibial tubercle hgt w/ toe f ............................................................... .................... .................... .................... .................... ....................

L5050 A Ank symes mold sckt sach ft ........................................................... .................... .................... .................... .................... ....................

L5060 A Symes met fr leath socket ar ........................................................... .................... .................... .................... .................... ....................

L5100 A Molded socket shin sach foot .......................................................... .................... .................... .................... .................... ....................

L5105 A Plast socket jts/thgh lacer ................................................................ .................... .................... .................... .................... ....................

L5150 A Mold sckt ext knee shin sach .......................................................... .................... .................... .................... .................... ....................

L5160 A Mold socket bent knee shin s .......................................................... .................... .................... .................... .................... ....................

L5200 A Kne sing axis fric shin sach ............................................................. .................... .................... .................... .................... ....................

L5210 A No knee/ankle joints w/ ft b ............................................................. .................... .................... .................... .................... ....................

L5220 A No knee joint with artic ali ................................................................ .................... .................... .................... .................... ....................

L5230 A Fem focal defic constant fri .............................................................. .................... .................... .................... .................... ....................

L5250 A Hip canad sing axi cons fric ............................................................. .................... .................... .................... .................... ....................

L5270 A Tilt table locking hip sing ................................................................. .................... .................... .................... .................... ....................

L5280 A Hemipelvect canad sing axis ........................................................... .................... .................... .................... .................... ....................

L5300 A Bk sach soft cover & finish .............................................................. .................... .................... .................... .................... ....................

L5310 A Knee disart sach soft cv/fin .............................................................. .................... .................... .................... .................... ....................

L5320 A Ak open end sach soft cv/fin ........................................................... .................... .................... .................... .................... ....................

L5330 A Hip canadian sach sft cv/fin ............................................................. .................... .................... .................... .................... ....................

L5340 A Hemipelvectomy canad cv/fin .......................................................... .................... .................... .................... .................... ....................

L5400 A Postop dress & 1 cast chg bk .......................................................... .................... .................... .................... .................... ....................

L5410 A Postop dsg bk ea add cast ch ......................................................... .................... .................... .................... .................... ....................

L5420 A Postop dsg & 1 cast chg ak/d .......................................................... .................... .................... .................... .................... ....................

L5430 A Postop dsg ak ea add cast ch ......................................................... .................... .................... .................... .................... ....................

67991

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L5450 A Postop app non-wgt bear dsg .......................................................... .................... .................... .................... .................... ....................

L5460 A Postop app non-wgt bear dsg .......................................................... .................... .................... .................... .................... ....................

L5500 A Init bk ptb plaster direct ................................................................... .................... .................... .................... .................... ....................

L5505 A Init ak ischal plstr direct ................................................................... .................... .................... .................... .................... ....................

L5510 A Prep BK ptb plaster molded ............................................................. .................... .................... .................... .................... ....................

L5520 A Perp BK ptb thermopls direct ........................................................... .................... .................... .................... .................... ....................

L5530 A Prep BK ptb thermopls molded ........................................................ .................... .................... .................... .................... ....................

L5535 A Prep BK ptb open end socket .......................................................... .................... .................... .................... .................... ....................

L5540 A Prep BK ptb laminated socket ......................................................... .................... .................... .................... .................... ....................

L5560 A Prep AK ischial plast molded ........................................................... .................... .................... .................... .................... ....................

L5570 A Prep AK ischial direct form .............................................................. .................... .................... .................... .................... ....................

L5580 A Prep AK ischial thermo mold ........................................................... .................... .................... .................... .................... ....................

L5585 A Prep AK ischial open end ................................................................ .................... .................... .................... .................... ....................

L5590 A Prep AK ischial laminated ................................................................ .................... .................... .................... .................... ....................

L5595 A Hip disartic sach thermopls .............................................................. .................... .................... .................... .................... ....................

L5600 A Hip disart sach laminat mold ........................................................... .................... .................... .................... .................... ....................

L5610 A Above knee hydracadence .............................................................. .................... .................... .................... .................... ....................

L5611 A Ak 4 bar link w/fric swing ................................................................. .................... .................... .................... .................... ....................

L5613 A Ak 4 bar ling w/hydraul swig ............................................................ .................... .................... .................... .................... ....................

L5614 A 4-bar link above knee w/swng ......................................................... .................... .................... .................... .................... ....................

L5616 A Ak univ multiplex sys frict ................................................................ .................... .................... .................... .................... ....................

L5617 A AK/BK self-aligning unit ea .............................................................. .................... .................... .................... .................... ....................

L5618 A Test socket symes ........................................................................... .................... .................... .................... .................... ....................

L5620 A Test socket below knee ................................................................... .................... .................... .................... .................... ....................

L5622 A Test socket knee disarticula ............................................................ .................... .................... .................... .................... ....................

L5624 A Test socket above knee ................................................................... .................... .................... .................... .................... ....................

L5626 A Test socket hip disarticulat .............................................................. .................... .................... .................... .................... ....................

L5628 A Test socket hemipelvectomy ............................................................ .................... .................... .................... .................... ....................

L5629 A Below knee acrylic socket ................................................................ .................... .................... .................... .................... ....................

L5630 A Syme typ expandabl wall sckt ......................................................... .................... .................... .................... .................... ....................

L5631 A Ak/knee disartic acrylic soc .............................................................. .................... .................... .................... .................... ....................

L5632 A Symes type ptb brim design s ......................................................... .................... .................... .................... .................... ....................

L5634 A Symes type poster opening so ........................................................ .................... .................... .................... .................... ....................

L5636 A Symes type medial opening so ........................................................ .................... .................... .................... .................... ....................

L5637 A Below knee total contact .................................................................. .................... .................... .................... .................... ....................

L5638 A Below knee leather socket ............................................................... .................... .................... .................... .................... ....................

L5639 A Below knee wood socket ................................................................. .................... .................... .................... .................... ....................

L5640 A Knee disarticulat leather so ............................................................. .................... .................... .................... .................... ....................

L5642 A Above knee leather socket .............................................................. .................... .................... .................... .................... ....................

L5643 A Hip flex inner socket ext fr ............................................................... .................... .................... .................... .................... ....................

L5644 A Above knee wood socket ................................................................. .................... .................... .................... .................... ....................

L5645 A Ak flexibl inner socket ext ................................................................ .................... .................... .................... .................... ....................

L5646 A Below knee air cushion socke ......................................................... .................... .................... .................... .................... ....................

L5647 A Below knee suction socket .............................................................. .................... .................... .................... .................... ....................

L5648 A Above knee air cushion socke ......................................................... .................... .................... .................... .................... ....................

L5649 A Isch containmt/narrow m-l so ........................................................... .................... .................... .................... .................... ....................

L5650 A Tot contact ak/knee disart s ............................................................. .................... .................... .................... .................... ....................

L5651 A Ak flex inner socket ext fra .............................................................. .................... .................... .................... .................... ....................

L5652 A Suction susp ak/knee disart ............................................................. .................... .................... .................... .................... ....................

L5653 A Knee disart expand wall sock .......................................................... .................... .................... .................... .................... ....................

L5654 A Socket insert symes ......................................................................... .................... .................... .................... .................... ....................

L5655 A Socket insert below knee ................................................................. .................... .................... .................... .................... ....................

L5656 A Socket insert knee articulat .............................................................. .................... .................... .................... .................... ....................

L5658 A Socket insert above knee ................................................................ .................... .................... .................... .................... ....................

L5660 A Sock insrt syme silicone gel ............................................................ .................... .................... .................... .................... ....................

L5661 A Multi-durometer symes ..................................................................... .................... .................... .................... .................... ....................

L5662 A Socket insert bk silicone ge ............................................................. .................... .................... .................... .................... ....................

L5663 A Sock knee disartic silicone ............................................................... .................... .................... .................... .................... ....................

L5664 A Socket insert ak silicone ge ............................................................. .................... .................... .................... .................... ....................

L5665 A Multi-durometer below knee ............................................................. .................... .................... .................... .................... ....................

L5666 A Below knee cuff suspension ............................................................ .................... .................... .................... .................... ....................

L5667 A Socket insert w lock lower ............................................................... .................... .................... .................... .................... ....................

L5668 A Socket insert w/o lock lower ............................................................ .................... .................... .................... .................... ....................

L5669 A Below knee socket w/o lock ............................................................. .................... .................... .................... .................... ....................

L5670 A Bk molded supracondylar susp ........................................................ .................... .................... .................... .................... ....................

L5672 A Bk removable medial brim sus ........................................................ .................... .................... .................... .................... ....................

L5674 A Bk latex sleeve suspension/e .......................................................... .................... .................... .................... .................... ....................

L5675 A Bk latex sleeve susp/eq hvy ............................................................ .................... .................... .................... .................... ....................

L5676 A Bk knee joints single axis p ............................................................. .................... .................... .................... .................... ....................

L5677 A Bk knee joints polycentric p ............................................................. .................... .................... .................... .................... ....................

L5678 A Bk joint covers pair .......................................................................... .................... .................... .................... .................... ....................

L5680 A Bk thigh lacer non-molded ............................................................... .................... .................... .................... .................... ....................

L5682 A Bk thigh lacer glut/ischia m .............................................................. .................... .................... .................... .................... ....................

L5684 A Bk fork strap ..................................................................................... .................... .................... .................... .................... ....................

67992

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L5686 A Bk back check .................................................................................. .................... .................... .................... .................... ....................

L5688 A Bk waist belt webbing ...................................................................... .................... .................... .................... .................... ....................

L5690 A Bk waist belt padded and lin ............................................................ .................... .................... .................... .................... ....................

L5692 A Ak pelvic control belt light ................................................................ .................... .................... .................... .................... ....................

L5694 A Ak pelvic control belt pad/l ............................................................... .................... .................... .................... .................... ....................

L5695 A Ak sleeve susp neoprene/equa ....................................................... .................... .................... .................... .................... ....................

L5696 A Ak/knee disartic pelvic join ............................................................... .................... .................... .................... .................... ....................

L5697 A Ak/knee disartic pelvic band ............................................................ .................... .................... .................... .................... ....................

L5698 A Ak/knee disartic silesian ba ............................................................. .................... .................... .................... .................... ....................

L5699 A Shoulder harness ............................................................................. .................... .................... .................... .................... ....................

L5700 A Replace socket below knee ............................................................. .................... .................... .................... .................... ....................

L5701 A Replace socket above knee ............................................................. .................... .................... .................... .................... ....................

L5702 A Replace socket hip ........................................................................... .................... .................... .................... .................... ....................

L5704 A Custom shape covr below knee ...................................................... .................... .................... .................... .................... ....................

L5705 A Custm shape cover above knee ...................................................... .................... .................... .................... .................... ....................

L5706 A Custm shape cvr knee disart ........................................................... .................... .................... .................... .................... ....................

L5707 A Custm shape cover hip disart .......................................................... .................... .................... .................... .................... ....................

L5710 A Kne-shin exo sng axi mnl loc ........................................................... .................... .................... .................... .................... ....................

L5711 A Knee-shin exo mnl lock ultra ........................................................... .................... .................... .................... .................... ....................

L5712 A Knee-shin exo frict swg & st ............................................................ .................... .................... .................... .................... ....................

L5714 A Knee-shin exo variable frict ............................................................. .................... .................... .................... .................... ....................

L5716 A Knee-shin exo mech stance ph ....................................................... .................... .................... .................... .................... ....................

L5718 A Knee-shin exo frct swg & sta ........................................................... .................... .................... .................... .................... ....................

L5722 A Knee-shin pneum swg frct exo ........................................................ .................... .................... .................... .................... ....................

L5724 A Knee-shin exo fluid swing ph ........................................................... .................... .................... .................... .................... ....................

L5726 A Knee-shin ext jnts fld swg e ............................................................. .................... .................... .................... .................... ....................

L5728 A Knee-shin fluid swg & stance .......................................................... .................... .................... .................... .................... ....................

L5780 A Knee-shin pneum/hydra pneum ....................................................... .................... .................... .................... .................... ....................

L5785 A Exoskeletal bk ultralt mater .............................................................. .................... .................... .................... .................... ....................

L5790 A Exoskeletal ak ultra-light m .............................................................. .................... .................... .................... .................... ....................

L5795 A Exoskel hip ultra-light mate .............................................................. .................... .................... .................... .................... ....................

L5810 A Endoskel knee-shin mnl lock ........................................................... .................... .................... .................... .................... ....................

L5811 A Endo knee-shin mnl lck ultra ........................................................... .................... .................... .................... .................... ....................

L5812 A Endo knee-shin frct swg & st ........................................................... .................... .................... .................... .................... ....................

L5814 A Endo knee-shin hydral swg ph ........................................................ .................... .................... .................... .................... ....................

L5816 A Endo knee-shin polyc mch sta ......................................................... .................... .................... .................... .................... ....................

L5818 A Endo knee-shin frct swg & st ........................................................... .................... .................... .................... .................... ....................

L5822 A Endo knee-shin pneum swg frc ....................................................... .................... .................... .................... .................... ....................

L5824 A Endo knee-shin fluid swing p ........................................................... .................... .................... .................... .................... ....................

L5826 A Miniature knee joint .......................................................................... .................... .................... .................... .................... ....................

L5828 A Endo knee-shin fluid swg/sta ........................................................... .................... .................... .................... .................... ....................

L5830 A Endo knee-shin pneum/swg pha ..................................................... .................... .................... .................... .................... ....................

L5840 A Multi-axial knee/shin system ............................................................ .................... .................... .................... .................... ....................

L5845 A Knee-shin sys stance flexion ........................................................... .................... .................... .................... .................... ....................

L5846 A Knee-shin sys microprocessor ......................................................... .................... .................... .................... .................... ....................

L5850 A Endo ak/hip knee extens assi .......................................................... .................... .................... .................... .................... ....................

L5855 A Mech hip extension assist ................................................................ .................... .................... .................... .................... ....................

L5910 A Endo below knee alignable sy ......................................................... .................... .................... .................... .................... ....................

L5920 A Endo ak/hip alignable system .......................................................... .................... .................... .................... .................... ....................

L5925 A Above knee manual lock .................................................................. .................... .................... .................... .................... ....................

L5930 A High activity knee frame .................................................................. .................... .................... .................... .................... ....................

L5940 A Endo bk ultra-light material .............................................................. .................... .................... .................... .................... ....................

L5950 A Endo ak ultra-light material .............................................................. .................... .................... .................... .................... ....................

L5960 A Endo hip ultra-light materia .............................................................. .................... .................... .................... .................... ....................

L5962 A Below knee flex cover system ......................................................... .................... .................... .................... .................... ....................

L5964 A Above knee flex cover system ......................................................... .................... .................... .................... .................... ....................

L5966 A Hip flexible cover system ................................................................. .................... .................... .................... .................... ....................

L5968 A Multiaxial ankle w dorsiflex .............................................................. .................... .................... .................... .................... ....................

L5970 A Foot external keel sach foot ............................................................ .................... .................... .................... .................... ....................

L5972 A Flexible keel foot .............................................................................. .................... .................... .................... .................... ....................

L5974 A Foot single axis ankle/foot ............................................................... .................... .................... .................... .................... ....................

L5975 A Combo ankle/foot prosthesis ........................................................... .................... .................... .................... .................... ....................

L5976 A Energy storing foot ........................................................................... .................... .................... .................... .................... ....................

L5978 A Ft prosth multiaxial ankl/ft ................................................................ .................... .................... .................... .................... ....................

L5979 A Multi-axial ankle/ft prosth ................................................................. .................... .................... .................... .................... ....................

L5980 A Flex foot system ............................................................................... .................... .................... .................... .................... ....................

L5981 A Flex-walk sys low ext prosth ............................................................ .................... .................... .................... .................... ....................

L5982 A Exoskeletal axial rotation u .............................................................. .................... .................... .................... .................... ....................

L5984 A Endoskeletal axial rotation ............................................................... .................... .................... .................... .................... ....................

L5985 A Lwr ext dynamic prosth pylon .......................................................... .................... .................... .................... .................... ....................

L5986 A Multi-axial rotation unit ..................................................................... .................... .................... .................... .................... ....................

L5987 A Shank ft w vert load pylon ............................................................... .................... .................... .................... .................... ....................

L5988 A Vertical shock reducing pylo ............................................................ .................... .................... .................... .................... ....................

L5999 A Lowr extremity prosthes NOS .......................................................... .................... .................... .................... .................... ....................

67993

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L6000 A Par hand robin-aids thum rem ......................................................... .................... .................... .................... .................... ....................

L6010 A Hand robin-aids little/ring ................................................................. .................... .................... .................... .................... ....................

L6020 A Part hand robin-aids no fing ............................................................ .................... .................... .................... .................... ....................

L6050 A Wrst MLd sck flx hng tri pad ............................................................ .................... .................... .................... .................... ....................

L6055 A Wrst mold sock w/exp interfa ........................................................... .................... .................... .................... .................... ....................

L6100 A Elb mold sock flex hinge pad ........................................................... .................... .................... .................... .................... ....................

L6110 A Elbow mold sock suspension t ........................................................ .................... .................... .................... .................... ....................

L6120 A Elbow mold doub splt soc ste .......................................................... .................... .................... .................... .................... ....................

L6130 A Elbow stump activated lock h .......................................................... .................... .................... .................... .................... ....................

L6200 A Elbow mold outsid lock hinge .......................................................... .................... .................... .................... .................... ....................

L6205 A Elbow molded w/ expand inter ......................................................... .................... .................... .................... .................... ....................

L6250 A Elbow inter loc elbow forarm ........................................................... .................... .................... .................... .................... ....................

L6300 A Shlder disart int lock elbow .............................................................. .................... .................... .................... .................... ....................

L6310 A Shoulder passive restor comp ......................................................... .................... .................... .................... .................... ....................

L6320 A Shoulder passive restor cap ............................................................ .................... .................... .................... .................... ....................

L6350 A Thoracic intern lock elbow ............................................................... .................... .................... .................... .................... ....................

L6360 A Thoracic passive restor comp .......................................................... .................... .................... .................... .................... ....................

L6370 A Thoracic passive restor cap ............................................................. .................... .................... .................... .................... ....................

L6380 A Postop dsg cast chg wrst/elb ........................................................... .................... .................... .................... .................... ....................

L6382 A Postop dsg cast chg elb dis/ ............................................................ .................... .................... .................... .................... ....................

L6384 A Postop dsg cast chg shlder/t ........................................................... .................... .................... .................... .................... ....................

L6386 A Postop ea cast chg & realign ........................................................... .................... .................... .................... .................... ....................

L6388 A Postop applicat rigid dsg on ............................................................ .................... .................... .................... .................... ....................

L6400 A Below elbow prosth tiss shap .......................................................... .................... .................... .................... .................... ....................

L6450 A Elb disart prosth tiss shap ............................................................... .................... .................... .................... .................... ....................

L6500 A Above elbow prosth tiss shap .......................................................... .................... .................... .................... .................... ....................

L6550 A Shldr disar prosth tiss shap ............................................................. .................... .................... .................... .................... ....................

L6570 A Scap thorac prosth tiss shap ........................................................... .................... .................... .................... .................... ....................

L6580 A Wrist/elbow bowden cable mol ........................................................ .................... .................... .................... .................... ....................

L6582 A Wrist/elbow bowden cbl dir f ............................................................ .................... .................... .................... .................... ....................

L6584 A Elbow fair lead cable molded ........................................................... .................... .................... .................... .................... ....................

L6586 A Elbow fair lead cable dir fo .............................................................. .................... .................... .................... .................... ....................

L6588 A Shdr fair lead cable molded ............................................................. .................... .................... .................... .................... ....................

L6590 A Shdr fair lead cable direct ................................................................ .................... .................... .................... .................... ....................

L6600 A Polycentric hinge pair ....................................................................... .................... .................... .................... .................... ....................

L6605 A Single pivot hinge pair ..................................................................... .................... .................... .................... .................... ....................

L6610 A Flexible metal hinge pair .................................................................. .................... .................... .................... .................... ....................

L6615 A Disconnect locking wrist uni ............................................................. .................... .................... .................... .................... ....................

L6616 A Disconnect insert locking wr ............................................................ .................... .................... .................... .................... ....................

L6620 A Flexion-friction wrist unit .................................................................. .................... .................... .................... .................... ....................

L6623 A Spring-ass rot wrst w/ latch ............................................................. .................... .................... .................... .................... ....................

L6625 A Rotation wrst w/ cable lock .............................................................. .................... .................... .................... .................... ....................

L6628 A Quick disconn hook adapter o ......................................................... .................... .................... .................... .................... ....................

L6629 A Lamination collar w/ couplin ............................................................. .................... .................... .................... .................... ....................

L6630 A Stainless steel any wrist .................................................................. .................... .................... .................... .................... ....................

L6632 A Latex suspension sleeve each ......................................................... .................... .................... .................... .................... ....................

L6635 A Lift assist for elbow .......................................................................... .................... .................... .................... .................... ....................

L6637 A Nudge control elbow lock ................................................................. .................... .................... .................... .................... ....................

L6640 A Shoulder abduction joint pai ............................................................ .................... .................... .................... .................... ....................

L6641 A Excursion amplifier pulley t .............................................................. .................... .................... .................... .................... ....................

L6642 A Excursion amplifier lever ty .............................................................. .................... .................... .................... .................... ....................

L6645 A Shoulder flexion-abduction j ............................................................. .................... .................... .................... .................... ....................

L6650 A Shoulder universal joint .................................................................... .................... .................... .................... .................... ....................

L6655 A Standard control cable extra ............................................................ .................... .................... .................... .................... ....................

L6660 A Heavy duty control cable ................................................................. .................... .................... .................... .................... ....................

L6665 A Teflon or equal cable lining .............................................................. .................... .................... .................... .................... ....................

L6670 A Hook to hand cable adapter ............................................................ .................... .................... .................... .................... ....................

L6672 A Harness chest/shlder saddle ............................................................ .................... .................... .................... .................... ....................

L6675 A Harness figure of 8 sing con ............................................................ .................... .................... .................... .................... ....................

L6676 A Harness figure of 8 dual con ........................................................... .................... .................... .................... .................... ....................

L6680 A Test sock wrist disart/bel e .............................................................. .................... .................... .................... .................... ....................

L6682 A Test sock elbw disart/above ............................................................ .................... .................... .................... .................... ....................

L6684 A Test socket shldr disart/tho .............................................................. .................... .................... .................... .................... ....................

L6686 A Suction socket .................................................................................. .................... .................... .................... .................... ....................

L6687 A Frame typ socket bel elbow/w ......................................................... .................... .................... .................... .................... ....................

L6688 A Frame typ sock above elb/dis .......................................................... .................... .................... .................... .................... ....................

L6689 A Frame typ socket shoulder di .......................................................... .................... .................... .................... .................... ....................

L6690 A Frame typ sock interscap-tho .......................................................... .................... .................... .................... .................... ....................

L6691 A Removable insert each .................................................................... .................... .................... .................... .................... ....................

L6692 A Silicone gel insert or equal .............................................................. .................... .................... .................... .................... ....................

L6693 A Lockingelbow forearm cntrbal .......................................................... .................... .................... .................... .................... ....................

L6700 A Terminal device model #3 ................................................................ .................... .................... .................... .................... ....................

L6705 A Terminal device model #5 ................................................................ .................... .................... .................... .................... ....................

L6710 A Terminal device model #5x .............................................................. .................... .................... .................... .................... ....................

67994

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L6715 A Terminal device model #5xa ............................................................ .................... .................... .................... .................... ....................

L6720 A Terminal device model #6 ................................................................ .................... .................... .................... .................... ....................

L6725 A Terminal device model #7 ................................................................ .................... .................... .................... .................... ....................

L6730 A Terminal device model #7lo ............................................................. .................... .................... .................... .................... ....................

L6735 A Terminal device model #8 ................................................................ .................... .................... .................... .................... ....................

L6740 A Terminal device model #8x .............................................................. .................... .................... .................... .................... ....................

L6745 A Terminal device model #88x ............................................................ .................... .................... .................... .................... ....................

L6750 A Terminal device model #10p ............................................................ .................... .................... .................... .................... ....................

L6755 A Terminal device model #10x ............................................................ .................... .................... .................... .................... ....................

L6765 A Terminal device model #12p ............................................................ .................... .................... .................... .................... ....................

L6770 A Terminal device model #99x ............................................................ .................... .................... .................... .................... ....................

L6775 A Terminal device model #555 ............................................................ .................... .................... .................... .................... ....................

L6780 A Terminal device model #ss555 ........................................................ .................... .................... .................... .................... ....................

L6790 A Hooks-accu hook or equal ............................................................... .................... .................... .................... .................... ....................

L6795 A Hooks-2 load or equal ...................................................................... .................... .................... .................... .................... ....................

L6800 A Hooks-aprl vc or equal ..................................................................... .................... .................... .................... .................... ....................

L6805 A Modifier wrist flexion unit ................................................................. .................... .................... .................... .................... ....................

L6806 A Trs grip vc or equal .......................................................................... .................... .................... .................... .................... ....................

L6807 A Term device grip1/2 or equal ........................................................... .................... .................... .................... .................... ....................

L6808 A Term device infant or child .............................................................. .................... .................... .................... .................... ....................

L6809 A Trs super sport passive ................................................................... .................... .................... .................... .................... ....................

L6810 A Pincher tool otto bock or eq ............................................................. .................... .................... .................... .................... ....................

L6825 A Hands dorrance vo ........................................................................... .................... .................... .................... .................... ....................

L6830 A Hand aprl vc ..................................................................................... .................... .................... .................... .................... ....................

L6835 A Hand sierra vo .................................................................................. .................... .................... .................... .................... ....................

L6840 A Hand becker imperial ....................................................................... .................... .................... .................... .................... ....................

L6845 A Hand becker lock grip ...................................................................... .................... .................... .................... .................... ....................

L6850 A Term dvc-hand becker plylite ........................................................... .................... .................... .................... .................... ....................

L6855 A Hand robin-aids vo ........................................................................... .................... .................... .................... .................... ....................

L6860 A Hand robin-aids vo soft .................................................................... .................... .................... .................... .................... ....................

L6865 A Hand passive hand .......................................................................... .................... .................... .................... .................... ....................

L6867 A Hand detroit infant hand .................................................................. .................... .................... .................... .................... ....................

L6868 A Passive inf hand steeper/hos ........................................................... .................... .................... .................... .................... ....................

