Wednesday,

January 7, 2004

Part IX

Department of 

Health and Human 

Services

Centers for Medicare & Medicaid Services 

42 CFR Parts 405 and 414

Medicare Program; Changes to Medicare 

Payment for Drugs and Physician Fee 

Schedule Payments for Calendar Year 

2004; Interim Final Rule

1084 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

DEPARTMENT OF HEALTH AND 

HUMAN SERVICES 

Centers for Medicare & Medicaid 

Services 

42 CFR Parts 405 and 414

[CMS–1372–IFC] 

RIN 0938–AM97

Medicare Program; Changes to 

Medicare Payment for Drugs and 

Physician Fee Schedule Payments for 

Calendar Year 2004

AGENCY: Centers for Medicare & 

Medicaid Services (CMS), HHS.

ACTION: Interim final rule with comment 

period. 

SUMMARY: This interim final rule 

implements the provisions of the 

Medicare Prescription Drug, 

Improvement, and Modernization Act 

(MPDIMA) of 2003, Pub. L. 108–173, 

which are applicable in 2004 to 

Medicare payment for covered drugs 

and physician fee schedule services. 

These provisions revise the current 

payment methodology for Part B 

covered drugs and biologicals that are 

not paid on a cost or prospective 

payment basis; make changes to 

Medicare payment for furnishing or 

administering drugs and biologicals; 

revise the geographic practice cost 

indices and change the physician fee 

schedule conversion factor. The 2004 

physician fee schedule conversion 

factor will be $37.3374. The 2004 

national anesthesia conversion factor 

(prior to making adjustment for the 

geographic practice cost indices) will be 

$17.4969. The information contained in 

this final rule related to payment under 

the physician fee schedule supercedes 

the information contained in the 

November 7, 2003, final rule to the 

extent that the two are inconsistent. All 

other provisions of the November 7, 

2003, final rule are unchanged unless 

otherwise noted. This rule also extends 

the ‘‘opt-out’’ provisions of 1802(b)(5)(3) 

of the Social Security Act to dentists, 

podiatrists, and optometrists.

DATES: Effective date: These regulations 

are effective on January 1, 2004. 

Comment date: We will consider 

comments if we receive them at the 

appropriate address, as provided in the 

addresses section, no later than 5 p.m. 

on March 8, 2004.

ADDRESSES: In commenting, please refer 

to file code CMS–1372–FC. Because of 

staff and resource limitations, we cannot 

accept comments by facsimile (FAX) 

transmission. 

Mail written comments (one original 

and two copies) to the following address 

only: Centers for Medicare & Medicaid 

Services, Department of Health and 

Human Services, Attention: CMS–1372–

FC, P.O. Box 8013, Baltimore, MD 

21244–8013. 

Please allow sufficient time for us to 

receive mailed comments on time in the 

event of delivery delays.

If you prefer, you may deliver (by 

hand or courier) your written comments 

(one original and two copies) to one of 

the following addresses: Room 445–G, 

Hubert H. Humphrey Building, 200 

Independence Avenue, SW., 

Washington, DC 20201, or Room C5–14–

03, 7500 Security Boulevard, Baltimore, 

MD 21244–8013. 

(Because access to the interior of the 

HHH Building is not readily available to 

persons without Federal government 

identification, commenters are 

encouraged to leave their comments in 

the CMS drop slots located in the main 

lobby of the building. A stamp-in clock 

is available if you wish to retain proof 

of filing by stamping in and retaining an 

extra copy of the comments being filed.) 

Comments mailed to the addresses 

indicated as appropriate for hand or 

courier delivery may be delayed and 

could be considered late. 

For information on viewing public 

comments, see the beginning of the 

SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT:

Jennifer Fan, (410) 786–0548 regarding 

Medicare payment for Part B covered 

drugs and biologicals. 

Rick Ensor, (410) 786–5617 regarding 

provisions related to geographic practice 

cost indices. 

Diane Milstead, (410) 786–3355 for 

provisions related to the physician fee 

schedule. 

Gaysha Brooks, (410) 786–9649 for 

questions related to obtaining Medicare 

physician fee schedule information from 

the CMS Web site.

SUPPLEMENTARY INFORMATION: 

Inspection of Public Comments:

Comments received timely will be 

available for public inspection as they 

are processed, generally beginning 

approximately 3 weeks after publication 

of a document, at the headquarters of 

the Centers for Medicare & Medicaid 

Services, 7500 Security Boulevard, 

Baltimore, Maryland 21244, Monday 

through Friday of each week from 8:30 

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

appointment to view public comments, 

phone (410) 786–7197. 

Copies: To order copies of the Federal 

Register containing this document, send 

your request to: New Orders, 

Superintendent of Documents, P.O. Box 

371954, Pittsburgh, PA 15250–7954. 

Specify the date of the issue requested 

and enclose a check or money order 

payable to the Superintendent of 

Documents, or enclose your Visa or 

Master Card number and expiration 

date. Credit card orders can also be 

placed by calling the order desk at (202) 

512–1800 or by faxing to (202) 512–

2250. The cost for each copy is $10. As 

an alternative, you can view and 

photocopy the Federal Register

document at most libraries designated 

as Federal Depository Libraries and at 

many other public and academic 

libraries throughout the country that 

receive the Federal Register. 

This Federal Register document is 

also available from the Federal Register

online database through GPO Access, a 

service of the U.S. Government Printing 

Office. The Web site address is http://

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

Accessing Physician Fee Schedule Web 

Site and Pricing Information 

Information on the physician fee 

schedule and pricing files can be found 

on our home page. You can access this 

data at the following Web site: http://

cms.hhs.gov/physicians/pfs or you can 

access this data by using the following 

directions: 

1. Go to the CMS home page (http:/

/www.cms.hhs.gov). 

2. Place your cursor over the word 

‘‘Professionals’’ in the blue area near the 

top of the page. Select ‘‘Physicians’’ 

from the drop-down menu. 

3. Scroll down and under ‘‘Payment/

Billing’’ select ‘‘Physician Fee 

Schedule’’. 

The Physician Fee Schedule pricing 

information is contained in two public 

use files. 

(1) National Physician Fee Schedule 

Relative Value File—This file contains 

all CPT/HCPCS (excluding codes 

beginning with B, E, L, K, and 0), their 

short descriptions and a status 

indicator, which denotes whether or not 

the service is priced under the 

physician fee schedule. The file also 

contains the components used in the 

calculation of the annual pricing 

amount (that is, the RVUs, GPCIs, and 

conversion factor), anesthesia 

conversion factors, and the payment 

policy indicators used to price the 

claims with surgical modifiers. This file 

does not contain the calculated pricing 

amounts. 

(2) Physician Fee Schedule Payment 

Amount File National/Carrier—This file 

contains the CPT code and the Medicare 

price for all services priced under the 

Physician Fee Schedule. These data can 

be downloaded for the entire country, or 

for a selected carrier (in most cases 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1085

carriers correlate with States). There is 

no option of requesting data for selected 

HCPCS codes. The zip file, which is 

downloaded, contains a file named 

‘‘PF04pc’’, which explains the data 

contained in each column. This file also 

contains a description of pricing 

localities used in the Physician Fee 

Schedule. Due to the size of the national 

file (as well as many of the carrierspecific files), these data are provided in 

a comma-delimited format, which can 

be used to populate database 

applications. Generally speaking, these 

data are too large for Excel, however if 

a carrier specific file has 3 or fewer 

localities, Excel can be used.

Another file that may prove useful is 

the Zip Code to Carrier Locality file. 

This file will map ZIP Codes to CMS 

carriers and localities and map Zip 

Codes to their State and determine 

whether the ZIP Code has a rural 

designation as determined by CMS. You 

can access this file at the following Web 

site: http://cms.hhs.gov/providers/

pufdownload/default.asp#alphanu or 

you can access this data by using the 

following directions: 

1. Go to the CMS home page (http:/

/www.cms.hhs.gov). 

2. Place your cursor over the word 

‘‘Professionals’’ in the blue area near the 

top of the page. Select ‘‘Physicians’’

from the drop-down menu. 

3. Scroll down and under ‘‘Payment/

Billing’’ select ‘‘Medicare Payment 

Systems.’’

4. Scroll down and under Coding 

Files select ‘‘Zip Code to Carrier 

Locality File.’’

Table of Contents 

I. Background 

A. Medicare Payment for Part B Covered 

Drugs and the Furnishing or 

Administration of Drugs 

B. Geographic Practice Cost Indices and 

Physician Fee Schedule Conversion 

Factor 

II. Provisions of the Final Rule 

A. Application of Market-Based Systems of 

Medicare Payment for Part B Drugs 

B. Payment for Inhalation Drugs 

C. Pharmacy Supplying Fee for Certain 

Drugs and Biologicals 

D. Physician Fee Schedule Provisions 

Related to the Administration of Drugs 

1. Provisions Related to Budget Neutrality 

2. Adjustments in Practice Expense 

Relative Value Units for Certain Drug 

Administration Services beginning with 

2004 

3. Pricing of Clinical Oncology Nurses in 

the Practice Expense Methodology 

4. Work Relative Value Units for Certain 

Drug Administration Services 

5. Adjustments in the Practice Expense 

Relative Value Units for Certain Drug 

Administration Services Beginning with 

2005 

6. Provisions for Appropriate Reporting 

and Billing for Physicians’ Services 

Associated with the Administration of 

Covered Outpatient Drugs and 

Biologicals 

7. Treatment of Other Services Currently in 

the Nonphysician Work Pool

8. Payment for Multiple Chemotherapy 

Agents Furnished on a Single Day 

through the Push Technique 

9. Transitional Adjustment to Medicare 

Payment for Certain Drug Administration 

Services 

E. Geographic Practice Cost Indices 

F. Adjustments to the Work, Practice 

Expense and Malpractice Relative Value 

Units 

G. Anesthesia and Physician Fee Schedule 

Conversion Factors for 2004 

H. Publication of Addenda 

III. Private Contracting with Medicare 

Beneficiaries 

IV. Waiver of Proposed Rulemaking and 

Delay in Effective Date 

V. Collection of Information Requirements 

VI. Response to Comments 

VII. Regulatory Impact Analysis 

Addendum A—Explanation and Use of 

Addendum B 

Addendum B—Relative Value Units and 

Related Information Used in Determining 

Medicare Payments for 2004 

Addendum C—Codes with Interim Relative 

Value Units 

Addendum D—2004 Geographic Practice 

Cost Indices by Medicare Carrier and 

Locality 

Addendum E—2005 Geographic Practice 

Cost Indices by Medicare Carrier and 

Locality 

Addendum F—List of Medicare Covered Part 

B Drugs Under Payment Reform

I. Background 

A. Medicare Payment for Part B Covered 

Drugs and the Furnishing or 

Administration of Drugs 

Medicare Part B covers a limited 

number of prescription drugs and 

biologicals. For the purposes of this 

final rule, the term ‘‘drugs’’ will 

hereafter refer to both drugs and 

biologicals. Currently, covered Medicare 

drugs generally fall into three categories: 

drugs furnished incident to a 

physician’s service, durable medical 

equipment (DME) drugs, and drugs 

specifically covered by statute (for 

example, oral immunosuppressive 

drugs). Prior to January 1, 2004, drugs 

not paid on a cost or prospective 

payment basis are paid based on the 

lower of the actual charge or 95 percent 

of the average wholesale price (AWP) 

(section 1842(o)(1) of the Social Security 

Act (the Act), as added by section 4556 

of the Balanced Budget Act of 1997 

(Pub. L. 105–33)). In December 2000, the 

Congress passed the Medicare, 

Medicaid, and SCHIP Benefits 

Improvement and Protection Act (BIPA). 

Section 429(a) of BIPA required the 

GAO to conduct a study of the current 

payment methodology. Section 429(b) of 

BIPA requires the Secretary, 

notwithstanding any other provision of 

law, to revise the Medicare payment 

methodology for drugs based on the 

GAO study. In September 2001, the 

GAO presented its study to the Congress 

in a report titled, ‘‘Medicare: Payments 

for Covered Outpatient Drugs Exceed 

Providers’ Costs’’ (GAO–01–1118). 

Consistent with the recommendations in 

the report, we published four options 

for revising the current drug payment 

system in a proposed rule published 

August 20, 2003 (68 FR 50428), in the 

Federal Register. This proposed rule 

also discussed changes to Medicare 

payment under the physician fee 

schedule for furnishing or administering 

certain drugs and biologicals. However, 

as discussed in the November 7, 2003, 

final rule (68 FR 63196), ‘‘Revisions to 

Payment Policies Under the Physician 

Fee Schedule for Calendar Year 2004’’, 

since the Congress was considering 

legislation to address these issues, we 

were reluctant to proceed with 

finalizing the proposals contained in the 

August 20, 2003, proposed rule. On 

November 25, 2003, the Congress 

enacted the Medicare Prescription Drug, 

Improvement, and Modernization Act 

(MPDIMA) of 2003, Pub L. 108–173. The 

President signed Pub. L. 108–173 into 

law on December 8, 2003. Sections 303 

through 305 of MPDIMA make revisions 

to payment methodology for Part B 

covered drugs that are not paid on a cost 

or prospective payment basis. Sections 

303 and 304 also require the Secretary 

of Health and Human Services to revise 

Medicare payments for the 

administration of drugs made using the 

physician fee schedule. We are using 

this final rule to implement those 

sections of MPDIMA that are effective 

January 1, 2004, and prior to January 1, 

2006, and affect Medicare payment for 

covered Part B drugs and their 

administration. 

B. Geographic Practice Cost Indices 

(GPCIs) and Physician Fee Schedule 

Conversion Factor 

Section 1848(e) of the Act requires 

that payments vary among Medicare 

physician fee schedule areas according 

to the extent resource costs vary, as 

measured by Geographic Practice Cost 

Indices (GPCIs) for each of the three fee 

schedule components—work, practice 

expense and malpractice. As explained 

later in this document, for services 

provided on or after January 1, 2004, 

and prior to January 1, 2007, section 412 

of MPDIMA requires that the work GPCI 

cannot be less than 1.00. Section 602 of 

MPDIMA requires that work, practice 

1086 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

expense and malpractice GPCIs 

otherwise calculated cannot be less than 

1.67 for services furnished in Alaska on 

or after January 1, 2004, or prior to 

January 1, 2006. 

Sections 1848(d) and (f) of the Act 

establish a formula for determining the 

physician fee schedule update and 

conversion factor (CF). As indicated in 

the November 7, 2003, final rule (68 FR 

63239), the application of the formula in 

the statute resulted in a 2004 physician 

fee CF of $35.1339, a reduction of 4.5 

percent. However, section 601 of 

MPDIMA requires that the update to the 

physician fee schedule CF for 2004 

cannot be less than 1.5 percent. We are 

using this final rule to announce the CF 

and GPCIs that will be used to 

determine physician fee schedule rates 

in 2004. 

II. Provisions of the Final Rule 

A. Application of Market-Based Systems 

of Medicare Payment for Part B Drugs 

1. General Rule 

Subject to the other provisions of 

MPDIMA, section 303(b) of MPDIMA 

specifies that drugs not paid on a cost 

or prospective payment basis will be 

paid at 85 percent of the average 

wholesale price (AWP) determined as of 

April 1, 2003. 

2. Specific Provisions 

Section 303(b)(1) of MPDIMA 

specifies that for CY 2004 the following 

drugs will be paid at 95 percent of the 

AWP: 

•Blood clotting factors; 

• A drug or biological furnished 

during 2004 that was not available for 

Medicare payment as of April 1, 2003; 

• Pneumococcal and influenza 

vaccines as well as hepatitis B vaccine 

that is furnished to individuals at high 

or intermediate risk of contracting 

hepatitis B (as determined by the 

Secretary); and

• A drug or biological furnished 

during 2004 in connection with the 

furnishing of renal dialysis services if 

separately billed by renal dialysis 

facilities. 

Section 303(b)(1) of MPDIMA also 

specifies that infusion drugs will be 

paid at 95 percent of the AWP in effect 

on October 1, 2003, when furnished 

through a covered item of durable 

medical equipment. 

Section 303(b)(2) of MPDIMA 

specifies that the payment for a drug 

contained in the table entitled ‘‘Table 

3—Medicare Part B Drugs in the Most 

Recent GAO and OIG Studies’’

published in the August 20, 2003, 

proposed rule (68 FR 50445) will be the 

percentage of the AWP indicated in the 

column entitled ‘‘Average of the GAO 

and OIG data (percent)’’. This 

percentage will be applied to the AWP 

determined as of April 1, 2003. 

However, in the event that the 

percentage from Table 3 is less than 80 

percent, the percentage applied to the 

AWP determined as of April 1, 2003, 

will be 80 percent. Table 1 below is a 

reprint of Table 3 from the August 20, 

2003, proposed rule. Table 2 highlights 

the relevant column from the August 20, 

2003, proposed rule table and applies 

the 80 percent limit where applicable. 

We note that there was a 

typographical error in Table 3 as 

published on August 20, 2003, for J1642 

‘‘Heparin Sodium Lock Flush’’. The 

percentage in the column specified in 

MPDIMA is missing for J1642. Given 

that this column is calculated as the 

average of the values in the preceding 

two columns for the drugs in this table, 

we will treat the missing value as the 

average of the values in the prior two 

columns for J1642, namely 66 percent. 

This is the percentage that would have 

been in that column in the table in the 

absence of the typographical error. We 

believe that this correction is consistent 

with Congress’ intent to revise the 

percentage based on the average of 

accurate GAO and OIG data. This 

percentage will be subject to the 80 

percent limitation described above. 

We also note that there was another 

typographical error in Table 3 as 

published on August 20, 2003, for J9390 

‘‘Vinorelbine Tartrate (Navelbine).’’ The 

percentage listed under the column 

titled ‘‘GAO Average Widely Available 

Price as a Percent of AWP (2001)’’ for 

J9390 in Table 3 is incorrect and should 

not have been listed at all since GAO 

did not include this drug in its study. 

The percentage under the column titled 

‘‘OIG Median Catalogue Price as a 

Percent of AWP (2000)’’ is correct. Since 

the column specified in MPDIMA is 

calculated as the average of the values 

in the preceding two columns for the 

drugs in this table, the correct 

percentage listed for J9390 under this 

column will be 81 percent based on the 

data from OIG. We believe that this 

correction is also consistent with 

Congress’ intent to revise rates based on 

the average of accurate GAO and OIG 

data. This is the percentage that would 

have been in that column in the table in 

the absence of the typographical error.

BILLING CODE 4120–01–P

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BILLING CODE 4120–01–C


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Section 303(b)(2) of MPDIMA also 

provides an opportunity for the 

manufacturer of a drug to submit data 

and information requesting a different 

percentage from the percentage 

indicated in Table 1A or the 85 percent 

general rule. The Secretary may adjust 

the percentage based on this data and 

information beginning April 1, 2004. 

Section 303(b) of MPDIMA specifies 

that this data and information can be 

submitted after October 15, 2003, and 

before January 1, 2004. As required by 

the statute, manufacturers need to 

submit this data and information before 

January 1, 2004. Manufacturers may 

supplement this data and information; 

however, any additional supplemental 

information should be received by CMS 

before 5 p.m. e.s.t. on January 16, 2004. 