L6870 A Hand child mitt ................................................................................. .................... .................... .................... .................... ....................

L6872 A Hand nyu child hand ........................................................................ .................... .................... .................... .................... ....................

L6873 A Hand mech inf steeper or equ ......................................................... .................... .................... .................... .................... ....................

L6875 A Hand bock vc ................................................................................... .................... .................... .................... .................... ....................

L6880 A Hand bock vo ................................................................................... .................... .................... .................... .................... ....................

L6890 A Production glove .............................................................................. .................... .................... .................... .................... ....................

L6895 A Custom glove ................................................................................... .................... .................... .................... .................... ....................

L6900 A Hand restorat thumb/1 finger ........................................................... .................... .................... .................... .................... ....................

L6905 A Hand restoration multiple fi .............................................................. .................... .................... .................... .................... ....................

L6910 A Hand restoration no fingers ............................................................. .................... .................... .................... .................... ....................

L6915 A Hand restoration replacmnt g .......................................................... .................... .................... .................... .................... ....................

L6920 A Wrist disarticul switch ctrl ................................................................. .................... .................... .................... .................... ....................

L6925 A Wrist disart myoelectronic c ............................................................. .................... .................... .................... .................... ....................

L6930 A Below elbow switch control .............................................................. .................... .................... .................... .................... ....................

L6935 A Below elbow myoelectronic ct .......................................................... .................... .................... .................... .................... ....................

L6940 A Elbow disarticulation switch ............................................................. .................... .................... .................... .................... ....................

L6945 A Elbow disart myoelectronic c ........................................................... .................... .................... .................... .................... ....................

L6950 A Above elbow switch control ............................................................. .................... .................... .................... .................... ....................

L6955 A Above elbow myoelectronic ct ......................................................... .................... .................... .................... .................... ....................

L6960 A Shldr disartic switch contro .............................................................. .................... .................... .................... .................... ....................

L6965 A Shldr disartic myoelectronic ............................................................. .................... .................... .................... .................... ....................

L6970 A Interscapular-thor switch ct .............................................................. .................... .................... .................... .................... ....................

L6975 A Interscap-thor myoelectronic ............................................................ .................... .................... .................... .................... ....................

L7010 A Hand otto back steeper/eq sw ......................................................... .................... .................... .................... .................... ....................

L7015 A Hand sys teknik village swit ............................................................. .................... .................... .................... .................... ....................

L7020 A Electronic greifer switch ct ............................................................... .................... .................... .................... .................... ....................

L7025 A Electron hand myoelectronic ............................................................ .................... .................... .................... .................... ....................

L7030 A Hand sys teknik vill myoelec ............................................................ .................... .................... .................... .................... ....................

L7035 A Electron greifer myoelectro .............................................................. .................... .................... .................... .................... ....................

L7040 A Prehensile actuator hosmer s .......................................................... .................... .................... .................... .................... ....................

L7045 A Electron hook child michigan ........................................................... .................... .................... .................... .................... ....................

L7170 A Electronic elbow hosmer swit .......................................................... .................... .................... .................... .................... ....................

L7180 A Electronic elbow utah myoele .......................................................... .................... .................... .................... .................... ....................

L7185 A Electron elbow adolescent sw ......................................................... .................... .................... .................... .................... ....................

L7186 A Electron elbow child switch .............................................................. .................... .................... .................... .................... ....................

L7190 A Elbow adolescent myoelectron ........................................................ .................... .................... .................... .................... ....................

L7191 A Elbow child myoelectronic ct ............................................................ .................... .................... .................... .................... ....................

L7260 A Electron wrist rotator otto ................................................................. .................... .................... .................... .................... ....................

L7261 A Electron wrist rotator utah ................................................................ .................... .................... .................... .................... ....................

L7266 A Servo control steeper or equ ........................................................... .................... .................... .................... .................... ....................

L7272 A Analogue control unb or equa ......................................................... .................... .................... .................... .................... ....................

67995

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L7274 A Proportional ctl 12 volt uta ............................................................... .................... .................... .................... .................... ....................

L7360 A Six volt bat otto bock/eq ea ............................................................. .................... .................... .................... .................... ....................

L7362 A Battery chrgr six volt otto ................................................................. .................... .................... .................... .................... ....................

L7364 A Twelve volt battery utah/equ ............................................................ .................... .................... .................... .................... ....................

L7366 A Battery chrgr 12 volt utah/e ............................................................. .................... .................... .................... .................... ....................

L7499 A Upper extremity prosthes NOS ........................................................ .................... .................... .................... .................... ....................

L7500 A Prosthetic dvc repair hourly ............................................................. .................... .................... .................... .................... ....................

L7510 A Prosthetic device repair rep ............................................................. .................... .................... .................... .................... ....................

L7520 A Repair prosthesis per 15 min ........................................................... .................... .................... .................... .................... ....................

L7900 A Vacuum erection system .................................................................. .................... .................... .................... .................... ....................

L8000 A Mastectomy bra ................................................................................ .................... .................... .................... .................... ....................

L8010 A Mastectomy sleeve .......................................................................... .................... .................... .................... .................... ....................

L8015 A Ext breastprosthesis garment .......................................................... .................... .................... .................... .................... ....................

L8020 A Mastectomy form .............................................................................. .................... .................... .................... .................... ....................

L8030 A Breast prosthesis silicone/e ............................................................. .................... .................... .................... .................... ....................

L8035 A Custom breast prosthesis ................................................................ .................... .................... .................... .................... ....................

L8039 A Breast prosthesis NOS .................................................................... .................... .................... .................... .................... ....................

L8040 A Nasal prosthesis ............................................................................... .................... .................... .................... .................... ....................

L8041 A Midfacial prosthesis .......................................................................... .................... .................... .................... .................... ....................

L8042 A Orbital prosthesis ............................................................................. .................... .................... .................... .................... ....................

L8043 A Upper facial prosthesis .................................................................... .................... .................... .................... .................... ....................

L8044 A Hemi-facial prosthesis ...................................................................... .................... .................... .................... .................... ....................

L8045 A Auricular prosthesis .......................................................................... .................... .................... .................... .................... ....................

L8046 A Partial facial prosthesis .................................................................... .................... .................... .................... .................... ....................

L8047 A Nasal septal prosthesis .................................................................... .................... .................... .................... .................... ....................

L8048 A Unspec maxillofacial prosth ............................................................. .................... .................... .................... .................... ....................

L8049 A Repair maxillofacial prosth ............................................................... .................... .................... .................... .................... ....................

L8100 E Compression stocking BK18-30 ....................................................... .................... .................... .................... .................... ....................

L8110 E Compression stocking BK30-40 ....................................................... .................... .................... .................... .................... ....................

L8120 E Compression stocking BK40-50 ....................................................... .................... .................... .................... .................... ....................

L8130 E Gc stocking thighlngth 18-30 ........................................................... .................... .................... .................... .................... ....................

L8140 E Gc stocking thighlngth 30-40 ........................................................... .................... .................... .................... .................... ....................

L8150 E Gc stocking thighlngth 40-50 ........................................................... .................... .................... .................... .................... ....................

L8160 E Gc stocking full lngth 18-30 ............................................................. .................... .................... .................... .................... ....................

L8170 E Gc stocking full lngth 30-40 ............................................................. .................... .................... .................... .................... ....................

L8180 E Gc stocking full lngth 40-50 ............................................................. .................... .................... .................... .................... ....................

L8190 E Gc stocking waistlngth 18-30 ........................................................... .................... .................... .................... .................... ....................

L8195 E Gc stocking waistlngth 30-40 ........................................................... .................... .................... .................... .................... ....................

L8200 E Gc stocking waistlngth 40-50 ........................................................... .................... .................... .................... .................... ....................

L8210 E Gc stocking custom made ............................................................... .................... .................... .................... .................... ....................

L8220 E Gc stocking lymphedema ................................................................. .................... .................... .................... .................... ....................

L8230 E Gc stocking garter belt ..................................................................... .................... .................... .................... .................... ....................

L8239 E G compression stocking NOS .......................................................... .................... .................... .................... .................... ....................

L8300 A Truss single w/ standard pad ........................................................... .................... .................... .................... .................... ....................

L8310 A Truss double w/ standard pad ......................................................... .................... .................... .................... .................... ....................

L8320 A Truss addition to std pad wa ........................................................... .................... .................... .................... .................... ....................

L8330 A Truss add to std pad scrotal ............................................................ .................... .................... .................... .................... ....................

L8400 A Sheath below knee .......................................................................... .................... .................... .................... .................... ....................

L8410 A Sheath above knee .......................................................................... .................... .................... .................... .................... ....................

L8415 A Sheath upper limb ............................................................................ .................... .................... .................... .................... ....................

L8417 A Pros sheath/sock w gel cushn ......................................................... .................... .................... .................... .................... ....................

L8420 A Prosthetic sock multi ply BK ............................................................ .................... .................... .................... .................... ....................

L8430 A Prosthetic sock multi ply AK ............................................................ .................... .................... .................... .................... ....................

L8435 A Pros sock multi ply upper lm ........................................................... .................... .................... .................... .................... ....................

L8440 A Shrinker below knee ........................................................................ .................... .................... .................... .................... ....................

L8460 A Shrinker above knee ........................................................................ .................... .................... .................... .................... ....................

L8465 A Shrinker upper limb .......................................................................... .................... .................... .................... .................... ....................

L8470 A Pros sock single ply BK ................................................................... .................... .................... .................... .................... ....................

L8480 A Pros sock single ply AK ................................................................... .................... .................... .................... .................... ....................

L8485 A Pros sock single ply upper l ............................................................. .................... .................... .................... .................... ....................

L8490 A Air seal suction reten systm ............................................................. .................... .................... .................... .................... ....................

L8499 A Unlisted misc prosthetic ser ............................................................. .................... .................... .................... .................... ....................

L8500 A Artificial larynx .................................................................................. .................... .................... .................... .................... ....................

L8501 A Tracheostomy speaking valve ......................................................... .................... .................... .................... .................... ....................

L8600 N Implant breast silicone/eq ................................................................ .................... .................... .................... .................... ....................

L8603 N Collagen imp urinary 2.5 CC ........................................................... .................... .................... .................... .................... ....................

L8606 N Synthetic implnt urinary 1ml ............................................................. .................... .................... .................... .................... ....................

L8610 N Ocular implant .................................................................................. .................... .................... .................... .................... ....................

L8612 N Aqueous shunt prosthesis ................................................................ .................... .................... .................... .................... ....................

L8613 N Ossicular implant .............................................................................. .................... .................... .................... .................... ....................

*L8614 H Cochlear device/system ................................................................... 1002 .................... .................... .................... ....................

L8619 A Replace cochlear processor ............................................................ .................... .................... .................... .................... ....................

L8630 N Metacarpophalangeal implant .......................................................... .................... .................... .................... .................... ....................

L8641 N Metatarsal joint implant .................................................................... .................... .................... .................... .................... ....................

67996

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

L8642 N Hallux implant ................................................................................... .................... .................... .................... .................... ....................

L8658 N Interphalangeal joint implnt .............................................................. .................... .................... .................... .................... ....................

L8670 N Vascular graft, synthetic ................................................................... .................... .................... .................... .................... ....................

L8699 N Prosthetic implant NOS .................................................................... .................... .................... .................... .................... ....................

L9900 A O&P supply/accessory/service ......................................................... .................... .................... .................... .................... ....................

M0064 X Visit for drug monitoring ................................................................... 0374 1.17 $58.03 $13.08 $11.61

M0075 E Cellular therapy ................................................................................ .................... .................... .................... .................... ....................

M0076 E Prolotherapy ..................................................................................... .................... .................... .................... .................... ....................

M0100 E Intragastric hypothermia ................................................................... .................... .................... .................... .................... ....................

M0300 E IV chelationtherapy .......................................................................... .................... .................... .................... .................... ....................

M0301 E Fabric wrapping of aneurysm .......................................................... .................... .................... .................... .................... ....................

M0302 T Assessment of cardiac output .......................................................... 0970 0.52 $25.79 .................... $5.16

P2028 A Cephalin floculation test ................................................................... .................... .................... .................... .................... ....................

P2029 A Congo red blood test ....................................................................... .................... .................... .................... .................... ....................

P2031 E Hair analysis ..................................................................................... .................... .................... .................... .................... ....................

P2033 A Blood thymol turbidity ....................................................................... .................... .................... .................... .................... ....................

P2038 A Blood mucoprotein ........................................................................... .................... .................... .................... .................... ....................

P3000 A Screen pap by tech w md supv ....................................................... .................... .................... .................... .................... ....................

P3001 E Screening pap smear by phys ......................................................... .................... .................... .................... .................... ....................

P7001 E Culture bacterial urine ...................................................................... .................... .................... .................... .................... ....................

P9010 K Whole blood for transfusion ............................................................. 0950 2.08 $103.33 .................... $20.67

P9011 E Blood split unit .................................................................................. .................... .................... .................... .................... ....................

P9012 K Cryoprecipitate each unit ................................................................. 0952 0.70 $34.70 .................... $6.94

P9013D K Unit/s blood fibrinogen ..................................................................... 0953 0.48 $23.80 .................... $4.76

P9016 K Leukocyte poor blood, unit ............................................................... 0954 2.83 $140.35 .................... $28.07

P9017 K One donor fresh frozn plasma ......................................................... 0955 2.26 $111.85 .................... $22.37

P9018D K Plasma protein fract, unit ................................................................. 0956 1.26 $62.49 .................... $12.50

P9019 K Platelet concentrate unit .................................................................. 0957 0.98 $48.55 .................... $9.71

P9020 K Plaelet rich plasma unit .................................................................... 0958 1.16 $57.54 .................... $11.51

P9021 K Red blood cells unit ......................................................................... 0959 2.04 $101.31 .................... $20.26

P9022 K Washed red blood cells unit ............................................................ 0960 3.81 $188.75 .................... $37.75

P9023 K Frozen plasma, pooled, sd .............................................................. 0949 2.94 $145.76 .................... $29.15

P9031 K Platelets leukocytes reduced ........................................................... 0954 2.83 $140.35 .................... $28.07

P9032 K Platelets, irradiated .......................................................................... 9500 1.77 $87.97 .................... $17.59

P9033 K Platelets leukoreduced irrad ............................................................ 0954 2.83 $140.35 .................... $28.07

P9034 K Platelets, pheresis ............................................................................ 9501 9.69 $480.75 .................... $96.15

P9035 K Platelet pheres leukoreduced .......................................................... 9501 9.69 $480.75 .................... $96.15

P9036 K Platelet pheresis irradiated .............................................................. 9502 10.52 $521.66 .................... $104.33

P9037 K Plate pheres leukoredu irrad ............................................................ 9501 9.69 $480.75 .................... $96.15

P9038 K RBC irradiated .................................................................................. 9505 2.58 $127.86 .................... $25.57

P9039 K RBC deglycerolized .......................................................................... 9504 4.35 $215.83 .................... $43.17

P9040 K RBC leukoreduced irradiated ........................................................... 9504 4.35 $215.83 .................... $43.17

P9041 K Albumin(human), 5%, 500 ML ......................................................... 0961 2.77 $137.38 .................... $27.48

P9042 K Albumin (human), 25%, 50 ML ........................................................ 0962 1.38 $68.44 .................... $13.69

P9043 K Plasma protein fraction .................................................................... 0956 1.26 $62.49 .................... $12.50

P9044 K Cryoprecipitate reduced plasma ...................................................... 1009 0.86 $42.76 .................... $8.55

P9603 A One-way allow prorated miles ......................................................... .................... .................... .................... .................... ....................

P9604 A One-way allow prorated trip ............................................................. .................... .................... .................... .................... ....................

P9612 N Catheterize for urine spec ................................................................ .................... .................... .................... .................... ....................

P9615 N Urine specimen collect mult ............................................................. .................... .................... .................... .................... ....................

Q0034D K Admin of influenza vaccine .............................................................. 0354 0.13 $6.33 .................... ....................

Q0035 X Cardiokymography ........................................................................... 0100 1.70 $84.32 $71.57 $16.86

Q0081 T Infusion ther other than che ............................................................. 0120 1.66 $82.33 $42.67 $16.47

Q0082D P Activity therapy w/partial h ............................................................... 0033 4.17 $206.82 $48.17 $41.36

Q0083 S Chemo by other than infusion .......................................................... 0116 2.34 $116.06 $23.21 $23.21

Q0084 S Chemotherapy by infusion ............................................................... 0117 1.84 $91.26 $71.80 $18.25

Q0085 S Chemo by both infusion and o ......................................................... 0118 2.90 $143.83 $72.03 $28.77

Q0086 A Physical therapy evaluation/ ............................................................ .................... .................... .................... .................... ....................

Q0091 T Obtaining screen pap smear ............................................................ 0191 1.19 $59.02 $17.43 $11.80

Q0092 N Set up port xray equipment ............................................................. .................... .................... .................... .................... ....................

Q0111 A Wet mounts/ w preparations ............................................................ .................... .................... .................... .................... ....................

Q0112 A Potassium hydroxide preps .............................................................. .................... .................... .................... .................... ....................

Q0113 A Pinworm examinations ..................................................................... .................... .................... .................... .................... ....................

Q0114 A Fern test ........................................................................................... .................... .................... .................... .................... ....................

Q0115 A Post-coital mucous exam ................................................................. .................... .................... .................... .................... ....................

Q0136 G Non esrd epoetin alpha inj ............................................................... 0733 .................... $11.40 .................... $1.53

Q0144 E Azithromycin dihydrate, oral ............................................................. .................... .................... .................... .................... ....................

Q0156D K Human albumin 5% .......................................................................... 0961 2.77 $137.38 .................... $27.48

Q0157D K Human albumin 25% ........................................................................ 0962 1.38 $68.44 .................... $13.69

Q0160 G Factor IX non-recombinant .............................................................. 0931 .................... $.72 .................... $.10

Q0161 G Factor IX recombinant ...................................................................... 0932 .................... $1.12 .................... $.10

Q0163 G Diphenhydramine HCl 50mg ............................................................ 1400 .................... $1.18 .................... $.16

Q0164 G Prochlorperazine maleate 5mg ........................................................ 1401 .................... $1.31 .................... $.18

Q0165 E Prochlorperazine maleate10mg ....................................................... .................... .................... .................... .................... ....................

67997

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

Q0166 G Granisetron HCl 1 mg oral ............................................................... 0765 .................... $44.70 .................... $5.99

Q0167 G Dronabinol 2.5mg oral ...................................................................... 0762 .................... $3.20 .................... $.48

Q0168 E Dronabinol 5mg oral ......................................................................... .................... .................... .................... .................... ....................

Q0169 G Promethazine HCl 12.5mg oral ........................................................ 1402 .................... $.03 .................... ....................

Q0170 E Promethazine HCl 25 mg oral ......................................................... .................... .................... .................... .................... ....................

Q0171 G Chlorpromazine HCl 10mg oral ....................................................... 1403 .................... $.55 .................... $.07

Q0172 E Chlorpromazine HCl 25mg oral ....................................................... .................... .................... .................... .................... ....................

Q0173 G Trimethobenzamide HCl 250mg ...................................................... 1404 .................... $.36 .................... $.05

Q0174 G Thiethylperazine maleate10mg ........................................................ 1405 .................... $.69 .................... $.09

Q0175 G Perphenazine 4mg oral .................................................................... 1406 .................... $.71 .................... $.10

Q0176 E Perphenazine 8mg oral .................................................................... .................... .................... .................... .................... ....................

Q0177 G Hydroxyzine pamoate 25mg ............................................................ 1407 .................... $.20 .................... $.03

Q0178 E Hydroxyzine pamoate 50mg ............................................................ .................... .................... .................... .................... ....................

Q0179 G Ondansetron HCl 8mg oral .............................................................. 0769 .................... $25.15 .................... $3.37

Q0180 G Dolasetron mesylate oral ................................................................. 0763 .................... $65.21 .................... $8.74

Q0181 G Unspecified oral anti-emetic ............................................................. 0761 .................... $.60 .................... $.08

Q0183 N Nonmetabolic active tissue .............................................................. .................... .................... .................... .................... ....................

Q0184 N Metabolically active tissue ............................................................... .................... .................... .................... .................... ....................

Q0185 N Metabolic active D/E tissue .............................................................. .................... .................... .................... .................... ....................

Q0186D E Paramedic intercept, rural ................................................................ .................... .................... .................... .................... ....................

Q0187 G Factor viia recombinant .................................................................... 1409 .................... $1,596.00 .................... $213.86

Q0188D N Contrast medium .............................................................................. .................... .................... .................... .................... ....................

Q1001 E Ntiol category 1 ................................................................................ .................... .................... .................... .................... ....................

Q1002 E Ntiol category 2 ................................................................................ .................... .................... .................... .................... ....................

Q1003 E Ntiol category 3 ................................................................................ .................... .................... .................... .................... ....................

Q1004 E Ntiol category 4 ................................................................................ .................... .................... .................... .................... ....................

Q1005 E Ntiol category 5 ................................................................................ .................... .................... .................... .................... ....................

Q2001 N Cabergoline, 0.5 mg, oral ................................................................ .................... .................... .................... .................... ....................

Q2002 G Elliot’s B solution, per ml ................................................................. 7022 .................... $14.25 .................... $1.91

Q2003 G Aprotinin, 10,000 kiu ........................................................................ 7019 .................... $196.35 .................... $26.31

Q2004 G Treatment for bladder calculi, per 500 ml ........................................ 7023 .................... $23.54 .................... $3.15

Q2005 G Corticorelin ovine triflutate, per 0.1 mg ............................................ 7024 .................... $353.88 .................... $45.77

Q2006 G Digoxin immune FAB (Ovine), 40 mg vial ....................................... 7025 .................... $530.44 .................... $64.71

Q2007 G Ethanolamine oleate, 100 mg .......................................................... 7026 .................... $27.21 .................... $3.65

Q2008 G Fomepizole, 1.5 mg ......................................................................... 7027 .................... $728.33 .................... $97.60

Q2009 G Fosphenytoin, 50 mg ....................................................................... 7028 .................... $8.55 .................... $1.15

Q2010 G Glatiramer acetate, 20 mg ............................................................... 7029 .................... $27.40 .................... $3.67

Q2011 G Hemin, 1 mg ..................................................................................... 7030 .................... $.90 .................... $.12

Q2012 G Pegademase bovine inj 25 I.U ......................................................... 7039 .................... $139.33 .................... $18.67

Q2013 G Pentastarch 10% inj, 100 ml ............................................................ 7040 .................... $15.11 .................... $2.04

Q2014 G Sermorelin acetate, 0.5 mg .............................................................. 7032 .................... $15.78 .................... $2.11

Q2015 G Somatrem, 5 mg .............................................................................. 7033 .................... $199.50 .................... $26.73

Q2016 G Somatropin, 1 mg (any derivation) .................................................. 7034 .................... $39.90 .................... $5.35

Q2017 G Teniposide, 50 mg ........................................................................... 7035 .................... $195.28 .................... $26.17

Q2018 G Urofollitropin, 75 I.U. ........................................................................ 7037 .................... $69.73 .................... $9.34

*Q2019 G Basiliximab, 20 mg ........................................................................... 1615 .................... $1,250.01 .................... $167.50

*Q2020 G Histrelin Acetate, 0.5 mg .................................................................. 1616 .................... $14.91 .................... $2.00

*Q2021 G Lepirdin, 50 mg ................................................................................ 1617 .................... $124.49 .................... $16.68

*Q2022 G Von Willebrand factor, per iu ........................................................... 1618 .................... $.95 .................... $.13

Q3001 H Brachytherapy Seeds ....................................................................... 0918 .................... .................... .................... ....................

*Q3002 G Ga 67, per mCi ................................................................................ 1619 .................... $25.97 .................... $3.17

*Q3003 G TC 99M Bicisate, per vial ................................................................. 1620 .................... $417.53 .................... $55.95

*Q3004 G Xe 133, per mCi ............................................................................... 1621 .................... $28.50 .................... $3.66

*Q3005 G TC 99M Mertiatide, per vial ............................................................. 1622 .................... $185.82 .................... $24.90

*Q3006 G TC 99M Gluceptate .......................................................................... 1623 .................... $22.61 .................... $2.76

*Q3007 G P32 sodium, per mCi ....................................................................... 1624 .................... $74.10 .................... $9.04

*Q3008 G IN 111 Pentetreotide, per mCi ......................................................... 1625 .................... $283.42 .................... $37.98

*Q3009 G TC 99M Oxidronate, per vial ............................................................ 1626 .................... $38.38 .................... $4.68

*Q3010 G TC-99 labeled red blood cell, per test ............................................. 1627 .................... $38.95 .................... $4.75

*Q3011 G P32 phosphate chromic, per mCi .................................................... 1628 .................... $137.12 .................... $16.73

Q9920 A Epoetin with hct <= 20 ..................................................................... .................... .................... .................... .................... ....................

Q9921 A Epoetin with hct = 21 ....................................................................... .................... .................... .................... .................... ....................

Q9922 A Epoetin with hct = 22 ....................................................................... .................... .................... .................... .................... ....................

Q9923 A Epoetin with hct = 23 ....................................................................... .................... .................... .................... .................... ....................

Q9924 A Epoetin with hct = 24 ....................................................................... .................... .................... .................... .................... ....................

Q9925 A Epoetin with hct = 25 ....................................................................... .................... .................... .................... .................... ....................

Q9926 A Epoetin with hct = 26 ....................................................................... .................... .................... .................... .................... ....................

Q9927 A Epoetin with hct = 27 ....................................................................... .................... .................... .................... .................... ....................

Q9928 A Epoetin with hct = 28 ....................................................................... .................... .................... .................... .................... ....................

Q9929 A Epoetin with hct = 29 ....................................................................... .................... .................... .................... .................... ....................

Q9930 A Epoetin with hct = 30 ....................................................................... .................... .................... .................... .................... ....................

Q9931 A Epoetin with hct = 31 ....................................................................... .................... .................... .................... .................... ....................

Q9932 A Epoetin with hct = 32 ....................................................................... .................... .................... .................... .................... ....................

Q9933 A Epoetin with hct = 33 ....................................................................... .................... .................... .................... .................... ....................

67998

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

Q9934 A Epoetin with hct = 34 ....................................................................... .................... .................... .................... .................... ....................

Q9935 A Epoetin with hct = 35 ....................................................................... .................... .................... .................... .................... ....................