We will use the supplemental 

information to help us evaluate the 

initial submission of data and 

information. 

We expect that the data and 

information submitted by a 

manufacturer would include the 

manufacturer’s average sales price for 

the drug for the most recent quarter 

available. For the purposes of the 

exceptions process, the manufacturer’s 

average sales price is calculated as the 

manufacturer’s sales to all purchasers in 

the United States (excluding sales 

exempted below) for the quarter divided 

by the total number of units of such 

drug or biological sold by the 

manufacturer in that quarter. The 

submission should also specify the units 

used in the calculation (for example, 

micrograms). 

In the calculation of the 

manufacturer’s average sales price, a 

manufacturer should include volume 

discounts, prompt pay discounts, cash 

discounts, free goods that are contingent 

on any purchase requirement, 

chargebacks, and rebates (other than 

rebates under the Medicaid program). 

To the extent that there is a lag in the 

availability of this information 

applicable to the quarter, the 

manufacturer should apply a 

methodology based on the most recent 

12-month period available to estimate 

costs attributable to these price 

concessions. The manufacturer should 

submit a description of the methodology 

used to estimate these costs.

In the calculation of the 

manufacturer’s average sales price, a 

manufacturer should exclude the 

following sales as defined for the 

Medicaid best price calculation under 

section 1827(c)(1)(C)(i) of the Act: 

1. Sales to the Indian Health Service, 

the Department of Veterans Affairs, a 

state home as defined for the purposes 

of the Medicaid best price calculation, 

the Department of Defense, the Public 

Health Service and entities described in 

section 340(B)(a)(4) of the Public Health 

Act; 

2. Sales under the Federal Supply 

Schedule of the General Services 

Administration; 

3. Sales under a State pharmaceutical 

assistance program; and 

4. Any depot sales and single award 

contract sales as defined for the 

purposes of the Medicaid best price 

calculation. 

A manufacturer should also exclude 

sales at a nominal charge. Sales at a 

nominal charge are defined as sales 

below 10 percent of the average 

calculated as described above. In other 

words, after following the methodology 

described above, sales below 10 percent 

of the resulting average should be 

excluded and the average recalculated. 

The result of this final calculation is the 

manufacturer’s average sales price for 

the purpose of the exceptions process. 

Note that we would base any changes 

to the percentage indicated in Table 1 or 

the 85 percent general rule only on data 

that we could make available to the 

public. 

Section 303(b)(2) of MPDIMA also 

specifies that we may adjust the 

percentage effective January 1, 2004, 

based on data and information that a 

manufacturer submitted by October 15, 

2003. We accepted data from the 

manufacturer of two biologicals: 

imiglucerase and alglucerase. The data 

and information submitted by the 

manufacturer indicated that the 

manufacturer’s average sales price was 

94 percent of the average wholesale 

price. Based on this data, we will pay 

for these two biologicals when 

furnished in 2004 at 94 percent of the 

average wholesale price determined as 

of April 1, 2003. 

B. Payment for Inhalation Drugs 

Section 305(a) of MPDIMA specifies 

that inhalation drugs furnished through 

durable medical equipment covered 

under 1861(n) of the Act will be paid in 

accordance with section 1842(o)(4) of 

the Act, as added by section 303(b)(2) of 

MPDIMA. The methodology for 

determining the payment for a drug 

under section 303(b)(2) of MPDIMA is 

described above in section II.A.2 of this 

rule. 

C. Pharmacy Supplying Fee for Certain 

Drugs and Biologicals 

Section 303(e)(2) of MPDIMA 

provides that the Secretary shall pay a 

pharmacy supplying fee, less applicable 

deductible and coinsurance, for 

immunosuppressive drugs described in 

section 1861(s)(2)(J) and oral anti-cancer 

and anti-nausea drugs described in 

subparagraph (Q) and (T) of the same 

section as determined appropriate by 

the Secretary. We believe that the 

payment of this fee should be bundled 

into the current payment for these drugs 

and the 2004 payment amounts 

specified in section 303(b) of MPDIMA. 

We do not have data indicating that the 

85% figure is insufficient to cover the 

cost of supplying these drugs. However, 

for 2005, we will re-examine this issue 

in light of the average sales price (ASP) 

data that will be submitted by 

manufacturers. 

D. Physician Fee Schedule Provisions 

Related to the Administration of Drugs 

As indicated above, sections 303 and 

304 of MPDIMA amend section 1848 of 

the Act for physician fee schedule 

payments made beginning January 1, 

2004. We are describing our 

implementation of the parts of sections 

303 and 304 which have a January 1, 

2004, effective date. 

1. Provisions Related to Budget 

Neutrality

Section 303(a)(1) of MPDIMA amends 

section 1848(c) of the Act to require 

changes to the practice expense and 

physician work relative value units 

(RVUs) used to determine payment for 

drug administration services. In general, 

section 1848(c)(2)(B)(ii)(II) provides that 

the Secretary shall review and may 

make adjustments to the RVUs if the 

changes do not cause the amount of 

expenditures to increase or decrease by 

more than $20 million. Section 303(a) of 

MPDIMA amends section 1848(c)(2)(B) 

of the Act to add a new clause (iv) that 

exempts from this limitation, any 

additional expenditures in 2004 

attributable to: 

(1) The increase in practice expense 

RVUs for drug administration services 

resulting from the use of a practice 

expense survey meeting specific criteria 

described in the statute; 

(2) The increase in practice expense 

RVUs resulting from using survey data 

on the compensation of clinical 

oncology nurses; and 

(3) New physician work RVUs that we 

are adding to the drug administration 

services consistent with the new 

statutory provisions. 

In addition, section 303(a)(1) of 

MPDIMA also modifies section 

1848(c)(2)(B) of the Act to provide an 

exemption from the budget neutrality 

requirements in 2005 or 2006 for further 

increases in practice expense RVUs for 

drug administration services that may 

result from using additional survey data 

from physician specialties meeting 

specific criteria that we will discuss in 

1092 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

more detail later in this document. 

Furthermore, any increase in spending 

associated with any coding or policy 

changes resulting from the Secretary’s 

review of existing drug administration 

codes is also exempted from budget 

neutrality requirements of section 1848 

(c)(2)(B) by section 303 of MPDIMA. 

Section 303(a)(3) also requires the 

Secretary to review the policy in effect 

for the administration of more than one 

drug administered by the push 

technique. This change is also exempt 

from budget neutrality. 

In general, we have met the budget 

neutrality requirements in the statute by 

either applying an adjustment to the 

physician fee schedule CF or to the 

RVUs themselves. However, section 

303(a) of MPDIMA specifically amends 

the statute to exempt the additional 

expenditures that result from changes to 

the RVUs for drug administration 

services from the budget neutrality 

requirements. Therefore, we will make 

no changes to the physician fee 

schedule CF or physician work RVUs to 

account for physician work RVUs being 

added to drug administration services. 

We will add the additional expenditures 

as a result of these provisions to the 

expenditure base in applying our 

practice expense methodology.

2. Adjustments in Practice Expense 

Relative Value Units for Certain Drug 

Administration Services Beginning with 

2004 

Section 303(a)(1)(B) of MPDIMA 

amends section 1848(c)(2) of the Act by 

adding new subparagraph (H), 

‘‘Adjustments in Practice Expense 

Relative Value Units for Certain Drug 

Administration Services beginning in 

2004’’. Subparagraph (H)(i) requires the 

Secretary to determine the practice 

expense RVUs for 2004 using practice 

expense surveys submitted to the 

Secretary as of January 1, 2003, by a 

physician specialty organization in 

accordance with section 212 of the 

Medicare, Medicaid, and SCHIP 

Balanced Budget Refinement Act 

(BBRA) of 1999 if the survey: (1) Covers 

practice expenses for oncology drug 

administration services; and (2) meets 

criteria established by the Secretary for 

acceptance of such surveys. 

Section 212 of the BBRA directed the 

Secretary to establish a process under 

which we would accept and use, to the 

maximum extent practicable and 

consistent with sound data practices, 

data collected or developed by entities 

and organizations. In an interim final 

rule with comment published in the 

Federal Register on May 3, 2000 (65 FR 

25664), we established the criteria 

under which we would accept 

supplemental data for use in computing 

the practice expense RVUs. We 

subsequently modified those criteria in 

the November 1, 2000, physician fee 

schedule final rule (65 FR 65383) and 

the December 31, 2002, final rule (67 FR 

79971). 

The American Society of Clinical 

Oncology (ASCO) provided us with a 

supplemental survey prior to January 1, 

2003, that includes expenses associated 

with the administration of 

chemotherapy drugs. While the survey 

meets the criteria we established, we 

initially decided not to use the 

information because of concerns about 

the data (for more information, see the 

December 31, 2003, final rule (67 FR 

79973)). In a proposed rule published in 

the Federal Register on August 20, 2003 

(68 FR 50437), we described subsequent 

discussions held with ASCO that 

resolved our concerns about the data. 

Consistent with section 

1848(c)(2)(H)(i) of the Act, we are using 

the ASCO survey to determine the 

practice expense RVUs for physician fee 

schedule services furnished on or after 

January 1, 2004, because it: (1) Was 

submitted prior to January 1, 2003; (2) 

includes expenses for drug 

administration services; and (3) meets 

criteria we have established for use of 

surveys. 

Section 303(j) of MPDIMA applies the 

amendments made by section 303 for 

payments for drugs or biologicals and 

drug administrative services to 

physicians in the specialties of 

hematology, hematology/oncology and 

medical oncology. Section 304 indicates 

that: ‘‘Notwithstanding section 303(j), 

the amendments made by section 303 

shall also apply to payments for drugs 

or biologicals and drug administration 

services furnished by physicians in 

specialties other than the specialties of 

hematology, hematology/oncology and 

medical oncology.’’

Because the section 303 (a)(1) 

provisions apply to hematology, 

hematology/oncology and medical 

oncology, we will use the supplemental 

survey submitted by ASCO for CMS 

specialty codes 82 (hematology), 83 

(hematology/oncology) and 90 (medical 

oncology). 

The Conference Report indicates that 

section 304 requires the Secretary to 

disregard the (section 303) exemption 

and apply the adjustments in section 

303 to these other specialties. The 

Conference report further indicates the 

intent in drafting the provisions in this 

fashion: ‘‘The intent in drafting the two 

sections in this manner is to segregate 

the savings achieved from adjustments 

to payments to oncologists from savings 

derived from other physician 

specialties. The specialties to which the 

provisions apply are the specialties as 

used by the carriers in administering 

Medicare.’’

The purpose of the separation is only 

to display the budget scoring effects 

separately for oncologists from other 

physician specialties. There is no

substantive policy effect at all from the 

enactment of the amendments in this 

manner. The combined effect of the 

amendments made by both section 

303(j) and section 304 is that the 

substantive changes in both payments 

for drugs and biologicals as well as drug 

administration services apply to 

physicians of all specialties. 

When we use supplemental survey 

data, we have generally blended the 

supplemental survey data with prior 

survey data from the American Medical 

Association’s Socioeconomic 

Monitoring Survey (SMS). However, 

section 1848(c)(2)(H)(i) of the Act 

indicates that the Secretary should use 

survey data that meets the specific 

criteria specified in the statute. We are 

using the ASCO survey data and are not 

blending it with the prior SMS data. 

Because we are not blending the 

ASCO survey with the SMS data, we are 

adopting a consistent policy in 2004 for 

survey data received in 1999 from the 

Society for Thoracic Surgery (STS). That 

is, we will use the STS supplemental 

survey data without blending it with the 

SMS data. However, we have not made 

a final decision and will continue to 

consider the issue of whether to blend 

supplemental survey with prior SMS 

data or to use specialty submitted 

supplemental surveys without blending. 

At this time, we are not using the ASCO 

and STS cases as precedent for our 

consideration of future survey data. 

While some may argue that the 

inclusion of newer, more specific survey 

data will improve the precision of the 

data underlying the calculation of the 

practice expense resource based RVUs, 

and lead to more stability in the practice 

expense methodology, it can also be 

argued that a specialty society would 

only undertake a survey (arguing that 

existing SMS data were not sufficiently 

representative of the specialty’s practice 

expenses) if it believed that higher 

practice expense payments for that 

specialty could be achieved by 

submitting additional data. We do not 

believe that it would be prudent for the 

program to commit to the use of 

supplemental survey data without 

blending it with the SMS data for any 

and all future supplementary surveys. 

We will continue to consider this issue 

in 2004 when we make proposals for the 

2005 physician fee schedule. At this 

time, we suggest that supplemental 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1093

survey data should be used without 

blending only under certain conditions 

that would be specified in a future rule. 

(Note that this issue does not affect 

specialties that are not included in the 

SMS sample, and for which we have no 

other previous survey data. In such 

cases there would obviously be no SMS 

survey data to blend.) 

We invite comments on this issue and 

on appropriate criteria for determining 

when to employ specialty submitted 

supplemental surveys without blending. 

Table 2 shows the revised practice 

expense per hour for each cost pool for 

the specialties of cardiac and thoracic 

surgery and oncology, hematology/

oncology and hematology.

TABLE 2 

Specialty Clin Staff Admin. 

Staff 

Office

Expense 

Med. 

Supplies 

Med. 

Equip Other Total 

Cardiac/Thoracic Surgery .................................................... 19.5 18.0 17.2 2.1 2.1 14.2 73.1 

Oncology .............................................................................. 53.4 34.7 34.4 16.9 7.4 42.2 189.0 

3. Pricing of Clinical Oncology Nurses 

in the Practice Expense Methodology 

Section 1848(c)(2)(H)(ii) of the Act (as 

added by section 303(a)(1) of MPDIMA) 

specifies that if a survey meets the 

criteria described above (that is, the 

survey that is submitted prior to January 

1, 2003, meets criteria established by the 

Secretary, etc.) and includes data on 

wages, salaries and compensation of 

clinical oncology nurses, the Secretary 

will use the data in the methodology for 

determining the practice expense RVUs. 

The ASCO survey meets the criteria 

specified in the statute and also 

includes data on oncology nursing 

compensation. For this reason, we are 

using information from the survey to 

determine the wage rate per minute for 

oncology certified nurses (OCN). The 

OCN is included as a practice expense 

input for the nonchemotherapy infusion 

codes (90780 through 90781) and the 

chemotherapy administration codes 

(96400 through 96549). Using 

information from the ASCO survey, we 

determined a wage rate of 0.79 per 

minute (increase from the 0.56 per 

minute we are currently using) for the 

OCN. We used this revised wage rate to 

determine the practice expense RVUs 

for the drug administration services 

shown in Addendum B. 

4. Work Relative Value Units for Certain 

Drug Administration Services 

For services furnished on or after 

January 1, 2004, section 

1848(c)(2)(H)(iii) of the Act (as added by 

section 303(a)(1) of MPDIMA) requires 

the Secretary to establish work RVUs for 

drug administration services equal to 

the work RVUs for a level 1 office 

medical visit for an established patient 

(CPT code 99211). Section 

1848(c)(2)(H)(iv) of the Act defines drug 

administration services as those 

classified as of October 1, 2003, within 

any of the following groups: therapeutic 

or diagnostic infusions (excluding 

chemotherapy); chemotherapy 

administration services; and 

therapeutic, prophylactic, or diagnostic 

injections for which there are no work 

RVUs assigned and for which national 

RVUs have been assigned. 

CPT code 99211 is a level 1 

established patient office visit with 

physician work RVUs of 0.17. 

Consistent with the statute we are 

adding physician work RVUs of 0.17 to 

the following drug administration 

services: CPT codes 90780 through 

90781, 90782 through 90788, 96400, 

96408 through 96425, 96520, and 96530.

Currently, section 15010 of the 

Medicare Carriers Manual (MCM) does 

not allow payment for CPT codes 90782, 

90783, 90784 and 90788 unless these 

are the only physician fee schedule 

services provided on that day. We do 

pay separately for cancer chemotherapy 

injections (CPT codes 96400–96549) in 

addition to an office visit (CPT codes 

99211–99215) furnished on the same 

day by the same physician. CPT code 

99211 does not require a face-to-face 

encounter between the physician and 

the patient like other office visit services 

(CPT codes 99212–99215) and can be 

used be physicians supervising a nurse 

performing chemotherapy 

administration. Currently, physicians 

typically bill for CPT code 99211 

approximately 34 percent of the time 

that they are also providing a drug 

administration service. We believe that 

adding physician work to the drug 

administration services will subsume 

the supervision that physicians billing 

for a 99211 on the same day are 

typically providing. Therefore, we will 

no longer allow for 99211 to be billed 

on the same day as a chemotherapy 

administration service. 

Although less common than CPT 

99211, physicians also bill for other 

office visit (CPT codes 99212–99215) 

provided on the same day as 

chemotherapy administration. We will 

continue to allow other office visits to 

be billed on the same day as a drug 

administration service with modifier 25 

indicating that a separately identifiable 

evaluation and management service was 

provided. This policy will make our 

practice with chemotherapy 

administration consistent with all other 

physician fee schedule services where 

we require use of modifier 25 if a 

separately identifiable evaluation and 

management service is provided on the 

day as a procedure. Section 15400(D) of 

the Medicare Carrier Manual (MCM) 

describes Medicare payment policy with 

respect to chemotherapy administration 

and ‘‘incident to’’ services provided on 

the same day. We will be revising 

section 15400 of the MCM (in addition 

to section 15010 that describes 

‘‘bundled services’’) to reflect that CPT 

code 99211 and a chemotherapy 

administration service cannot be billed 

for the same patient on a single day. 

5. Adjustments in the Practice Expense 

Relative Value Units for Certain Drug 

Administration Services Beginning with 

2005 

Section 303(a)(1) of MPDIMA also 

modifies section 1848(c)(2)(B) of the Act 

to provide an exemption from the 

budget neutrality requirements in 2005 

or 2006 for further increases in practice 

expense RVUs for drug administration 

services that may result from using 

additional survey data from physician 

specialties meeting specific criteria. 

Section 1848(c)(2)(I) of the Act specifies 

that the exemption from budget 

neutrality will apply for any survey 

(other than the ASCO survey that meets 

the exemption requirement specified by 

another provision of the statute) 

submitted by a specialty group where 40 

percent or more of its payments for Part 

B services are attributable to the 

administration of drugs in 2002 as 

determined by the Secretary. The statute 

indicates that the survey must include 

expenses for the administration of drugs 

and must be received by the Secretary 

prior to March 1, 2004, to determine the 

2005 practice expense RVUs and prior 

to March 1, 2005, to determine the 2006 

practice expense RVUs. 

1094 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

We have reviewed Medicare allowed 

charge data for 2002. Based on the 2002 

data, we found that the specialties of 

gynecology/oncology (specialty code 98) 

rheumatology (specialty code 66) and 

urology (specialty code 30) received 

more than 40 percent of total Part B 

revenues from drugs. We will apply the 

exemption from budget neutrality 

specified in section 1848(c)(2)(I) of the 

Act for additional expenditures that 

result from the increases in drug 

administration practice expense RVUs 

in 2005 or 2006 resulting from use of a 

survey that is submitted timely by any 

of these specialties and otherwise meets 

criteria we have established for use of 

supplemental surveys. Hematology 

(specialty 82), hematology/oncology 

(specialty 83) and medical oncology 

(specialty 90) also receive more than 40 

percent of their Medicare revenues from 

drugs. However, we are already using 

the ASCO survey for these specialties 

and the increase in payment for drug 

administration is exempt from budget 

neutrality by another provision of the 

statute.