Q9936 A Epoetin with hct = 36 ....................................................................... .................... .................... .................... .................... ....................

Q9937 A Epoetin with hct = 37 ....................................................................... .................... .................... .................... .................... ....................

Q9938 A Epoetin with hct = 38 ....................................................................... .................... .................... .................... .................... ....................

Q9939 A Epoetin with hct = 39 ....................................................................... .................... .................... .................... .................... ....................

Q9940 A Epoetin with hct >= 40 ..................................................................... .................... .................... .................... .................... ....................

R0070 N Transport portable x-ray ................................................................... .................... .................... .................... .................... ....................

R0075 N Transport port x-ray multipl .............................................................. .................... .................... .................... .................... ....................

R0076 N Transport portable EKG ................................................................... .................... .................... .................... .................... ....................

V2020 A Vision svcs frames purchases ......................................................... .................... .................... .................... .................... ....................

V2025 E Eyeglasses delux frames ................................................................. .................... .................... .................... .................... ....................

V2100 A Lens spher single plano 4.00 ........................................................... .................... .................... .................... .................... ....................

V2101 A Single visn sphere 4.12-7.00 ........................................................... .................... .................... .................... .................... ....................

V2102 A Singl visn sphere 7.12-20.00 ........................................................... .................... .................... .................... .................... ....................

V2103 A Spherocylindr 4.00d/12-2.00d .......................................................... .................... .................... .................... .................... ....................

V2104 A Spherocylindr 4.00d/2.12-4d ............................................................ .................... .................... .................... .................... ....................

V2105 A Spherocylinder 4.00d/4.25-6d .......................................................... .................... .................... .................... .................... ....................

V2106 A Spherocylinder 4.00d/>6.00d ........................................................... .................... .................... .................... .................... ....................

V2107 A Spherocylinder 4.25d/12-2d ............................................................. .................... .................... .................... .................... ....................

V2108 A Spherocylinder 4.25d/2.12-4d .......................................................... .................... .................... .................... .................... ....................

V2109 A Spherocylinder 4.25d/4.25-6d .......................................................... .................... .................... .................... .................... ....................

V2110 A Spherocylinder 4.25d/over 6d .......................................................... .................... .................... .................... .................... ....................

V2111 A Spherocylindr 7.25d/.25-2.25 ........................................................... .................... .................... .................... .................... ....................

V2112 A Spherocylindr 7.25d/2.25-4d ............................................................ .................... .................... .................... .................... ....................

V2113 A Spherocylindr 7.25d/4.25-6d ............................................................ .................... .................... .................... .................... ....................

V2114 A Spherocylinder over 12.00d ............................................................. .................... .................... .................... .................... ....................

V2115 A Lens lenticular bifocal ...................................................................... .................... .................... .................... .................... ....................

V2116 A Nonaspheric lens bifocal .................................................................. .................... .................... .................... .................... ....................

V2117 A Aspheric lens bifocal ........................................................................ .................... .................... .................... .................... ....................

V2118 A Lens aniseikonic single .................................................................... .................... .................... .................... .................... ....................

V2199 A Lens single vision not oth c ............................................................. .................... .................... .................... .................... ....................

V2200 A Lens spher bifoc plano 4.00d .......................................................... .................... .................... .................... .................... ....................

V2201 A Lens sphere bifocal 4.12-7.0 ........................................................... .................... .................... .................... .................... ....................

V2202 A Lens sphere bifocal 7.12-20. ........................................................... .................... .................... .................... .................... ....................

V2203 A Lens sphcyl bifocal 4.00d/.1 ............................................................ .................... .................... .................... .................... ....................

V2204 A Lens sphcy bifocal 4.00d/2.1 ........................................................... .................... .................... .................... .................... ....................

V2205 A Lens sphcy bifocal 4.00d/4.2 ........................................................... .................... .................... .................... .................... ....................

V2206 A Lens sphcy bifocal 4.00d/ove .......................................................... .................... .................... .................... .................... ....................

V2207 A Lens sphcy bifocal 4.25-7d/. ............................................................ .................... .................... .................... .................... ....................

V2208 A Lens sphcy bifocal 4.25-7/2. ............................................................ .................... .................... .................... .................... ....................

V2209 A Lens sphcy bifocal 4.25-7/4. ............................................................ .................... .................... .................... .................... ....................

V2210 A Lens sphcy bifocal 4.25-7/ov ........................................................... .................... .................... .................... .................... ....................

V2211 A Lens sphcy bifo 7.25-12/.25- ........................................................... .................... .................... .................... .................... ....................

V2212 A Lens sphcyl bifo 7.25-12/2.2 ............................................................ .................... .................... .................... .................... ....................

V2213 A Lens sphcyl bifo 7.25-12/4.2 ............................................................ .................... .................... .................... .................... ....................

V2214 A Lens sphcyl bifocal over 12. ............................................................ .................... .................... .................... .................... ....................

V2215 A Lens lenticular bifocal ...................................................................... .................... .................... .................... .................... ....................

V2216 A Lens lenticular nonaspheric ............................................................. .................... .................... .................... .................... ....................

V2217 A Lens lenticular aspheric bif .............................................................. .................... .................... .................... .................... ....................

V2218 A Lens aniseikonic bifocal ................................................................... .................... .................... .................... .................... ....................

V2219 A Lens bifocal seg width over ............................................................. .................... .................... .................... .................... ....................

V2220 A Lens bifocal add over 3.25d ............................................................ .................... .................... .................... .................... ....................

V2299 A Lens bifocal speciality ...................................................................... .................... .................... .................... .................... ....................

V2300 A Lens sphere trifocal 4.00d ............................................................... .................... .................... .................... .................... ....................

V2301 A Lens sphere trifocal 4.12-7. ............................................................. .................... .................... .................... .................... ....................

V2302 A Lens sphere trifocal 7.12-20 ............................................................ .................... .................... .................... .................... ....................

V2303 A Lens sphcy trifocal 4.0/.12- .............................................................. .................... .................... .................... .................... ....................

V2304 A Lens sphcy trifocal 4.0/2.25 ............................................................. .................... .................... .................... .................... ....................

V2305 A Lens sphcy trifocal 4.0/4.25 ............................................................. .................... .................... .................... .................... ....................

V2306 A Lens sphcyl trifocal 4.00/>6 ............................................................. .................... .................... .................... .................... ....................

V2307 A Lens sphcy trifocal 4.25-7/. .............................................................. .................... .................... .................... .................... ....................

V2308 A Lens sphc trifocal 4.25-7/2. .............................................................. .................... .................... .................... .................... ....................

V2309 A Lens sphc trifocal 4.25-7/4. .............................................................. .................... .................... .................... .................... ....................

V2310 A Lens sphc trifocal 4.25-7/>6 ............................................................. .................... .................... .................... .................... ....................

V2311 A Lens sphc trifo 7.25-12/.25- ............................................................. .................... .................... .................... .................... ....................

V2312 A Lens sphc trifo 7.25-12/2.25 ............................................................ .................... .................... .................... .................... ....................

V2313 A Lens sphc trifo 7.25-12/4.25 ............................................................ .................... .................... .................... .................... ....................

V2314 A Lens sphcyl trifocal over 12 ............................................................. .................... .................... .................... .................... ....................

V2315 A Lens lenticular trifocal ...................................................................... .................... .................... .................... .................... ....................

V2316 A Lens lenticular nonaspheric ............................................................. .................... .................... .................... .................... ....................

V2317 A Lens lenticular aspheric tri ............................................................... .................... .................... .................... .................... ....................

V2318 A Lens aniseikonic trifocal ................................................................... .................... .................... .................... .................... ....................

V2319 A Lens trifocal seg width > 28 ............................................................. .................... .................... .................... .................... ....................

67999

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

V2320 A Lens trifocal add over 3.25d ............................................................ .................... .................... .................... .................... ....................

V2399 A Lens trifocal speciality ...................................................................... .................... .................... .................... .................... ....................

V2410 A Lens variab asphericity sing ............................................................ .................... .................... .................... .................... ....................

V2430 A Lens variable asphericity bi ............................................................. .................... .................... .................... .................... ....................

V2499 A Variable asphericity lens .................................................................. .................... .................... .................... .................... ....................

V2500 A Contact lens pmma spherical .......................................................... .................... .................... .................... .................... ....................

V2501 A Cntct lens pmma-toric/prism ............................................................ .................... .................... .................... .................... ....................

V2502 A Contact lens pmma bifocal .............................................................. .................... .................... .................... .................... ....................

V2503 A Cntct lens pmma color vision ........................................................... .................... .................... .................... .................... ....................

V2510 A Cntct gas permeable sphericl .......................................................... .................... .................... .................... .................... ....................

V2511 A Cntct toric prism ballast ................................................................... .................... .................... .................... .................... ....................

V2512 A Cntct lens gas permbl bifocl ............................................................ .................... .................... .................... .................... ....................

V2513 A Contact lens extended wear ............................................................ .................... .................... .................... .................... ....................

V2520 A Contact lens hydrophilic ................................................................... .................... .................... .................... .................... ....................

V2521 A Cntct lens hydrophilic toric ............................................................... .................... .................... .................... .................... ....................

V2522 A Cntct lens hydrophil bifocl ................................................................ .................... .................... .................... .................... ....................

V2523 A Cntct lens hydrophil extend ............................................................. .................... .................... .................... .................... ....................

V2530 A Contact lens gas impermeable ........................................................ .................... .................... .................... .................... ....................

V2531 A Contact lens gas permeable ............................................................ .................... .................... .................... .................... ....................

V2599 A Contact lens/es other type ............................................................... .................... .................... .................... .................... ....................

V2600 A Hand held low vision aids ................................................................ .................... .................... .................... .................... ....................

V2610 A Single lens spectacle mount ............................................................ .................... .................... .................... .................... ....................

V2615 A Telescop/othr compound lens .......................................................... .................... .................... .................... .................... ....................

V2623 A Plastic eye prosth custom ................................................................ .................... .................... .................... .................... ....................

V2624 A Polishing artifical eye ....................................................................... .................... .................... .................... .................... ....................

V2625 A Enlargemnt of eye prosthesis .......................................................... .................... .................... .................... .................... ....................

V2626 A Reduction of eye prosthesis ............................................................ .................... .................... .................... .................... ....................

V2627 A Scleral cover shell ............................................................................ .................... .................... .................... .................... ....................

V2628 A Fabrication & fitting .......................................................................... .................... .................... .................... .................... ....................

V2629 A Prosthetic eye other type ................................................................. .................... .................... .................... .................... ....................

V2630 N Anter chamber intraocul lens ........................................................... .................... .................... .................... .................... ....................

V2631 N Iris support intraoclr lens .................................................................. .................... .................... .................... .................... ....................

V2632 N Post chmbr intraocular lens ............................................................. .................... .................... .................... .................... ....................

V2700 A Balance lens ..................................................................................... .................... .................... .................... .................... ....................

V2710 A Glass/plastic slab off prism .............................................................. .................... .................... .................... .................... ....................

V2715 A Prism lens/es .................................................................................... .................... .................... .................... .................... ....................

V2718 A Fresnell prism press-on lens ............................................................ .................... .................... .................... .................... ....................

V2730 A Special base curve ........................................................................... .................... .................... .................... .................... ....................

V2740 A Rose tint plastic ................................................................................ .................... .................... .................... .................... ....................

V2741 A Non-rose tint plastic ......................................................................... .................... .................... .................... .................... ....................

V2742 A Rose tint glass ................................................................................. .................... .................... .................... .................... ....................

V2743 A Non-rose tint glass ........................................................................... .................... .................... .................... .................... ....................

V2744 A Tint photochromatic lens/es ............................................................. .................... .................... .................... .................... ....................

V2750 A Anti-reflective coating ....................................................................... .................... .................... .................... .................... ....................

V2755 A UV lens/es ........................................................................................ .................... .................... .................... .................... ....................

V2760 A Scratch resistant coating .................................................................. .................... .................... .................... .................... ....................

V2770 A Occluder lens/es .............................................................................. .................... .................... .................... .................... ....................

V2780 A Oversize lens/es ............................................................................... .................... .................... .................... .................... ....................

V2781 E Progressive lens per lens ................................................................ .................... .................... .................... .................... ....................

V2785 F Corneal tissue processing ................................................................ .................... .................... .................... .................... ....................

V2790 N Amniotic membrane ......................................................................... .................... .................... .................... .................... ....................

V2799 A Miscellaneous vision service ............................................................ .................... .................... .................... .................... ....................

V5008 E Hearing screening ............................................................................ .................... .................... .................... .................... ....................

V5010 E Assessment for hearing aid ............................................................. .................... .................... .................... .................... ....................

V5011 E Hearing aid fitting/checking .............................................................. .................... .................... .................... .................... ....................

V5014 E Hearing aid repair/modifying ............................................................ .................... .................... .................... .................... ....................

V5020 E Conformity evaluation ...................................................................... .................... .................... .................... .................... ....................

V5030 E Body-worn hearing aid air ................................................................ .................... .................... .................... .................... ....................

V5040 E Body-worn hearing aid bone ............................................................ .................... .................... .................... .................... ....................

V5050 E Body-worn hearing aid in ear ........................................................... .................... .................... .................... .................... ....................

V5060 E Behind ear hearing aid ..................................................................... .................... .................... .................... .................... ....................

V5070 E Glasses air conduction ..................................................................... .................... .................... .................... .................... ....................

V5080 E Glasses bone conduction ................................................................. .................... .................... .................... .................... ....................

V5090 E Hearing aid dispensing fee .............................................................. .................... .................... .................... .................... ....................

V5100 E Body-worn bilat hearing aid ............................................................. .................... .................... .................... .................... ....................

V5110 E Hearing aid dispensing fee .............................................................. .................... .................... .................... .................... ....................

V5120 E Body-worn binaur hearing aid .......................................................... .................... .................... .................... .................... ....................

V5130 E In ear binaural hearing aid ............................................................... .................... .................... .................... .................... ....................

V5140 E Behind ear binaur hearing ai ........................................................... .................... .................... .................... .................... ....................

V5150 E Glasses binaural hearing aid ........................................................... .................... .................... .................... .................... ....................

V5160 E Dispensing fee binaural ................................................................... .................... .................... .................... .................... ....................

V5170 E Within ear cros hearing aid .............................................................. .................... .................... .................... .................... ....................

V5180 E Behind ear cros hearing aid ............................................................. .................... .................... .................... .................... ....................

V5190 E Glasses cros hearing aid ................................................................. .................... .................... .................... .................... ....................

68000

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

V5200 E Cros hearing aid dispens fee ........................................................... .................... .................... .................... .................... ....................

V5210 E In ear bicros hearing aid .................................................................. .................... .................... .................... .................... ....................

V5220 E Behind ear bicros hearing ai ............................................................ .................... .................... .................... .................... ....................

V5230 E Glasses bicros hearing aid .............................................................. .................... .................... .................... .................... ....................

V5240 E Dispensing fee bicros ....................................................................... .................... .................... .................... .................... ....................

V5299 E Hearing service ................................................................................ .................... .................... .................... .................... ....................

V5336 E Repair communication device .......................................................... .................... .................... .................... .................... ....................

V5362 A Speech screening ............................................................................ .................... .................... .................... .................... ....................

V5363 A Language screening ......................................................................... .................... .................... .................... .................... ....................

V5364 A Dysphagia screening ........................................................................ .................... .................... .................... .................... ....................

25310 T Transplant forearm tendon ............................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25312 T Transplant forearm tendon ............................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25315 T Revise palsy hand tendon(s) ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25316 T Revise palsy hand tendon(s) ........................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25320 T Repair/revise wrist joint .................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25332 T Revise wrist joint .............................................................................. 0047 22.09 $1,095.58 $537.03 $219.12

25335 T Realignment of hand ........................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25337 T Reconstruct ulna/radioulnar ............................................................. 0051 27.76 $1,376.79 $675.24 $275.36

25350 T Revision of radius ............................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25355 T Revision of radius ............................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25360 T Revision of ulna ............................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25365 T Revise radius & ulna ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25370 T Revise radius or ulna ....................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25375 T Revise radius & ulna ........................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25390 C Shorten radius or ulna ..................................................................... .................... .................... .................... .................... ....................

25391 C Lengthen radius or ulna ................................................................... .................... .................... .................... .................... ....................

25392 C Shorten radius & ulna ...................................................................... .................... .................... .................... .................... ....................

25393 C Lengthen radius & ulna .................................................................... .................... .................... .................... .................... ....................

25400 T Repair radius or ulna ....................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25405 T Repair/graft radius or ulna ............................................................... 0050 21.13 $1,047.96 $513.86 $209.59

25415 T Repair radius & ulna ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

25420 C Repair/graft radius & ulna ................................................................ .................... .................... .................... .................... ....................

25425 T Repair/graft radius or ulna ............................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25426 T Repair/graft radius & ulna ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25440 T Repair/graft wrist bone ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25441 T Reconstruct wrist joint ...................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

25442 T Reconstruct wrist joint ...................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

25443 T Reconstruct wrist joint ...................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

25444 T Reconstruct wrist joint ...................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

25445 T Reconstruct wrist joint ...................................................................... 0048 29.06 $1,441.26 $725.94 $288.25

25446 T Wrist replacement ............................................................................ 0048 29.06 $1,441.26 $725.94 $288.25

25447 T Repair wrist joint(s) .......................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

25449 T Remove wrist joint implant ............................................................... 0047 22.09 $1,095.58 $537.03 $219.12

25450 T Revision of wrist joint ....................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25455 T Revision of wrist joint ....................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25490 T Reinforce radius ............................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25491 T Reinforce ulna .................................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

25492 T Reinforce radius and ulna ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25500 T Treat fracture of radius .................................................................... 0044 2.17 $107.63 $38.08 $21.53

25505 T Treat fracture of radius .................................................................... 0044 2.17 $107.63 $38.08 $21.53

25515 T Treat fracture of radius .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25520 T Treat fracture of radius .................................................................... 0044 2.17 $107.63 $38.08 $21.53

25525 T Treat fracture of radius .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25526 T Treat fracture of radius .................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25530 T Treat fracture of ulna ....................................................................... 0044 2.17 $107.63 $38.08 $21.53

25535 T Treat fracture of ulna ....................................................................... 0044 2.17 $107.63 $38.08 $21.53

25545 T Treat fracture of ulna ....................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25560 T Treat fracture radius & ulna ............................................................. 0044 2.17 $107.63 $38.08 $21.53

25565 T Treat fracture radius & ulna ............................................................. 0044 2.17 $107.63 $38.08 $21.53

25574 T Treat fracture radius & ulna ............................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25575 T Treat fracture radius/ulna ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25600 T Treat fracture radius/ulna ................................................................. 0044 2.17 $107.63 $38.08 $21.53

25605 T Treat fracture radius/ulna ................................................................. 0044 2.17 $107.63 $38.08 $21.53

25611 T Treat fracture radius/ulna ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25620 T Treat fracture radius/ulna ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25622 T Treat wrist bone fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

25624 T Treat wrist bone fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

25628 T Treat wrist bone fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25630 T Treat wrist bone fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

25635 T Treat wrist bone fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

25645 T Treat wrist bone fracture .................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

25650 T Treat wrist bone fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

25660 T Treat wrist dislocation ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

25670 T Treat wrist dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

68001

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

25675 T Treat wrist dislocation ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

25676 T Treat wrist dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25680 T Treat wrist fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

25685 T Treat wrist fracture ........................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25690 T Treat wrist dislocation ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

25695 T Treat wrist dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

25800 T Fusion of wrist joint .......................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

25805 T Fusion/graft of wrist joint .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

25810 T Fusion/graft of wrist joint .................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

25820 T Fusion of hand bones ...................................................................... 0053 11.32 $561.42 $253.49 $112.28

25825 T Fuse hand bones with graft ............................................................. 0054 19.66 $975.06 $472.33 $195.01

25830 T Fusion, radioulnar jnt/ulna ................................................................ 0051 27.76 $1,376.79 $675.24 $275.36

25900 C Amputation of forearm ..................................................................... .................... .................... .................... .................... ....................

25905 C Amputation of forearm ..................................................................... .................... .................... .................... .................... ....................

25907 T Amputation follow-up surgery .......................................................... 0049 15.04 $745.93 $356.95 $149.19

25909 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

25915 C Amputation of forearm ..................................................................... .................... .................... .................... .................... ....................

25920 C Amputate hand at wrist .................................................................... .................... .................... .................... .................... ....................

25922 T Amputate hand at wrist .................................................................... 0049 15.04 $745.93 $356.95 $149.19

25924 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

25927 C Amputation of hand .......................................................................... .................... .................... .................... .................... ....................

25929 T Amputation follow-up surgery .......................................................... 0026 12.11 $600.61 $277.92 $120.12

25931 C Amputation follow-up surgery .......................................................... .................... .................... .................... .................... ....................

25999 T Forearm or wrist surgery .................................................................. 0044 2.17 $107.63 $38.08 $21.53

26010 T Drainage of finger abscess .............................................................. 0006 2.00 $99.19 $33.95 $19.84

26011 T Drainage of finger abscess .............................................................. 0007 3.68 $182.51 $72.03 $36.50

26020 T Drain hand tendon sheath ............................................................... 0053 11.32 $561.42 $253.49 $112.28

26025 T Drainage of palm bursa ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26030 T Drainage of palm bursa(s) ............................................................... 0053 11.32 $561.42 $253.49 $112.28

26034 T Treat hand bone lesion .................................................................... 0053 11.32 $561.42 $253.49 $112.28

26035 T Decompress fingers/hand ................................................................ 0053 11.32 $561.42 $253.49 $112.28

26037 T Decompress fingers/hand ................................................................ 0053 11.32 $561.42 $253.49 $112.28

26040 T Release palm contracture ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26045 T Release palm contracture ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26055 T Incise finger tendon sheath .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26060 T Incision of finger tendon ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26070 T Explore/treat hand joint .................................................................... 0053 11.32 $561.42 $253.49 $112.28

26075 T Explore/treat finger joint ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26080 T Explore/treat finger joint ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26100 T Biopsy hand joint lining .................................................................... 0053 11.32 $561.42 $253.49 $112.28

26105 T Biopsy finger joint lining ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26110 T Biopsy finger joint lining ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26115 T Removal of hand lesion ................................................................... 0022 12.49 $619.45 $292.94 $123.89

26116 T Removal of hand lesion ................................................................... 0022 12.49 $619.45 $292.94 $123.89

26117 T Remove tumor, hand/finger ............................................................. 0022 12.49 $619.45 $292.94 $123.89

26121 T Release palm contracture ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26123 T Release palm contracture ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26125 T Release palm contracture ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26130 T Remove wrist joint lining .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26135 T Revise finger joint, each .................................................................. 0054 19.66 $975.06 $472.33 $195.01

26140 T Revise finger joint, each .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26145 T Tendon excision, palm/finger ........................................................... 0053 11.32 $561.42 $253.49 $112.28

26160 T Remove tendon sheath lesion ......................................................... 0053 11.32 $561.42 $253.49 $112.28

26170 T Removal of palm tendon, each ........................................................ 0053 11.32 $561.42 $253.49 $112.28

26180 T Removal of finger tendon ................................................................. 0053 11.32 $561.42 $253.49 $112.28

26185 T Remove finger bone ......................................................................... 0053 11.32 $561.42 $253.49 $112.28

26200 T Remove hand bone lesion ............................................................... 0053 11.32 $561.42 $253.49 $112.28

26205 T Remove/graft bone lesion ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26210 T Removal of finger lesion .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26215 T Remove/graft finger lesion ............................................................... 0053 11.32 $561.42 $253.49 $112.28

26230 T Partial removal of hand bone ........................................................... 0053 11.32 $561.42 $253.49 $112.28

26235 T Partial removal, finger bone ............................................................. 0053 11.32 $561.42 $253.49 $112.28

26236 T Partial removal, finger bone ............................................................. 0053 11.32 $561.42 $253.49 $112.28

26250 T Extensive hand surgery ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26255 T Extensive hand surgery ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26260 T Extensive finger surgery .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26261 T Extensive finger surgery .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26262 T Partial removal of finger ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26320 T Removal of implant from hand ......................................................... 0020 6.51 $322.87 $130.53 $64.57

26350 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26352 T Repair/graft hand tendon ................................................................. 0054 19.66 $975.06 $472.33 $195.01

26356 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26357 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26358 T Repair/graft hand tendon ................................................................. 0054 19.66 $975.06 $472.33 $195.01

68002

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

26370 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26372 T Repair/graft hand tendon ................................................................. 0054 19.66 $975.06 $472.33 $195.01

26373 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26390 T Revise hand/finger tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26392 T Repair/graft hand tendon ................................................................. 0054 19.66 $975.06 $472.33 $195.01

26410 T Repair hand tendon ......................................................................... 0053 11.32 $561.42 $253.49 $112.28

26412 T Repair/graft hand tendon ................................................................. 0054 19.66 $975.06 $472.33 $195.01

26415 T Excision, hand/finger tendon ............................................................ 0054 19.66 $975.06 $472.33 $195.01

26416 T Graft hand or finger tendon ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26418 T Repair finger tendon ........................................................................ 0053 11.32 $561.42 $253.49 $112.28

26420 T Repair/graft finger tendon ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26426 T Repair finger/hand tendon ............................................................... 0054 19.66 $975.06 $472.33 $195.01

26428 T Repair/graft finger tendon ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26432 T Repair finger tendon ........................................................................ 0053 11.32 $561.42 $253.49 $112.28

26433 T Repair finger tendon ........................................................................ 0053 11.32 $561.42 $253.49 $112.28

26434 T Repair/graft finger tendon ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26437 T Realignment of tendons ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26440 T Release palm/finger tendon ............................................................. 0053 11.32 $561.42 $253.49 $112.28

26442 T Release palm & finger tendon ......................................................... 0054 19.66 $975.06 $472.33 $195.01

26445 T Release hand/finger tendon ............................................................. 0053 11.32 $561.42 $253.49 $112.28

26449 T Release forearm/hand tendon ......................................................... 0054 19.66 $975.06 $472.33 $195.01

26450 T Incision of palm tendon .................................................................... 0053 11.32 $561.42 $253.49 $112.28

26455 T Incision of finger tendon ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26460 T Incise hand/finger tendon ................................................................. 0053 11.32 $561.42 $253.49 $112.28

26471 T Fusion of finger tendons .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26474 T Fusion of finger tendons .................................................................. 0053 11.32 $561.42 $253.49 $112.28

26476 T Tendon lengthening ......................................................................... 0053 11.32 $561.42 $253.49 $112.28

26477 T Tendon shortening ........................................................................... 0053 11.32 $561.42 $253.49 $112.28

26478 T Lengthening of hand tendon ............................................................ 0053 11.32 $561.42 $253.49 $112.28

26479 T Shortening of hand tendon .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26480 T Transplant hand tendon ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26483 T Transplant/graft hand tendon ........................................................... 0054 19.66 $975.06 $472.33 $195.01

26485 T Transplant palm tendon ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26489 T Transplant/graft palm tendon ........................................................... 0054 19.66 $975.06 $472.33 $195.01

26490 T Revise thumb tendon ....................................................................... 0054 19.66 $975.06 $472.33 $195.01

26492 T Tendon transfer with graft ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26494 T Hand tendon/muscle transfer ........................................................... 0054 19.66 $975.06 $472.33 $195.01

26496 T Revise thumb tendon ....................................................................... 0054 19.66 $975.06 $472.33 $195.01

26497 T Finger tendon transfer ...................................................................... 0054 19.66 $975.06 $472.33 $195.01

26498 T Finger tendon transfer ...................................................................... 0054 19.66 $975.06 $472.33 $195.01

26499 T Revision of finger ............................................................................. 0054 19.66 $975.06 $472.33 $195.01

26500 T Hand tendon reconstruction ............................................................. 0053 11.32 $561.42 $253.49 $112.28

26502 T Hand tendon reconstruction ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26504 T Hand tendon reconstruction ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26508 T Release thumb contracture .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26510 T Thumb tendon transfer ..................................................................... 0054 19.66 $975.06 $472.33 $195.01

26516 T Fusion of knuckle joint ..................................................................... 0054 19.66 $975.06 $472.33 $195.01

26517 T Fusion of knuckle joints ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26518 T Fusion of knuckle joints ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26520 T Release knuckle contracture ............................................................ 0053 11.32 $561.42 $253.49 $112.28

26525 T Release finger contracture ............................................................... 0053 11.32 $561.42 $253.49 $112.28

26530 T Revise knuckle joint ......................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

26531 T Revise knuckle with implant ............................................................. 0048 29.06 $1,441.26 $725.94 $288.25

26535 T Revise finger joint ............................................................................ 0047 22.09 $1,095.58 $537.03 $219.12

26536 T Revise/implant finger joint ................................................................ 0048 29.06 $1,441.26 $725.94 $288.25

26540 T Repair hand joint .............................................................................. 0053 11.32 $561.42 $253.49 $112.28

26541 T Repair hand joint with graft .............................................................. 0054 19.66 $975.06 $472.33 $195.01

26542 T Repair hand joint with graft .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26545 T Reconstruct finger joint .................................................................... 0054 19.66 $975.06 $472.33 $195.01

26546 T Repair nonunion hand ...................................................................... 0054 19.66 $975.06 $472.33 $195.01

26548 T Reconstruct finger joint .................................................................... 0054 19.66 $975.06 $472.33 $195.01

26550 T Construct thumb replacement .......................................................... 0054 19.66 $975.06 $472.33 $195.01

26551 C Great toe-hand transfer .................................................................... .................... .................... .................... .................... ....................

26553 C Single transfer, toe-hand .................................................................. .................... .................... .................... .................... ....................

26554 C Double transfer, toe-hand ................................................................ .................... .................... .................... .................... ....................

26555 T Positional change of finger .............................................................. 0054 19.66 $975.06 $472.33 $195.01

26556 C Toe joint transfer .............................................................................. .................... .................... .................... .................... ....................

26560 T Repair of web finger ......................................................................... 0053 11.32 $561.42 $253.49 $112.28

26561 T Repair of web finger ......................................................................... 0054 19.66 $975.06 $472.33 $195.01

26562 T Repair of web finger ......................................................................... 0054 19.66 $975.06 $472.33 $195.01

26565 T Correct metacarpal flaw ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26567 T Correct finger deformity ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26568 T Lengthen metacarpal/finger ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26580 T Repair hand deformity ...................................................................... 0054 19.66 $975.06 $472.33 $195.01

68003

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

26585 T Repair finger deformity ..................................................................... 0054 19.66 $975.06 $472.33 $195.01

26587 T Reconstruct extra finger ................................................................... 0053 11.32 $561.42 $253.49 $112.28

26590 T Repair finger deformity ..................................................................... 0054 19.66 $975.06 $472.33 $195.01

26591 T Repair muscles of hand ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26593 T Release muscles of hand ................................................................ 0053 11.32 $561.42 $253.49 $112.28

26596 T Excision constricting tissue .............................................................. 0054 19.66 $975.06 $472.33 $195.01

26597 T Release of scar contracture ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26600 T Treat metacarpal fracture ................................................................. 0044 2.17 $107.63 $38.08 $21.53

26605 T Treat metacarpal fracture ................................................................. 0044 2.17 $107.63 $38.08 $21.53

26607 T Treat metacarpal fracture ................................................................. 0044 2.17 $107.63 $38.08 $21.53

26608 T Treat metacarpal fracture ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

26615 T Treat metacarpal fracture ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

26641 T Treat thumb dislocation .................................................................... 0044 2.17 $107.63 $38.08 $21.53

26645 T Treat thumb fracture ........................................................................ 0044 2.17 $107.63 $38.08 $21.53

26650 T Treat thumb fracture ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

26665 T Treat thumb fracture ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

26670 T Treat hand dislocation ...................................................................... 0044 2.17 $107.63 $38.08 $21.53

26675 T Treat hand dislocation ...................................................................... 0045 11.02 $546.55 $277.12 $109.31

26676 T Pin hand dislocation ......................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26685 T Treat hand dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26686 T Treat hand dislocation ...................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26700 T Treat knuckle dislocation ................................................................. 0043 1.64 $81.34 $25.46 $16.27

26705 T Treat knuckle dislocation ................................................................. 0045 11.02 $546.55 $277.12 $109.31

26706 T Pin knuckle dislocation ..................................................................... 0044 2.17 $107.63 $38.08 $21.53

26715 T Treat knuckle dislocation ................................................................. 0046 22.29 $1,105.50 $535.76 $221.10

26720 T Treat finger fracture, each ............................................................... 0043 1.64 $81.34 $25.46 $16.27

26725 T Treat finger fracture, each ............................................................... 0043 1.64 $81.34 $25.46 $16.27

26727 T Treat finger fracture, each ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26735 T Treat finger fracture, each ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26740 T Treat finger fracture, each ............................................................... 0043 1.64 $81.34 $25.46 $16.27

26742 T Treat finger fracture, each ............................................................... 0044 2.17 $107.63 $38.08 $21.53

26746 T Treat finger fracture, each ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26750 T Treat finger fracture, each ............................................................... 0043 1.64 $81.34 $25.46 $16.27

26755 T Treat finger fracture, each ............................................................... 0043 1.64 $81.34 $25.46 $16.27

26756 T Pin finger fracture, each ................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26765 T Treat finger fracture, each ............................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26770 T Treat finger dislocation ..................................................................... 0043 1.64 $81.34 $25.46 $16.27

26775 T Treat finger dislocation ..................................................................... 0045 11.02 $546.55 $277.12 $109.31

26776 T Pin finger dislocation ........................................................................ 0046 22.29 $1,105.50 $535.76 $221.10

26785 T Treat finger dislocation ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

26820 T Thumb fusion with graft ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26841 T Fusion of thumb ............................................................................... 0054 19.66 $975.06 $472.33 $195.01

26842 T Thumb fusion with graft ................................................................... 0054 19.66 $975.06 $472.33 $195.01

26843 T Fusion of hand joint ......................................................................... 0054 19.66 $975.06 $472.33 $195.01

26844 T Fusion/graft of hand joint ................................................................. 0054 19.66 $975.06 $472.33 $195.01

26850 T Fusion of knuckle ............................................................................. 0054 19.66 $975.06 $472.33 $195.01

26852 T Fusion of knuckle with graft ............................................................. 0054 19.66 $975.06 $472.33 $195.01

26860 T Fusion of finger joint ........................................................................ 0054 19.66 $975.06 $472.33 $195.01

26861 T Fusion of finger jnt, add-on .............................................................. 0054 19.66 $975.06 $472.33 $195.01

26862 T Fusion/graft of finger joint ................................................................ 0054 19.66 $975.06 $472.33 $195.01

26863 T Fuse/graft added joint ...................................................................... 0054 19.66 $975.06 $472.33 $195.01

26910 T Amputate metacarpal bone .............................................................. 0054 19.66 $975.06 $472.33 $195.01

26951 T Amputation of finger/thumb .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26952 T Amputation of finger/thumb .............................................................. 0053 11.32 $561.42 $253.49 $112.28

26989 T Hand/finger surgery .......................................................................... 0043 1.64 $81.34 $25.46 $16.27

26990 T Drainage of pelvis lesion .................................................................. 0049 15.04 $745.93 $356.95 $149.19

26991 T Drainage of pelvis bursa .................................................................. 0049 15.04 $745.93 $356.95 $149.19

26992 C Drainage of bone lesion ................................................................... .................... .................... .................... .................... ....................

27000 T Incision of hip tendon ....................................................................... 0049 15.04 $745.93 $356.95 $149.19

27001 T Incision of hip tendon ....................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27003 T Incision of hip tendon ....................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27005 C Incision of hip tendon ....................................................................... .................... .................... .................... .................... ....................

27006 C Incision of hip tendons ..................................................................... .................... .................... .................... .................... ....................

27025 C Incision of hip/thigh fascia ................................................................ .................... .................... .................... .................... ....................

27030 C Drainage of hip joint ......................................................................... .................... .................... .................... .................... ....................

27033 T Exploration of hip joint ..................................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27035 C Denervation of hip joint .................................................................... .................... .................... .................... .................... ....................

27036 C Excision of hip joint/muscle .............................................................. .................... .................... .................... .................... ....................

27040 T Biopsy of soft tissues ....................................................................... 0021 10.49 $520.26 $236.51 $104.05

27041 T Biopsy of soft tissues ....................................................................... 0022 12.49 $619.45 $292.94 $123.89

27047 T Remove hip/pelvis lesion ................................................................. 0022 12.49 $619.45 $292.94 $123.89

27048 T Remove hip/pelvis lesion ................................................................. 0022 12.49 $619.45 $292.94 $123.89

27049 T Remove tumor, hip/pelvis ................................................................ 0022 12.49 $619.45 $292.94 $123.89

27050 T Biopsy of sacroiliac joint .................................................................. 0049 15.04 $745.93 $356.95 $149.19

68004

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27052 T Biopsy of hip joint ............................................................................. 0049 15.04 $745.93 $356.95 $149.19

27054 C Removal of hip joint lining ................................................................ .................... .................... .................... .................... ....................

27060 T Removal of ischial bursa .................................................................. 0049 15.04 $745.93 $356.95 $149.19

27062 T Remove femur lesion/bursa ............................................................. 0049 15.04 $745.93 $356.95 $149.19

27065 T Removal of hip bone lesion ............................................................. 0049 15.04 $745.93 $356.95 $149.19

27066 T Removal of hip bone lesion ............................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27067 T Remove/graft hip bone lesion .......................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27070 C Partial removal of hip bone .............................................................. .................... .................... .................... .................... ....................

27071 C Partial removal of hip bone .............................................................. .................... .................... .................... .................... ....................

27075 C Extensive hip surgery ....................................................................... .................... .................... .................... .................... ....................

27076 C Extensive hip surgery ....................................................................... .................... .................... .................... .................... ....................

27077 C Extensive hip surgery ....................................................................... .................... .................... .................... .................... ....................

27078 C Extensive hip surgery ....................................................................... .................... .................... .................... .................... ....................

27079 C Extensive hip surgery ....................................................................... .................... .................... .................... .................... ....................

27080 T Removal of tail bone ........................................................................ 0050 21.13 $1,047.96 $513.86 $209.59

27086 T Remove hip foreign body ................................................................. 0019 4.00 $198.39 $78.91 $39.68

27087 T Remove hip foreign body ................................................................. 0049 15.04 $745.93 $356.95 $149.19

27090 C Removal of hip prosthesis ............................................................... .................... .................... .................... .................... ....................

27091 C Removal of hip prosthesis ............................................................... .................... .................... .................... .................... ....................

27093 N Injection for hip x-ray ....................................................................... .................... .................... .................... .................... ....................

27095 N Injection for hip x-ray ....................................................................... .................... .................... .................... .................... ....................

27096 N Inject sacroiliac joint ......................................................................... .................... .................... .................... .................... ....................

27097 T Revision of hip tendon ..................................................................... 0050 21.13 $1,047.96 $513.86 $209.59

27098 T Transfer tendon to pelvis ................................................................. 0050 21.13 $1,047.96 $513.86 $209.59

27100 T Transfer of abdominal muscle ......................................................... 0051 27.76 $1,376.79 $675.24 $275.36

27105 T Transfer of spinal muscle ................................................................. 0051 27.76 $1,376.79 $675.24 $275.36

27110 T Transfer of iliopsoas muscle ............................................................ 0051 27.76 $1,376.79 $675.24 $275.36

27111 T Transfer of iliopsoas muscle ............................................................ 0051 27.76 $1,376.79 $675.24 $275.36

27120 C Reconstruction of hip socket ............................................................ .................... .................... .................... .................... ....................

27122 C Reconstruction of hip socket ............................................................ .................... .................... .................... .................... ....................

27125 C Partial hip replacement .................................................................... .................... .................... .................... .................... ....................

27130 C Total hip replacement ...................................................................... .................... .................... .................... .................... ....................

27132 C Total hip replacement ...................................................................... .................... .................... .................... .................... ....................

27134 C Revise hip joint replacement ............................................................ .................... .................... .................... .................... ....................

27137 C Revise hip joint replacement ............................................................ .................... .................... .................... .................... ....................

27138 C Revise hip joint replacement ............................................................ .................... .................... .................... .................... ....................

27140 C Transplant femur ridge ..................................................................... .................... .................... .................... .................... ....................

27146 C Incision of hip bone .......................................................................... .................... .................... .................... .................... ....................

27147 C Revision of hip bone ........................................................................ .................... .................... .................... .................... ....................

27151 C Incision of hip bones ........................................................................ .................... .................... .................... .................... ....................

27156 C Revision of hip bones ...................................................................... .................... .................... .................... .................... ....................

27158 C Revision of pelvis ............................................................................. .................... .................... .................... .................... ....................

27161 C Incision of neck of femur .................................................................. .................... .................... .................... .................... ....................

27165 C Incision/fixation of femur .................................................................. .................... .................... .................... .................... ....................

27170 C Repair/graft femur head/neck .......................................................... .................... .................... .................... .................... ....................

27175 C Treat slipped epiphysis .................................................................... .................... .................... .................... .................... ....................

27176 C Treat slipped epiphysis .................................................................... .................... .................... .................... .................... ....................

27177 C Treat slipped epiphysis .................................................................... .................... .................... .................... .................... ....................

27178 C Treat slipped epiphysis .................................................................... .................... .................... .................... .................... ....................

27179 C Revise head/neck of femur .............................................................. .................... .................... .................... .................... ....................

27181 C Treat slipped epiphysis .................................................................... .................... .................... .................... .................... ....................

27185 C Revision of femur epiphysis ............................................................. .................... .................... .................... .................... ....................

27187 C Reinforce hip bones ......................................................................... .................... .................... .................... .................... ....................

27193 T Treat pelvic ring fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

27194 T Treat pelvic ring fracture .................................................................. 0045 11.02 $546.55 $277.12 $109.31

27200 T Treat tail bone fracture ..................................................................... 0043 1.64 $81.34 $25.46 $16.27

27202 T Treat tail bone fracture ..................................................................... 0046 22.29 $1,105.50 $535.76 $221.10

27215 C Treat pelvic fracture(s) ..................................................................... .................... .................... .................... .................... ....................

27216 C Treat pelvic ring fracture .................................................................. .................... .................... .................... .................... ....................

27217 C Treat pelvic ring fracture .................................................................. .................... .................... .................... .................... ....................

27218 C Treat pelvic ring fracture .................................................................. .................... .................... .................... .................... ....................

27220 T Treat hip socket fracture .................................................................. 0044 2.17 $107.63 $38.08 $21.53

27222 C Treat hip socket fracture .................................................................. .................... .................... .................... .................... ....................

27226 C Treat hip wall fracture ...................................................................... .................... .................... .................... .................... ....................

27227 C Treat hip fracture(s) ......................................................................... .................... .................... .................... .................... ....................

27228 C Treat hip fracture(s) ......................................................................... .................... .................... .................... .................... ....................

27230 T Treat thigh fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

27232 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27235 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27236 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27238 T Treat thigh fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

27240 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27244 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27245 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

68005

ADDENDUM B.—HOSPITAL OUTPATIENT DEPARTMENT (HOPD) PAYMENT STATUS BY HCPCS CODE AND RELATED INFORMATION—

Continued

CPT/

HCPCS

HOPD

Status

Indicator

Description APC Relative

Weight

Payment

Rate

National

Unadjusted

Coinsurance

Minimum

Unadjusted

Coinsurance

27246 T Treat thigh fracture ........................................................................... 0044 2.17 $107.63 $38.08 $21.53

27248 C Treat thigh fracture ........................................................................... .................... .................... .................... .................... ....................

27250 T Treat hip dislocation ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

27252 T Treat hip dislocation ......................................................................... 0045 11.02 $546.55 $277.12 $109.31

27253 C Treat hip dislocation ......................................................................... .................... .................... .................... .................... ....................

27254 C Treat hip dislocation ......................................................................... .................... .................... .................... .................... ....................

27256 T Treat hip dislocation ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

27257 T Treat hip dislocation ......................................................................... 0045 11.02 $546.55 $277.12 $109.31

27258 C Treat hip dislocation ......................................................................... .................... .................... .................... .................... ....................

27259 C Treat hip dislocation ......................................................................... .................... .................... .................... .................... ....................

27265 T Treat hip dislocation ......................................................................... 0044 2.17 $107.63 $38.08 $21.53

27266 T Treat hip dislocation ......................................................................... 0047 22.09 $1,095.58 $537.03 $219.12

27275 T Manipulation of hip joint ................................................................... 0045 11.02 $546.55 $277.12 $109.31

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Addendum C—[Reserved]

ADDENDUM D.—STATUS INDICATORS: HOW VARIOUS SERVICES ARE TREATED UNDER THE HOSPITAL OUTPATIENT PROSPECTIVE

PAYMENT SYSTEM

Indicator Service Status

A .................. Pulmonary Rehabilitation Clinical Trial ......................................................... Not Paid Under Ourpatient PPS.

C ................. Inpatient Procedures .................................................................................... Admit Patient; Bill as Inpatient.

A .................. Durable Medical Equipment, Prosthetics and Orthotics .............................. DMEPOS Fee Schedule.

E .................. Non-Covered Items and Services ................................................................ Not Paid Under Outpatient PPS.

A .................. Physical, Occupational and Speech Therapy .............................................. Rehabilitation Fee Schedule.

A .................. Ambulance .................................................................................................... Ambulance Fee Schedule.

A .................. EPO for ESRD Patients ............................................................................... National Rate.

A .................. Clinical Diagnostic Laboratory Services ....................................................... Laboratory Fee Schedule.

A .................. Physician Services for ESRD Patients ......................................................... Not Paid Under Outpatient PPS.

A .................. Screening Mammography ............................................................................ Lower of Charges or National Rate.

N ................. Incidental Services, packaged into APC Rate ............................................. Packaged.

P .................. Partial Hospitalization ................................................................................... Paid Per Diem APC.

S .................. Significant Procedure, Not Discounted When Multiple ................................ Paid Under Outpatient PPS.

T .................. Significant Procedure, Multiple Procedure Reduction Applies ..................... Paid Under Outpatient PPS.

V .................. Visit to Clinic or Emergency Department ..................................................... Paid Under Outpatient PPS.

X .................. Ancillary Service ........................................................................................... Paid Under Outpatient PPS.

F .................. Acquisition of Corneal Tissue ....................................................................... Paid at Reasonable Cost.

G ................. Current Drug/Biological Pass-Through ......................................................... Additional Payment.

H ................. Device Pass-Through ................................................................................... Additional Payment.

J .................. New Drug/Biological Pass-Through ............................................................. Additional Payment.

K .................. Non Pass-Through Drug/Biological .............................................................. Paid Under Outpatient PPS.