6. Provisions for Appropriate Reporting 

and Billing for Physicians’ Services 

Associated with the Administration of 

Covered Outpatient Drugs 

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

requires the Secretary to promptly 

evaluate existing drug administration 

codes for physicians’ services to ensure 

accurate reporting and billing for such 

services, taking into account levels of 

complexity of the administration and 

resource consumption. The statute 

further specifies that the Secretary will 

use existing processes for the 

consideration of coding changes and, to 

the extent changes are made, will use 

the processes to establish relative values 

for these services. The Secretary is also 

required to consult with physician 

specialties affected by the provisions 

that change Medicare payments for 

drugs. 

We expect to review this issue in the 

context of all the payment changes 

being made by the statute to Medicare 

payment for drug administration in 

order to assure accurate reporting and 

billing for such services taking into 

account levels of complexity of the 

administration and resource 

consumption. The existing processes we 

plan to use include review by our 

Physician’s Regulatory Issues Team 

(PRIT) and consultation with the AMA’s 

CPT Editorial Committee and physician 

specialties affected by changes in 

payment for drugs and drug 

administration. The PRIT, an internal 

CMS group that is working to eliminate 

unnecessary regulations, is reviewing 

the issue of coding for drug 

administration services including 

section 15400 of the Medicare Carriers 

Manual (MCM) that currently governs 

Medicare policy with respect to use of 

CPT codes in the 96400 through 96549 

series for chemotherapy administration. 

7. Treatment of Other Services Currently 

in the Nonphysician Work Pool 

The nonphysician work pool is a 

special interim methodology that we use 

to determine practice expense RVUs for 

many services that do not have 

physician work RVUs. The drug 

administration codes listed above are 

currently valued using the nonphysician 

work pool methodology. Because we are 

now assigning work RVUs to these drug 

administration codes, they will no 

longer be included in the nonphysician 

work pool. Practice expense RVUs for 

these services will be computed using 

the standard practice expense 

methodology that applies to all other 

physicians’ services. 

Section 303(a)(2) of MPDIMA requires 

the Secretary to make adjustments to the 

nonphysician work pool methodology 

for the determination of practice 

expense RVUs under the physician fee 

schedule so that the practice expense 

RVUs for services determined under 

such methodology are not affected 

relative to the practice expense RVUs of 

services not determined under such 

methodology as a result of the 

amendments made by section 303(a)(2) 

of MPDIMA. If we made no other 

changes, removing drug administration 

codes from the nonphysician work pool 

would result in a reduction to the 

practice expense RVUs for services 

remaining in the nonphysician work 

pool. Consistent with section 303(a)(1) 

of MPDIMA, we are making two changes 

to the nonphysician work pool 

methodology so that the practice 

expense RVUs for nonphysician work 

pool services are not affected relative to 

other services. 

First, we are changing the practice 

expense per hour assigned to the 

nonphysician work pool. In place of the 

‘‘all physician’’ average, we are using a 

weighted average practice expense per 

hour of the specialties that perform the 

services affected by its calculations. 

Specifically, we will use the following 

revised data in the practice expense 

methodology for services remaining in 

the nonphysician work pool:

TABLE 3 

Specialty Clin Staff Admin. 

Staff 

Office

Expense 

Med. 

Supplies 

Med. 

Equip Other Total 

Nonphysician Work pool ...................................................... 15.8 17.4 21.5 7.9 4.9 15.0 82.6 

Second, we are adjusting the clinical 

staff times used in the creation of the 

pool. By definition, nonphysician work 

pool services do not involve the 

physician and have no physician time. 

To create the nonphysician work pool, 

we have used clinical staff time per 

procedure in the computation. We will 

now use the total staff time rather than 

the previously utilized maximum staff 

time for developing the 2004 physician 

fee schedule. Consistent with section 

303(a)(2) of MPDIMA, the change to the 

practice expense per hour and staff time 

will result in no reduction to the 

practice expense RVUs for the services 

remaining in the nonphysician work 

pool once drug administration services 

are removed. By using the maximum 

staff time, we are assuming that clinical 

staff are working concurrently. 

However, it is possible that clinical staff 

are working sequentially and it would 

be appropriate to use the total staff time 

for each service. We are proposing to 

use the total staff in place of the 

maximum staff for developing the 2004 

physician fee schedule since each are 

equally likely to address staff time 

arrangements for non-physician work 

pool services and the latter approach 

will assist in meeting the statutory 

directive that payment for nonphysician work pool services not be 

affected by the changes we are making 

to drug administration services. 

8. Payment for Multiple Chemotherapy 

Agents Furnished on a Single Day 

Through the Push Technique 

Section 303(a)(3) of MPDIMA requires 

the Secretary to review the policy as in 

effect October 1, 2003, for section 1848 

of the Act for the administration of more 

than one drug or biological to an 

individual on a single day through the 

push technique. Subsequent to that 

review, the Secretary will modify the 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1095

payment policy as determined to be 

appropriate. Section 303(a)(3)(C) of 

MPDIMA indicates that any change in 

policy resulting from this review will be 

treated as additional expenditures 

attributable to section 1848(c)(2)(H). 

(This section relates to the additional 

expenditures that result from use of 

survey data that includes expenses for 

drug administration and clinical 

oncology nurses and requires that we 

establish work RVUs equal to a level 1 

office visit for drug administration 

services. Currently, a level 1 office has 

0.17 work RVUs) 

In the November 25, 1991, Federal 

Register (56 FR 59541), we specified 

that Medicare will allow CPT code 

96408 (Chemotherapy administration, 

intravenous; push technique) to be 

reported only once per day even if the 

physician administers multiple drugs 

and this policy is contained in Section 

15400 of MCM. In the August 20, 2003, 

proposed rule (68 FR 50439) concerning 

payment reform for part B drugs under 

Medicare, we had proposed revising this 

policy to allow for CPT code 96408 to 

be reported once per day for each drug 

administered. This revision was 

supported by commenters.

Upon review of this issue and in 

acknowledgement that there are 

additional resources involved in 

administering each subsequent drug 

which should be considered in a 

resource-based payment system, we are 

changing our policy and will allow for 

CPT code 96408 to be reported once per 

day for each drug administered. The 

effective date for this change is for 

services furnished on or after January 1, 

2004. We will modify section 15400 of 

the manual consistent with this change. 

In addition, as previously mentioned, 

the PRIT will be reviewing the issue of 

use of the chemotherapy administration 

codes in the 96400 CPT code series and 

Medicare’s manual provisions on their 

use. 

9. Transitional Adjustment to Medicare 

Payment for Certain Drug 

Administration Services 

Section 303(a)(4) of MPDIMA 

provides for a transitional adjustment to 

Medicare payment for drug 

administration services to reflect 

implementation of the amendments 

made by section 303 of MPDIMA 

affecting Medicare’s payments for drugs. 

Specifically, section 303(a)(4) of 

MPDIMA requires Medicare to increase 

the physician fee schedule amounts 

otherwise determined by 32 percent for 

2004 and 3 percent for 2005. Thus, we 

will determine the payment for CPT 

codes 90780 through 90781, 90782 

through 90788, 96400, 96408 through 

96425, 96520, and 96530 based on the 

work, practice expense and malpractice 

RVUs shown in Addendum B and the 

2004 CF of $37.3374. Consistent with 

section 303(a)(4) of MPDIMA, we will 

increase the physician fee schedule 

amount by an additional 32 percent for 

2004. (The physician fee schedule 

amounts applicable in 2005 will be 

increased by 3 percent.) 

C. Geographic Practice Cost Indices 

(GPCIs) 

The Act requires that payments vary 

among physician fee schedule areas 

according to the extent that resource 

costs vary as measured by the 

Geographic Practice Cost Indices 

(GPCIs) for each of the three fee 

schedule components: work, practice 

expense, and malpractice. 

Section 412 of MPDIMA amended 

section 1848(e)(1) of the Act and 

establishes a floor of 1.0 for the work 

geographic index for any locality to be 

used for purposes of payment for 

services furnished on or after January 1, 

2004, and before January 1, 2007. In 

addition, section 602 of MPDIMA 

further amended section 1848(e)(1) of 

the Act for purposes of payment for 

services furnished in Alaska under the 

physician fee schedule on or after 

January 1, 2004, and before January 1, 

2006, and sets the practice expense, 

malpractice and work indices at 1.67 if 

the index would otherwise be less than 

1.67. 

Based on these changes to the Act, we 

are revising the addenda published in 

the November 7, 2003, final rule 

concerning the transitional 2004 and 

full 2005 GPCIs (Addendum D and 

Addendum E, respectively). No locality 

will have a work GPCI of less than 1.00 

and the work, practice expense and 

malpractice GPCIs for Alaska are set at 

1.67. Addendum D in the November 7, 

2003, final rule listed 58 localities 

having work GPCIs of less than 1.00. Of 

these, the range was from 0.881 for 

Puerto Rico to 0.998 for ‘‘Rest of New 

York’’ and New Orleans, Louisiana. 

Addendum D and E that are included in 

this final rule will replace the addenda 

previously published November 7, 2003. 

D. Adjustments to the Work, Practice 

Expense and Malpractice Relative Value 

Units 

In the August 15, 2003, proposed rule 

(68 FR 49058), we proposed to adjust 

the work, practice expense and 

malpractice RVUs to match the rebased 

MEI weights. In the November 7, 2003, 

final rule (68 FR 63245), we responded 

to public comments and applied 

adjustments of ¥0.57 percent (0.9943) 

to the physician work RVUs, ¥0.77 

percent (0.9923) to the practice expense 

RVUs and 19.86 percent (1.1986) to the 

malpractice RVUs. These adjustments 

were intended to make the aggregate 

work, practice expense and malpractice 

RVUs used to determine payments in 

2004 consistent with their respective 

weights in the rebased MEI. 

However, the changes required by 

MPDIMA change the 2004 work, 

practice expense and malpractice RVUs. 

Provisions that require changes to the 

work and practice expense RVUs and 

exempt them from budget neutrality 

will increase the number of work and 

practice expense RVUs.

As we indicated in the November 7, 

2003, final rule, we believe Medicare 

payment policy will be improved by 

adjusting the work, practice expense 

and malpractice RVUs to match the 

revised MEI weights. By matching the 

aggregate pools of RVUs to the rebased 

MEI weights, Medicare’s payments for 

physician work, practice expense and 

malpractice will more closely match the 

proportion of expenses incurred by 

physicians in these categories. 

Therefore, we are revising the 

adjustments applied to the RVUs in the 

November 7, 2003, final rule consistent 

with our goal of making the work, 

practice expense and malpractice RVUs 

match the rebased MEI weights. The 

revised adjustments are ¥0.15 percent 

(0.9985) for physician work, ¥1.320 

percent (0.9868) for practice expense, 

and 20.61 percent (1.2061) for 

malpractice. We have incorporated 

these adjustments into the RVUs shown 

in Addenda B and C of this final rule. 

E. Anesthesia and Physician Fee 

Schedule Conversion Factors for 2004 

The physician fee schedule update is 

determined under a methodology 

specified by statute. In the November 7, 

2003, final rule (68 FR 63251), we used 

the formula specified in section 

1848(d)(4) of the Act to determine a 4.5 

percent reduction to the physician fee 

schedule CF. However, section 601 of 

MPDIMA amended section 1848(d) of 

the Act to specify that the update to the 

single CF for 2004 and 2005 will not be 

less than 1.5 percent. Because the 

statutory formula will yield a 4.5 

percent reduction to the physician fee 

schedule CF and the amendments to the 

statute indicate that the update for 2004 

cannot be less than 1.5 percent, we will 

increase the physician fee schedule CF 

by 1.5 percent for 2004. 

The specific calculations to determine 

the physician fee schedule and 

anesthesia CFs for 2004 are explained 

below. 

1096 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

• Physician Fee Schedule Conversion 

Factor 

Under section 1848(d)(1)(A) of the 

Act, the physician fee schedule CF is 

equal to the CF for the previous year 

multiplied by the update determined 

under section 1848(d)(4) of the Act. 

We illustrate the calculation for the 

2004 physician fee schedule CF in table 

4:

TABLE 4 

2003 Conversion Factor ....... $36.7856 

2004 Update ......................... 1.5% (1.015) 

2004 Conversion Factor ....... $37.3374 

• Anesthesia Fee Schedule Conversion 

Factor 

As described in the November 7, 

2003, final rule (68 FR 63252), 

anesthesia services do not have RVUs 

like other physician fee schedule 

services. For this reason, we are 

accounting for the adjustments to match 

the revised MEI weights and changes to 

anesthesia work and practice expenses 

through a 1.09 percent 1.0109 

adjustment to the anesthesia fee 

schedule CF. The 1.09 percent increase 

reflects a 0.15 percent reduction on the 

work portion (79 percent), a 2.0 percent 

reduction on the practice expense 

portion (13.7 percent) and a 20.61 

percent increase on the malpractice 

portion (7.2 percent) of the anesthesia 

conversion factor. (The adjustment to 

the practice expense portion is 

comprised of 1.3 percent for the MEI 

weights and 0.7 percent for the revisions 

in the practice expense methodology). 

To determine the anesthesia fee 

schedule CF for 2004, we used the 

following figures:

TABLE 5 

2003 Conversion Factor $17.0522 

Adjustments for Work 

and Practice Expense 1.09% (1.0109) 

2004 Update ................... 1.5% (1.0150) 

2004 Conversion Factor $17.4969 

F. Publication of Addenda 

The addenda included in this final 

rule concerning RVUs and Related 

Information Used in Determining 

Medicare Payments for 2004 (Addenda 

A, B and C) and GPCIs by Medicare 

Carrier and Locality (Addenda D and E) 

replace the addenda published 

November 7, 2003 (68 FR 63261). The 

revised addenda reflect changes 

required by MPDIMA as well as 

corrections to minor errors contained in 

the addenda published November 7, 

2003. 

III. Private Contracting With Medicare 

Beneficiaries 

Section 4507 of the Balanced Budget 

Act of 1997 added section 1802(b) to the 

Act. This section provides that 

physicians and certain nonphysician 

practitioners may opt out of Medicare 

and enter into private contracts with 

Medicare beneficiaries. Under these 

contracts, no limits apply to what 

physicians or nonphysician 

practitioners can charge beneficiaries. 

Physicians opting out of Medicare file 

an affidavit with the Medicare carrier in 

which they agree to opt out of Medicare 

for a period of 2 years and to meet 

certain other criteria. In general, the 

statute requires that during that twoyear period, physicians and 

nonphysician practitioners who have 

filed affidavits opting out of Medicare 

have private contracts with all Medicare 

beneficiaries to whom they furnish 

Medicare covered services. These 

contracts may not be entered into at a 

time when a beneficiary needs 

emergency or urgent care services. 

Moreover, the statute requires that the 

private contract be in writing and be 

signed by the Medicare beneficiary 

before any item or service is provided in 

accordance with the contract and that:

• The beneficiary agrees not to submit 

a claim (or to request that the physician 

or practitioner submit a claim) with 

Medicare for Medicare covered services. 

• The beneficiary agrees to be 

responsible, whether through insurance 

or otherwise, for services furnished 

under a private contract. 

• The beneficiary acknowledges that 

no limits (including the limits under 

section 1848(g) of the Social Security 

Act) apply to amounts that are charged 

under the private contract. 

• The beneficiary acknowledges that 

no payment will be made under a 

Medigap plan, and other insurers may 

elect not to make payment for services 

furnished under the private contract. 

• The beneficiary acknowledges that 

Medicare may make payment for 

covered services if the service was 

received from a physician or nonphysician practitioner with whom the 

beneficiary has not signed a private 

contract. 

Prior to enactment of MPDIMA, 

section 1802(b)(5)(B) of the Act limited 

the types of physicians who could 

choose to opt out of Medicare to doctors 

of medicine and doctors of osteopathy. 

Section 603 of MPDIMA amends section 

1802(b)(5)(B) of the Act to include 

dentists, podiatrists, and optometrists, 

in certain circumstances, in the 

definition of physicians who may opt 

out of Medicare. We are making 

conforming changes to our regulations 

to reflect this change in the statute. 

IV. Waiver of Proposed Rulemaking 

and Delay in Effective Date 

We ordinarily publish a notice of 

proposed rulemaking in the Federal 

Register and invite public comment on 

a 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 issues involved. This 

procedure can be waived, however, if an 

agency finds good cause that notice-andcomment procedure is impracticable, 

unnecessary, or contrary to the public 

interest and incorporates a statement of 

the finding and its reasons in the rule 

issued. In addition, the Administrative 

Procedure Act (APA) normally requires 

a 30-day delay in the effective date of 

a final rule. Furthermore, the 

Congressional Review Act (CRA) 

generally requires an agency to delay 

the effective date of a major rule by 60-

days in order to allow for congressional 

review of the agency action. 

Section 1871 of the Act provides for 

publication of a notice of proposed 

rulemaking and opportunity for public 

comment before CMS issues a final rule. 

However, section 1871(b)(2)(B) provides 

an exception when a law establishes a 

specific deadline for implementation of 

a provision and the deadline is less than 

150 days after the law’s date of 

enactment. MPDIMA was enacted by 

Congress on November 25, 2003, and 

signed into law by the President on 

December 8, 2003. The provisions of 

this rule that amend the physician fee 

schedule and drug payment rate are 

required to be implemented January 1, 

2004. Therefore, these provisions are 

subject to waiver of proposed 

rulemaking and public comment in 

accordance with section 1871(b)(2)(B) of 

the Act. 

Even if section 1871(b)(2)(B) of the 

Act were not directly applicable here, 

we would find good cause to waive the 

requirement for publication of an notice 

of proposed rulemaking and public 

comment on the grounds that it is 

impracticable, unnecessary, and 

contrary to the public interest. This final 

rule, with the exception of 

implementation of billing for a level 1 

office visit and pharmacy supplying fee 

and the technical correction of minor 

errors in the November rule, merely sets 

out the non-discretionary provisions of 

MPDIMA with respect to payment 

under the physician fee schedule and 

drug AWP methodology. Because the 

rule is generally ministerial, we believe 

that pursuing notice and comment is 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1097

unnecessary. Moreover, because such 

process would prevent congressionallymandated revisions, updates, and 

increases in payment under the 

physician fee schedule for 2004, we find 

that pursuing such process would be 

both impracticable and contrary to the 

public interest.

For these same reasons, we are 

waiving the 30-day delay in effective 

date contained in 5 U.S.C. section 

553(d). 

With respect to the requirement of a 

60-day delay in the effective date of any 

final rule pursuant to the CRA, see 5 

U.S.C. section 801, the CRA provides 

that the 60-day delayed effective date 

shall not apply to any rule ‘‘which an 

agency for good cause finds . . . that 

notice and public procedure thereon are 

impracticable, unnecessary, or contrary 

to the public interest’’ (5 U.S.C. section 

808(2)). For the reasons set forth above, 

we believe that additional notice-andcomment rulemaking on this subject 

would be impracticable, unnecessary, or 

contrary to the public interest. 