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

15756 C Free muscle flap, microvasc

15757 C Free skin flap, microvasc

15758 C Free fascial flap, microvasc

16035 C Incision of burn scab

* 16036 C Incision of burn scab

19200 C Removal of breast

19220 C Removal of breast

19271 C Revision of chest wall

19272 C Extensive chest wall surgery

19361 C Breast reconstruction

19364 C Breast reconstruction

19367 C Breast reconstruction

19368 C Breast reconstruction

19369 C Breast reconstruction

20660 C Apply, remove fixation device

20661 C Application of head brace

20662 C Application of pelvis brace

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

20663 C Application of thigh brace

20664 C Halo brace application

20802 C Replantation, arm, complete

20805 C Replant, forearm, complete

20808 C Replantation hand, complete

20816 C Replantation digit, complete

20822 C Replantation digit, complete

20824 C Replantation thumb, complete

20827 C Replantation thumb, complete

20838 C Replantation foot, complete

20930 C Spinal bone allograft

20931 C Spinal bone allograft

20936 C Spinal bone autograft

20937 C Spinal bone autograft

20938 C Spinal bone autograft

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

20955 C Fibula bone graft, microvasc

20956 C Iliac bone graft, microvasc

20957 C Mt bone graft, microvasc

20962 C Other bone graft, microvasc

20969 C Bone/skin graft, microvasc

20970 C Bone/skin graft, iliac crest

20972 C Bone/skin graft, metatarsal

20973 C Bone/skin graft, great toe

21045 C Extensive jaw surgery

21141 C Reconstruct midface, lefort

21142 C Reconstruct midface, lefort

21143 C Reconstruct midface, lefort

21145 C Reconstruct midface, lefort

21146 C Reconstruct midface, lefort

21147 C Reconstruct midface, lefort

68006

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

21150 C Reconstruct midface, lefort

21151 C Reconstruct midface, lefort

21154 C Reconstruct midface, lefort

21155 C Reconstruct midface, lefort

21159 C Reconstruct midface, lefort

21160 C Reconstruct midface, lefort

21172 C Reconstruct orbit/forehead

21175 C Reconstruct orbit/forehead

21179 C Reconstruct entire forehead

21180 C Reconstruct entire forehead

21182 C Reconstruct cranial bone

21183 C Reconstruct cranial bone

21184 C Reconstruct cranial bone

21188 C Reconstruction of midface

21193 C Reconstruct lower jaw bone

21194 C Reconstruct lower jaw bone

21195 C Reconstruct lower jaw bone

21196 C Reconstruct lower jaw bone

21247 C Reconstruct lower jaw bone

21255 C Reconstruct lower jaw bone

21256 C Reconstruction of orbit

21268 C Revise eye sockets

21343 C Treatment of sinus fracture

21344 C Treatment of sinus fracture

21346 C Treat nose/jaw fracture

21347 C Treat nose/jaw fracture

21348 C Treat nose/jaw fracture

21356 C Treat cheek bone fracture

21360 C Treat cheek bone fracture

21365 C Treat cheek bone fracture

21366 C Treat cheek bone fracture

21385 C Treat eye socket fracture

21386 C Treat eye socket fracture

21387 C Treat eye socket fracture

21390 C Treat eye socket fracture

21395 C Treat eye socket fracture

21408 C Treat eye socket fracture

21422 C Treat mouth roof fracture

21423 C Treat mouth roof fracture

21431 C Treat craniofacial fracture

21432 C Treat craniofacial fracture

21433 C Treat craniofacial fracture

21435 C Treat craniofacial fracture

21436 C Treat craniofacial fracture

21495 C Treat hyoid bone fracture

21510 C Drainage of bone lesion

21557 C Remove tumor, neck/chest

21615 C Removal of rib

21616 C Removal of rib and nerves

21620 C Partial removal of sternum

21627 C Sternal debridement

21630 C Extensive sternum surgery

21632 C Extensive sternum surgery

21705 C Revision of neck muscle/rib

21740 C Reconstruction of sternum

21750 C Repair of sternum separation

21810 C Treatment of rib fracture(s)

21825 C Treat sternum fracture

22100 C Remove part of neck vertebra

22101 C Remove part, thorax vertebra

22102 C Remove part, lumbar vertebra

22103 C Remove extra spine segment

22110 C Remove part of neck vertebra

22112 C Remove part, thorax vertebra

22114 C Remove part, lumbar vertebra

22116 C Remove extra spine segment

22210 C Revision of neck spine

22212 C Revision of thorax spine

22214 C Revision of lumbar spine

22216 C Revise, extra spine segment

22220 C Revision of neck spine

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

22222 C Revision of thorax spine

22224 C Revision of lumbar spine

22226 C Revise, extra spine segment

22318 C Treat odontoid fx w/o graft

22319 C Treat odontoid fx w/graft

22325 C Treat spine fracture

22326 C Treat neck spine fracture

22327 C Treat thorax spine fracture

22328 C Treat each add spine fx

22548 C Neck spine fusion

22554 C Neck spine fusion

22556 C Thorax spine fusion

22558 C Lumbar spine fusion

22585 C Additional spinal fusion

22590 C Spine & skull spinal fusion

22595 C Neck spinal fusion

22600 C Neck spine fusion

22610 C Thorax spine fusion

22612 C Lumbar spine fusion

22614 C Spine fusion, extra segment

22630 C Lumbar spine fusion

22632 C Spine fusion, extra segment

22800 C Fusion of spine

22802 C Fusion of spine

22804 C Fusion of spine

22808 C Fusion of spine

22810 C Fusion of spine

22812 C Fusion of spine

22818 C Kyphectomy, 1-2 segments

22819 C Kyphectomy, 3 or more

22830 C Exploration of spinal fusion

22840 C Insert spine fixation device

22841 C Insert spine fixation device

22842 C Insert spine fixation device

22843 C Insert spine fixation device

22844 C Insert spine fixation device

22845 C Insert spine fixation device

22846 C Insert spine fixation device

22847 C Insert spine fixation device

22848 C Insert pelv fixation device

22849 C Reinsert spinal fixation

22850 C Remove spine fixation device

22851 C Apply spine prosth device

22852 C Remove spine fixation device

22855 C Remove spine fixation device

23035 C Drain shoulder bone lesion

23125 C Removal of collar bone

23195 C Removal of head of humerus

23200 C Removal of collar bone

23210 C Removal of shoulder blade

23220 C Partial removal of humerus

23221 C Partial removal of humerus

23222 C Partial removal of humerus

23332 C Remove shoulder foreign body

23395 C Muscle transfer, shoulder/arm

23397 C Muscle transfers

23400 C Fixation of shoulder blade

23440 C Remove/transplant tendon

23470 C Reconstruct shoulder joint

23472 C Reconstruct shoulder joint

23900 C Amputation of arm & girdle

23920 C Amputation at shoulder joint

24149 C Radical resection of elbow

24150 C Extensive humerus surgery

24151 C Extensive humerus surgery

24152 C Extensive radius surgery

24153 C Extensive radius surgery

24900 C Amputation of upper arm

24920 C Amputation of upper arm

24930 C Amputation follow-up surgery

24931 C Amputate upper arm & implant

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

24940 C Revision of upper arm

25170 C Extensive forearm surgery

25390 C Shorten radius or ulna

25391 C Lengthen radius or ulna

25392 C Shorten radius & ulna

25393 C Lengthen radius & ulna

25420 C Repair/graft radius & ulna

25900 C Amputation of forearm

25905 C Amputation of forearm

25909 C Amputation follow-up surgery

25915 C Amputation of forearm

25920 C Amputate hand at wrist

25924 C Amputation follow-up surgery

25927 C Amputation of hand

25931 C Amputation follow-up surgery

26551 C Great toe-hand transfer

26553 C Single transfer, toe-hand

26554 C Double transfer, toe-hand

26556 C Toe joint transfer

26992 C Drainage of bone lesion

27005 C Incision of hip tendon

27006 C Incision of hip tendons

27025 C Incision of hip/thigh fascia

27030 C Drainage of hip joint

27035 C Denervation of hip joint

27036 C Excision of hip joint/muscle

27054 C Removal of hip joint lining

27070 C Partial removal of hip bone

27071 C Partial removal of hip bone

27075 C Extensive hip surgery

27076 C Extensive hip surgery

27077 C Extensive hip surgery

27078 C Extensive hip surgery

27079 C Extensive hip surgery

27090 C Removal of hip prosthesis

27091 C Removal of hip prosthesis

27120 C Reconstruction of hip socket

27122 C Reconstruction of hip socket

27125 C Partial hip replacement

27130 C Total hip replacement

27132 C Total hip replacement

27134 C Revise hip joint replacement

27137 C Revise hip joint replacement

27138 C Revise hip joint replacement

27140 C Transplant femur ridge

27146 C Incision of hip bone

27147 C Revision of hip bone

27151 C Incision of hip bones

27156 C Revision of hip bones

27158 C Revision of pelvis

27161 C Incision of neck of femur

27165 C Incision/fixation of femur

27170 C Repair/graft femur head/neck

27175 C Treat slipped epiphysis

27176 C Treat slipped epiphysis

27177 C Treat slipped epiphysis

27178 C Treat slipped epiphysis

27179 C Revise head/neck of femur

27181 C Treat slipped epiphysis

27185 C Revision of femur epiphysis

27187 C Reinforce hip bones

27215 C Treat pelvic fracture(s)

27216 C Treat pelvic ring fracture

27217 C Treat pelvic ring fracture

27218 C Treat pelvic ring fracture

27222 C Treat hip socket fracture

27226 C Treat hip wall fracture

27227 C Treat hip fracture(s)

27228 C Treat hip fracture(s)

27232 C Treat thigh fracture

27235 C Treat thigh fracture

68007

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

27236 C Treat thigh fracture

27240 C Treat thigh fracture

27244 C Treat thigh fracture

27245 C Treat thigh fracture

27248 C Treat thigh fracture

27253 C Treat hip dislocation

27254 C Treat hip dislocation

27258 C Treat hip dislocation

27259 C Treat hip dislocation

27280 C Fusion of sacroiliac joint

27282 C Fusion of pubic bones

27284 C Fusion of hip joint

27286 C Fusion of hip joint

27290 C Amputation of leg at hip

27295 C Amputation of leg at hip

27303 C Drainage of bone lesion

27365 C Extensive leg surgery

27445 C Revision of knee joint

27446 C Revision of knee joint

27447 C Total knee replacement

27448 C Incision of thigh

27450 C Incision of thigh

27454 C Realignment of thigh bone

27455 C Realignment of knee

27457 C Realignment of knee

27465 C Shortening of thigh bone

27466 C Lengthening of thigh bone

27468 C Shorten/lengthen thighs

27470 C Repair of thigh

27472 C Repair/graft of thigh

27475 C Surgery to stop leg growth

27477 C Surgery to stop leg growth

27479 C Surgery to stop leg growth

27485 C Surgery to stop leg growth

27486 C Revise/replace knee joint

27487 C Revise/replace knee joint

27488 C Removal of knee prosthesis

27495 C Reinforce thigh

27506 C Treatment of thigh fracture

27507 C Treatment of thigh fracture

27511 C Treatment of thigh fracture

27513 C Treatment of thigh fracture

27514 C Treatment of thigh fracture

27519 C Treat thigh fx growth plate

27535 C Treat knee fracture

27536 C Treat knee fracture

27540 C Treat knee fracture

27556 C Treat knee dislocation

27557 C Treat knee dislocation

27558 C Treat knee dislocation

27580 C Fusion of knee

27590 C Amputate leg at thigh

27591 C Amputate leg at thigh

27592 C Amputate leg at thigh

27596 C Amputation follow-up surgery

27598 C Amputate lower leg at knee

27645 C Extensive lower leg surgery

27646 C Extensive lower leg surgery

27702 C Reconstruct ankle joint

27703 C Reconstruction, ankle joint

27712 C Realignment of lower leg

27715 C Revision of lower leg

27720 C Repair of tibia

27722 C Repair/graft of tibia

27724 C Repair/graft of tibia

27725 C Repair of lower leg

27727 C Repair of lower leg

27880 C Amputation of lower leg

27881 C Amputation of lower leg

27882 C Amputation of lower leg

27886 C Amputation follow-up surgery

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

27888 C Amputation of foot at ankle

28800 C Amputation of midfoot

28805 C Amputation thru metatarsal

31225 C Removal of upper jaw

31230 C Removal of upper jaw

31290 C Nasal/sinus endoscopy, surg

31291 C Nasal/sinus endoscopy, surg

31292 C Nasal/sinus endoscopy, surg

31293 C Nasal/sinus endoscopy, surg

31294 C Nasal/sinus endoscopy, surg

31360 C Removal of larynx

31365 C Removal of larynx

31367 C Partial removal of larynx

31368 C Partial removal of larynx

31370 C Partial removal of larynx

31375 C Partial removal of larynx

31380 C Partial removal of larynx

31382 C Partial removal of larynx

31390 C Removal of larynx & pharynx

31395 C Reconstruct larynx & pharynx

31582 C Revision of larynx

31584 C Treat larynx fracture

31587 C Revision of larynx

31725 C Clearance of airways

31760 C Repair of windpipe

31766 C Reconstruction of windpipe

31770 C Repair/graft of bronchus

31775 C Reconstruct bronchus

31780 C Reconstruct windpipe

31781 C Reconstruct windpipe

31785 C Remove windpipe lesion

31786 C Remove windpipe lesion

31800 C Repair of windpipe injury

31805 C Repair of windpipe injury

32035 C Exploration of chest

32036 C Exploration of chest

32095 C Biopsy through chest wall

32100 C Exploration/biopsy of chest

32110 C Explore/repair chest

32120 C Re-exploration of chest

32124 C Explore chest free adhesions

32140 C Removal of lung lesion(s)

32141 C Remove/treat lung lesions

32150 C Removal of lung lesion(s)

32151 C Remove lung foreign body

32160 C Open chest heart massage

32200 C Drain, open, lung lesion

32201 C Drain, percut, lung lesion

32215 C Treat chest lining

32220 C Release of lung

32225 C Partial release of lung

32310 C Removal of chest lining

32320 C Free/remove chest lining

32402 C Open biopsy chest lining

32440 C Removal of lung

32442 C Sleeve pneumonectomy

32445 C Removal of lung

32480 C Partial removal of lung

32482 C Bilobectomy

32484 C Segmentectomy

32486 C Sleeve lobectomy

32488 C Completion pneumonectomy

32491 C Lung volume reduction

32500 C Partial removal of lung

32501 C Repair bronchus add-on

32520 C Remove lung & revise chest

32522 C Remove lung & revise chest

32525 C Remove lung & revise chest

32540 C Removal of lung lesion

32650 C Thoracoscopy, surgical

32651 C Thoracoscopy, surgical

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

32652 C Thoracoscopy, surgical

32653 C Thoracoscopy, surgical

32654 C Thoracoscopy, surgical

32655 C Thoracoscopy, surgical

32656 C Thoracoscopy, surgical

32657 C Thoracoscopy, surgical

32658 C Thoracoscopy, surgical

32659 C Thoracoscopy, surgical

32660 C Thoracoscopy, surgical

32661 C Thoracoscopy, surgical

32662 C Thoracoscopy, surgical

32663 C Thoracoscopy, surgical

32664 C Thoracoscopy, surgical

32665 C Thoracoscopy, surgical

32800 C Repair lung hernia

32810 C Close chest after drainage

32815 C Close bronchial fistula

32820 C Reconstruct injured chest

32850 C Donor pneumonectomy

32851 C Lung transplant, single

32852 C Lung transplant with bypass

32853 C Lung transplant, double

32854 C Lung transplant with bypass

32900 C Removal of rib(s)

32905 C Revise & repair chest wall

32906 C Revise & repair chest wall

32940 C Revision of lung

32997 C Total lung lavage

33015 C Incision of heart sac

33020 C Incision of heart sac

33025 C Incision of heart sac

33030 C Partial removal of heart sac

33031 C Partial removal of heart sac

33050 C Removal of heart sac lesion

33120 C Removal of heart lesion

33130 C Removal of heart lesion

33140 C Heart revascularize (tmr)

* 33141 C Heart revascularize (tmr)

33200 C Insertion of heart pacemaker

33201 C Insertion of heart pacemaker

33236 C Remove electrode/

thoracotomy

33237 C Remove electrode/

thoracotomy

33238 C Remove electrode/

thoracotomy

33243 C Remove eltrd/thoracotomy

33245 C Insert epic eltrd pace-defib

33246 C Insert epic eltrd/generator

33250 C Ablate heart dysrhythm focus

33251 C Ablate heart dysrhythm focus

33253 C Reconstruct atria

33261 C Ablate heart dysrhythm focus

33300 C Repair of heart wound

33305 C Repair of heart wound

33310 C Exploratory heart surgery

33315 C Exploratory heart surgery

33320 C Repair major blood vessel(s)

33321 C Repair major vessel

33322 C Repair major blood vessel(s)

33330 C Insert major vessel graft

33332 C Insert major vessel graft

33335 C Insert major vessel graft

33400 C Repair of aortic valve

33401 C Valvuloplasty, open

33403 C Valvuloplasty, w/cp bypass

33404 C Prepare heart-aorta conduit

33405 C Replacement of aortic valve

33406 C Replacement of aortic valve

33410 C Replacement of aortic valve

33411 C Replacement of aortic valve

68008

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

33412 C Replacement of aortic valve

33413 C Replacement of aortic valve

33414 C Repair of aortic valve

33415 C Revision, subvalvular tissue

33416 C Revise ventricle muscle

33417 C Repair of aortic valve

33420 C Revision of mitral valve

33422 C Revision of mitral valve

33425 C Repair of mitral valve

33426 C Repair of mitral valve

33427 C Repair of mitral valve

33430 C Replacement of mitral valve

33460 C Revision of tricuspid valve

33463 C Valvuloplasty, tricuspid

33464 C Valvuloplasty, tricuspid

33465 C Replace tricuspid valve

33468 C Revision of tricuspid valve

33470 C Revision of pulmonary valve

33471 C Valvotomy, pulmonary valve

33472 C Revision of pulmonary valve

33474 C Revision of pulmonary valve

33475 C Replacement, pulmonary

valve

33476 C Revision of heart chamber

33478 C Revision of heart chamber

33496 C Repair, prosth valve clot

33500 C Repair heart vessel fistula

33501 C Repair heart vessel fistula

33502 C Coronary artery correction

33503 C Coronary artery graft

33504 C Coronary artery graft

33505 C Repair artery w/tunnel

33506 C Repair artery, translocation

33510 C CABG, vein, single

33511 C CABG, vein, two

33512 C CABG, vein, three

33513 C CABG, vein, four

33514 C CABG, vein, five

33516 C Cabg, vein, six or more

33517 C CABG, artery-vein, single

33518 C CABG, artery-vein, two

33519 C CABG, artery-vein, three

33521 C CABG, artery-vein, four

33522 C CABG, artery-vein, five

33523 C Cabg, art-vein, six or more

33530 C Coronary artery, bypass/reop

33533 C CABG, arterial, single

33534 C CABG, arterial, two

33535 C CABG, arterial, three

33536 C Cabg, arterial, four or more

33542 C Removal of heart lesion

33545 C Repair of heart damage

33572 C Open coronary

endarterectomy

33600 C Closure of valve

33602 C Closure of valve

33606 C Anastomosis/artery-aorta

33608 C Repair anomaly w/conduit

33610 C Repair by enlargement

33611 C Repair double ventricle

33612 C Repair double ventricle

33615 C Repair, simple fontan

33617 C Repair, modified fontan

33619 C Repair single ventricle

33641 C Repair heart septum defect

33645 C Revision of heart veins

33647 C Repair heart septum defects

33660 C Repair of heart defects

33665 C Repair of heart defects

33670 C Repair of heart chambers

33681 C Repair heart septum defect

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

33684 C Repair heart septum defect

33688 C Repair heart septum defect

33690 C Reinforce pulmonary artery

33692 C Repair of heart defects

33694 C Repair of heart defects

33697 C Repair of heart defects

33702 C Repair of heart defects

33710 C Repair of heart defects

33720 C Repair of heart defect

33722 C Repair of heart defect

33730 C Repair heart-vein defect(s)

33732 C Repair heart-vein defect

33735 C Revision of heart chamber

33736 C Revision of heart chamber

33737 C Revision of heart chamber

33750 C Major vessel shunt

33755 C Major vessel shunt

33762 C Major vessel shunt

33764 C Major vessel shunt & graft

33766 C Major vessel shunt

33767 C Major vessel shunt

33770 C Repair great vessels defect

33771 C Repair great vessels defect

33774 C Repair great vessels defect

33775 C Repair great vessels defect

33776 C Repair great vessels defect

33777 C Repair great vessels defect

33778 C Repair great vessels defect

33779 C Repair great vessels defect

33780 C Repair great vessels defect

33781 C Repair great vessels defect

33786 C Repair arterial trunk

33788 C Revision of pulmonary artery

33800 C Aortic suspension

33802 C Repair vessel defect

33803 C Repair vessel defect

33813 C Repair septal defect

33814 C Repair septal defect

33820 C Revise major vessel

33822 C Revise major vessel

33824 C Revise major vessel

33840 C Remove aorta constriction

33845 C Remove aorta constriction

33851 C Remove aorta constriction

33852 C Repair septal defect

33853 C Repair septal defect

33860 C Ascending aortic graft

33861 C Ascending aortic graft

33863 C Ascending aortic graft

33870 C Transverse aortic arch graft

33875 C Thoracic aortic graft

33877 C Thoracoabdominal graft

33910 C Remove lung artery emboli

33915 C Remove lung artery emboli

33916 C Surgery of great vessel

33917 C Repair pulmonary artery

33918 C Repair pulmonary atresia

33919 C Repair pulmonary atresia

33920 C Repair pulmonary atresia

33922 C Transect pulmonary artery

33924 C Remove pulmonary shunt

33930 C Removal of donor heart/lung

33935 C Transplantation, heart/lung

33940 C Removal of donor heart

33945 C Transplantation of heart

33960 C External circulation assist

33961 C External circulation assist

33968 C Remove aortic assist device

33970 C Aortic circulation assist

33971 C Aortic circulation assist

33973 C Insert balloon device

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

33974 C Remove intra-aortic balloon

33975 C Implant ventricular device

33976 C Implant ventricular device

33977 C Remove ventricular device

33978 C Remove ventricular device

34001 C Removal of artery clot

34051 C Removal of artery clot

34151 C Removal of artery clot

34401 C Removal of vein clot

34451 C Removal of vein clot

34502 C Reconstruct vena cava

* 34800 C Repair abdominal aortic aneurysm * 34802 C Repair abdominal aortic aneurysm * 34804 C Repair abdominal aortic aneurysm * 34808 C Repair abdominal aortic aneurysm * 34812 C Repair abdominal aortic aneurysm * 34813 C Repair abdominal aortic aneurysm * 34820 C Repair abdominal aortic aneurysm * 34825 C Repair abdominal aortic aneurysm * 34826 C Repair abdominal aortic aneurysm * 34830 C Repair abdominal aortic aneurysm * 34831 C Repair abdominal aortic aneurysm * 34832 C Repair abdominal aortic aneurysm

35001 C Repair defect of artery

35002 C Repair artery rupture, neck

35005 C Repair defect of artery

35013 C Repair artery rupture, arm

35021 C Repair defect of artery

35022 C Repair artery rupture, chest

35045 C Repair defect of arm artery

35081 C Repair defect of artery

35082 C Repair artery rupture, aorta

35091 C Repair defect of artery

35092 C Repair artery rupture, aorta

35102 C Repair defect of artery

35103 C Repair artery rupture, groin

35111 C Repair defect of artery

35112 C Repair artery rupture,spleen

35121 C Repair defect of artery

35122 C Repair artery rupture, belly

35131 C Repair defect of artery

35132 C Repair artery rupture, groin

35141 C Repair defect of artery

35142 C Repair artery rupture, thigh

35151 C Repair defect of artery

35152 C Repair artery rupture, knee

35161 C Repair defect of artery

35162 C Repair artery rupture

35182 C Repair blood vessel lesion

35189 C Repair blood vessel lesion

35211 C Repair blood vessel lesion

35216 C Repair blood vessel lesion

35221 C Repair blood vessel lesion

35241 C Repair blood vessel lesion

35246 C Repair blood vessel lesion

35251 C Repair blood vessel lesion

35271 C Repair blood vessel lesion

35276 C Repair blood vessel lesion

35281 C Repair blood vessel lesion

68009

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

35301 C Rechanneling of artery

35311 C Rechanneling of artery

35331 C Rechanneling of artery

35341 C Rechanneling of artery

35351 C Rechanneling of artery

35355 C Rechanneling of artery

35361 C Rechanneling of artery

35363 C Rechanneling of artery

35371 C Rechanneling of artery

35372 C Rechanneling of artery

35381 C Rechanneling of artery

35390 C Reoperation, carotid add-on

35400 C Angioscopy

35450 C Repair arterial blockage

35452 C Repair arterial blockage

35454 C Repair arterial blockage

35456 C Repair arterial blockage

35480 C Atherectomy, open

35482 C Atherectomy, open

35483 C Atherectomy, open

35501 C Artery bypass graft

35506 C Artery bypass graft

35507 C Artery bypass graft

35508 C Artery bypass graft

35509 C Artery bypass graft

35511 C Artery bypass graft

35515 C Artery bypass graft

35516 C Artery bypass graft

35518 C Artery bypass graft

35521 C Artery bypass graft

35526 C Artery bypass graft

35531 C Artery bypass graft

35533 C Artery bypass graft

35536 C Artery bypass graft

35541 C Artery bypass graft

35546 C Artery bypass graft

35548 C Artery bypass graft

35549 C Artery bypass graft

35551 C Artery bypass graft

35556 C Artery bypass graft

35558 C Artery bypass graft

35560 C Artery bypass graft

35563 C Artery bypass graft

35565 C Artery bypass graft

35566 C Artery bypass graft

35571 C Artery bypass graft

35582 C Vein bypass graft

35583 C Vein bypass graft

35585 C Vein bypass graft

35587 C Vein bypass graft

* 35600 C Harvest artery graft

35601 C Artery bypass graft

35606 C Artery bypass graft

35612 C Artery bypass graft

35616 C Artery bypass graft

35621 C Artery bypass graft

35623 C Bypass graft, not vein

35626 C Artery bypass graft

35631 C Artery bypass graft

35636 C Artery bypass graft

35641 C Artery bypass graft

35642 C Artery bypass graft

35645 C Artery bypass graft

35646 C Artery bypass graft

35650 C Artery bypass graft

35651 C Artery bypass graft

35654 C Artery bypass graft

35656 C Artery bypass graft

35661 C Artery bypass graft

35663 C Artery bypass graft

35665 C Artery bypass graft

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

35666 C Artery bypass graft

35671 C Artery bypass graft

35681 C Composite bypass graft

35682 C Composite bypass graft

35683 C Composite bypass graft

35691 C Arterial transposition

35693 C Arterial transposition

35694 C Arterial transposition

35695 C Arterial transposition

35700 C Reoperation, bypass graft

35701 C Exploration, carotid artery

35721 C Exploration, femoral artery

35741 C Exploration popliteal artery

35800 C Explore neck vessels

35820 C Explore chest vessels

35840 C Explore abdominal vessels

35870 C Repair vessel graft defect

35901 C Excision, graft, neck

35905 C Excision, graft, thorax

35907 C Excision, graft, abdomen

36510 C Insertion of catheter, vein

36660 C Insertion catheter, artery

36822 C Insertion of cannula(s)

36823 C Insertion of cannula(s)

37140 C Revision of circulation

37145 C Revision of circulation

37160 C Revision of circulation

37180 C Revision of circulation

37181 C Splice spleen/kidney veins

37195 C Thrombolytic therapy, stroke

37616 C Ligation of chest artery

37617 C Ligation of abdomen artery

37618 C Ligation of extremity artery

37660 C Revision of major vein

37788 C Revascularization, penis

38100 C Removal of spleen, total

38101 C Removal of spleen, partial

38102 C Removal of spleen, total

38115 C Repair of ruptured spleen

38380 C Thoracic duct procedure

38381 C Thoracic duct procedure

38382 C Thoracic duct procedure

38562 C Removal, pelvic lymph nodes

38564 C Removal, abdomen lymph

nodes

38700 C Removal of lymph nodes,

neck

38724 C Removal of lymph nodes,

neck

38746 C Remove thoracic lymph nodes

38747 C Remove abdominal lymph

nodes

38765 C Remove groin lymph nodes

38770 C Remove pelvis lymph nodes

38780 C Remove abdomen lymph

nodes

39000 C Exploration of chest

39010 C Exploration of chest

39200 C Removal chest lesion

39220 C Removal chest lesion

39499 C Chest procedure

39501 C Repair diaphragm laceration

39502 C Repair paraesophageal hernia

39503 C Repair of diaphragm hernia

39520 C Repair of diaphragm hernia

39530 C Repair of diaphragm hernia

39531 C Repair of diaphragm hernia

39540 C Repair of diaphragm hernia

39541 C Repair of diaphragm hernia

39545 C Revision of diaphragm

39560 C Resect diaphragm, simple

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

39561 C Resect diaphragm, complex

39599 C Diaphragm surgery procedure

41130 C Partial removal of tongue

41135 C Tongue and neck surgery

41140 C Removal of tongue

41145 C Tongue removal, neck surgery

41150 C Tongue, mouth, jaw surgery

41153 C Tongue, mouth, neck surgery

41155 C Tongue, jaw, & neck surgery

42426 C Excise parotid gland/lesion

42842 C Extensive surgery of throat

42845 C Extensive surgery of throat

42894 C Revision of pharyngeal walls

42953 C Repair throat, esophagus

42961 C Control throat bleeding

42971 C Control nose/throat bleeding

43030 C Throat muscle surgery

43045 C Incision of esophagus

43100 C Excision of esophagus lesion

43101 C Excision of esophagus lesion

43107 C Removal of esophagus

43108 C Removal of esophagus

43112 C Removal of esophagus

43113 C Removal of esophagus

43116 C Partial removal of esophagus

43117 C Partial removal of esophagus

43118 C Partial removal of esophagus

43121 C Partial removal of esophagus

43122 C Parital removal of esophagus

43123 C Partial removal of esophagus

43124 C Removal of esophagus

43135 C Removal of esophagus pouch

43300 C Repair of esophagus

43305 C Repair esophagus and fistula

43310 C Repair of esophagus

43312 C Repair esophagus and fistula

43320 C Fuse esophagus & stomach

43324 C Revise esophagus & stomach

43325 C Revise esophagus & stomach

43326 C Revise esophagus & stomach

43330 C Repair of esophagus

43331 C Repair of esophagus

43340 C Fuse esophagus & intestine

43341 C Fuse esophagus & intestine

43350 C Surgical opening, esophagus

43351 C Surgical opening, esophagus

43352 C Surgical opening, esophagus

43360 C Gastrointestinal repair

43361 C Gastrointestinal repair

43400 C Ligate esophagus veins

43401 C Esophagus surgery for veins

43405 C Ligate/staple esophagus

43410 C Repair esophagus wound

43415 C Repair esophagus wound

43420 C Repair esophagus opening

43425 C Repair esophagus opening

43460 C Pressure treatment esophagus

43496 C Free jejunum flap, microvasc

43500 C Surgical opening of stomach

43501 C Surgical repair of stomach

43502 C Surgical repair of stomach

43510 C Surgical opening of stomach

43520 C Incision of pyloric muscle

43605 C Biopsy of stomach

43610 C Excision of stomach lesion

43611 C Excision of stomach lesion

43620 C Removal of stomach

43621 C Removal of stomach

43622 C Removal of stomach

43631 C Removal of stomach, partial

43632 C Removal of stomach, partial

68010

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

43633 C Removal of stomach, partial

43634 C Removal of stomach, partial

43635 C Removal of stomach, partial

43638 C Removal of stomach, partial

43639 C Removal of stomach, partial

43640 C Vagotomy & pylorus repair

43641 C Vagotomy & pylorus repair

43800 C Reconstruction of pylorus

43810 C Fusion of stomach and bowel

43820 C Fusion of stomach and bowel

43825 C Fusion of stomach and bowel

43832 C Place gastrostomy tube

43840 C Repair of stomach lesion

43842 C Gastroplasty for obesity

43843 C Gastroplasty for obesity

43846 C Gastric bypass for obesity

43847 C Gastric bypass for obesity

43848 C Revision gastroplasty

43850 C Revise stomach-bowel fusion

43855 C Revise stomach-bowel fusion

43860 C Revise stomach-bowel fusion

43865 C Revise stomach-bowel fusion

43880 C Repair stomach-bowel fistula

44005 C Freeing of bowel adhesion

44010 C Incision of small bowel

44015 C Insert needle cath bowel

44020 C Exploration of small bowel

44021 C Decompress small bowel

44025 C Incision of large bowel

44050 C Reduce bowel obstruction

44055 C Correct malrotation of bowel

44110 C Excision of bowel lesion(s)

44111 C Excision of bowel lesion(s)

44120 C Removal of small intestine

44121 C Removal of small intestine

44125 C Removal of small intestine

* 44130 C Bowel to bowel fusion

* 44132 C Donor enterectomy

* 44133 C Donor enterectomy

* 44135 C Intestinal allotransplantation

* 44136 C Intestinal allotransplantation

44139 C Mobilization of colon

44140 C Partial removal of colon

44141 C Partial removal of colon

44143 C Partial removal of colon

44144 C Partial removal of colon

44145 C Partial removal of colon

44146 C Partial removal of colon

44147 C Partial removal of colon

44150 C Removal of colon

44151 C Removal of colon/ileostomy

44152 C Removal of colon/ileostomy

44153 C Removal of colon/ileostomy

44155 C Removal of colon/ileostomy

44156 C Removal of colon/ileostomy

44160 C Removal of colon

44202 C Laparo, resect intestine

44300 C Open bowel to skin

44310 C Ileostomy/jejunostomy

44314 C Revision of ileostomy

44316 C Devise bowel pouch

44320 C Colostomy

44322 C Colostomy with biopsies

44345 C Revision of colostomy

44346 C Revision of colostomy

44602 C Suture, small intestine

44603 C Suture, small intestine

44604 C Suture, large intestine

44605 C Repair of bowel lesion

44615 C Intestinal stricturoplasty

44620 C Repair bowel opening

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

44625 C Repair bowel opening

44626 C Repair bowel opening

44640 C Repair bowel-skin fistula

44650 C Repair bowel fistula

44660 C Repair bowel-bladder fistula

44661 C Repair bowel-bladder fistula

44680 C Surgical revision, intestine

44700 C Suspend bowel w/prosthesis

44800 C Excision of bowel pouch

44820 C Excision of mesentery lesion

44850 C Repair of mesentery

44899 C Bowel surgery procedure

44900 C Drain app abscess, open

44901 C Drain app abscess, percut

44950 C Appendectomy

44955 C Appendectomy add-on

44960 C Appendectomy

45110 C Removal of rectum

45111 C Partial removal of rectum

45112 C Removal of rectum

45113 C Partial proctectomy

45114 C Partial removal of rectum

45116 C Partial removal of rectum

45119 C Remove rectum w/reservoir

45120 C Removal of rectum

45121 C Removal of rectum and colon

45123 C Partial proctectomy

45126 C Pelvic exenteration

45130 C Excision of rectal prolapse

45135 C Excision of rectal prolapse

45540 C Correct rectal prolapse

45541 C Correct rectal prolapse

45550 C Repair rectum/remove sigmoid

45562 C Exploration/repair of rectum

45563 C Exploration/repair of rectum

45800 C Repair rect/bladder fistula

45805 C Repair fistula w/colostomy

45820 C Repair rectourethral fistula

45825 C Repair fistula w/colostomy

46705 C Repair of anal stricture

46715 C Repair of anovaginal fistula

46716 C Repair of anovaginal fistula

46730 C Construction of absent anus

46735 C Construction of absent anus

46740 C Construction of absent anus

46742 C Repair of imperforated anus

46744 C Repair of cloacal anomaly

46746 C Repair of cloacal anomaly

46748 C Repair of cloacal anomaly

46751 C Repair of anal sphincter

47001 C Needle biopsy, liver add-on

47010 C Open drainage, liver lesion

47011 C Percut drain, liver lesion

47015 C Inject/aspirate liver cyst

47100 C Wedge biopsy of liver

47120 C Partial removal of liver

47122 C Extensive removal of liver

47125 C Partial removal of liver

47130 C Partial removal of liver

47133 C Removal of donor liver

47134 C Partial removal, donor liver

47135 C Transplantation of liver

47136 C Transplantation of liver

47300 C Surgery for liver lesion

47350 C Repair liver wound

47360 C Repair liver wound

47361 C Repair liver wound

47362 C Repair liver wound

47400 C Incision of liver duct

47420 C Incision of bile duct

47425 C Incision of bile duct

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

47460 C Incise bile duct sphincter

47480 C Incision of gallbladder

47490 C Incision of gallbladder

47550 C Bile duct endoscopy add-on

47570 C Laparo cholecystoenterostomy

47600 C Removal of gallbladder

47605 C Removal of gallbladder

47610 C Removal of gallbladder

47612 C Removal of gallbladder

47620 C Removal of gallbladder

47700 C Exploration of bile ducts

47701 C Bile duct revision

47711 C Excision of bile duct tumor

47712 C Excision of bile duct tumor

47715 C Excision of bile duct cyst

47716 C Fusion of bile duct cyst

47720 C Fuse gallbladder & bowel

47721 C Fuse upper gi structures

47740 C Fuse gallbladder & bowel

47741 C Fuse gallbladder & bowel

47760 C Fuse bile ducts and bowel

47765 C Fuse liver ducts & bowel

47780 C Fuse bile ducts and bowel

47785 C Fuse bile ducts and bowel

47800 C Reconstruction of bile ducts

47801 C Placement, bile duct support

47802 C Fuse liver duct & intestine

47900 C Suture bile duct injury

48000 C Drainage of abdomen

48001 C Placement of drain, pancreas

48005 C Resect/debride pancreas

48020 C Removal of pancreatic stone

48100 C Biopsy of pancreas

48120 C Removal of pancreas lesion

48140 C Partial removal of pancreas

48145 C Partial removal of pancreas

48146 C Pancreatectomy

48148 C Removal of pancreatic duct

48150 C Partial removal of pancreas

48152 C Pancreatectomy

48153 C Pancreatectomy

48154 C Pancreatectomy

48155 C Removal of pancreas

48180 C Fuse pancreas and bowel

48400 C Injection, intraop add-on

48500 C Surgery of pancreas cyst

48510 C Drain pancreatic pseudocyst

48511 C Drain pancreatic pseudocyst

48520 C Fuse pancreas cyst and bowel

48540 C Fuse pancreas cyst and bowel

48545 C Pancreatorrhaphy

48547 C Duodenal exclusion

48556 C Removal, allograft pancreas

49000 C Exploration of abdomen

49002 C Reopening of abdomen

49010 C Exploration behind abdomen

49020 C Drain abdominal abscess

49021 C Drain abdominal abscess

49040 C Drain, open, abdom abscess

49041 C Drain, percut, abdom abscess

49060 C Drain, open, retrop abscess

49061 C Drain, percut, retroper absc

49062 C Drain to peritoneal cavity

49200 C Removal of abdominal lesion

49201 C Removal of abdominal lesion

49215 C Excise sacral spine tumor

49220 C Multiple surgery, abdomen

49255 C Removal of omentum

49425 C Insert abdomen-venous drain

49428 C Ligation of shunt

49605 C Repair umbilical lesion

68011

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

49606 C Repair umbilical lesion

49610 C Repair umbilical lesion

49611 C Repair umbilical lesion

49900 C Repair of abdominal wall

49905 C Omental flap

49906 C Free omental flap, microvasc

50010 C Exploration of kidney

50020 C Renal abscess, open drain

50021 C Renal abscess, percut drain

50040 C Drainage of kidney

50045 C Exploration of kidney

50060 C Removal of kidney stone

50065 C Incision of kidney

50070 C Incision of kidney

50075 C Removal of kidney stone

50100 C Revise kidney blood vessels

50120 C Exploration of kidney

50125 C Explore and drain kidney

50130 C Removal of kidney stone

50135 C Exploration of kidney

50205 C Biopsy of kidney

50220 C Removal of kidney

50225 C Removal of kidney

50230 C Removal of kidney

50234 C Removal of kidney & ureter

50236 C Removal of kidney & ureter

50240 C Partial removal of kidney

50280 C Removal of kidney lesion

50290 C Removal of kidney lesion

50300 C Removal of donor kidney

50320 C Removal of donor kidney

50340 C Removal of kidney

50360 C Transplantation of kidney

50365 C Transplantation of kidney

50370 C Remove transplanted kidney

50380 C Reimplantation of kidney

50400 C Revision of kidney/ureter

50405 C Revision of kidney/ureter

50500 C Repair of kidney wound

50520 C Close kidney-skin fistula

50525 C Repair renal-abdomen fistula

50526 C Repair renal-abdomen fistula

50540 C Revision of horseshoe kidney

* 50545 C Laparoscopic nephrectomy

50546 C Laparoscopic nephrectomy

50547 C Laparo removal donor kidney

50548 C Laparo-asst remove k/ureter

50570 C Kidney endoscopy

50572 C Kidney endoscopy

50574 C Kidney endoscopy & biopsy

50575 C Kidney endoscopy

50576 C Kidney endoscopy & treatment

50578 C Renal endoscopy/radiotracer

50580 C Kidney endoscopy & treatment

50600 C Exploration of ureter

50605 C Insert ureteral support

50610 C Removal of ureter stone

50620 C Removal of ureter stone

50630 C Removal of ureter stone

50650 C Removal of ureter

50660 C Removal of ureter

50700 C Revision of ureter

50715 C Release of ureter

50722 C Release of ureter

50725 C Release/revise ureter

50727 C Revise ureter

50728 C Revise ureter

50740 C Fusion of ureter & kidney

50750 C Fusion of ureter & kidney

50760 C Fusion of ureters

50770 C Splicing of ureters

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

50780 C Reimplant ureter in bladder

50782 C Reimplant ureter in bladder

50783 C Reimplant ureter in bladder

50785 C Reimplant ureter in bladder

50800 C Implant ureter in bowel

50810 C Fusion of ureter & bowel

50815 C Urine shunt to bowel

50820 C Construct bowel bladder

50825 C Construct bowel bladder

50830 C Revise urine flow

50840 C Replace ureter by bowel

50845 C Appendico-vesicostomy

50860 C Transplant ureter to skin

50900 C Repair of ureter

50920 C Closure ureter/skin fistula

50930 C Closure ureter/bowel fistula

50940 C Release of ureter

51060 C Removal of ureter stone

51525 C Removal of bladder lesion

51530 C Removal of bladder lesion

51535 C Repair of ureter lesion

51550 C Partial removal of bladder

51555 C Partial removal of bladder

51565 C Revise bladder & ureter(s)

51570 C Removal of bladder

51575 C Removal of bladder & nodes

51580 C Remove bladder/revise tract

51585 C Removal of bladder & nodes

51590 C Remove bladder/revise tract

51595 C Remove bladder/revise tract

51596 C Remove bladder/create pouch

51597 C Removal of pelvic structures

51800 C Revision of bladder/urethra

51820 C Revision of urinary tract

51840 C Attach bladder/urethra

51841 C Attach bladder/urethra

51845 C Repair bladder neck

51860 C Repair of bladder wound

51865 C Repair of bladder wound

51900 C Repair bladder/vagina lesion

51920 C Close bladder-uterus fistula

51925 C Hysterectomy/bladder repair

51940 C Correction of bladder defect

51960 C Revision of bladder & bowel

51980 C Construct bladder opening

53085 C Drainage of urinary leakage

53415 C Reconstruction of urethra

53443 C Reconstruction of urethra

54125 C Removal of penis

54130 C Remove penis & nodes

54135 C Remove penis & nodes

54332 C Revise penis/urethra

54336 C Revise penis/urethra

54390 C Repair penis and bladder

54430 C Revision of penis

54535 C Extensive testis surgery

54560 C Exploration for testis

54650 C Orchiopexy (Fowler-Stephens)

55600 C Incise sperm duct pouch

55605 C Incise sperm duct pouch

55650 C Remove sperm duct pouch

55801 C Removal of prostate

55810 C Extensive prostate surgery

55812 C Extensive prostate surgery

55815 C Extensive prostate surgery

55821 C Removal of prostate

55831 C Removal of prostate

55840 C Extensive prostate surgery

55842 C Extensive prostate surgery

55845 C Extensive prostate surgery

55862 C Extensive prostate surgery

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

55865 C Extensive prostate surgery

56630 C Extensive vulva surgery

56631 C Extensive vulva surgery

56632 C Extensive vulva surgery

56633 C Extensive vulva surgery

56634 C Extensive vulva surgery

56637 C Extensive vulva surgery

56640 C Extensive vulva surgery

57110 C Remove vagina wall, complete

57111 C Remove vagina tissue, compl

57112 C Vaginectomy w/nodes, compl

57270 C Repair of bowel pouch

57280 C Suspension of vagina

57282 C Repair of vaginal prolapse

57292 C Construct vagina with graft

57305 C Repair rectum-vagina fistula

57307 C Fistula repair & colostomy

57308 C Fistula repair, transperine

57311 C Repair urethrovaginal lesion

57335 C Repair vagina

57531 C Removal of cervix, radical

57540 C Removal of residual cervix

57545 C Remove cervix/repair pelvis

58140 C Removal of uterus lesion

58150 C Total hysterectomy

58152 C Total hysterectomy

58180 C Partial hysterectomy

58200 C Extensive hysterectomy

58210 C Extensive hysterectomy

58240 C Removal of pelvis contents

58260 C Vaginal hysterectomy

58262 C Vaginal hysterectomy

58263 C Vaginal hysterectomy

58267 C Hysterectomy & vagina repair

58270 C Hysterectomy & vagina repair

58275 C Hysterectomy/revise vagina

58280 C Hysterectomy/revise vagina

58285 C Extensive hysterectomy

58400 C Suspension of uterus

58410 C Suspension of uterus

58520 C Repair of ruptured uterus

58540 C Revision of uterus

58605 C Division of fallopian tube

58611 C Ligate oviduct(s) add-on

58700 C Removal of fallopian tube

58720 C Removal of ovary/tube(s)

58740 C Revise fallopian tube(s)

58750 C Repair oviduct

58752 C Revise ovarian tube(s)

58760 C Remove tubal obstruction

58770 C Create new tubal opening

58805 C Drainage of ovarian cyst(s)

58822 C Drain ovary abscess, percut

58823 C Drain pelvic abscess, percut

58825 C Transposition, ovary(s)

58940 C Removal of ovary(s)

58943 C Removal of ovary(s)

58950 C Resect ovarian malignancy

58951 C Resect ovarian malignancy

58952 C Resect ovarian malignancy

58960 C Exploration of abdomen

59100 C Remove uterus lesion

59120 C Treat ectopic pregnancy

59121 C Treat ectopic pregnancy

59130 C Treat ectopic pregnancy

59135 C Treat ectopic pregnancy

59136 C Treat ectopic pregnancy

59140 C Treat ectopic pregnancy

59325 C Revision of cervix

59350 C Repair of uterus

59514 C Cesarean delivery only

68012

——————————

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

Copyright American Dental Association. All rights reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

59525 C Remove uterus after cesarean

59620 C Attempted vbac delivery only

59830 C Treat uterus infection

59850 C Abortion

59851 C Abortion

59852 C Abortion

59855 C Abortion

59856 C Abortion

59857 C Abortion

60254 C Extensive thyroid surgery

60270 C Removal of thyroid

60271 C Removal of thyroid

60502 C Re-explore parathyroids

60505 C Explore parathyroid glands

60520 C Removal of thymus gland

60521 C Removal of thymus gland

60522 C Removal of thymus gland

60540 C Explore adrenal gland

60545 C Explore adrenal gland

60600 C Remove carotid body lesion

60605 C Remove carotid body lesion

60650 C Laparoscopy adrenalectomy

61105 C Twist drill hole

61107 C Drill skull for implantation

61108 C Drill skull for drainage

61120 C Burr hole for puncture

61140 C Pierce skull for biopsy

61150 C Pierce skull for drainage

61151 C Pierce skull for drainage

61154 C Pierce skull & remove clot

61156 C Pierce skull for drainage

61210 C Pierce skull, implant device

61250 C Pierce skull & explore

61253 C Pierce skull & explore

61304 C Open skull for exploration

61305 C Open skull for exploration

61312 C Open skull for drainage

61313 C Open skull for drainage

61314 C Open skull for drainage

61315 C Open skull for drainage

61320 C Open skull for drainage

61321 C Open skull for drainage

61332 C Explore/biopsy eye socket

61333 C Explore orbit/remove lesion

61334 C Explore orbit/remove object

61340 C Relieve cranial pressure

61343 C Incise skull (press relief)

61345 C Relieve cranial pressure

61440 C Incise skull for surgery

61450 C Incise skull for surgery

61458 C Incise skull for brain wound

61460 C Incise skull for surgery

61470 C Incise skull for surgery

61480 C Incise skull for surgery

61490 C Incise skull for surgery

61500 C Removal of skull lesion

61501 C Remove infected skull bone

61510 C Removal of brain lesion

61512 C Remove brain lining lesion

61514 C Removal of brain abscess

61516 C Removal of brain lesion

61518 C Removal of brain lesion

61519 C Remove brain lining lesion

61520 C Removal of brain lesion

61521 C Removal of brain lesion

61522 C Removal of brain abscess

61524 C Removal of brain lesion

61526 C Removal of brain lesion

61530 C Removal of brain lesion

61531 C Implant brain electrodes

61533 C Implant brain electrodes

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

61534 C Removal of brain lesion

61535 C Remove brain electrodes

61536 C Removal of brain lesion

61538 C Removal of brain tissue

61539 C Removal of brain tissue

61541 C Incision of brain tissue

61542 C Removal of brain tissue

61543 C Removal of brain tissue

61544 C Remove & treat brain lesion

61545 C Excision of brain tumor

61546 C Removal of pituitary gland

61548 C Removal of pituitary gland

61550 C Release of skull seams

61552 C Release of skull seams

61556 C Incise skull/sutures

61557 C Incise skull/sutures

61558 C Excision of skull/sutures

61559 C Excision of skull/sutures

61563 C Excision of skull tumor

61564 C Excision of skull tumor

61570 C Remove foreign body, brain

61571 C Incise skull for brain wound

61575 C Skull base/brainstem surgery

61576 C Skull base/brainstem surgery

61580 C Craniofacial approach, skull

61581 C Craniofacial approach, skull

61582 C Craniofacial approach, skull

61583 C Craniofacial approach, skull

61584 C Orbitocranial approach/skull

61585 C Orbitocranial approach/skull

61586 C Resect nasopharynx, skull

61590 C Infratemporal approach/skull

61591 C Infratemporal approach/skull

61592 C Orbitocranial approach/skull

61595 C Transtemporal approach/skull

61596 C Transcochlear approach/skull

61597 C Transcondylar approach/skull

61598 C Transpetrosal approach/skull

61600 C Resect/excise cranial lesion

61601 C Resect/excise cranial lesion

61605 C Resect/excise cranial lesion

61606 C Resect/excise cranial lesion

61607 C Resect/excise cranial lesion

61608 C Resect/excise cranial lesion

61609 C Transect artery, sinus

61610 C Transect artery, sinus

61611 C Transect artery, sinus

61612 C Transect artery, sinus

61613 C Remove aneurysm, sinus

61615 C Resect/excise lesion, skull

61616 C Resect/excise lesion, skull

61618 C Repair dura

61619 C Repair dura

61624 C Occlusion/embolization cath

61626 C Occlusion/embolization cath

61680 C Intracranial vessel surgery

61682 C Intracranial vessel surgery

61684 C Intracranial vessel surgery

61686 C Intracranial vessel surgery

61690 C Intracranial vessel surgery

61692 C Intracranial vessel surgery

* 61697 C Intracranial aneurysm surgery

* 61698 C Intracranial aneurysm surgery

61700 C Inner skull vessel surgery

61702 C Inner skull vessel surgery

61703 C Clamp neck artery

61705 C Revise circulation to head

61708 C Revise circulation to head

61710 C Revise circulation to head

61711 C Fusion of skull arteries

61720 C Incise skull/brain surgery

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

61735 C Incise skull/brain surgery

61750 C Incise skull/brain biopsy

61751 C Brain biopsy w/ ct/mr guide

61760 C Implant brain electrodes

61770 C Incise skull for treatment

61791 C Treat trigeminal tract

61850 C Implant neuroelectrodes

61860 C Implant neuroelectrodes

61862 C Implant neurostimul, subcort

61870 C Implant neuroelectrodes

61875 C Implant neuroelectrodes

62000 C Treat skull fracture

62005 C Treat skull fracture

62010 C Treatment of head injury

62100 C Repair brain fluid leakage

62115 C Reduction of skull defect

62116 C Reduction of skull defect

62117 C Reduction of skull defect

62120 C Repair skull cavity lesion

62121 C Incise skull repair

62140 C Repair of skull defect

62141 C Repair of skull defect

62142 C Remove skull plate/flap

62143 C Replace skull plate/flap

62145 C Repair of skull & brain

62146 C Repair of skull with graft

62147 C Repair of skull with graft

62180 C Establish brain cavity shunt

62190 C Establish brain cavity shunt

62192 C Establish brain cavity shunt

62200 C Establish brain cavity shunt

62201 C Establish brain cavity shunt

62220 C Establish brain cavity shunt

62223 C Establish brain cavity shunt

62256 C Remove brain cavity shunt

62258 C Replace brain cavity shunt

62351 C Implant spinal canal cath

63001 C Removal of spinal lamina

63003 C Removal of spinal lamina

63005 C Removal of spinal lamina

63011 C Removal of spinal lamina

63012 C Removal of spinal lamina

63015 C Removal of spinal lamina

63016 C Removal of spinal lamina

63017 C Removal of spinal lamina

63020 C Neck spine disk surgery

63030 C Low back disk surgery

63035 C Spinal disk surgery add-on

63040 C Neck spine disk surgery

63042 C Low back disk surgery

* 63043 C Repair of skull

* 63044 C Repair of skull

63045 C Removal of spinal lamina

63046 C Removal of spinal lamina

63047 C Removal of spinal lamina

63048 C Remove spinal lamina add-on

63055 C Decompress spinal cord

63056 C Decompress spinal cord

63057 C Decompress spine cord addon

63064 C Decompress spinal cord

63066 C Decompress spine cord addon

63075 C Neck spine disk surgery

63076 C Neck spine disk surgery

63077 C Spine disk surgery, thorax

63078 C Spine disk surgery, thorax

63081 C Removal of vertebral body

63082 C Remove vertebral body addon

63085 C Removal of vertebral body

68013

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

63086 C Remove vertebral body addon

63087 C Removal of vertebral body

63088 C Remove vertebral body addon

63090 C Removal of vertebral body

63091 C Remove vertebral body addon

63170 C Incise spinal cord tract(s)

63172 C Drainage of spinal cyst

63173 C Drainage of spinal cyst

63180 C Revise spinal cord ligaments

63182 C Revise spinal cord ligaments

63185 C Incise spinal column/nerves

63190 C Incise spinal column/nerves

63191 C Incise spinal column/nerves

63194 C Incise spinal column & cord

63195 C Incise spinal column & cord

63196 C Incise spinal column & cord

63197 C Incise spinal column & cord

63198 C Incise spinal column & cord

63199 C Incise spinal column & cord

63200 C Release of spinal cord

63250 C Revise spinal cord vessels

63251 C Revise spinal cord vessels

63252 C Revise spinal cord vessels

63265 C Excise intraspinal lesion

63266 C Excise intraspinal lesion

63267 C Excise intraspinal lesion

63268 C Excise intraspinal lesion

63270 C Excise intraspinal lesion

63271 C Excise intraspinal lesion

63272 C Excise intraspinal lesion

63273 C Excise intraspinal lesion

63275 C Biopsy/excise spinal tumor

63276 C Biopsy/excise spinal tumor

63277 C Biopsy/excise spinal tumor

63278 C Biopsy/excise spinal tumor

63280 C Biopsy/excise spinal tumor

63281 C Biopsy/excise spinal tumor

63282 C Biopsy/excise spinal tumor

63283 C Biopsy/excise spinal tumor

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

63285 C Biopsy/excise spinal tumor

63286 C Biopsy/excise spinal tumor

63287 C Biopsy/excise spinal tumor

63290 C Biopsy/excise spinal tumor

63300 C Removal of vertebral body

63301 C Removal of vertebral body

63302 C Removal of vertebral body

63303 C Removal of vertebral body

63304 C Removal of vertebral body

63305 C Removal of vertebral body

63306 C Removal of vertebral body

63307 C Removal of vertebral body

63308 C Remove vertebral body addon

63655 C Implant neuroelectrodes

63700 C Repair of spinal herniation

63702 C Repair of spinal herniation

63704 C Repair of spinal herniation

63706 C Repair of spinal herniation

63707 C Repair spinal fluid leakage

63709 C Repair spinal fluid leakage

63710 C Graft repair of spine defect

63740 C Install spinal shunt

64752 C Incision of vagus nerve

64755 C Incision of stomach nerves

64760 C Incision of vagus nerve

64763 C Incise hip/thigh nerve

64766 C Incise hip/thigh nerve

64802 C Remove sympathetic nerves

64804 C Remove sympathetic nerves

64809 C Remove sympathetic nerves

64818 C Remove sympathetic nerves

64820 C Remove sympathetic nerves

64866 C Fusion of facial/other nerve

64868 C Fusion of facial/other nerve

65273 C Repair of eye wound

69150 C Extensive ear canal surgery

69155 C Extensive ear/neck surgery

69502 C Mastoidectomy

69535 C Remove part of temporal bone

69554 C Remove ear lesion

69950 C Incise inner ear nerve

ADDENDUM E.—CPT CODES WHICH WILL

BE PAID ONLY AS INPATIENT PROCEDURES—Continued

[Calendar Year 2001]

CPT/

HCPCS

HOPD

status

indicator

Description

69970 C Remove inner ear lesion

75900 C Arterial catheter exchange

* 75952 C Abdominal aortic aneurysm repair * 75953 C Abdominal aortic aneurysm repair

92970 C Cardioassist, internal

92971 C Cardioassist, external

92975 C Dissolve clot, heart vessel

92986 C Revision of aortic valve

92987 C Revision of mitral valve

92990 C Revision of pulmonary valve

92992 C Revision of heart chamber

92993 C Revision of heart chamber

92997 C Pul art balloon repr, percut

92998 C Pul art balloon repr, percut

94652 C Pressure breathing (IPPB)

99190 C Special pump services

99191 C Special pump services

99192 C Special pump services

99251 C Initial inpatient consult

99252 C Initial inpatient consult

99253 C Initial inpatient consult

99254 C Initial inpatient consult

99255 C Initial inpatient consult

99261 C Follow-up inpatient consult

99262 C Follow-up inpatient consult

99263 C Follow-up inpatient consult

99295 C Neonatal critical care

99296 C Neonatal critical care

99297 C Neonatal critical care

99298 C Neonatal critical care

99356 C Prolonged service, inpatient

99357 C Prolonged service, inpatient

99433 C Normal newborn care/hospital

CPT codes and descriptions only are copyright

American Medical Association. All Rights Reserved.