Therefore, we do not believe that the 

CRA requires a 60-day delay in the 

effective date of this final rule. 

V. Response to Comments 

Because of the large number of items 

of correspondence we normally receive 

on Federal Register documents 

published for comment, we are not able 

to acknowledge or respond to them 

individually. We will consider all 

comments we receive by the date and 

time specified in the DATES section of 

this preamble, and, if we proceed with 

a subsequent document, we will 

respond to the major comments in the 

preamble to that document. 

VI. Collection of Information 

Requirements 

Under the Paperwork Reduction Act 

(PRA) of 1995, we are required to 

provide 60-day notice in the Federal 

Register and solicit public comment 

before a collection of information 

requirement is submitted to the Office of 

Management and Budget (OMB) for 

review and approval. In order to fairly 

evaluate whether an information 

collection should be approved by OMB, 

section 3506(c)(2)(A) of the PRA of 1995 

requires that we solicit comment on the 

following issues: 

The need for the information 

collection and its usefulness in carrying 

out the proper functions of our agency. 

• The accuracy of our estimate of the 

information collection burden. 

• The quality, utility, and clarity of 

the information to be collected. 

• Recommendations to minimize the 

information collection burden on the 

affected public, including automated 

collection techniques. 

Therefore, we are soliciting public 

comments on each of these issues for 

the information collection requirement 

discussed below. 

The following information collection 

requirement and associated burden are 

subject to the PRA. 

§ 414.707 Basis of payment

Under paragraph (a)(7) of this section, 

a manufacturer requesting a drug 

payment exception to the default 85 

percent used in the general rule or the 

percentage specified in Table 1 will 

have to submit data and information 

including the manufacturer’s average 

sales price for the drug. The burden 

associated with this requirement is the 

time involved in providing us the 

information for the submission due 

before January 1, 2004, and the optional 

supplemental submission due by 

January 16, 2004. We believe that it 

would take an average of one hour to 

submit the request and the necessary 

data and information. Given the 

universe of approximately 450 Medicare 

drug codes and assuming an average of 

10 manufacturers per drug code, the 

maximum aggregate burden associated 

with this activity would be 4500 hours. 

We are soliciting public comment on 

this requirement in conjunction with a 

request for emergency approval of this 

information collection so that 

manufacturers may submit their 

requests during the statutorily 

prescribed timeframe. These 

requirements were submitted to OMB 

for review and are approved by OMB 

under OMB control number 0938–0913. 

If you comment on any of these 

information collection and record 

keeping requirements, please mail 

copies directly to the following: Centers 

for Medicare & Medicaid Services, 

Office of Strategic Operations and 

Regulatory Affairs, Regulations 

Development and Issuances Group, 

Attn: Julie Brown, CMS–1372–FC, Room 

C5–16–03, 7500 Security Boulevard, 

Baltimore, MD 21244–1850; and Office 

of Information and Regulatory Affairs, 

Office of Management and Budget, 

Room 10235, New Executive Office 

Building, Washington, DC 20503, Attn: 

Brenda Aguilar, CMS Desk Officer. 

Comments submitted to OMB may 

also be emailed to the following 

address: email: baguilar@omb.eop.gov;

or faxed to OMB at (202) 395–6974. 

VII. Regulatory Impact Analysis 

We have examined the impact of this 

rule as required by Executive Order 

12866 (September 1993, Regulatory 

Planning and Review), the Regulatory 

Flexibility Act (RFA) (September 16, 

1980, Pub. L. 96–354), section 1102(b) of 

the Social Security Act, the Unfunded 

Mandates Reform Act of 1995 (Pub. L. 

104–4), and Executive Order 13132. 

Executive Order 12866 directs agencies 

to assess all costs and benefits of 

available regulatory alternatives and, 

when regulation is necessary, to select 

regulatory approaches that maximize 

net benefits (including potential 

economic, environmental, public health 

and safety effects, distributive impacts, 

and equity). A regulatory impact 

analysis must be prepared for final rules 

with economically significant effects 

(that is, a final rule that would have an 

annual effect on the economy of $100 

million or more in any 1 year, or would 

adversely affect in a material way the 

economy, a sector of the economy, 

productivity, competition, jobs, the 

environment, public health or safety, or 

State, local, or tribal governments or 

communities). We estimate that the 

combined effect of the physician fee 

schedule update and GPCI provisions 

included in this final rule will increase 

Medicare spending by $1.0 billion in FY 

2004. We have simulated the effect of 

both the drug payment and physician 

fee schedule changes that we are 

adopting in this final rule. We are 

making several changes to the physician 

fee schedule RVUs in this final rule. In 

general, section 1848(c)(2)(B)(ii)(II) of 

the Act requires that changes to RVUs 

cannot increase or decrease 

expenditures more than $20 million 

from the amount of expenditures that 

would have resulted with such 

adjustments. However, section 303(a)(1) 

of the MPDIMA specifically exempts the 

changes we are making to the RVUs in 

this final rule from the budget neutrality 

requirements of section 

1848(c)(2)(B)(ii)(II) of the Act. Thus, the 

changes that we are making to the 

physician fee schedule RVUs will 

increase aggregate spending for 

Medicare physician fee schedule 

services. Because the changes in this 

final rule will increase Medicare 

spending by more than $1.0 billion in 

FY 2004, we are considering this final 

rule to be economically significant. 

Therefore, this final rule is a major rule 

and we have prepared a regulatory 

impact analysis. The table 6 below 

shows our estimates of the fiscal year 

2004 impact of specific MPDIMA 

provisions we are implementing in this 

final rule (rounded to the nearest $0.1 

billion).

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TABLE 6 

Section Description 

FY 2004

impact

($ in billions) 

303 ............................................................ Competitive Acquisition of Covered Outpatient Drugs ................................................ $0.0 

304 ............................................................ Application to Certain Specialties ................................................................................ ¥0.1 

305 ............................................................ Payment for Inhalation Drugs ...................................................................................... ¥0.1 

412 ............................................................ Work GPCI Floor for Physicians .................................................................................. 0.2 

601 ............................................................ Update Revisions ......................................................................................................... 0.8 

602 ............................................................ Services in Alaska ........................................................................................................ 0.0 

The RFA requires that we analyze 

regulatory options for small businesses 

and other entities. We prepare a 

Regulatory Flexibility Analysis unless 

we certify that a rule would not have a 

significant economic impact on a 

substantial number of small entities. 

The analysis must include a justification 

concerning the reason action is being 

taken, the kinds and number of small 

entities the rule affects, and an 

explanation of any meaningful options 

that achieve the objectives and less 

significant adverse economic impact on 

the small entities. 

Section 1102(b) of the Act requires us 

to prepare a regulatory impact analysis 

for any proposed rule that may have a 

significant impact on the operations of 

a substantial number of small rural 

hospitals. This analysis must conform to 

the provisions of section 603 of the 

RFA. For purposes of section 1102(b) of 

the Act, we define a small rural hospital 

as a hospital that is located outside a 

Metropolitan Statistical Area and has 

fewer than 100 beds. 

For purposes of the RFA, physicians, 

non-physician practitioners, and 

suppliers are considered small 

businesses if they generate revenues of 

$6 million or less. Approximately 95 

percent of physicians (except mental 

health specialists) are considered to be 

small entities. There are about 875,000 

physicians, other practitioners and 

medical suppliers that receive Medicare 

payment under the physician fee 

schedule. There are in excess of 20,000 

physicians and other practitioners that 

receive Medicare payment for drugs. 

These physicians are concentrated in 

the specialties of oncology, urology and 

rheumatology. Of the physicians in 

these specialties, approximately 40 

percent are in oncology and 45 percent 

in urology. 

For purposes of the RFA, 

approximately 98 percent of suppliers of 

DME and prosthetic devices are 

considered small businesses according 

to the Small Business Administration’s 

(SBA) size standards. We estimate that 

106,000 entities bill Medicare for DME, 

prosthetics, orthotics, surgical dressings, 

and other equipment and supplies each 

year. Total Medicare expenditures for 

DME are approximately $7.7 billion per 

year, of which approximately $1.4 

billion are for DME drugs. 

The analysis and discussion provided 

in this section as well as elsewhere in 

this final rule complies with the RFA 

requirements. Section 202 of the 

Unfunded Mandates Reform Act of 1995 

also requires that agencies assess 

anticipated costs and benefits before 

issuing any rule that may result in 

expenditure in any 1 year by State, 

local, or tribal governments, in the 

aggregate, or by the private sector, of 

$110 million. This final rule would not 

impose unfunded mandates on State, 

local, or tribal governments, or on the 

private sector of more than $110 

million. 

We have examined this final rule in 

accordance with Executive Order 13132 

and have determined that this 

regulation would not have any 

significant impact on the rights, roles, or 

responsibilities of State, local, or tribal 

governments. 

We have prepared the following 

analysis, which together with the rest of 

this preamble meets all assessment 

requirements. It explains the rationale 

for, and purposes of, the rule, details the 

costs and benefits of the rule, analyzes 

alternatives, and presents the measures 

we propose to use to minimize the 

burden on small entities. This final rule 

changes Medicare payment rates for 

drugs and their administration as well 

as other physician fee schedule services. 

We are providing information for each 

of the policy changes in the relevant 

sections of this final rule. We are 

unaware of any relevant Federal rules 

that duplicate, overlap or conflict with 

this final rule. The relevant sections of 

this final rule contain a description of 

significant alternatives if applicable.

A. Application of Market-Based Systems 

of Medicare Payment for Part B Drugs 

As described in more detail earlier in 

this final rule, effective January 1, 2004, 

with some exceptions, section 303(b) of 

MPDIMA specifies that drugs not paid 

on a cost or prospective payment basis 

will be paid at 85 percent of the average 

wholesale price determined as of April 

1, 2003. Section 303(a) directs the 

Secretary to make changes to the 

physician fee schedule that will 

increase Medicare spending for 

physicians’ services. Section 303 

applies only to oncology payments 

while section 304 indicates that 

identical provisions to those in section 

303 apply to other physicians. We have 

estimated that section 303 of MPDIMA 

would have no cost in FY 2004 and that 

section 304 would save $0.1 billion in 

FY 2004. 

B. Payment for Inhalation Drugs 

Section 305(a) of MPDIMA specifies 

that inhalation drugs furnished through 

durable medical equipment covered 

under 1861(n) of the Act will be paid at 

80 percent of the average wholesale 

price determined as of April 1, 2003. We 

estimated savings associated with 

implementing section 305(a) of the 

MPDIMA is $0.1 billion in FY 2004. 

C. Pharmacy Supplying Fee for Certain 

Drugs and Biologicals 

Section 303(e)(2) provides for 

payment of a pharmacy supplying fee, 

less applicable deductible and 

coinsurance, for immunosuppressive 

drugs described in subparagraph (J) of 

section 1861(s)(2) and oral anti-cancer 

and anti-nausea drugs described in 

subparagraphs (Q) and (T) of such 

section. The payment of this fee is 

bundled into the current payment for 

these drugs and the 2004 payment 

amounts specified in section 303(b). 

This provision has no impact on 

Medicare expenditures in 2004. 

D. Physician Fee Schedule Provisions 

Related to the Administration of Drugs 

As indicated above, we are making 

changes to the work and practice 

expense RVUs under the provisions of 

section 1848(c)(2) of the Act as amended 

by section 303 of MPDIMA. In general, 

under section 1848(c)(2) of the Act, 

adjustments to RVUs may not cause the 

amount of expenditures to differ by 

more than $20 million from the amount 

of expenditures that would have 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1099

resulted without such adjustments. 

However, section 303(a)(1) of the 

MPDIMA specifically exempts the 

changes we are making to the RVUs in 

this final rule from the budget neutrality 

requirements of section 

1848(c)(2)(B)(ii)(II). As described above, 

consistent with section 303(a)(1), we are 

making several changes to the physician 

fee schedule work and practice expense 

RVUs. 

Table 6A shows the specialty level 

impact on payment of changes being 

made for CY 2004. The payment 

impacts reflect averages for each 

specialty based on Medicare utilization. 

The payment impact for an individual 

physician would be different from the 

average, based on the mix of services the 

physician provides. The average change 

in total revenues would be less than the 

impact displayed here since physicians 

furnish services to both Medicare and 

non-Medicare patients and specialties 

may receive substantial Medicare 

revenues for services that are not paid 

under the physician fee schedule. For 

instance, oncologists receive 

approximately 20 percent of their 

Medicare revenues from physician fee 

schedule services and approximately 77 

percent of their Medicare revenues from 

drugs. Table 6A shows only the 

payment impact on physician fee 

schedule services. Table 11 below 

shows the combined impact of the 

physician fee schedule and drug 

payment changes for selected specialties 

and suppliers that receive a high 

percentage of their Medicare revenues 

from drugs. 

We modeled the impact of all changes 

to the relative value units and 

illustrated their effect in table 6A. The 

column labeled ‘‘Impact 11/7/2003 

Final Rule Pre-MEI Weight 

Adjustments’’ shows the combined 

effect of all of the relative value unit 

changes contained in the August 15, 

2003, proposed rule and the November 

7, 2003, final rule other than the 

adjustments to make the aggregate work, 

practice expense and malpractice RVUs 

match the MEI weights. (For a 

description of the impact of the 

provisions of the August 15, 2003, 

proposed rule see 68 FR 49060–49065. 

For a description of the impact of 

additional impacts resulting from the 

November 7, 2003, final rule, see 68 FR 

63252–63253). As described below, we 

have revised the MEI weight 

adjustments and will illustrate their 

impact once we show the effect of all 

other provisions that change RVUs. 

The column labeled ‘‘Section 303 and 

304 Changes without Transition 

Payments’’ shows the impact of changes 

made in this final rule implementing 

section 303 and 304 of MPDIMA other 

than section 303(a)(4) that requires a 

‘‘transitional adjustment’’ that increases 

payments for specific drug 

administration services by an additional 

32 percent in 2004. This column shows 

the effect of increases in payments for 

drug administration services resulting 

from the higher work and practice 

expense RVUs required by section 303 

and 304 of MPDIMA as well allowing 

oncologists to bill for multiple drug 

administrations by the ‘‘push’’

technique on a single day. In addition, 

because there will be no same day 

billing of a level 1 office visit and a drug 

administration service, the impacts 

shown include the effect of fewer office 

visit billings by the minority of 

oncologists who billed for such services. 

Taken together, these provisions will 

increase payments to oncologists by an 

estimated 27 percent. We estimate that 

payments to other physicians that 

provide drug administration services 

(rheumatology, infectious disease, 

obstetrics/gynecology) will increase by 1 

to 2 percent. The revision to the practice 

expense per hour for cardiac and 

thoracic surgeons will increase their 

payments by an estimated 1 percent. All 

of the other increases shown in the table 

are a result of changes that we are 

making to the non-physician work pool. 

These changes will increase payments 

to physicians, practitioners and 

suppliers (Allergy/Immunology, 

Radiation Oncology, Radiology, 

Audiology, Diagnostic Testing Facility 

and Portable X-Ray suppliers) that 

provide services affected by the nonphysician work pool calculations by 

approximately 1 percent. There will be 

little or no change in payments for all 

other specialties from the changes we 

are making in this interim final rule 

because the changes to the RVUs 

resulting from MPDIMA are exempt 

from the budget neutrality requirements 

of section 1848(c)(2)(ii)(II) of the Act. 

The column labeled ‘‘Transition 

Payments’’ shows the impact on 

payment from the 32 percent increase in 

payment for drug administration 

services required by section 303(a)(4) of 

MPDIMA. This provision will have an 

effect on only those specialties that 

provide drug administration services 

and is estimated to increase payments to 

oncologists by an additional 14 percent. 

We estimate that payments to other 

physicians that provide drug 

administration services (infectious 

disease, obstetrics/gynecology 

rheumatology and urology) will increase 

by 1 to 2 percent. 

We also modeled the effect of 

adjusting the RVUs to match the new 

MEI weights. Because we are increasing 

the malpractice RVUs by more than 20 

percent, adjusting the RVUs to match 

the new MEI weights will result in an 

increase in payment for those specialties 

that perform services with high 

malpractice RVUs. Payments to 

anesthesiology, cardiac surgery, 

emergency medicine, neurosurgery, 

orthopedic surgery, thoracic surgery and 

vascular surgery will increase by 

approximately 1 percent. There will be 

a small impact on payment to all other 

physicians, practitioners and suppliers 

from the adjustments that reduce 

physician work and practice expense 

RVUs to match the new MEI weights. 

The total change in payment from 

provisions of the November 7, 2003, 

final rule and this final rule are shown 

in the total column.

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In general, the statutory methodology 

for updating the physician fee schedule 

conversion factor is specified in section 

1848(d)(4) of the Act. However, section 

1848(d)(5) specifies that the update to 

the conversion factor for 2004 and 2005 

shall not be less than 1.5 percent. 

Application of the statutory 

methodology of section 1848(d)(4) of the 

Act would reduce the physician fee 

schedule conversion factor by 4.5 

percent. However, because section 

1848(d)(5) of the Act indicates that the 

update can be no less than 1.5 percent, 

we are increasing the 2004 physician fee 

schedule conversion factor by 1.5 

percent. In table 7, we are showing the 

estimated change in average payments 

by specialty based on provisions of this 

final rule and the estimated physician 

fee schedule update.


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In the November 7, 2003, final rule, 

we showed the impact of all RVUs 

changes and a 4.5 percent reduction in 

the physician fee schedule conversion 

factor. In the table below, we are 

showing the effect of MPDIMA on 

payment for physician fee schedule 

services relative to the changes that 

would have occurred in 2004 under 

current law had MPDIMA not been 

enacted. That is, because the physician 

fee schedule conversion factor would 

have been reduced by 4.5 percent to 

$35.1339 and MPDIMA requires that it 

be increased by 1.5 percent to $37.3374, 

MPDIMA provisions affecting the 

update increased average physician fee 

schedule rates by 6.3 percent ($37.3374/

$35.339 ¥ 1 = 1.063 or 6.3 percent). 

Furthermore, MPDIMA required 

changes to relative value units that also 

resulted in further average increases in 

Medicare payment for physician fee 

schedule services. The following table 

also includes the impact of the GPCI 

provision that does not allow a work 

GPCI to be less than 1.0 and another one 

that increases the Alaska GPCI to 1.67. 

However, the impact on any specific 

physician, practitioner or supplier will 

be different than the average depending 

upon on whether the individual is 

located in Alaska or an area that would 

have had a GPCI that is less than 1.0. 

The column labeled ‘‘Impact 11/7/

2003’’ final rule shows the impacts from 

table 27 of the November 7, 2003, final 

rule (68 FR 63256). The next column 

shows the impacts from table 7 and an 

estimate of the increase in payments 

due to the GPCI provisions. The 

percentage difference between these 

columns isolates the impact of the 

MPDIMA provisions we are adopting in 

this final rule and are shown in the last 

column.


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Table 9 shows the impact on 

payments for selected high volume 

procedures of all of the changes 

previously discussed. This table shows 

the combined impact of the change in 

the work, practice expense and 

malpractice RVUs and the estimated 

physician fee schedule update on total 

payment for the procedure. There are 

separate columns that show the change 

in the facility rates and the non-facility 

rates. For an explanation of facility and 

non-facility practice expense refer to 

§ 414.22(b)(5)(i). The figures in tables 9 

and 10 show the impact of the RVU 

changes and the physician fee schedule 

update but do not include the impact of 

the GPCI changes.


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The next table shows the change in 

payments from 2003 to 2004 for selected 

high volume drug administration 

services. This table shows the impact of 

the increases in the physician work and 

practice expense RVUs, the 1.5 percent 

increase in the physician fee schedule 

conversion factor and the additional 32 

percent ‘‘transition adjustment’’

required by section 303(a)(4) of 

MPDIMA in 2004.

Table 11 shows the combined impact 

of changes we are making to Medicare 

drug and physician fee schedule 

payments on selected specialties/

medical suppliers that receive a 

significant portion of their total 

Medicare revenues from drugs. These 

figures do not include the impact of the 

legislated increases in the GPCI. The 

table shows the amount and proportion 

of total Medicare revenues received 

from drugs and physician fee schedule 

services (DME fee schedule services for 

DME/Other Medical Suppliers). We note 

that these impacts and percentages 

represent averages for each specialty or 

supplier. The percentages and impacts 

for any individual physician or DME 

supplier are dependent on the mix of 

drugs and physician fee schedule 

services they provide to Medicare 

beneficiaries. These tables are intended 

to illustrate the combined payment 

impact in a single year across all of the 

services that these specialties or 

suppliers perform using the most recent 

data available to us. The first two 

columns of table 11 list the specialty 

and its combined Medicare revenues 

from all sources. The next three 

columns show estimated total Medicare 

drug revenues, the proportion of total 

revenues represented by drugs and the 

percent change in Medicare drug 

payments estimated in the first year. 

The revenue reduction shown includes 

the effect of limiting decreases in drug 

payments to 15 percent, the maximum 

reduction allowed in 2004 consistent 

with section 1842(o)(4)(D) of the Act (as 

added by section 303(b) of MPDIMA). 

The following three columns show 

analogous information for physician fee 

schedule services. The last column 

shows the combined percentage change 

across all Medicare revenues. For 

example, as indicated in the table, 

approximately 77 percent of total 

Medicare revenues for oncologists are 

attributed to drugs. As indicated in the 

next column, we estimate that Medicare 

revenues from drugs will decline by 

approximately 12 percent for 

oncologists as a result of policies 

adopted in this interim final rule or 

about $510 million. We are increasing 

oncology physician fee schedule 

payments by 47 percent in this interim 

final rule or about $510 million. We 

estimated that the one-year decrease in 

drug payments and increase in 

physician fee schedule payments 

resulting from this final rule will 

produce virtually no net change in total 

Medicare payments for oncologists. 

For DME/Other Medical Suppliers, 42 

and 58 percent of Medicare revenues 

respectively are received from drugs and 

DME fee schedule services. These 

suppliers will receive an approximate 

reduction of 13 percent in their 

Medicare drug revenues the first year. 

The total reduction in payment in one 

year across all of the services they 

provide will be approximately 6 

percent. 

In general, the other physician 

specialties receive a smaller share of 

their total Medicare revenues from 

drugs than oncologists. However, they 

are also less affected by the payment 

increases for drug administration 

services. Taken together, we estimate a 

net change in revenues from the drug 

and drug administration payment 

changes for urology (¥4 percent), 

rheumatology (¥2 percent), obstetrics/

gynecology (+1 percent) and infectious 

disease (+4 percent).


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C. Geographic Practice Cost Indices 

(GPCIs) Changes 

Section 412 of MPDIMA amended 

section 1848(e)(1) of the Act and 

establishes a floor of 1.0 for the work 

geographic index for any locality to be 

used for purposes of payment for 

services furnished on or after January 1, 

2004, and before January 1, 2007. In 

addition, section 602 of MPDIMA 

further amended 1848 (e)(1) of the Act 

for purposes of payment for services 

furnished in Alaska under the physician 

fee schedule on or after January 1, 2004, 

and before January 1, 2006, and sets the 

practice expense, malpractice and work 

indices at 1.67 if such index would 

otherwise be less than 1.67. The impact 

of the MPDIMA provisions on the work 

GPCI is illustrated in Table 12. 

An impact of these legislative changes 

to the GPCI can also be demonstrated by 

a comparison of area geographic 

adjustment factors (GAFs). The GAFs 

are a weighted composite of each area’s 

work, practice expense, and malpractice 

expense GPCIs using the national GPCI 

cost share weights. While we do not 

actually use the GAFs in computing the 

fee schedule payment for a specific 

service, they are useful in comparing 

overall area costs and payments. The 

actual effect on payment for any specific 

service will deviate from the GAF to the 

extent that the service’s proportions of 

work, practice expenses, and 

malpractice expense RVUs differ from 

those of the GAF. Table 13 shows the 

effects of the legislative revisions to the 

GPCIs on area GAFs for 2004. As 

directed by the legislation no locality 

will have a work GPCI of less than 1.00 

and the work, practice expense and 

malpractice GPCIs for Alaska are set at 

1.67. Tables 12 and 13 are sorted by 

decreasing percent change in work GPCI 

and GAF respectively.

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1111


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Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1115

BILLING CODE 4120–01–C

We estimate the cost of the provisions 

affecting the GPCI will increase 

Medicare spending by 0.2 billion in FY 

2004. 

E. Alternatives Considered 

For the most part, this interim final 

implements prescriptive provisions of 

MPDIMA and the statute does not 

permit us to exercise our discretion. 

Nevertheless, the preamble identifies 

ancillary policies and rationale for our 

decisions. 

For instance, the statutory provisions 

requiring changes to Medicare’s 

payments for drugs were prescriptive. 

We did not consider any alternatives 

because of the clear direction in the 

statute to determine Medicare prices for 

drugs in 2004. Similarly, the provisions 

of the statute with respect to the GPCI 

were also prescriptive and did not allow 

for us to consider any alternatives. 

While we considered using the formula 

contained in section 1848(d)(4) of the 

Act to update the physician fee 

schedule conversion factor, its 

application would result in a reduction 

of 4.5 percent and would be 

inconsistent with the MPDIMA 

provision requiring an update to the 

physician fee schedule conversion 

factor for 2004 of not less than 1.5 

percent. With respect to the provisions 

of this final rule that require changes to 

Medicare payments for the 

administration of drugs, we generally 

did not find that the statute permitted 

discretion. Nevertheless, earlier in the 

preamble of this final rule, we provided 

detailed descriptions of the statutory 

provisions and its requirements and, 

where possible, of the alternatives we 

considered. 

F. Impact on Beneficiaries 

Although changes in physicians’

payments were large when the 

physician fee schedule was 

implemented in 1992, we detected no 

problems with beneficiary access to 

care. We do not believe that there would 

be any problem with access to care as 

a result of the changes in this rule. For 

the most part, we are increasing 

payments for physicians fee schedule 

services that otherwise would be 

reduced. We don’t believe the drug 

payment changes will have an impact 

on beneficiary access to services but we 

will continue to monitor this issue. 

We estimate that beneficiary liability 

will increase in CY 2004 by $1.0 billion 

for the physician fee schedule 

provisions relative to current law. 

Payment changes we are making in this 

final rule for drug administration will 

increase beneficiary liability. However, 

we estimate that the provisions that 

change Medicare’s drug payments to 

oncologists (section 303 of MPDIMA), 

other physicians (section 304 of 

MPDIMA) and inhalation drugs (section 

305 of MPDIMA) will offset the 

additional beneficiary liability for drug 

administration. We estimate that the net 

effect of changes to payment for drugs 

and drug administration will result in 

savings to beneficiaries of 

approximately $100 million in CY 2004. 

In accordance with the provisions of 

Executive Order 12866, this regulation 

was reviewed by the Office of 

Management and Budget.

List of Subjects 

42 CFR Part 405 

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medical 

devices, Medicare, Reporting and 

recordkeeping requirements, Rural 

areas, X-rays. 

42 CFR Part 414 

Administrative practice and 

procedure, Health facilities, Health 

professions, Kidney diseases, Medicare, 

Reporting and recordkeeping 

requirements, Rural areas, X-rays.

(Catalog of Federal Domestic Assistance 

Program No. 93.774, Medicare—

Supplementary Medical Insurance Program.)


ER06JA04.019</GPH>
1116 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

Dated: December 15, 2003. 

Thomas A Scully, 

Administrator, Centers for Medicare & 

Medicaid Services. 

Approved: December 24, 2003. 

Tommy G. Thompson, 

Secretary.

For the reasons set forth in the 

preamble, the Centers for Medicare & 

Medicaid Services amends 42 CFR 

chapter IV as follows:

PART 405—FEDERAL HEALTH 

INSURANCE FOR THE AGED AND 

DISABLED

■ 1. The authority citation for part 405 

continues to read as follows:

Authority: Secs. 1102, 1802, and 1871 of 

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

1395a, and 1395hh).

■ 2. Section 405.400 is amended by 

revising the definition of ‘‘physician’’ to 

read as follows:

§ 405.400 Definitions.

* * * * *

Physician means a doctor of 

medicine; doctor of osteopathy; doctor 

of dental surgery or of dental medicine; 

doctor of podiatric medicine; or doctor 

of optometry who is legally authorized 

to practice medicine, osteopathy, dental 

surgery, dental medicine, podiatric 

medicine, or optometry by the State in 

which he performs such function and 

who is acting within the scope of his 

license when he performs such 

functions.

* * * * *

■ 3. Section 405.517 is amended by—

■ A. Redesignating the text of paragraph 

(a) as paragraph (a)(1) and adding a 

heading;

■ B. Adding a new paragraph (a)(2).

§ 405.517 Payment for drugs and 

biologicals that are not paid on a cost or 

prospective payment basis. 

(a) Applicability. (1) Payment for 

drugs and biologicals before January 1, 

2004. * * * 

(2) Payment for drugs and biologicals 

on or after January 1, 2004. Effective 

January 1, 2004, payment for drugs and 

biologicals that are not paid on a cost or 

prospective payment basis are paid in 

accordance with Part 414, subpart I of 

this chapter.

* * * * *

PART 414—PAYMENT FOR PART B 

MEDICAL AND OTHER HEALTH 

SERVICES

■ 4. The authority citation for part 414 

continues to read as follows:

Authority: Secs. 1102, 1871, and 1881(b)(1) 

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

1395hh, and 1395rr(b)(1)).

■ 5. The list in § 414.1 is amended by 

adding a new entry in numerical order as 

follows:

§ 414.1 Basis and scope.

* * * * *

1842(o)—Rules for payment of certain 

drugs and biologicals.

* * * * *

■ 6. A new subpart I is added to read as 

follows:

Subpart I—Payment for Drugs and 

Biologicals 

Sec. 

414.701 Purpose. 

414.704 Definitions. 

414.707 Basis of payment.

§ 414.701 Purpose. 

This subpart implements section 

1842(o) of the Social Security Act by 

specifying the methodology for 

determining the payment allowance 

limit for drugs and biologicals covered 

under Part B of Title XVIII of the Act 

(hereafter in this subpart referred to as 

the ‘‘program’’) that are not paid on a 

cost or prospective payment system 

basis. Examples of drugs that are subject 

to the rules contained in this subpart 

are: drugs furnished incident to a 

physician’s service; durable medical 

equipment (DME) drugs; separately 

billable drugs at independent dialysis 

facilities not under the ESRD composite 

rate; statutorily covered drugs, for 

example, influenza, pneumococcal and 

hepatitis vaccines, antigens, hemophilia 

blood clotting factor, 

immunosuppressive drugs and certain 

oral anti-cancer drugs.

§ 414.704 Definitions. 

As used in this subpart, the following 

definition applies. Drug refers to both 

drugs and biologicals.

§ 414.707 Basis of payment.

(a) Method of payment. (1) Payment 

for a drug in calendar year 2004 is based 

on the lesser of—

(i) The actual charge on the claim for 

program benefits; or 

(ii) 85 percent of the average 

wholesale price determined as of April 

1, 2003, subject to the exceptions as 

specified in paragraphs (a)(2) through 

(a)(8) of this section. 

(2) The payment limits for the 

following drugs are calculated using 95 

percent of the average wholesale price: 

(i) Blood clotting factors. 

(ii) A drug or biological furnished 

during 2004 that was not available for 

Medicare payment as of April 1, 2003. 

(iii) Pneumococcal and influenza 

vaccines as well as hepatitis B vaccine 

that is furnished to individuals at high 

or intermediate risk of contracting 

hepatitis B (as determined by the 

Secretary). 

(iv) A drug or biological furnished 

during 2004 in connection with the 

furnishing of renal dialysis services if 

separately billed by renal dialysis 

facilities. 

(3) The payment limits for infusion 

drugs furnished through a covered item 

of durable medical equipment are 

calculated using 95 percent of the 

average wholesale price in effect on 

October 1, 2003. 

(4) The payments limits for drugs 

contained in the following table are 

calculated based on the percentages of 

the average wholesale price determined 

as of April 1, 2003 that are specified in 

the table.

Drug 

Percentage 

used to calculate 2004 

payment 

limit 

EPOETIN ALFA .................................. 87

LEUPROLIDE ACETATE .................... 81

GOSERELIN ACETATE ...................... 80

RITUXIMAB ......................................... 81

PACLITAXEL ....................................... 81

DOCETAXEL ....................................... 80

CARBOPLATIN ................................... 81

IRINOTECAN ...................................... 80

GEMCITABINE HCL ........................... 80

PAMIDRONATE DISODIUM ............... 85

DOLASETRON MESYLATE ............... 80

FILGRASTIM ....................................... 81

HYLAN G–F 20 ................................... 82

MYCOPHENOLATE MOFETIL ........... 86

GRANISETRON HCL .......................... 80

ONDANSETRON ................................ 87

VINORELBINE TARTATE ................... 81

SARGRAMOSTIM ............................... 80

TOPOTECAN ...................................... 84

IPRATROPIUM BROMIDE ................. 80

ALBUTEROL SULFATE ...................... 80

IMMUNE GLOBULIN .......................... 80

LEUCOVORIN CALCIUM ................... 80

DOXORUBICIN HCL ........................... 80

DEXAMETHOSONE SODIUM PHOSPHATE ............................................. 86

HEPARIN SODIUM LOCK-FLUSH ..... 80

CROMOLYN SODIUM ........................ 80

ACETYLCYSTEINE ............................ 80

(5) The payment limits for 

imiglucerase and alglucerase are 

calculated using 94 percent of the 

average wholesale price determined as 

of April 1, 2003. 

(6) Exception. The payment limit for 

a drug otherwise subject to paragraph 

(a)(1)(ii) or paragraph (a)(4) of this 

section may be calculated using the 

percentage of the average wholesale 

price as the Secretary deems appropriate 

based on data and information 

submitted by the drug manufacturer. 

(i) The manufacturer must submit 

data after October 15, 2003 and before 

January 1, 2004. 

(ii) The percentage only applies for 

drugs furnished on or after April 1, 

2004.

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 1117

(7) In the case of blood and blood 

products (other than blood clotting 

factors), the payment limits shall be 

determined in the same manner as such 

payment limit was determined on 

October 1, 2003. 

(b) Mandatory assignment. Effective 

with services furnished on or after 

February 1, 2001, payment for any drug 

covered under Part B of Medicare may 

be made on an assignment-related basis 

only. All billers must accept the 

program allowed charge as payment in 

full and may not bill nor collect from 

the beneficiary any amount other than 

the unmet Part B deductible and Part B 

coinsurance amounts, if applicable. 

Violations of this requirement may 

subject the supplier to sanctions, as 

provided by the statute (See § 402 of this 

chapter).

Note: These addenda will not appear in the 

Code of Federal Regulations.

Addendum A—Explanation and Use of 

Addenda B 

The addenda on the following pages 

provide various data pertaining to the 

Medicare fee schedule for physicians’

services furnished in 2004. Addendum B 

contains the RVUs for work, non-facility 

practice expense, facility practice expense, 

and malpractice expense, and other 

information for all services included in the 

physician fee schedule. 

In previous years, we have listed many 

services in Addendum B that are not paid 

under the physician fee schedule. To avoid 

publishing as many pages of codes for these 

services, we are not including clinical 

laboratory codes and most alpha-numeric 

codes (Healthcare Common Procedure 

Coding System (HCPCS) codes not included 

in CPT) in Addendum B. 

Addendum B—2004 Relative Value Units 

and Related Information Used in 

Determining Medicare Payments for 2004 

This addendum contains the following 

information for each CPT code and 

alphanumeric HCPCS code, except for 

alphanumeric codes beginning with B 

(enteral and parenteral therapy), E (durable 

medical equipment), K (temporary codes for 

nonphysicians’ services or items), or L 

(orthotics), and codes for anesthesiology. 

1. CPT/HCPCS code. This is the CPT or 

alphanumeric HCPCS number for the service. 

Alphanumeric HCPCS codes are included at 

the end of this addendum.

2. Modifier. A modifier is shown if there 

is a technical component (modifier TC) and 

a professional component (PC) (modifier 

¥26) for the service. If there is a PC and a 

TC for the service, Addendum B contains 

three entries for the code: One for the global 

values (both professional and technical); one 

for modifier ¥26 (PC); and one for modifier 

TC. The global service is not designated by 

a modifier, and physicians must bill using 

the code without a modifier if the physician 

furnishes both the PC and the TC of the 

service. 

Modifier ¥53 is shown for a discontinued 

procedure. There will be RVUs for the code 

(CPT code 45378) with this modifier. 

3. Status indicator. This indicator shows 

whether the CPT/HCPCS code is in the 

physician fee schedule and whether it is 

separately payable if the service is covered. 

A = Active code. These codes are 

separately payable under the fee schedule if 

covered. There will be RVUs for codes with 

this status. The presence of an ‘‘A’’ indicator 

does not mean that Medicare has made a 

national decision regarding the coverage of 

the service. Carriers remain responsible for 

coverage decisions in the absence of a 

national Medicare policy. 

B = Bundled code. Payment for covered 

services is always bundled into payment for 

other services not specified. If RVUs are 

shown, they are not used for Medicare 

payment. If these services are covered, 

payment for them is subsumed by the 

payment for the services to which they are 

incident. (An example is a telephone call 

from a hospital nurse regarding care of a 

patient.) 

C = Carrier-priced code. Carriers will 

establish RVUs and payment amounts for 

these services, generally on a case-by-case 

basis following review of documentation, 

such as an operative report. 

D = Deleted code. These codes are deleted 

effective with the beginning of the calendar 

year. 

E = Excluded from physician fee schedule 

by regulation. These codes are for items or 

services that we chose to exclude from the 

physician fee schedule payment by 

regulation. No RVUs are shown, and no 

payment may be made under the physician 

fee schedule for these codes. Payment for 

them, if they are covered, continues under 

reasonable charge or other payment 

procedures. 

F = Deleted/discontinued codes. Code not 

subject to a 90-day grace period. 