Applicable FARS/DFARS Apply.

Copyright American Dental Association. All rights

reserved.

* Code is new in 2001.

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS

Urban Area

(Constituent Counties)

Wage

Index

0040 Abilene, ¥+* .................................... 0.8240

Taylor, TX

0060 Aguadilla, PR ................................... 0.4391

Aguada, PR

Aguadilla, PR

Moca, PR

0080 Akron, OH ........................................ 0.9736

Portage, OH

Summit, OH

0120 Albany, GA ...................................... 0.9933

Dougherty, GA

Lee, GA

0160 Albany-Schenectady-Troy, NY ........ 0.8549

Albany, NY

Montgomery, NY

Rensselaer, NY

Saratoga, NY

Schenectady, NY

Schoharie, NY

0200 Albuquerque, NM ............................. 0.9136

Bernalillo, NM

Sandoval, NM

Valencia, NM

0220 Alexandria, LA ................................. 0.8170

Rapides, LA

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

0240 Allentown-Bethlehem-Easton, PA .... 0.9925

Carbon, PA

Lehigh, PA

Northampton, PA

0280 Altoona, PA ...................................... 0.9346

Blair, PA

0320 Amarillo, TX Potter, TX .................... 0.8715

Randall, TX

0380 Anchorage, AK ................................ 1.2865

Anchorage, AK

0440 Ann Arbor, MI .................................. 1.1254

Lenawee, MI

Livingston, MI

Washtenaw, MI

0450 Anniston, AL .................................... 0.8284

Calhoun, AL

0460 Appleton-Oshkosh-Neenah, WI ....... 0.9052

Calumet, WI

Outagamie, WI

Winnebago, WI

0470 Arecibo, PR ..................................... 0.4525

Arecibo, PR

Camuy, PR

Hatillo, PR

0480 Asheville, NC ................................... 0.9516

Buncombe, NC

Madison, NC

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

0500 Athens, GA ...................................... 0.9739

Clarke, GA

Madison, GA

Oconee, GA

0520 Atlanta, GA1 .................................... 1.0096

Barrow, GA

Bartow, GA

Carroll, GA

Cherokee, GA

Clayton, GA

Cobb, GA

Coweta, GA

DeKalb, GA

Douglas, GA

Fayette, GA

Forsyth, GA

Fulton, GA

Gwinnett, GA

Henry, GA

Newton, GA

Paulding, GA

Pickens, GA

Rockdale, GA

Spalding, GA

Walton, GA

0560 Atlantic-Cape May, NJ ..................... 1.1182

Atlantic, NJ

68014 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Cape May, NJ

0580 Auburn-Opelika, AL ......................... 0.8106

Lee, AL

0600 Augusta-Aiken, GA–SC ................... 0.9160

Columbia, GA

McDuffie, GA

Richmond, GA

Aiken, SC

Edgefield, SC

0640 Austin-San Marcos, TX1 ................. 0.9577

Bastrop, TX

Caldwell, TX

Hays, TX

Travis, TX

Williamson, TX

0680 Bakersfield, CA2 .............................. 0.9861

Kern, CA

0720 Baltimore, MD 1 ................................ 0.9365

Anne Arundel, MD

Baltimore County, MD

Baltimore City, MD

Carroll, MD

Harford, MD

Howard, MD

Queen Anne’s, MD

0733 Bangor, ME ...................................... 0.9561

Penobscot, ME

0743 Barnstable-Yarmouth, MA ............... 1.3839

Barnstable, MA

0760 Baton Rouge, LA ............................. 0.8842

Ascension, LA

East Baton Rouge, LA

Livingston, LA

West Baton Rouge, LA

0840 Beaumont-Port Arthur, TX ............... 0.8744

Hardin, TX

Jefferson, TX

Orange, TX

0860 Bellingham, WA ............................... 1.1439

Whatcom, WA

0870 Benton Harbor, MI 2 ......................... 0.9021

Berrien, MI

0875 Bergen-Passaic, NJ 1 ....................... 1.1605

Bergen, NJ

Passaic, NJ

0880 Billings, MT ...................................... 0.9591

Yellowstone, MT

0920 Biloxi-Gulfport-Pascagoula, MS ....... 0.8236

Hancock, MS

Harrison, MS

Jackson, MS

0960 Binghamton, NY .............................. 0.8690

Broome, NY

Tioga, NY

1000 Birmingham, AL ............................... 0.8477

Blount, AL

Jefferson, AL

St. Clair, AL

Shelby, AL

1010 Bismarck, ND ................................... 0.7897

Burleigh, ND

Morton, ND

1020 Bloomington, IN ............................... 0.8733

Monroe, IN

1040 Bloomington-Normal, IL ................... 0.9156

McLean, IL

1080 Boise City, ID ................................... 0.9042

Ada, ID

Canyon, ID

1123 Boston-Worcester-Lawrence-LowellBrockton, MA–NH (MA Hospitals) 1, 2 ...... 1.1204

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Merrimack, NH

Rockingham, NH

Strafford, NH

1123 Boston-Worcester-Lawrence-LowellBrockton, MA–NH (NH Hospitals) 1 ......... 1.1160

Bristol, MA

Essex, MA

Middlesex, MA

Norfolk, MA

Plymouth, MA

Suffolk, MA

Worcester, MA

Hillsborough, NH

Merrimack, NH

Rockingham, NH

Strafford, NH

1125 Boulder-Longmont, CO .................... 0.9731

Boulder, CO

1145 Brazoria, TX ..................................... 0.8658

Brazoria, TX

1150 Bremerton, WA ................................ 1.0975

Kitsap, WA

1240 Brownsville-Harlingen-San Benito,

TX ............................................................ 0.8722

Cameron, TX

1260 Bryan-College Station, TX ............... 0.8237

Brazos, TX

1280 Buffalo-Niagara Falls, NY1 .............. 0.9580

Erie, NY

Niagara, NY

1303 Burlington, VT .................................. 1.0735

Chittenden, VT

Franklin, VT

Grand Isle, VT

1310 Caguas, PR ..................................... 0.4562

Caguas, PR

Cayey, PR

Cidra, PR

Gurabo, PR

San Lorenzo, PR

1320 Canton-Massillon, OH 2 ................... 0.8670

Carroll, OH

Stark, OH

1350 Casper, WY2 ................................... 0.8817

Natrona, WY

1360 Cedar Rapids, IA ............................. 0.8736

Linn, IA

1400 Champaign-Urbana, IL .................... 0.9198

Champaign, IL

1440 Charleston-North Charleston, SC .... 0.9067

Berkeley, SC

Charleston, SC

Dorchester, SC

1480 Charleston, WV ............................... 0.9240

Kanawha, WV

Putnam, WV

1520 Charlotte-Gastonia-Rock Hill, NC–

SC 1 .......................................................... 0.9391

Cabarrus, NC

Gaston, NC

Lincoln, NC

Mecklenburg, NC

Rowan, NC

Stanly, NC

Union, NC

York, SC

1540 Charlottesville, VA ........................... 1.0789

Albemarle, VA

Charlottesville City, VA

Fluvanna, VA

Greene, VA

1560 Chattanooga, TN–GA ...................... 0.9833

Catoosa, GA

Dade, GA

Walker, GA

Hamilton, TN

Marion, TN

1580 Cheyenne, WY2 .............................. 0.8817

Laramie, WY

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

1600 Chicago, IL 1 .................................... 1.1146

Cook, IL

DeKalb, IL

DuPage, IL

Grundy, IL

Kane, IL

Kendall, IL

Lake, IL

McHenry, IL

Will, IL

1620 Chico-Paradise, CA ......................... 0.9918

Butte, CA

1640 Cincinnati, OH–KY–IN 1 ................... 0.9415

Dearborn, IN

Ohio, IN

Boone, KY

Campbell, KY

Gallatin, KY

Grant, KY

Kenton, KY

Pendleton, KY

Brown, OH

Clermont, OH

Hamilton, OH

Warren, OH

1660 Clarksville-Hopkinsville, TN–KY ...... 0.8277

Christian, KY

Montgomery, TN

1680 Cleveland-Lorain-Elyria, OH 1 .......... 0.9593

Ashtabula, OH

Cuyahoga, OH

Geauga, OH

Lake, OH

Lorain, OH

Medina, OH

1720 Colorado Springs, CO ..................... 0.9697

El Paso, CO

1740 Columbia, MO .................................. 0.8961

Boone, MO

1760 Columbia, SC .................................. 0.9554

Lexington, SC

Richland, SC

1800 Columbus, GA–AL Russell, AL ....... 0.8568

Chattahoochee, GA

Harris, GA

Muscogee, GA

1840 Columbus, OH 1 ............................... 0.9619

Delaware, OH

Fairfield, OH

Franklin, OH

Licking, OH

Madison, OH

Pickaway, OH

1880 Corpus Christi, TX ........................... 0.8726

Nueces, TX

San Patricio, TX

1890 Corvallis, OR ................................... 1.1326

Benton, OR

1900 Cumberland, MD–WV (MD Hospitals) 2 ..................................................... 0.8651

Allegany, MD

Mineral, WV

1900 Cumberland, MD–WV (WV Hospital) ......................................................... 0.8369

Allegany, MD

Mineral, WV

1920 Dallas, TX1 ...................................... 0.9913

Collin, TX

Dallas, TX

Denton, TX

Ellis, TX

Henderson, TX

Hunt, TX

Kaufman, TX

Rockwall, TX

1950 Danville, VA ..................................... 0.8589

Danville City, VA

Pittsylvania, VA

1960 Davenport-Moline-Rock Island, IA–

IL .............................................................. 0.8898

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 68015

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Scott, IA

Henry, IL

Rock Island, IL

2000 Dayton-Springfield, OH .................... 0.9442

Clark, OH

Greene, OH

Miami, OH

Montgomery, OH

2020 Daytona Beach, FL .......................... 0.9147

Flagler, FL

Volusia, FL

2030 Decatur, AL ...................................... 0.8534

Lawrence, AL

Morgan, AL

2040 Decatur, IL 2 ..................................... 0.8160

Macon, IL

2080 Denver, CO 1 .................................... 1.0181

Adams, CO

Arapahoe, CO

Denver, CO

Douglas, CO

Jefferson, CO

2120 Des Moines, IA ................................ 0.9118

Dallas, IA

Polk, IA

Warren, IA

2160 Detroit, MI 1 ...................................... 1.0510

Lapeer, MI

Macomb, MI

Monroe, MI

Oakland, MI

St. Clair, MI

Wayne, MI

2180 Dothan, AL ....................................... 0.8013

Dale, AL

Houston, AL

2190 Dover, DE ........................................ 1.0078

Kent, DE

2200 Dubuque, IA ..................................... 0.8746

Dubuque, IA

2240 Duluth-Superior, MN–WI ................. 1.0043

St. Louis, MN

Douglas, WI

2281 Dutchess County, NY ...................... 0.9491

Dutchess, NY

2290 Eau Claire, WI 2 ............................... 0.8880

Chippewa, WI

Eau Claire, WI

2320 El Paso, TX ..................................... 0.9346

El Paso, TX

2330 Elkhart-Goshen, IN .......................... 0.9145

Elkhart, IN

2335 Elmira, NY ....................................... 0.8546

Chemung, NY

2340 Enid, OK .......................................... 0.8610

Garfield, OK

2360 Erie, PA ........................................... 0.8985

Erie, PA

2400 Eugene-Springfield, OR ................... 1.0965

Lane, OR

2440 Evansville-Henderson, IN–KY (IN

Hospitals) 2 ............................................... 0.8602

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2440 Evansville-Henderson, IN–KY (KY