G = Code not valid for Medicare purposes. 

Medicare does not recognize codes assigned 

this status. Medicare uses another code for 

reporting of, and payment for, these services. 

H = Deleted modifier. Either the TC or PC 

component shown for the code has been 

deleted, and the deleted component is shown 

in the data base with the H status indicator. 

(Code subject to a 90-day grace period.) 

I = Not valid for Medicare purposes. 

Medicare uses another code for the reporting 

of, and the payment for these services. (Code 

NOT subject to a 90-day grace period.) 

N = Noncovered service. These codes are 

noncovered services. Medicare payment may 

not be made for these codes. If RVUs are 

shown, they are not used for Medicare 

payment. 

P = Bundled or excluded code. There are 

no RVUs for these services. No separate 

payment should be made for them under the 

physician fee schedule. 

• If the item or service is covered as 

incident to a physician’s service and is 

furnished on the same day as a physician’s 

service, payment for it is bundled into the 

payment for the physician’s service to which 

it is incident (an example is an elastic 

bandage furnished by a physician incident to 

a physician’s service). 

• If the item or service is covered as other 

than incident to a physician’s service, it is 

excluded from the physician fee schedule 

(for example, colostomy supplies) and is paid 

under the other payment provisions of the 

Act. 

R = Restricted coverage. Special coverage 

instructions apply. If the service is covered 

and no RVUs are shown, it is carrier-priced. 

T = Injections. There are RVUs for these 

services, but they are only paid if there are 

no other services payable under the 

physician fee schedule billed on the same 

date by the same provider. If any other 

services payable under the physician fee 

schedule are billed on the same date by the 

same provider, these services are bundled 

into the service(s) for which payment is 

made. 

X = Exclusion by law. These codes 

represent an item or service that is not within 

the definition of ‘‘physicians’ services’’ for 

physician fee schedule payment purposes. 

No RVUs are shown for these codes, and no 

payment may be made under the physician 

fee schedule. (Examples are ambulance 

services and clinical diagnostic laboratory 

services.) 

4. Description of code. This is an 

abbreviated version of the narrative 

description of the code. 

5. Physician work RVUs. These are the 

RVUs for the physician work for this service 

in 2003. Codes that are not used for Medicare 

payment are identified with a ‘‘+.’’

6. Non-facility practice expense RVUs.

These are the fully implemented resourcebased practice expense RVUs for non-facility 

settings. 

7. Facility practice expense RVUs. These 

are the fully implemented resource-based 

practice expense RVUs for facility settings. 

8. Malpractice expense RVUs. These are 

the RVUs for the malpractice expense for the 

service for 2004. 

9. Non-facility total. This is the sum of the 

work, fully implemented non-facility practice 

expense, and malpractice expense RVUs. 

10. Facility total. This is the sum of the 

work, fully implemented facility practice 

expense, and malpractice expense RVUs. 

11. Global period. This indicator shows the 

number of days in the global period for the 

code (0, 10, or 90 days). An explanation of 

the alpha codes follows: 

MMM = The code describes a service 

furnished in uncomplicated maternity cases 

including antepartum care, delivery, and 

postpartum care. The usual global surgical 

concept does not apply. See the 1999 

Physicians’ Current Procedural Terminology 

for specific definitions. 

XXX = The global concept does not apply. 

YYY = The global period is to be set by the 

carrier (for example, unlisted surgery codes). 

ZZZ = Code related to another service that 

is always included in the global period of the 

other service. (Note: Physician work and 

practice expense are associated with intra 

service time and in some instances the post 

service time.)

1118

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

0001F ......... ............ I Blood pressure, measured .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0001T ......... ............ C Endovas repr abdo ao aneurys ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0002F ......... ............ I Tobacco use, smoking, assess ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0002T ......... ............ D endo repair abd aa aorto uni ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0003F ......... ............ I Tobacco use, non-smoking ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0003T ......... ............ C Cervicography .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0004F ......... ............ I Tobacco use txmnt counseling .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0005F ......... ............ I Tobacco use txmnt, pharmacol ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0005T ......... ............ C Perc cath stent/brain cv art ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0006F ......... ............ I Statin therapy, prescribed ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0006T ......... ............ C Perc cath stent/brain cv art ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0007F ......... ............ I Beta-blocker thx prescribed ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0007T ......... ............ C Perc cath stent/brain cv art ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0008F ......... ............ I Ace inhibitor thx prescribed ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0008T ......... ............ C Upper gi endoscopy w/suture ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0009F ......... ............ I Assess anginal symptom/level .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0009T ......... ............ C Endometrial cryoablation ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0010F ......... ............ I Assess anginal symptom/level .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0010T ......... ............ C Tb test, gamma interferon ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0011F ......... ............ I Oral antiplat thx prescribed ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0012T ......... ............ C Osteochondral knee autograft ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0013T ......... ............ C Osteochondral knee allograft ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0014T ......... ............ C Meniscal transplant, knee ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0016T ......... ............ C Thermotx choroid vasc lesion ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0017T ......... ............ C Photocoagulat macular drusen .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0018T ......... ............ C Transcranial magnetic stimul ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0019T ......... ............ I Extracorp shock wave tx, ms ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0020T ......... ............ C Extracorp shock wave tx, ft ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0021T ......... ............ C Fetal oximetry, trnsvag/cerv ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0023T ......... ............ C Phenotype drug test, hiv 1 .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0024T ......... ............ C Transcath cardiac reduction ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0025T ......... ............ D Ultrasonic pachymetry ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0026T ......... ............ C Measure remnant lipoproteins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0027T ......... ............ C Endoscopic epidural lysis ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0028T ......... ............ C Dexa body composition study ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0029T ......... ............ C Magnetic tx for incontinence ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0030T ......... ............ C Antiprothrombin antibody ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0031T ......... ............ C Speculoscopy ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0032T ......... ............ C Speculoscopy w/direct sample .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0033T ......... ............ C Endovasc taa repr incl subcl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0034T ......... ............ C Endovasc taa repr w/o subcl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0035T ......... ............ C Insert endovasc prosth, taa ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0036T ......... ............ C Endovasc prosth, taa, add-on ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0037T ......... ............ C Artery transpose/endovas taa ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0038T ......... ............ C Rad endovasc taa rpr w/cover .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0039T ......... ............ C Rad s/i, endovasc taa repair ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0040T ......... ............ C Rad s/i, endovasc taa prosth ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0041T ......... ............ C Detect ur infect agnt w/cpas ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0042T ......... ............ C Ct perfusion w/contrast, cbf ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0043T ......... ............ C Co expired gas analysis .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0044T ......... ............ C Whole body photography ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0045T ......... ............ C Whole body photography ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0046T ......... ............ C Cath lavage, mammary duct(s .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0047T ......... ............ C Cath lavage, mammary duct(s) ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0048T ......... ............ C Implant ventricular device ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0049T ......... ............ C External circulation assist ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0050T ......... ............ C Removal circulation assist ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0051T ......... ............ C Implant total heart system ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0052T ......... ............ C Replace component heart syst .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0053T ......... ............ C Replace component heart syst .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0054T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0055T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0056T ......... ............ C Bone surgery using computer ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0057T ......... ............ C Uppr gi scope w/ thrml txmnt ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0058T ......... ............ C Cryopreservation, ovary tiss ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0059T ......... ............ C Cryopreservation, oocyte ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0060T ......... ............ C Electrical impedance scan ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

0061T ......... ............ C Destruction of tumor, breast ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

10021 ......... ............ A Fna w/o image ............................................. 1.27 2.20 0.54 0.08 3.55 1.89 XXX 

10022 ......... ............ A Fna w/image ................................................ 1.27 2.61 0.42 0.06 3.94 1.75 XXX 

10040 ......... ............ A Acne surgery ................................................ 1.18 1.02 0.68 0.06 2.26 1.92 010 

10060 ......... ............ A Drainage of skin abscess ............................ 1.17 1.20 0.94 0.10 2.47 2.21 010 

10061 ......... ............ A Drainage of skin abscess ............................ 2.40 1.81 1.51 0.21 4.42 4.12 010 

10080 ......... ............ A Drainage of pilonidal cyst ............................ 1.17 3.13 1.14 0.11 4.41 2.42 010 

10081 ......... ............ A Drainage of pilonidal cyst ............................ 2.45 4.11 1.51 0.23 6.79 4.19 010 

1119

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

10120 ......... ............ A Remove foreign body .................................. 1.22 1.46 0.41 0.12 2.80 1.75 010 

10121 ......... ............ A Remove foreign body .................................. 2.69 3.33 1.88 0.30 6.32 4.87 010 

10140 ......... ............ A Drainage of hematoma/fluid ........................ 1.53 1.51 0.91 0.18 3.22 2.62 010 

10160 ......... ............ A Puncture drainage of lesion ......................... 1.20 0.73 0.46 0.13 2.06 1.79 010 

10180 ......... ............ A Complex drainage, wound ........................... 2.25 3.25 2.08 0.30 5.80 4.63 010 

11000 ......... ............ A Debride infected skin ................................... 0.60 0.57 0.22 0.06 1.23 0.88 000 

11001 ......... ............ A Debride infected skin add-on ....................... 0.30 0.23 0.11 0.02 0.55 0.43 ZZZ 

11010 ......... ............ A Debride skin, fx ............................................ 4.19 6.74 2.33 0.54 11.47 7.06 010 

11011 ......... ............ A Debride skin/muscle, fx ............................... 4.94 8.03 2.37 0.64 13.61 7.95 000 

11012 ......... ............ A Debride skin/muscle/bone, fx ...................... 6.87 12.01 3.86 1.07 19.95 11.80 000 

11040 ......... ............ A Debride skin, partial ..................................... 0.50 0.51 0.21 0.06 1.07 0.77 000 

11041 ......... ............ A Debride skin, full .......................................... 0.82 0.65 0.33 0.07 1.54 1.22 000 

11042 ......... ............ A Debride skin/tissue ...................................... 1.12 0.97 0.45 0.11 2.20 1.68 000 

11043 ......... ............ A Debride tissue/muscle ................................. 2.38 3.41 2.61 0.29 6.08 5.28 010 

11044 ......... ............ A Debride tissue/muscle/bone ........................ 3.06 4.50 3.77 0.41 7.97 7.24 010 

11055 ......... ............ R Trim skin lesion ............................................ 0.43 0.55 0.17 0.02 1.00 0.62 000 

11056 ......... ............ R Trim skin lesions, 2 to 4 .............................. 0.61 0.63 0.24 0.04 1.28 0.89 000 

11057 ......... ............ R Trim skin lesions, over 4 ............................. 0.79 0.73 0.31 0.05 1.57 1.15 000 

11100 ......... ............ A Biopsy, skin lesion ....................................... 0.81 1.26 0.37 0.05 2.12 1.23 000 

11101 ......... ............ A Biopsy, skin add-on ..................................... 0.41 0.34 0.19 0.02 0.77 0.62 ZZZ 

11200 ......... ............ A Removal of skin tags ................................... 0.77 1.06 0.77 0.05 1.88 1.59 010 

11201 ......... ............ A Remove skin tags add-on ............................ 0.29 0.16 0.12 0.02 0.47 0.43 ZZZ 

11300 ......... ............ A Shave skin lesion ......................................... 0.51 1.00 0.22 0.04 1.55 0.77 000 

11301 ......... ............ A Shave skin lesion ......................................... 0.85 1.12 0.37 0.05 2.02 1.27 000 

11302 ......... ............ A Shave skin lesion ......................................... 1.05 1.31 0.46 0.06 2.42 1.57 000 

11303 ......... ............ A Shave skin lesion ......................................... 1.24 1.59 0.52 0.07 2.90 1.83 000 

11305 ......... ............ A Shave skin lesion ......................................... 0.67 0.84 0.27 0.05 1.56 0.99 000 

11306 ......... ............ A Shave skin lesion ......................................... 0.99 1.11 0.41 0.06 2.16 1.46 000 

11307 ......... ............ A Shave skin lesion ......................................... 1.14 1.29 0.49 0.06 2.49 1.69 000 

11308 ......... ............ A Shave skin lesion ......................................... 1.41 1.45 0.59 0.08 2.94 2.08 000 

11310 ......... ............ A Shave skin lesion ......................................... 0.73 1.12 0.33 0.05 1.90 1.11 000 

11311 ......... ............ A Shave skin lesion ......................................... 1.05 1.24 0.48 0.06 2.35 1.59 000 

11312 ......... ............ A Shave skin lesion ......................................... 1.20 1.44 0.55 0.07 2.71 1.82 000 

11313 ......... ............ A Shave skin lesion ......................................... 1.62 1.82 0.72 0.11 3.55 2.45 000 

11400 ......... ............ A Exc tr-ext b9+marg 0.5 < cm ....................... 0.85 2.00 0.89 0.07 2.92 1.81 010 

11401 ......... ............ A Exc tr-ext b9+marg 0.6-1 cm ....................... 1.23 2.07 1.03 0.11 3.41 2.37 010 

11402 ......... ............ A Exc tr-ext b9+marg 1.1-2 cm ....................... 1.51 2.25 1.10 0.14 3.90 2.75 010 

11403 ......... ............ A Exc tr-ext b9+marg 2.1-3 cm ....................... 1.79 2.42 1.33 0.19 4.40 3.31 010 

11404 ......... ............ A Exc tr-ext b9+marg 3.1-4 cm ....................... 2.06 2.73 1.41 0.22 5.01 3.69 010 

11406 ......... ............ A Exc tr-ext b9+marg > 4.0 cm ....................... 2.76 3.10 1.67 0.30 6.16 4.73 010 

11420 ......... ............ A Exc h-f-nk-sp b9+marg 0.5 < ....................... 0.98 1.77 0.94 0.10 2.85 2.02 010 

11421 ......... ............ A Exc h-f-nk-sp b9+marg 0.6-1 ....................... 1.42 2.08 1.12 0.13 3.63 2.67 010 

11422 ......... ............ A Exc h-f-nk-sp b9+marg 1.1-2 ....................... 1.63 2.27 1.34 0.17 4.07 3.14 010 

11423 ......... ............ A Exc h-f-nk-sp b9+marg 2.1-3 ....................... 2.01 2.61 1.46 0.21 4.83 3.68 010 

11424 ......... ............ A Exc h-f-nk-sp b9+marg 3.1-4 ....................... 2.43 2.82 1.61 0.25 5.50 4.29 010 

11426 ......... ............ A Exc h-f-nk-sp b9+marg > 4 cm .................... 3.77 3.52 2.11 0.41 7.70 6.29 010 

11440 ......... ............ A Exc face-mm b9+marg 0.5 < cm ................. 1.06 2.28 1.33 0.10 3.44 2.49 010 

11441 ......... ............ A Exc face-mm b9+marg 0.6-1 cm ................. 1.48 2.40 1.51 0.13 4.01 3.12 010 

11442 ......... ............ A Exc face-mm b9+marg 1.1-2 cm ................. 1.72 2.59 1.58 0.17 4.48 3.47 010 

11443 ......... ............ A Exc face-mm b9+marg 2.1-3 cm ................. 2.29 2.97 1.83 0.22 5.48 4.34 010 

11444 ......... ............ A Exc face-mm b9+marg 3.1-4 cm ................. 3.14 3.54 2.19 0.30 6.98 5.63 010 

11446 ......... ............ A Exc face-mm b9+marg > 4 cm .................... 4.48 4.11 2.78 0.36 8.95 7.62 010 

11450 ......... ............ A Removal, sweat gland lesion ....................... 2.73 5.11 2.03 0.31 8.15 5.07 090 

11451 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.74 2.56 0.47 11.15 6.97 090 

11462 ......... ............ A Removal, sweat gland lesion ....................... 2.51 5.20 2.02 0.28 7.99 4.81 090 

11463 ......... ............ A Removal, sweat gland lesion ....................... 3.94 6.96 2.69 0.48 11.38 7.11 090 

11470 ......... ............ A Removal, sweat gland lesion ....................... 3.25 5.14 2.27 0.36 8.75 5.88 090 

11471 ......... ............ A Removal, sweat gland lesion ....................... 4.40 6.85 2.78 0.48 11.73 7.66 090 

11600 ......... ............ A Exc tr-ext mlg+marg 0.5 < cm ..................... 1.31 2.65 0.98 0.11 4.07 2.40 010 

11601 ......... ............ A Exc tr-ext mlg+marg 0.6-1 cm ..................... 1.80 2.72 1.23 0.14 4.66 3.17 010 

11602 ......... ............ A Exc tr-ext mlg+marg 1.1-2 cm ..................... 1.95 2.86 1.27 0.16 4.97 3.38 010 

11603 ......... ............ A Exc tr-ext mlg+marg 2.1-3 cm ..................... 2.19 3.11 1.33 0.19 5.49 3.71 010 

11604 ......... ............ A Exc tr-ext mlg+marg 3.1-4 cm ..................... 2.40 3.41 1.40 0.22 6.03 4.02 010 

11606 ......... ............ A Exc tr-ext mlg+marg > 4 cm ........................ 3.42 4.11 1.75 0.34 7.87 5.51 010 

11620 ......... ............ A Exc h-f-nk-sp mlg+marg 0.5 < ..................... 1.19 2.62 0.96 0.11 3.92 2.26 010 

11621 ......... ............ A Exc h-f-nk-sp mlg+marg 0.6-1 ..................... 1.76 2.73 1.25 0.14 4.63 3.15 010 

11622 ......... ............ A Exc h-f-nk-sp mlg+marg 1.1-2 ..................... 2.09 3.00 1.39 0.18 5.27 3.66 010 

11623 ......... ............ A Exc h-f-nk-sp mlg+marg 2.1-3 ..................... 2.61 3.36 1.59 0.24 6.21 4.44 010 

11624 ......... ............ A Exc h-f-nk-sp mlg+marg 3.1-4 ..................... 3.06 3.79 1.78 0.30 7.15 5.14 010 

11626 ......... ............ A Exc h-f-nk-sp mlg+mar > 4 cm .................... 4.29 4.70 2.40 0.42 9.41 7.11 010 

11640 ......... ............ A Exc face-mm malig+marg 0.5 < .................. 1.35 2.69 1.12 0.12 4.16 2.59 010 

11641 ......... ............ A Exc face-mm malig+marg 0.6-1 .................. 2.16 3.06 1.54 0.18 5.40 3.88 010 

11642 ......... ............ A Exc face-mm malig+marg 1.1-2 .................. 2.59 3.44 1.73 0.22 6.25 4.54 010 

11643 ......... ............ A Exc face-mm malig+marg 2.1-3 .................. 3.10 3.85 1.96 0.29 7.24 5.35 010 

11644 ......... ............ A Exc face-mm malig+marg 3.1-4 .................. 4.02 4.74 2.47 0.40 9.16 6.89 010 

1120

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

11646 ......... ............ A Exc face-mm mlg+marg > 4 cm .................. 5.94 5.81 3.49 0.55 12.30 9.98 010 

11719 ......... ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 

11720 ......... ............ A Debride nail, 1-5 .......................................... 0.32 0.34 0.13 0.02 0.68 0.47 000 

11721 ......... ............ A Debride nail, 6 or more ................................ 0.54 0.43 0.21 0.05 1.02 0.80 000 

11730 ......... ............ A Removal of nail plate ................................... 1.13 1.02 0.43 0.11 2.26 1.67 000 

11732 ......... ............ A Remove nail plate, add-on .......................... 0.57 0.43 0.22 0.06 1.06 0.85 ZZZ 

11740 ......... ............ A Drain blood from under nail ......................... 0.37 0.85 0.14 0.04 1.26 0.55 000 

11750 ......... ............ A Removal of nail bed ..................................... 1.86 2.13 1.72 0.19 4.18 3.77 010 

11752 ......... ............ A Remove nail bed/finger tip ........................... 2.67 2.95 2.95 0.40 6.02 6.02 010 

11755 ......... ............ A Biopsy, nail unit ........................................... 1.31 1.10 0.54 0.07 2.48 1.92 000 

11760 ......... ............ A Repair of nail bed ........................................ 1.58 1.84 1.21 0.21 3.63 3.00 010 

11762 ......... ............ A Reconstruction of nail bed ........................... 2.89 2.27 1.83 0.39 5.55 5.11 010 

11765 ......... ............ A Excision of nail fold, toe .............................. 0.69 1.14 0.52 0.06 1.89 1.27 010 

11770 ......... ............ A Removal of pilonidal lesion .......................... 2.61 3.52 1.51 0.29 6.42 4.41 010 

11771 ......... ............ A Removal of pilonidal lesion .......................... 5.73 5.70 3.33 0.68 12.11 9.74 090 

11772 ......... ............ A Removal of pilonidal lesion .......................... 6.97 7.17 3.87 0.82 14.96 11.66 090 

11900 ......... ............ A Injection into skin lesions ............................. 0.52 0.65 0.22 0.02 1.19 0.76 000 

11901 ......... ............ A Added skin lesions injection ........................ 0.80 0.66 0.36 0.04 1.50 1.20 000 

11920 ......... ............ R Correct skin color defects ............................ 1.61 1.99 0.78 0.21 3.81 2.60 000 

11921 ......... ............ R Correct skin color defects ............................ 1.93 2.36 0.98 0.25 4.54 3.16 000 

11922 ......... ............ R Correct skin color defects ............................ 0.49 0.37 0.25 0.06 0.92 0.80 ZZZ 

11950 ......... ............ R Therapy for contour defects ........................ 0.84 1.15 0.40 0.07 2.06 1.31 000 

11951 ......... ............ R Therapy for contour defects ........................ 1.19 1.50 0.51 0.12 2.81 1.82 000 

11952 ......... ............ R Therapy for contour defects ........................ 1.69 1.87 0.68 0.21 3.77 2.58 000 

11954 ......... ............ R Therapy for contour defects ........................ 1.85 2.44 0.91 0.23 4.52 2.99 000 

11960 ......... ............ A Insert tissue expander(s) ............................. 9.07 NA 10.52 1.06 NA 20.65 090 

11970 ......... ............ A Replace tissue expander ............................. 7.05 NA 6.10 0.93 NA 14.08 090 

11971 ......... ............ A Remove tissue expander(s) ......................... 2.13 7.10 4.76 0.25 9.48 7.14 090 

11975 ......... ............ N Insert contraceptive cap .............................. +1.48 1.42 0.57 0.17 3.07 2.22 XXX 

11976 ......... ............ R Removal of contraceptive cap ..................... 1.78 1.70 0.68 0.21 3.69 2.67 000 

11977 ......... ............ N Removal/reinsert contra cap ........................ +3.30 2.27 1.26 0.37 5.94 4.93 XXX 

11980 ......... ............ A Implant hormone pellet(s) ............................ 1.48 1.10 0.54 0.12 2.70 2.14 000 

11981 ......... ............ A Insert drug implant device ........................... 1.48 1.74 0.68 0.17 3.39 2.33 XXX 

11982 ......... ............ A Remove drug implant device ....................... 1.78 1.97 0.84 0.21 3.96 2.83 XXX 

11983 ......... ............ A Remove/insert drug implant ......................... 3.30 2.32 1.47 0.37 5.99 5.14 XXX 

12001 ......... ............ A Repair superficial wound(s) ......................... 1.70 2.00 0.49 0.16 3.86 2.35 010 

12002 ......... ............ A Repair superficial wound(s) ......................... 1.86 2.06 0.93 0.18 4.10 2.97 010 

12004 ......... ............ A Repair superficial wound(s) ......................... 2.24 2.36 1.05 0.21 4.81 3.50 010 

12005 ......... ............ A Repair superficial wound(s) ......................... 2.86 2.85 1.23 0.28 5.99 4.37 010 

12006 ......... ............ A Repair superficial wound(s) ......................... 3.66 3.43 1.54 0.37 7.46 5.57 010 

12007 ......... ............ A Repair superficial wound(s) ......................... 4.11 3.86 1.84 0.45 8.42 6.40 010 

12011 ......... ............ A Repair superficial wound(s) ......................... 1.76 2.16 0.50 0.17 4.09 2.43 010 

12013 ......... ............ A Repair superficial wound(s) ......................... 1.99 2.31 0.97 0.19 4.49 3.15 010 

12014 ......... ............ A Repair superficial wound(s) ......................... 2.46 2.61 1.09 0.22 5.29 3.77 010 

12015 ......... ............ A Repair superficial wound(s) ......................... 3.19 3.19 1.28 0.29 6.67 4.76 010 

12016 ......... ............ A Repair superficial wound(s) ......................... 3.92 3.60 1.56 0.39 7.91 5.87 010 

12017 ......... ............ A Repair superficial wound(s) ......................... 4.70 NA 1.91 0.47 NA 7.08 010 

12018 ......... ............ A Repair superficial wound(s) ......................... 5.52 NA 2.27 0.55 NA 8.34 010 

12020 ......... ............ A Closure of split wound ................................. 2.62 2.65 1.75 0.29 5.56 4.66 010 

12021 ......... ............ A Closure of split wound ................................. 1.84 1.74 1.41 0.23 3.81 3.48 010 

12031 ......... ............ A Layer closure of wound(s) ........................... 2.15 2.31 0.81 0.18 4.64 3.14 010 

12032 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.88 1.84 0.18 6.53 4.49 010 

12034 ......... ............ A Layer closure of wound(s) ........................... 2.92 3.17 1.41 0.25 6.34 4.58 010 

12035 ......... ............ A Layer closure of wound(s) ........................... 3.42 5.26 2.18 0.36 9.04 5.96 010 

12036 ......... ............ A Layer closure of wound(s) ........................... 4.04 5.36 2.38 0.49 9.89 6.91 010 

12037 ......... ............ A Layer closure of wound(s) ........................... 4.66 6.41 2.78 0.59 11.66 8.03 010 

12041 ......... ............ A Layer closure of wound(s) ........................... 2.37 2.47 0.87 0.21 5.05 3.45 010 

12042 ......... ............ A Layer closure of wound(s) ........................... 2.74 3.21 1.37 0.21 6.16 4.32 010 

12044 ......... ............ A Layer closure of wound(s) ........................... 3.14 3.20 1.56 0.29 6.63 4.99 010 

12045 ......... ............ A Layer closure of wound(s) ........................... 3.63 3.67 2.17 0.41 7.71 6.21 010 

12046 ......... ............ A Layer closure of wound(s) ........................... 4.24 6.57 2.76 0.48 11.29 7.48 010 

12047 ......... ............ A Layer closure of wound(s) ........................... 4.64 6.42 3.10 0.49 11.55 8.23 010 

12051 ......... ............ A Layer closure of wound(s) ........................... 2.47 3.23 1.36 0.19 5.89 4.02 010 

12052 ......... ............ A Layer closure of wound(s) ........................... 2.77 3.17 1.34 0.21 6.15 4.32 010 

12053 ......... ............ A Layer closure of wound(s) ........................... 3.12 3.22 1.50 0.24 6.58 4.86 010 

12054 ......... ............ A Layer closure of wound(s) ........................... 3.45 3.54 1.60 0.30 7.29 5.35 010 

12055 ......... ............ A Layer closure of wound(s) ........................... 4.42 4.54 2.14 0.42 9.38 6.98 010 

12056 ......... ............ A Layer closure of wound(s) ........................... 5.23 6.76 3.07 0.52 12.51 8.82 010 

12057 ......... ............ A Layer closure of wound(s) ........................... 5.95 6.10 3.76 0.60 12.65 10.31 010 

13100 ......... ............ A Repair of wound or lesion ........................... 3.12 3.51 1.78 0.25 6.88 5.15 010 

13101 ......... ............ A Repair of wound or lesion ........................... 3.91 3.75 2.22 0.27 7.93 6.40 010 

13102 ......... ............ A Repair wound/lesion add-on ........................ 1.24 0.74 0.57 0.12 2.10 1.93 ZZZ 

13120 ......... ............ A Repair of wound or lesion ........................... 3.30 3.61 1.82 0.28 7.19 5.40 010 

13121 ......... ............ A Repair of wound or lesion ........................... 4.32 3.97 2.32 0.30 8.59 6.94 010 

13122 ......... ............ A Repair wound/lesion add-on ........................ 1.44 0.87 0.63 0.14 2.45 2.21 ZZZ 

1121

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

13131 ......... ............ A Repair of wound or lesion ........................... 3.78 3.88 2.14 0.30 7.96 6.22 010 

13132 ......... ............ A Repair of wound or lesion ........................... 5.94 4.68 3.17 0.39 11.01 9.50 010 

13133 ......... ............ A Repair wound/lesion add-on ........................ 2.19 1.19 1.03 0.21 3.59 3.43 ZZZ 

13150 ......... ............ A Repair of wound or lesion ........................... 3.80 5.50 2.61 0.35 9.65 6.76 010 

13151 ......... ............ A Repair of wound or lesion ........................... 4.44 5.40 3.03 0.34 10.18 7.81 010 

13152 ......... ............ A Repair of wound or lesion ........................... 6.32 6.08 3.93 0.46 12.86 10.71 010 

13153 ......... ............ A Repair wound/lesion add-on ........................ 2.38 1.34 1.14 0.22 3.94 3.74 ZZZ 

13160 ......... ............ A Late closure of wound ................................. 10.46 NA 7.14 1.44 NA 19.04 090 

14000 ......... ............ A Skin tissue rearrangement ........................... 5.88 8.52 5.12 0.55 14.95 11.55 090 

14001 ......... ............ A Skin tissue rearrangement ........................... 8.46 9.94 6.59 0.78 19.18 15.83 090 

14020 ......... ............ A Skin tissue rearrangement ........................... 6.58 9.17 5.99 0.60 16.35 13.17 090 

14021 ......... ............ A Skin tissue rearrangement ........................... 10.04 10.45 7.74 0.83 21.32 18.61 090 

14040 ......... ............ A Skin tissue rearrangement ........................... 7.86 8.25 6.86 0.66 16.77 15.38 090 

14041 ......... ............ A Skin tissue rearrangement ........................... 11.47 10.64 8.68 0.86 22.97 21.01 090 

14060 ......... ............ A Skin tissue rearrangement ........................... 8.49 9.08 7.69 0.71 18.28 16.89 090 

14061 ......... ............ A Skin tissue rearrangement ........................... 12.27 11.66 9.51 0.90 24.83 22.68 090 

14300 ......... ............ A Skin tissue rearrangement ........................... 11.74 11.19 9.17 1.06 23.99 21.97 090 

14350 ......... ............ A Skin tissue rearrangement ........................... 9.60 NA 7.12 1.31 NA 18.03 090 

15000 ......... ............ A Skin graft ...................................................... 3.99 3.81 2.20 0.45 8.25 6.64 000 

15001 ......... ............ A Skin graft add-on ......................................... 1.00 1.36 0.41 0.13 2.49 1.54 ZZZ 

15050 ......... ............ A Skin pinch graft ............................................ 4.29 5.97 4.74 0.55 10.81 9.58 090 

15100 ......... ............ A Skin split graft .............................................. 9.04 12.63 7.80 1.13 22.80 17.97 090 

15101 ......... ............ A Skin split graft add-on .................................. 1.72 3.83 1.66 0.22 5.77 3.60 ZZZ 

15120 ......... ............ A Skin split graft .............................................. 9.82 10.78 7.77 1.09 21.69 18.68 090 

15121 ......... ............ A Skin split graft add-on .................................. 2.67 4.58 1.87 0.33 7.58 4.87 ZZZ 

15200 ......... ............ A Skin full graft ................................................ 8.02 10.71 6.00 0.88 19.61 14.90 090 

15201 ......... ............ A Skin full graft add-on ................................... 1.32 1.04 0.62 0.17 2.53 2.11 ZZZ 

15220 ......... ............ A Skin full graft ................................................ 7.86 10.59 6.43 0.82 19.27 15.11 090 

15221 ......... ............ A Skin full graft add-on ................................... 1.19 0.91 0.56 0.14 2.24 1.89 ZZZ 

15240 ......... ............ A Skin full graft ................................................ 9.03 10.15 7.65 0.96 20.14 17.64 090 

15241 ......... ............ A Skin full graft add-on ................................... 1.86 1.45 0.92 0.21 3.52 2.99 ZZZ 

15260 ......... ............ A Skin full graft ................................................ 10.04 9.88 8.60 0.76 20.68 19.40 090 

15261 ......... ............ A Skin full graft add-on ................................... 2.23 2.72 1.42 0.21 5.16 3.86 ZZZ 

15342 ......... ............ A Cultured skin graft, 25 cm ........................... 1.00 1.83 0.55 0.11 2.94 1.66 010 

15343 ......... ............ A Culture skn graft addl 25 cm ....................... 0.25 0.27 0.10 0.02 0.54 0.37 ZZZ 

15350 ......... ............ A Skin homograft ............................................. 3.99 8.22 4.83 0.51 12.72 9.33 090 

15351 ......... ............ A Skin homograft add-on ................................ 1.00 0.94 0.39 0.13 2.07 1.52 ZZZ 

15400 ......... ............ A Skin heterograft ........................................... 3.99 4.18 4.10 0.48 8.65 8.57 090 

15401 ......... ............ A Skin heterograft add-on ............................... 1.00 1.22 0.44 0.13 2.35 1.57 ZZZ 

15570 ......... ............ A Form skin pedicle flap ................................. 9.20 9.17 6.68 1.16 19.53 17.04 090 

15572 ......... ............ A Form skin pedicle flap ................................. 9.26 8.38 6.25 1.12 18.76 16.63 090 

15574 ......... ............ A Form skin pedicle flap ................................. 9.87 8.79 6.95 1.11 19.77 17.93 090 

15576 ......... ............ A Form skin pedicle flap ................................. 8.68 9.39 6.42 0.87 18.94 15.97 090 

15600 ......... ............ A Skin graft ...................................................... 1.91 7.04 2.70 0.23 9.18 4.84 090 

15610 ......... ............ A Skin graft ...................................................... 2.42 3.73 3.03 0.30 6.45 5.75 090 

15620 ......... ............ A Skin graft ...................................................... 2.94 7.46 3.67 0.34 10.74 6.95 090 

15630 ......... ............ A Skin graft ...................................................... 3.27 6.84 3.93 0.34 10.45 7.54 090 

15650 ......... ............ A Transfer skin pedicle flap ............................ 3.96 6.70 4.02 0.43 11.09 8.41 090 

15732 ......... ............ A Muscle-skin graft, head/neck ....................... 17.81 18.05 12.22 1.81 37.67 31.84 090 

15734 ......... ............ A Muscle-skin graft, trunk ............................... 17.76 17.84 12.34 2.30 37.90 32.40 090 

15736 ......... ............ A Muscle-skin graft, arm ................................. 16.25 18.16 11.22 2.15 36.56 29.62 090 

15738 ......... ............ A Muscle-skin graft, leg ................................... 17.89 17.93 11.74 2.35 38.17 31.98 090 

15740 ......... ............ A Island pedicle flap graft ............................... 10.23 9.81 7.88 0.75 20.79 18.86 090 

15750 ......... ............ A Neurovascular pedicle graft ......................... 11.39 NA 9.04 1.40 NA 21.83 090 

15756 ......... ............ A Free myo/skin flap microvasc ...................... 35.18 NA 20.69 3.75 NA 59.62 090 

15757 ......... ............ A Free skin flap, microvasc ............................. 35.18 NA 21.73 4.06 NA 60.97 090 

15758 ......... ............ A Free fascial flap, microvasc ......................... 35.05 NA 21.72 4.25 NA 61.02 090 

15760 ......... ............ A Composite skin graft .................................... 8.73 9.71 7.02 0.87 19.31 16.62 090 

15770 ......... ............ A Derma-fat-fascia graft .................................. 7.51 NA 6.69 0.94 NA 15.14 090 

15775 ......... ............ R Hair transplant punch grafts ........................ 3.95 2.78 1.32 0.52 7.25 5.79 000 

15776 ......... ............ R Hair transplant punch grafts ........................ 5.53 5.39 2.81 0.72 11.64 9.06 000 

15780 ......... ............ A Abrasion treatment of skin ........................... 7.28 7.07 7.07 0.49 14.84 14.84 090 

15781 ......... ............ A Abrasion treatment of skin ........................... 4.84 5.35 5.35 0.33 10.52 10.52 090 

15782 ......... ............ A Abrasion treatment of skin ........................... 4.31 4.30 4.30 0.25 8.86 8.86 090 

15783 ......... ............ A Abrasion treatment of skin ........................... 4.28 4.92 4.17 0.31 9.51 8.76 090 

15786 ......... ............ A Abrasion, lesion, single ................................ 2.03 1.63 1.27 0.13 3.79 3.43 010 

15787 ......... ............ A Abrasion, lesions, add-on ............................ 0.33 0.32 0.16 0.02 0.67 0.51 ZZZ 

15788 ......... ............ R Chemical peel, face, epiderm ...................... 2.09 3.34 2.27 0.13 5.56 4.49 090 

15789 ......... ............ R Chemical peel, face, dermal ........................ 4.91 6.39 4.91 0.33 11.63 10.15 090 

15792 ......... ............ R Chemical peel, nonfacial ............................. 1.86 3.16 2.76 0.12 5.14 4.74 090 

15793 ......... ............ A Chemical peel, nonfacial ............................. 3.73 NA 4.14 0.21 NA 8.08 090 

15810 ......... ............ A Salabrasion .................................................. 4.73 3.87 3.87 0.51 9.11 9.11 090 

15811 ......... ............ A Salabrasion .................................................. 5.38 6.31 5.52 0.63 12.32 11.53 090 

15819 ......... ............ A Plastic surgery, neck ................................... 9.37 NA 7.20 0.93 NA 17.50 090 

15820 ......... ............ A Revision of lower eyelid ............................... 5.14 6.85 5.34 0.36 12.35 10.84 090 

1122

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

15821 ......... ............ A Revision of lower eyelid ............................... 5.71 7.23 5.52 0.37 13.31 11.60 090 

15822 ......... ............ A Revision of upper eyelid .............................. 4.44 5.80 4.36 0.27 10.51 9.07 090 

15823 ......... ............ A Revision of upper eyelid .............................. 7.04 7.79 6.24 0.39 15.22 13.67 090 