Hospitals) ................................................. 0.8173

Posey, IN

Vanderburgh, IN

Warrick, IN

Henderson, KY

2520 Fargo-Moorhead, ND–MN ............... 0.8749

Clay, MN

Cass, ND

2560 Fayetteville, NC ............................... 0.8655

Cumberland, NC

2580 Fayetteville-Springdale-Rogers, AR 0.7910

Benton, AR

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Washington, AR

2620 Flagstaff, AZ–UT ............................. 1.0686

Coconino, AZ

Kane, UT

2640 Flint, MI ............................................ 1.1205

Genesee, MI

2650 Florence, AL .................................... 0.7652

Colbert, AL

Lauderdale, AL

2655 Florence, SC .................................... 0.8777

Florence, SC

2670 Fort Collins-Loveland, CO ............... 1.0647

Larimer, CO

2680 1Ft. Lauderdale, FL ......................... 1.0152

Broward, FL

2700 Fort Myers-Cape Coral, FL .............. 0.9247

Lee, FL

2710 Fort Pierce-Port St. Lucie, FL .......... 0.9622

Martin, FL

St. Lucie, FL

2720 Fort Smith, AR–OK .......................... 0.8052

Crawford, AR

Sebastian, AR

Sequoyah, OK

2750 Fort Walton Beach, FL .................... 0.9607

Okaloosa, FL

2760 Fort Wayne, IN ................................ 0.8665

Adams, IN

Allen, IN

De Kalb, IN

Huntington, IN

Wells, IN

Whitley, IN

2800 Forth Worth-Arlington, TX1 ............. 0.9527

Hood, TX

Johnson, TX

Parker, TX

Tarrant, TX

2840 Fresno, CA ...................................... 1.0104

Fresno, CA

Madera, CA

2880 Gadsden, AL .................................... 0.8423

Etowah, AL

2900 Gainesville, FL ................................. 1.0074

Alachua, FL

2920 Galveston-Texas City, TX ................ 0.9918

Galveston, TX

2960 Gary, IN ........................................... 0.9454

Lake, IN

Porter, IN

2975 Glens Falls, NY2 ............................. 0.8499

Warren, NY

Washington, NY

2980 Goldsboro, NC 2 ............................... 0.8441

Wayne, NC

2985 Grand Forks, ND–MN ...................... 0.8954

Polk, MN

Grand Forks, ND

2995 Grand Junction, CO ......................... 0.9471

Mesa, CO

3000 Grand Rapids-Muskegon-Holland,

MI 1 ........................................................... 1.0248

Allegan, MI

Kent, MI

Muskegon, MI

Ottawa, MI

3040 Great Falls, MT ................................ 0.9330

Cascade, MT

3060 Greeley, CO ..................................... 0.9814

Weld, CO

3080 Green Bay, WI ................................. 0.9308

Brown, WI

3120 Greensboro-Winston-Salem-High

Point, NC 1 ............................................... 0.9124

Alamance, NC

Davidson, NC

Davie, NC

Forsyth, NC Guilford, NC

Randolph, NC

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Stokes, NC

Yadkin, NC

3150 Greenville, NC ................................. 0.9384

Pitt, NC

3160 Greenville-Spartanburg-Anderson,

SC ............................................................ 0.9003

Anderson, SC

Cherokee, SC

Greenville, SC

Pickens, SC

Spartanburg, SC

3180 Hagerstown, MD .............................. 0.9409

Washington, MD

3200 Hamilton-Middletown, OH ................ 0.9061

Butler, OH

3240 Harrisburg-Lebanon-Carlisle, PA ..... 0.9386

Cumberland, PA

Dauphin, PA

Lebanon, PA

Perry, PA

3283 Hartford, CT 1, 2 ................................ 1.1715

Hartford, CT

Litchfield, CT

Middlesex, CT

Tolland, CT

3285 Hattiesburg, MS2 ............................. 0.7491

Forrest, MS

Lamar, MS

3290 Hickory-Morganton-Lenoir, NC ........ 0.8755

Alexander, NC

Burke, NC

Caldwell, NC

Catawba, NC

3320 Honolulu, HI ..................................... 1.1866

Honolulu, HI

3350 Houma, LA ....................................... 0.8086

Lafourche, LA

Terrebonne, LA

3360 Houston, TX1 ................................... 0.9732

Chambers, TX

Fort Bend, TX

Harris, TX

Liberty, TX

Montgomery, TX

Waller, TX

3400 Huntington-Ashland, WV–KY–OH ... 0.9876

Boyd, KY

Carter, KY

Greenup, KY

Lawrence, OH

Cabell, WV

Wayne, WV

3440 Huntsville, AL ................................... 0.8932

Limestone, AL

Madison, AL

3480 Indianapolis, IN 1 .............................. 0.9787

Boone, IN

Hamilton, IN

Hancock, IN

Hendricks, IN

Johnson, IN

Madison, IN

Marion, IN

Morgan, IN

Shelby, IN

3500 Iowa City, IA .................................... 0.9657

Johnson, IA

3520 Jackson, MI ..................................... 0.9134

Jackson, MI

3560 Jackson, MS .................................... 0.8812

Hinds, MS

Madison, MS

Rankin, MS

3580 Jackson, TN ..................................... 0.8796

Madison, TN

Chester, TN

3600 Jacksonville, FL 1 ............................. 0.9208

Clay, FL

Duval, FL

68016 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Nassau, FL

St. Johns, FL

3605 Jacksonville, NC 2 ............................ 0.8441

Onslow, NC

3610 Jamestown, NY2 ............................. 0.8499

Chautauqua, NY

3620 Janesville-Beloit, WI ........................ 0.9585

Rock, WI

3640 Jersey City, NJ ................................ 1.1573

Hudson, NJ

3660 Johnson City-Kingsport-Bristol, TN–

VA ............................................................ 0.8328

Carter, TN

Hawkins, TN

Sullivan, TN

Unicoi, TN

Washington, TN

Bristol City, VA

Scott, VA

Washington, VA

3680 Johnstown, PA ................................. 0.8578

Cambria, PA

Somerset, PA

3700 Jonesboro, AR ................................. 0.7832

Craighead, AR

3710 Joplin, MO ....................................... 0.8148

Jasper, MO

Newton, MO

3720 Kalamazoo-Battlecreek, MI .............. 1.0453

Calhoun, MI

Kalamazoo, MI

Van Buren, MI

3740 Kankakee, IL .................................... 0.9902

Kankakee, IL

3760 Kansas City, KS–MO 1 ..................... 0.9661

Johnson, KS

Leavenworth, KS

Miami, KS

Wyandotte, KS

Cass, MO

Clay, MO

Clinton, MO

Jackson, MO

Lafayette, MO

Platte, MO

Ray, MO

3800 Kenosha, WI .................................... 0.9611

Kenosha, WI

3810 Killeen-Temple, TX .......................... 1.0119

Bell, TX

Coryell, TX

3840 Knoxville, TN ................................... 0.8340

Anderson, TN

Blount, TN

Knox, TN

Loudon, TN

Sevier, TN

Union, TN

3850 Kokomo, IN ...................................... 0.9525

Howard, IN

Tipton, IN

3870 La Crosse, WI–MN .......................... 0.9211

Houston, MN

La Crosse, WI

3880 Lafayette, LA ................................... 0.8490

Acadia, LA

Lafayette, LA

St. Landry, LA

St. Martin, LA

3920 Lafayette, IN .................................... 0.8834

Clinton, IN

Tippecanoe, IN

3960 Lake Charles, LA2 ........................... 0.7713

Calcasieu, LA

3980 Lakeland-Winter Haven, FL ............. 0.8928

Polk, FL

4000 Lancaster, PA .................................. 0.9259

Lancaster, PA

4040 Lansing-East Lansing, MI ................ 0.9934

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Clinton, MI

Eaton, MI

Ingham, MI

4080 Laredo, TX ....................................... 0.8168

Webb, TX

4100 Las Cruces, NM ............................... 0.8658

Dona Ana, NM

4120 Las Vegas, NV–AZ 1 ........................ 1.0796

Mohave, AZ

Clark, NV

Nye, NV

4150 Lawrence, KS .................................. 0.8190

Douglas, KS

4200 Lawton, OK ...................................... 0.8996

Comanche, OK

4243 Lewiston-Auburn, ME ...................... 0.9036

Androscoggin, ME

4280 Lexington, KY .................................. 0.8866

Bourbon, KY

Clark, KY

Fayette, KY

Jessamine, KY

Madison, KY

Scott, KY

Woodford, KY

4320 Lima, OH ......................................... 0.9320

Allen, OH

Auglaize, OH

4360 Lincoln, NE ...................................... 0.9666

Lancaster, NE

4400 Little Rock-North Little Rock, AR ..... 0.8906

Faulkner, AR

Lonoke, AR

Pulaski, AR

Saline, AR

4420 Longview-Marshall, TX .................... 0.8922

Gregg, TX

Harrison, TX

Upshur, TX

4480 Los Angeles-Long Beach, CA1 ....... 1.2033

Los Angeles, CA

4520 Louisville, KY–IN ............................. 0.9350

Clark, IN

Floyd, IN

Harrison, IN

Scott, IN

Bullitt, KY

Jefferson, KY

Oldham, KY

4600 Lubbock, TX .................................... 0.8838

Lubbock, TX

4640 Lynchburg, VA ................................. 0.8867

Amherst, VA

Bedford, VA

Bedford City, VA

Campbell, VA

Lynchburg City, VA

4680 Macon, GA ....................................... 0.8974

Bibb, GA

Houston, GA

Jones, GA

Peach, GA

Twiggs, GA

4720 Madison, WI ..................................... 1.0271

Dane, WI

4800 Mansfield, OH .................................. 0.8690

Crawford, OH

Richland, OH

4840 Mayaguez, PR ................................. 0.4589

Anasco, PR

Cabo Rojo, PR

Hormigueros, PR

Mayaguez, PR

Sabana Grande, PR

San German, PR

4880 McAllen-Edinburg-Mission, TX ........ 0.8566

Hidalgo, TX

4890 Medford-Ashland, OR ...................... 1.0344

Jackson, OR

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

4900 Melbourne-Titusville-Palm Bay, FL .. 0.9688

Brevard, Fl

4920 Memphis, TN–AR–MS1 ................... 0.8723

Crittenden, AR

DeSoto, MS

Fayette, TN

Shelby, TN

Tipton, TN

4940 Merced, CA2 .................................... 0.9861

Merced, CA

5000 Miami, FL 1 ....................................... 1.0059

Dade, FL

5015 Middlesex-Somerset-Hunterdon,

NJ 1 .......................................................... 1.0333

Hunterdon, NJ

Middlesex, NJ

Somerset, NJ

5080 Milwaukee-Waukesha, WI 1 ............. 0.9767

Milwaukee, WI

Ozaukee, WI

Washington, WI

Waukesha, WI

5120 Minneapolis-St. Paul, MN–WI 1 ....... 1.1017

Anoka, MN

Carver, MN

Chisago, MN

Dakota, MN

Hennepin, MN

Isanti, MN

Ramsey, MN

Scott, MN

Sherburne, MN

Washington, MN

Wright, MN

Pierce, WI

St. Croix, WI

5140 Missoula, MT ................................... 0.9332

Missoula, MT

5160 Mobile, AL ........................................ 0.8163

Baldwin, AL

Mobile, AL

5170 Modesto, CA .................................... 1.0396

Stanislaus, CA

5190 Monmouth-Ocean, NJ 1 ................... 1.1283

Monmouth, NJ

Ocean, NJ

5200 Monroe, LA ...................................... 0.8396

Ouachita, LA

5240 Montgomery, AL .............................. 0.7653

Autauga, AL

Elmore, AL

Montgomery, AL

5280 Muncie, IN ....................................... 1.0969

Delaware, IN

5330 Myrtle Beach, SC ............................ 0.8440

Horry, SC

5345 Naples, FL ....................................... 0.9661

Collier, FL

5360 Nashville, TN 1 ................................. 0.9490

Cheatham, TN

Davidson, TN

Dickson, TN

Robertson, TN

Rutherford, TN

Sumner, TN

Williamson, TN

Wilson, TN

5380 Nassau-Suffolk, NY1 ....................... 1.3932

Nassau, NY

Suffolk, NY

5483 New Haven-Bridgeport-StamfordWaterbury-Danbury, CT 1 ........................ 1.2034

Fairfield, CT

New Haven, CT

5523 New London-Norwich, CT ............... 1.2063

New London, CT

5560 New Orleans, LA1 ........................... 0.9295

Jefferson, LA

Orleans, LA

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 68017

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Plaquemines, LA

St. Bernard, LA

St. Charles, LA

St. James, LA

St. John The Baptist, LA

St. Tammany, LA

5600 New York, NY1 ................................ 1.4651

Bronx, NY

Kings, NY

New York, NY

Putnam, NY

Queens, NY

Richmond, NY

Rockland, NY

Westchester, NY

5640 Newark, NJ 1 .................................... 1.0757

Essex, NJ

Morris, NJ

Sussex, NJ

Union, NJ

Warren, NJ

5660 Newburgh, NY–PA .......................... 1.0847

Orange, NY

Pike, PA

5720 Norfolk-Virginia Beach-Newport

News, VA-NC 1 ........................................ 0.8422

Currituck, NC

Chesapeake City, VA

Gloucester, VA

Hampton City, VA

Isle of Wight, VA

James City, VA

Mathews, VA

Newport News City, VA

Norfolk City, VA

Poquoson City, VA

Portsmouth City, VA

Suffolk City, VA

Virginia Beach City VA

Williamsburg City, VA

York, VA

5775 Oakland, CA1 .................................. 1.4983

Alameda, CA

Contra Costa, CA

5790 Ocala, FL ......................................... 0.9243

Marion, FL

5800 Odessa-Midland, TX ........................ 0.9205

Ector, TX

Midland, TX

5880 Oklahoma City, OK1 ........................ 0.8822

Canadian, OK

Cleveland, OK

Logan, OK

McClain, OK

Oklahoma, OK

Pottawatomie, OK

5910 Olympia, WA .................................... 1.0677

Thurston, WA

5920 Omaha, NE–IA ................................ 0.9572

Pottawattamie, IA

Cass, NE

Douglas, NE

Sarpy, NE

Washington, NE

5945 Orange County, CA1 ....................... 1.1411

Orange, CA

5960 Orlando, FL 1 .................................... 0.9610

Lake, FL

Orange, FL

Osceola, FL

Seminole, FL

5990 Owensboro, KY ............................... 0.8159

Daviess, KY

6015 Panama City, FL .............................. 0.9010

Bay, FL

6020 Parkersburg-Marietta, WV-OH (WV

Hospitals) ................................................. 0.8274

Washington, OH

Wood, WV

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

6020 Parkersburg-Marietta, WV-OH (OH

Hospitals) 2 ............................................... 0.8670

Washington, OH

Wood, WV

6080 Pensacola, FL 2 ................................ 0.8928

Escambia, FL

Santa Rosa, FL

6120 Peoria-Pekin, IL ............................... 0.8646

Peoria, IL

Tazewell, IL

Woodford, IL

6160 Philadelphia, PA–NJ 1 ...................... 1.0937

Burlington, NJ

Camden, NJ

Gloucester, NJ

Salem, NJ

Bucks, PA

Chester, PA

Delaware, PA

Montgomery, PA

Philadelphia, PA

6200 Phoenix-Mesa, AZ 1 ......................... 0.9669

Maricopa, AZ

Pinal, AZ

6240 Pine Bluff, AR .................................. 0.7791

Jefferson, AR

6280 Pittsburgh, PA1 ................................ 0.9741

Allegheny, PA

Beaver, PA

Butler, PA

Fayette, PA

Washington, PA

Westmoreland, PA

6323 Pittsfield, MA2 .................................. 1.1204

Berkshire, MA

6340 Pocatello, ID .................................... 0.9076

Bannock, ID

6360 Ponce, PR ....................................... 0.5006

Guayanilla, PR

Juana Diaz, PR

Penuelas, PR

Ponce, PR

Villalba, PR

Yauco, PR

6403 Portland, ME .................................... 0.9748

Cumberland, ME

Sagadahoc, ME

York, ME

6440 Portland-Vancouver, 1 OR-WA ........ 1.0910

Clackamas, OR

Columbia, OR

Multnomah, OR

Washington, OR

Yamhill, OR

Clark, WA

6483 Providence-Warwick-Pawtucket, RI 1 1.0864

Bristol, RI

Kent, RI

Newport, RI

Providence, RI

Washington, RI

6520 Provo-Orem, UT .............................. 1.0041

Utah, UT

6560 Pueblo, CO 2 .................................... 0.8968

Pueblo, CO

6580 Punta Gorda, FL .............................. 0.9613

Charlotte, FL

6600 Racine, WI ....................................... 0.9246

Racine, WI

6640 Raleigh-Durham-Chapel Hill, NC 1 .. 0.9646

Chatham, NC

Durham, NC

Franklin, NC

Johnston, NC

Orange, NC

Wake, NC

6660 Rapid City, SD ................................. 0.8865

Pennington, SD

6680 Reading, PA .................................... 0.9152

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Berks, PA

690 Redding, CA ...................................... 1.1664

Shasta, CA

6720 Reno, NV ......................................... 1.0550

Washoe, NV

6740 Richland-Kennewick-Pasco, WA ..... 1.1460

Benton, WA

Franklin, WA

6760 Richmond-Petersburg, VA ............... 0.9617

Charles City County, VA

Chesterfield, VA

Colonial Heights City, VA

Dinwiddie, VA

Goochland, VA

Hanover, VA

Henrico, VA

Hopewell City, VA

New Kent, VA

Petersburg City, VA

Powhatan, VA

Prince George, VA

Richmond City, VA

6780 Riverside-San Bernardino, CA1 ...... 1.1115

Riverside, CA

San Bernardino, CA

6800 Roanoke, VA ................................... 0.8782

Botetourt, VA

Roanoke, VA

Roanoke City, VA

Salem City, VA

6820 Rochester, MN ................................. 1.1315

Olmsted, MN

6840 Rochester, NY1 ............................... 0.9182

Genesee, NY

Livingston, NY

Monroe, NY

Ontario, NY

Orleans, NY

Wayne, NY

6880 Rockford, IL ..................................... 0.8819

Boone, IL

Ogle, IL

Winnebago, IL

6895 Rocky Mount, NC ............................ 0.8849

Edgecombe, NC

Nash, NC

6920 Sacramento, CA1 ............................ 1.1957

El Dorado, CA

Placer, CA

Sacramento, CA

6960 Saginaw-Bay City-Midland, MI ........ 0.9575

Bay, MI

Midland, MI

Saginaw, MI

6980 St. Cloud, MN .................................. 1.0016

Benton, MN

Stearns, MN

7000 St. Joseph, MO ................................ 0.9071

Andrew, MO

Buchanan, MO

7040 St. Louis, MO–IL 1 ............................ 0.9049

Clinton, IL

Jersey, IL

Madison, IL

Monroe, IL

St. Clair, IL

Franklin, MO

Jefferson, MO

Lincoln, MO

St. Charles, MO

St. Louis, MO

St. Louis City, MO

Warren, MO

7080 Salem, OR ....................................... 1.0132

Marion, OR

Polk, OR

7120 Salinas, CA ...................................... 1.4502

Monterey, CA

7160 Salt Lake City-Ogden, UT 1 ............. 0.9811

68018 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

Davis, UT

Salt Lake, UT

Weber, UT

7200 San Angelo, TX ............................... 0.8083

Tom Green, TX

7240 San Antonio, TX1 ............................ 0.8580

Bexar, TX

Comal, TX

Guadalupe, TX

Wilson, TX

7320 San Diego, CA1 ............................... 1.1784

San Diego, CA

7360 San Francisco, CA1 ........................ 1.4193

Marin, CA

San Francisco, CA

San Mateo, CA

7400 San Jose, CA1 ................................ 1.3564

Santa Clara, CA

7440 San Juan-Bayamon, PR 1 ................ 0.4690

Aguas Buenas, PR

Barceloneta, PR

Bayamon, PR

Canovanas, PR

Carolina, PR

Catano, PR

Ceiba, PR

Comerio, PR

Corozal, PR

Dorado, PR

Fajardo, PR

Florida, PR

Guaynabo, PR

Humacao, PR

Juncos, PR

Los Piedras, PR

Loiza, PR

Luguillo, PR

Manati, PR

Morovis, PR

Naguabo, PR

Naranjito, PR

Rio Grande, PR

San Juan, PR

Toa Alta, PR

Toa Baja, PR

Trujillo Alto, PR

Vega Alta, PR

Vega Baja, PR

Yabucoa, PR

7460 San Luis Obispo-Atascadero-Paso

Robles, CA .............................................. 1.0673

San Luis Obispo, CA

7480 Santa Barbara-Santa MariaLompoc, CA ............................................. 1.0597

Santa Barbara, CA

7485 Santa Cruz-Watsonville, CA ............ 1.4095

Santa Cruz, CA

7490 Santa Fe, NM .................................. 1.0537

Los Alamos, NM

Santa Fe, NM

7500 Santa Rosa, CA ............................... 1.2646

Sonoma, CA

7510 Sarasota-Bradenton, FL .................. 0.9809

Manatee, FL

Sarasota, FL

7520 Savannah, GA ................................. 0.9697

Bryan, GA

Chatham, GA

Effingham, GA

7560 Scranton-Wilkes-Barre-Hazleton,

PA2 .......................................................... 0.8578

Columbia, PA

Lackawanna, PA

Luzerne, PA

Wyoming, PA

7600 Seattle-Bellevue-Everett, WA1 ........ 1.1016

Island, WA

King, WA

Snohomish, WA

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

7610 Sharon, PA2 .................................... 0.8578

Mercer, PA

7620 Sheboygan, WI 2 .............................. 0.8880

Sheboygan, WI

7640 Sherman-Denison, TX ..................... 0.8795

Grayson, TX

7680 Shreveport-Bossier City, LA ............ 0.8750

Bossier, LA

Caddo, LA

Webster, LA

7720 Sioux City, IA-NE ............................. 0.8473

Woodbury, IA

Dakota, NE

7760 Sioux Falls, SD ................................ 0.8790

Lincoln, SD

Minnehaha, SD

7800 South Bend, IN ................................ 1.0029

St. Joseph, IN

7840 Spokane, WA ................................... 1.0513

Spokane, WA

7880 Springfield, IL ................................... 0.8685

Menard, IL

Sangamon, IL

7920 Springfield, MO ................................ 0.8488

Christian, MO

Greene, MO

Webster, MO

8003 Springfield, MA2 .............................. 1.1204

Hampden, MA

Hampshire, MA

8050 State College, PA ............................ 0.9038

Centre, PA

8080 Steubenville-Weirton, OH–WV2 (OH

Hospitals) ................................................. 0.8670

Jefferson, OH

Brooke, WV

Hancock, WV

8080 Steubenville-Weirton, OH–WV (WV

Hospitals) ................................................. 0.8548

Jefferson, OH

Brooke, WV

Hancock, WV

8120 Stockton-Lodi, CA ............................ 1.0629

San Joaquin, CA

8140 Sumter, SC 2 .................................... 0.8370

Sumter, SC

8160 Syracuse, NY ................................... 0.9594

Cayuga, NY

Madison, NY

Onondaga, NY

Oswego, NY

8200 Tacoma, WA .................................... 1.1564

Pierce, WA

8240 Tallahassee, FL 2 ............................. 0.8928

Gadsden, FL

Leon, FL

8280 Tampa-St. Petersburg-Clearwater,

FL 1 ........................................................... 0.9099

Hernando, FL

Hillsborough, FL

Pasco, FL

Pinellas, FL

8320 Terre Haute, IN 2 .............................. 0.8602

Clay, IN

Vermillion, IN

Vigo, IN

8360 Texarkana, AR-Texarkana, TX ........ 0.8427

Miller, AR

Bowie, TX

8400 Toledo, OH ...................................... 0.9664

Fulton, OH

Lucas, OH

Wood, OH

8440 Topeka, KS ...................................... 0.9117

Shawnee, KS

8480 Trenton, NJ ...................................... 1.0137

Mercer, NJ

8520 Tucson, AZ ...................................... 0.8821

Pima, AZ

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

8560 Tulsa, OK ......................................... 0.8454

Creek, OK

Osage, OK

Rogers, OK

Tulsa, OK

Wagoner, OK

8600 Tuscaloosa, AL ................................ 0.8064

Tuscaloosa, AL

8640 Tyler, TX .......................................... 0.9404

Smith, TX

8680 Utica-Rome, NY ............................... 0.8560

Herkimer, NY

Oneida, NY

8720 Vallejo-Fairfield-Napa, CA ............... 1.2266

Napa, CA

Solano, CA

8735 Ventura, CA ..................................... 1.0479

Ventura, CA

8750 Victoria, TX ...................................... 0.8154

Victoria, TX

8760 Vineland-Millville-Bridgeton, NJ ....... 1.0501

Cumberland, NJ

8780 Visalia-Tulare-Porterville, CA2 ........ 0.9861

Tulare, CA

8800 Waco, TX ......................................... 0.8314

McLennan, TX

8840 Washington, DC–MD–VA–WV1 ...... 1.0755

District of Columbia, DC

Calvert, MD

Charles, MD

Frederick, MD

Montgomery, MD

Prince Georges, MD

Alexandria City, VA

Arlington, VA

Clarke, VA

Culpeper, VA

Fairfax, VA

Fairfax City, VA

Falls Church City, VA

Fauquier, VA

Fredericksburg City, VA

King George, VA

Loudoun, VA

Manassas City, VA

Manassas Park City, VA

Prince William, VA

Spotsylvania, VA

Stafford, VA

Warren, VA

Berkeley, WV

Jefferson, WV

8920 Waterloo-Cedar Falls, IA ................. 0.8802

Black Hawk, IA

8940 Wausau, WI ..................................... 0.9426

Marathon, WI

8960 1West Palm Beach-Boca Raton, FL 0.9615

Palm Beach, FL

9000 Wheeling, WV–OH 2 (WV Hospitals) 0.8231

Belmont, OH

Marshall, WV

Ohio, WV

9000 Wheeling, WV–OH 2 (OH Hospitals) 0.8670

Belmont, OH

Marshall, WV

Ohio, WV

9040 Wichita, KS ...................................... 0.9544

Butler, KS

Harvey, KS

Sedgwick, KS

9080 Wichita Falls, TX .............................. 0.7668

Archer, TX

Wichita, TX

9140 Williamsport, PA2 ............................ 0.8578

Lycoming, PA

9160 Wilmington-Newark, DE–MD ........... 1.1191

New Castle, DE

Cecil, MD

9200 Wilmington, NC ................................ 0.9402

Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations 68019

ADDENDUM F—WAGE INDEX FOR URBAN

AREAS—Continued

Urban Area

(Constituent Counties)

Wage

Index

New Hanover, NC

Brunswick, NC

9260 Yakima, WA2 ................................... 1.0434

Yakima, WA

9270 Yolo, CA .......................................... 1.0199

Yolo, CA

9280 York, PA .......................................... 0.9264

York, PA

9320 Youngstown-Warren, OH ................. 0.9543

Columbiana, OH

Mahoning, OH

Trumbull, OH

9340 Yuba City, CA .................................. 1.0706

Sutter, CA

Yuba, CA

9360 Yuma, AZ ......................................... 0.9529

Yuma, AZ

1 Large Urban Area

2 Hospitals geographically located in the area are

assigned the statewide rural wage index for FY 2001.

ADDENDUM G—WAGE INDEX FOR RURAL

AREAS

Nonurban area DWage

index

Alabama ...................................................... 0.7528

Alaska .......................................................... 1.2392

Arizona ........................................................ 0.8317

Arkansas ..................................................... 0.7445

California ..................................................... 0.9861

Colorado ...................................................... 0.8968

Connecticut ................................................. 1.1715

Delaware ..................................................... 0.9074

Florida ......................................................... 0.8928

Georgia ........................................................ 0.8329

Hawaii .......................................................... 1.1059

Idaho ........................................................... 0.8678

Illinois .......................................................... 0.8160

Indiana ......................................................... 0.8602

Iowa ............................................................. 0.8030

Kansas ........................................................ 0.7605

Kentucky ...................................................... 0.7931

Louisiana ..................................................... 0.7713

Maine ........................................................... 0.8766

Maryland ...................................................... 0.8651

Massachusetts ............................................ 1.1204

Michigan ...................................................... 0.9021

Minnesota .................................................... 0.8881

Mississippi ................................................... 0.7491

Missouri ....................................................... 0.7707

Montana ...................................................... 0.8688

Nebraska ..................................................... 0.8109

Nevada ........................................................ 0.9232

New Hampshire ........................................... 0.9845

New Jersey 1 ............................................... ............

New Mexico ................................................. 0.8497

New York ..................................................... 0.8499

North Carolina ............................................. 0.8441

North Dakota ............................................... 0.7716

Ohio ............................................................. 0.8670

Oklahoma .................................................... 0.7491

Oregon ........................................................ 1.0132

Pennsylvania ............................................... 0.8578

Puerto Rico ................................................. 0.4264

Rhode Island 1 ............................................. ............

South Carolina ............................................ 0.8370

South Dakota .............................................. 0.7570

Tennessee ................................................... 0.7838

Texas ........................................................... 0.7507

Utah ............................................................. 0.9037

Vermont ....................................................... 0.9409

Virginia ........................................................ 0.8189

Washington ................................................. 1.0434

West Virginia ............................................... 0.8231

Wisconsin .................................................... 0.8880

ADDENDUM G—WAGE INDEX FOR RURAL

AREAS—Continued

Nonurban area DWage

index

Wyoming ..................................................... 0.8817

1All counties within the State are classified as

urban.

ADDENDUM H—WAGE INDEX FOR

HOSPITALS THAT ARE RECLASSIFIED

Area Wage

Index

Abilene, TX .................................................. 0.8240

Akron, OH ................................................... 0.9736

Alexandria, LA ............................................. 0.8170

Amarillo, TX ................................................. 0.8715

Anchorage, AK ............................................ 1.2865

Ann Arbor, MI .............................................. 1.1064

Atlanta, GA .................................................. 1.0096

Atlantic-Cape May, NJ ................................ 1.0822

Augusta-Aiken, GA–SC ............................... 0.9160

Barnstable-Yarmouth, MA ........................... 1.3583

Baton Rouge, LA ......................................... 0.8734

Benton Harbor, MI ....................................... 0.9021

Bergen-Passaic, NJ .................................... 1.1605

Billings, MT .................................................. 0.9591

Binghamton, NY .......................................... 0.8690

Birmingham, AL ........................................... 0.8477

Bismarck, ND .............................................. 0.7897

Bloomington-Normal, IL .............................. 0.9156

Boise City, ID .............................................. 0.9042

Boston-Worcester-Lawrence-Lowell-Brockton, MA–NH (NH, RI, and VT Hospitals) 1.1160

Burlington, VT ............................................. 1.0236

Casper, WY ................................................. 0.8817

Champaign-Urbana, IL ................................ 0.9084

Charleston-North Charleston, SC ............... 0.9067

Charleston, WV ........................................... 0.8904

Charlotte-Gastonia-Rock Hill, NC–SC ........ 0.9391

Chattanooga, TN–GA .................................. 0.9624

Chicago, IL .................................................. 1.1015

Cincinnati, OH–KY–IN ................................. 0.9415

Clarksville-Hopkinsville, TN–KY .................. 0.8277

Cleveland-Lorain-Elyria, OH ........................ 0.9593

Columbia, MO ............................................. 0.8756

Columbia, SC .............................................. 0.9433

Columbus, OH ............................................. 0.9619

Dallas, TX .................................................... 0.9913

Danville, VA ................................................. 0.8212

Davenport-Moline-Rock Island, IA–IL ......... 0.8898

Dayton-Springfield, OH ............................... 0.9442

Denver, CO ................................................. 1.0181

Des Moines, IA ............................................ 0.9011

Dothan, AL .................................................. 0.8013

Dover, DE .................................................... 0.9769

Duluth-Superior, MN–WI ............................. 1.0043

Eau Claire, WI ............................................. 0.8880

Erie, PA ....................................................... 0.8985

Eugene-Springfield, OR .............................. 1.0965

Fargo-Moorhead, ND–MN ........................... 0.8517

Fayetteville, NC ........................................... 0.8469

Flagstaff, AZ–UT ......................................... 1.0525

Flint, MI ....................................................... 1.1058

Florence, AL ................................................ 0.7652

Florence, SC ............................................... 0.8777

Fort Collins-Loveland, CO ........................... 1.0647

Ft. Lauderdale, FL ....................................... 1.0152

Fort Pierce-Port St. Lucie, FL ..................... 0.9622

Fort Smith, AR–OK ..................................... 0.7947

Fort Walton Beach, FL ................................ 0.9358

Fort Wayne, IN ............................................ 0.8665

Forth Worth-Arlington, TX ........................... 0.9527

Gadsden, AL ............................................... 0.8423

Grand Forks, ND–MN ................................. 0.8954

Grand Junction, CO .................................... 0.9471

Grand Rapids-Muskegon-Holland, MI ......... 1.0248

Great Falls, MT ........................................... 0.9330

Greeley, CO ................................................ 0.9573

Green Bay, WI ............................................ 0.9308

Greensboro-Winston-Salem-High Point, NC 0.9124

ADDENDUM H—WAGE INDEX FOR HOSPITALS THAT ARE RECLASSIFIED—Continued

Area Wage

Index

Greenville, NC ............................................. 0.9172

Greenville-Spartanburg-Anderson, SC ....... 0.9003

Harrisburg-Lebanon-Carlisle, PA ................ 0.9386

Hartford, CT (MA Hospital) ......................... 1.1420

Hattiesburg, MS .......................................... 0.7491

Hickory-Morganton-Lenoir, NC .................... 0.8577

Honolulu, HI ................................................ 1.1866

Houston, TX ................................................ 0.9732

Huntington-Ashland, WV–KY–OH ............... 0.9605

Huntsville, AL .............................................. 0.8779

Indianapolis, IN ........................................... 0.9787

Jackson, MS ................................................ 0.8698

Jackson, TN ................................................ 0.8796

Jacksonville, FL ........................................... 0.9208

Jersey City, NJ ............................................ 1.1573

Johnson City-Kingsport-Bristol, TN–VA ...... 0.8328

Joplin, MO ................................................... 0.8148

Kalamazoo-Battlecreek, MI ......................... 1.0291

Kansas City, KS–MO .................................. 0.9509

Knoxville, TN ............................................... 0.8340

Kokomo, IN ................................................. 0.9525

Lafayette, LA ............................................... 0.8490

Lansing-East Lansing, MI ........................... 0.9934

Las Cruces, NM .......................................... 0.8510

Las Vegas, NV–AZ ..................................... 1.0796

Lexington, KY .............................................. 0.8712

Lima, OH ..................................................... 0.9320

Lincoln, NE .................................................. 0.9666

Little Rock-North Little Rock, AR ................ 0.8791

Longview-Marshall, TX ................................ 0.8732

Los Angeles-Long Beach, CA ..................... 1.2033

Louisville, KY–IN ......................................... 0.9350

Lynchburg, VA ............................................. 0.8749

Macon, GA .................................................. 0.8974

Madison, WI ................................................ 1.0271

Mansfield, OH ............................................. 0.8690

Memphis, TN–AR–MS ................................ 0.8584

Milwaukee-Waukesha, WI ........................... 0.9767

Minneapolis-St. Paul, MN–WI ..................... 1.1017

Missoula, MT ............................................... 0.9332

Mobile, AL ................................................... 0.8163

Monmouth-Ocean, NJ ................................. 1.1283

Montgomery, AL .......................................... 0.7653

Myrtle Beach, SC (NC Hospital) ................. 0.8441

Nashville, TN ............................................... 0.9301

New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT .................................... 1.2034

New London-Norwich, CT ........................... 1.1926

New Orleans, LA ......................................... 0.9295

New York, NY ............................................. 1.4463

Newburgh, NY–PA ...................................... 1.0317

Norfolk-Virginia Beach-Newport News, VA–

NC ............................................................ 0.8441

Oakland, CA ................................................ 1.4983

Ocala, FL ..................................................... 0.9243

Odessa-Midland, TX ................................... 0.9074

Oklahoma City, OK ..................................... 0.8822

Omaha, NE–IA ............................................ 0.9572

Orange County, CA ..................................... 1.1411

Orlando, FL ................................................. 0.9610

Peoria-Pekin, IL ........................................... 0.8646

Philadelphia, PA–NJ ................................... 1.0937

Pine Bluff, AR .............................................. 0.7680

Pittsburgh, PA ............................................. 0.9575

Pittsfield, MA (VT Hospital) ......................... 0.9914

Pocatello, ID ................................................ 0.8715

Portland, ME ............................................... 0.9629

Portland-Vancouver, OR–WA ..................... 1.0910

Provo-Orem, UT .......................................... 1.0041

Raleigh-Durham-Chapel Hill, NC ................ 0.9646

Rapid City, SD ............................................ 0.8865

Redding, CA ................................................ 1.1664

Reno, NV ..................................................... 1.0438

Richland-Kennewick-Pasco, WA ................. 1.1147

Roanoke, VA ............................................... 0.8782

Rochester, MN ............................................ 1.1315

Rockford, IL ................................................. 0.8819

Sacramento, CA .......................................... 1.1957

68020 Federal Register / Vol. 65, No. 219 / Monday, November 13, 2000 / Rules and Regulations

ADDENDUM H—WAGE INDEX FOR HOSPITALS THAT ARE RECLASSIFIED—Continued

Area Wage

Index

Saginaw-Bay City-Midland, MI .................... 0.9575

St. Cloud, MN .............................................. 1.0016

St. Joseph, MO ........................................... 0.8848

St. Louis, MO–IL ......................................... 0.9049

Salinas, CA ................................................. 1.4502

Salt Lake City-Ogden, UT ........................... 0.9811

San Diego, CA ............................................ 1.1784

Santa Cruz-Watsonville, CA ........................ 1.3897

Santa Fe, NM .............................................. 1.0000

Santa Rosa, CA .......................................... 1.2398

Seattle-Bellevue-Everett, WA ...................... 1.1016

Sherman-Denison, TX ................................. 0.8795

Sioux City, IA–NE ....................................... 0.8473

South Bend, IN ............................................ 1.0029

Spokane, WA .............................................. 1.0333

Springfield, IL .............................................. 0.8685

Springfield, MO ........................................... 0.8212

ADDENDUM H—WAGE INDEX FOR HOSPITALS THAT ARE RECLASSIFIED—Continued

Area Wage

Index

Syracuse, NY .............................................. 0.9594

Tampa-St. Petersburg-Clearwater, FL ........ 0.9099

Texarkana, AR-Texarkana, TX ................... 0.8427

Toledo, OH .................................................. 0.9664

Topeka, KS ................................................. 0.9117

Tucson, AZ .................................................. 0.8821

Tulsa, OK .................................................... 0.8454

Tuscaloosa, AL ........................................... 0.8064

Tyler, TX ...................................................... 0.9141

Victoria, TX .................................................. 0.8154

Washington, DC–MD–VA–WV .................... 1.0755

Waterloo-Cedar Falls, IA ............................. 0.8802

Wausau, WI ................................................. 0.9426

Wichita, KS .................................................. 0.9262

Rural Alabama ............................................ 0.7528

Rural Florida ................................................ 0.8928

Rural Illinois ................................................. 0.8160

ADDENDUM H—WAGE INDEX FOR HOSPITALS THAT ARE RECLASSIFIED—Continued

Area Wage

Index

Rural Louisiana ........................................... 0.7713

Rural Michigan ............................................ 0.9021

Rural Minnesota .......................................... 0.8881

Rural Missouri ............................................. 0.7707

Rural Montana ............................................. 0.8688

Rural Oregon ............................................... 1.0132

Rural Texas ................................................. 0.7507

Rural Washington ........................................ 1.0434

Rural West Virginia ..................................... 0.8231

Rural Wisconsin .......................................... 0.8880

Rural Wyoming (NE Hospital) ..................... 0.8671

[FR Doc. 00–28475 Filed 11–2–00; 11:43 am]

BILLING CODE 4120–01–P