15824 ......... ............ R Removal of forehead wrinkles ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15825 ......... ............ R Removal of neck wrinkles ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

15826 ......... ............ R Removal of brow wrinkles ........................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15828 ......... ............ R Removal of face wrinkles ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

15829 ......... ............ R Removal of skin wrinkles ............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

15831 ......... ............ A Excise excessive skin tissue ....................... 12.38 NA 8.22 1.57 NA 22.17 090 

15832 ......... ............ A Excise excessive skin tissue ....................... 11.57 NA 8.38 1.46 NA 21.41 090 

15833 ......... ............ A Excise excessive skin tissue ....................... 10.62 NA 8.24 1.41 NA 20.27 090 

15834 ......... ............ A Excise excessive skin tissue ....................... 10.83 NA 7.71 1.42 NA 19.96 090 

15835 ......... ............ A Excise excessive skin tissue ....................... 11.65 11.40 7.63 1.36 24.41 20.64 090 

15836 ......... ............ A Excise excessive skin tissue ....................... 9.33 NA 6.81 1.15 NA 17.29 090 

15837 ......... ............ A Excise excessive skin tissue ....................... 8.42 7.90 7.00 0.94 17.26 16.36 090 

15838 ......... ............ A Excise excessive skin tissue ....................... 7.12 NA 6.09 0.70 NA 13.91 090 

15839 ......... ............ A Excise excessive skin tissue ....................... 9.37 7.84 6.21 1.06 18.27 16.64 090 

15840 ......... ............ A Graft for face nerve palsy ............................ 13.24 NA 10.05 1.39 NA 24.68 090 

15841 ......... ............ A Graft for face nerve palsy ............................ 23.23 NA 15.08 3.20 NA 41.51 090 

15842 ......... ............ A Flap for face nerve palsy ............................. 37.90 NA 23.01 4.81 NA 65.72 090 

15845 ......... ............ A Skin and muscle repair, face ....................... 12.55 NA 9.36 0.96 NA 22.87 090 

15850 ......... ............ B Removal of sutures ...................................... +0.78 1.58 0.30 0.05 2.41 1.13 XXX 

15851 ......... ............ A Removal of sutures ...................................... 0.86 1.72 0.34 0.06 2.64 1.26 000 

15852 ......... ............ A Dressing change not for burn ...................... 0.86 1.87 0.36 0.08 2.81 1.30 000 

15860 ......... ............ A Test for blood flow in graft ........................... 1.95 1.28 0.79 0.16 3.39 2.90 000 

15876 ......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15877 ......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15878 ......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15879 ......... ............ R Suction assisted lipectomy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

15920 ......... ............ A Removal of tail bone ulcer ........................... 7.94 NA 5.61 1.00 NA 14.55 090 

15922 ......... ............ A Removal of tail bone ulcer ........................... 9.89 NA 7.31 1.28 NA 18.48 090 

15931 ......... ............ A Remove sacrum pressure sore ................... 9.23 NA 5.75 1.15 NA 16.13 090 

15933 ......... ............ A Remove sacrum pressure sore ................... 10.83 NA 7.94 1.37 NA 20.14 090 

15934 ......... ............ A Remove sacrum pressure sore ................... 12.67 NA 8.15 1.63 NA 22.45 090 

15935 ......... ............ A Remove sacrum pressure sore ................... 14.55 NA 10.40 1.88 NA 26.83 090 

15936 ......... ............ A Remove sacrum pressure sore ................... 12.36 NA 8.36 1.59 NA 22.31 090 

15937 ......... ............ A Remove sacrum pressure sore ................... 14.19 NA 9.96 1.82 NA 25.97 090 

15940 ......... ............ A Remove hip pressure sore .......................... 9.33 NA 6.23 1.18 NA 16.74 090 

15941 ......... ............ A Remove hip pressure sore .......................... 11.41 NA 9.58 1.48 NA 22.47 090 

15944 ......... ............ A Remove hip pressure sore .......................... 11.44 NA 8.70 1.46 NA 21.60 090 

15945 ......... ............ A Remove hip pressure sore .......................... 12.67 NA 9.74 1.66 NA 24.07 090 

15946 ......... ............ A Remove hip pressure sore .......................... 21.54 NA 14.41 2.80 NA 38.75 090 

15950 ......... ............ A Remove thigh pressure sore ....................... 7.53 NA 5.47 0.96 NA 13.96 090 

15951 ......... ............ A Remove thigh pressure sore ....................... 10.70 NA 7.95 1.37 NA 20.02 090 

15952 ......... ............ A Remove thigh pressure sore ....................... 11.37 NA 7.83 1.44 NA 20.64 090 

15953 ......... ............ A Remove thigh pressure sore ....................... 12.61 NA 9.07 1.66 NA 23.34 090 

15956 ......... ............ A Remove thigh pressure sore ....................... 15.50 NA 10.85 1.98 NA 28.33 090 

15958 ......... ............ A Remove thigh pressure sore ....................... 15.46 NA 11.13 2.00 NA 28.59 090 

15999 ......... ............ C Removal of pressure sore ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

16000 ......... ............ A Initial treatment of burn(s) ........................... 0.89 0.86 0.27 0.07 1.82 1.23 000 

16010 ......... ............ A Treatment of burn(s) .................................... 0.87 0.66 0.63 0.08 1.61 1.58 000 

16015 ......... ............ A Treatment of burn(s) .................................... 2.35 NA 1.15 0.27 NA 3.77 000 

16020 ......... ............ A Treatment of burn(s) .................................... 0.80 1.31 0.61 0.07 2.18 1.48 000 

16025 ......... ............ A Treatment of burn(s) .................................... 1.85 1.79 0.97 0.19 3.83 3.01 000 

16030 ......... ............ A Treatment of burn(s) .................................... 2.08 2.20 1.12 0.22 4.50 3.42 000 

16035 ......... ............ A Incision of burn scab, initi ............................ 3.74 NA 1.47 0.43 NA 5.64 090 

16036 ......... ............ A Escharotomy; add’l incision ......................... 1.50 NA 0.60 0.13 NA 2.23 ZZZ 

17000 ......... ............ A Destroy benign/premlg lesion ...................... 0.60 0.98 0.32 0.04 1.62 0.96 010 

17003 ......... ............ A Destroy lesions, 2-14 ................................... 0.15 0.11 0.07 0.01 0.27 0.23 ZZZ 

17004 ......... ............ A Destroy lesions, 15 or more ........................ 2.79 2.32 1.29 0.14 5.25 4.22 010 

17106 ......... ............ A Destruction of skin lesions ........................... 4.58 4.87 3.34 0.34 9.79 8.26 090 

17107 ......... ............ A Destruction of skin lesions ........................... 9.15 7.52 5.45 0.64 17.31 15.24 090 

17108 ......... ............ A Destruction of skin lesions ........................... 13.18 9.68 7.68 1.07 23.93 21.93 090 

17110 ......... ............ A Destruct lesion, 1-14 .................................... 0.65 1.63 0.49 0.05 2.33 1.19 010 

17111 ......... ............ A Destruct lesion, 15 or more ......................... 0.92 1.68 0.59 0.05 2.65 1.56 010 

17250 ......... ............ A Chemical cautery, tissue ............................. 0.50 1.23 0.35 0.05 1.78 0.90 000 

17260 ......... ............ A Destruction of skin lesions ........................... 0.91 1.28 0.44 0.05 2.24 1.40 010 

17261 ......... ............ A Destruction of skin lesions ........................... 1.17 1.62 0.59 0.06 2.85 1.82 010 

17262 ......... ............ A Destruction of skin lesions ........................... 1.58 1.89 0.78 0.08 3.55 2.44 010 

17263 ......... ............ A Destruction of skin lesions ........................... 1.79 2.07 0.86 0.10 3.96 2.75 010 

17264 ......... ............ A Destruction of skin lesions ........................... 1.94 2.23 0.89 0.10 4.27 2.93 010 

17266 ......... ............ A Destruction of skin lesions ........................... 2.34 2.53 0.99 0.13 5.00 3.46 010 

17270 ......... ............ A Destruction of skin lesions ........................... 1.32 1.71 0.64 0.07 3.10 2.03 010 

17271 ......... ............ A Destruction of skin lesions ........................... 1.49 1.79 0.74 0.07 3.35 2.30 010 

17272 ......... ............ A Destruction of skin lesions ........................... 1.77 2.00 0.88 0.08 3.85 2.73 010 

1123

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

17273 ......... ............ A Destruction of skin lesions ........................... 2.05 2.21 0.99 0.11 4.37 3.15 010 

17274 ......... ............ A Destruction of skin lesions ........................... 2.59 2.58 1.20 0.13 5.30 3.92 010 

17276 ......... ............ A Destruction of skin lesions ........................... 3.20 2.97 1.44 0.18 6.35 4.82 010 

17280 ......... ............ A Destruction of skin lesions ........................... 1.17 1.62 0.57 0.06 2.85 1.80 010 

17281 ......... ............ A Destruction of skin lesions ........................... 1.72 1.91 0.86 0.08 3.71 2.66 010 

17282 ......... ............ A Destruction of skin lesions ........................... 2.04 2.17 1.01 0.11 4.32 3.16 010 

17283 ......... ............ A Destruction of skin lesions ........................... 2.64 2.56 1.25 0.13 5.33 4.02 010 

17284 ......... ............ A Destruction of skin lesions ........................... 3.21 2.94 1.52 0.17 6.32 4.90 010 

17286 ......... ............ A Destruction of skin lesions ........................... 4.43 3.71 2.19 0.27 8.41 6.89 010 

17304 ......... ............ A 1 stage mohs, up to 5 spec ......................... 7.59 8.09 3.57 0.37 16.05 11.53 000 

17305 ......... ............ A 2 stage mohs, up to 5 spec ......................... 2.85 3.81 1.34 0.14 6.80 4.33 000 

17306 ......... ............ A 3 stage mohs, up to 5 spec ......................... 2.85 3.83 1.35 0.14 6.82 4.34 000 

17307 ......... ............ A Mohs addl stage up to 5 spec ..................... 2.85 3.78 1.37 0.14 6.77 4.36 000 

17310 ......... ............ A Mohs any stage > 5 spec each ................... 0.95 1.65 0.46 0.06 2.66 1.47 ZZZ 

17340 ......... ............ A Cryotherapy of skin ...................................... 0.76 0.37 0.31 0.05 1.18 1.12 010 

17360 ......... ............ A Skin peel therapy ......................................... 1.43 1.46 0.75 0.07 2.96 2.25 010 

17380 ......... ............ R Hair removal by electrolysis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

17999 ......... ............ C Skin tissue procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

19000 ......... ............ A Drainage of breast lesion ............................ 0.84 2.03 0.36 0.08 2.95 1.28 000 

19001 ......... ............ A Drain breast lesion add-on .......................... 0.42 0.79 0.14 0.04 1.25 0.60 ZZZ 

19020 ......... ............ A Incision of breast lesion ............................... 3.56 6.00 2.77 0.42 9.98 6.75 090 

19030 ......... ............ A Injection for breast x-ray .............................. 1.53 3.37 0.50 0.08 4.98 2.11 000 

19100 ......... ............ A Bx breast percut w/o image ......................... 1.27 2.15 0.42 0.12 3.54 1.81 000 

19101 ......... ............ A Biopsy of breast, open ................................. 3.18 4.69 1.68 0.24 8.11 5.10 010 

19102 ......... ............ A Bx breast percut w/image ............................ 2.00 3.98 0.66 0.16 6.14 2.82 000 

19103 ......... ............ A Bx breast percut w/device ........................... 3.69 12.07 1.23 0.19 15.95 5.11 000 

19110 ......... ............ A Nipple exploration ........................................ 4.29 5.82 3.06 0.53 10.64 7.88 090 

19112 ......... ............ A Excise breast duct fistula ............................. 3.66 5.80 2.68 0.46 9.92 6.80 090 

19120 ......... ............ A Removal of breast lesion ............................. 5.55 4.58 3.08 0.68 10.81 9.31 090 

19125 ......... ............ A Excision, breast lesion ................................. 6.05 4.83 3.30 0.74 11.62 10.09 090 

19126 ......... ............ A Excision, addl breast lesion ......................... 2.93 NA 1.01 0.36 NA 4.30 ZZZ 

19140 ......... ............ A Removal of breast tissue ............................. 5.13 7.29 3.42 0.63 13.05 9.18 090 

19160 ......... ............ A Removal of breast tissue ............................. 5.98 NA 3.45 0.74 NA 10.17 090 

19162 ......... ............ A Remove breast tissue, nodes ...................... 13.51 NA 6.38 1.66 NA 21.55 090 

19180 ......... ............ A Removal of breast ....................................... 8.79 NA 5.06 1.06 NA 14.91 090 

19182 ......... ............ A Removal of breast ....................................... 7.72 NA 4.81 0.95 NA 13.48 090 

19200 ......... ............ A Removal of breast ....................................... 15.47 NA 8.04 1.82 NA 25.33 090 

19220 ......... ............ A Removal of breast ....................................... 15.70 NA 8.30 1.88 NA 25.88 090 

19240 ......... ............ A Removal of breast ....................................... 15.98 NA 8.28 1.95 NA 26.21 090 

19260 ......... ............ A Removal of chest wall lesion ....................... 15.42 NA 11.30 1.98 NA 28.70 090 

19271 ......... ............ A Revision of chest wall .................................. 18.87 NA 18.23 2.74 NA 39.84 090 

19272 ......... ............ A Extensive chest wall surgery ....................... 21.52 NA 19.18 3.06 NA 43.76 090 

19290 ......... ............ A Place needle wire, breast ............................ 1.27 3.01 0.41 0.07 4.35 1.75 000 

19291 ......... ............ A Place needle wire, breast ............................ 0.63 1.75 0.21 0.04 2.42 0.88 ZZZ 

19295 ......... ............ A Place breast clip, percut .............................. 0.00 2.77 NA 0.01 2.78 NA ZZZ 

19316 ......... ............ A Suspension of breast ................................... 10.67 NA 7.59 1.39 NA 19.65 090 

19318 ......... ............ A Reduction of large breast ............................ 15.60 NA 11.20 2.04 NA 28.84 090 

19324 ......... ............ A Enlarge breast ............................................. 5.84 NA 4.92 0.76 NA 11.52 090 

19325 ......... ............ A Enlarge breast with implant ......................... 8.44 NA 6.59 1.09 NA 16.12 090 

19328 ......... ............ A Removal of breast implant ........................... 5.67 NA 5.07 0.74 NA 11.48 090 

19330 ......... ............ A Removal of implant material ........................ 7.58 NA 6.07 0.98 NA 14.63 090 

19340 ......... ............ A Immediate breast prosthesis ....................... 6.32 NA 3.12 0.82 NA 10.26 ZZZ 

19342 ......... ............ A Delayed breast prosthesis ........................... 11.18 NA 8.97 1.46 NA 21.61 090 

19350 ......... ............ A Breast reconstruction ................................... 8.91 14.20 7.11 1.15 24.26 17.17 090 

19355 ......... ............ A Correct inverted nipple(s) ............................ 7.56 12.80 5.00 0.96 21.32 13.52 090 

19357 ......... ............ A Breast reconstruction ................................... 18.13 NA 13.85 2.36 NA 34.34 090 

19361 ......... ............ A Breast reconstruction ................................... 19.23 NA 11.78 2.51 NA 33.52 090 

19364 ......... ............ A Breast reconstruction ................................... 40.94 NA 23.64 4.72 NA 69.30 090 

19366 ......... ............ A Breast reconstruction ................................... 21.25 NA 11.23 2.74 NA 35.22 090 

19367 ......... ............ A Breast reconstruction ................................... 25.69 NA 16.57 3.35 NA 45.61 090 

19368 ......... ............ A Breast reconstruction ................................... 32.37 NA 20.26 4.23 NA 56.86 090 

19369 ......... ............ A Breast reconstruction ................................... 29.78 NA 19.79 3.91 NA 53.48 090 

19370 ......... ............ A Surgery of breast capsule ........................... 8.04 NA 6.95 1.04 NA 16.03 090 

19371 ......... ............ A Removal of breast capsule .......................... 9.34 NA 7.87 1.22 NA 18.43 090 

19380 ......... ............ A Revise breast reconstruction ....................... 9.13 NA 7.76 1.18 NA 18.07 090 

19396 ......... ............ A Design custom breast implant ..................... 2.17 5.78 0.99 0.28 8.23 3.44 000 

19499 ......... ............ C Breast surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

20000 ......... ............ A Incision of abscess ...................................... 2.12 2.36 1.61 0.21 4.69 3.94 010 

20005 ......... ............ A Incision of deep abscess ............................. 3.41 3.34 2.12 0.41 7.16 5.94 010 

20100 ......... ............ A Explore wound, neck ................................... 10.06 5.79 4.38 1.19 17.04 15.63 010 

20101 ......... ............ A Explore wound, chest .................................. 3.22 2.96 1.61 0.29 6.47 5.12 010 

20102 ......... ............ A Explore wound, abdomen ............................ 3.93 3.51 1.80 0.42 7.86 6.15 010 

20103 ......... ............ A Explore wound, extremity ............................ 5.29 4.14 3.23 0.69 10.12 9.21 010 

20150 ......... ............ A Excise epiphyseal bar .................................. 13.67 NA 7.21 1.16 NA 22.04 090 

20200 ......... ............ A Muscle biopsy .............................................. 1.46 3.19 0.78 0.21 4.86 2.45 000 

1124

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

20205 ......... ............ A Deep muscle biopsy .................................... 2.35 4.14 1.21 0.28 6.77 3.84 000 

20206 ......... ............ A Needle biopsy, muscle ................................ 0.99 3.17 0.35 0.07 4.23 1.41 000 

20220 ......... ............ A Bone biopsy, trocar/needle .......................... 1.27 4.73 2.69 0.07 6.07 4.03 000 

20225 ......... ............ A Bone biopsy, trocar/needle .......................... 1.87 4.92 2.96 0.13 6.92 4.96 000 

20240 ......... ............ A Bone biopsy, excisional ............................... 3.23 NA 2.60 0.40 NA 6.23 010 

20245 ......... ............ A Bone biopsy, excisional ............................... 7.77 NA 6.36 0.53 NA 14.66 010 

20250 ......... ............ A Open bone biopsy ....................................... 5.02 NA 4.54 0.60 NA 10.16 010 

20251 ......... ............ A Open bone biopsy ....................................... 5.55 NA 5.17 0.95 NA 11.67 010 

20500 ......... ............ A Injection of sinus tract .................................. 1.23 5.88 3.89 0.12 7.23 5.24 010 

20501 ......... ............ A Inject sinus tract for x-ray ............................ 0.76 3.03 0.25 0.04 3.83 1.05 000 

20520 ......... ............ A Removal of foreign body ............................. 1.85 2.25 1.81 0.21 4.31 3.87 010 

20525 ......... ............ A Removal of foreign body ............................. 3.49 3.43 2.66 0.48 7.40 6.63 010 

20526 ......... ............ A Ther injection, carp tunnel ........................... 0.94 0.97 0.51 0.07 1.98 1.52 000 

20550 ......... ............ A Inj tendon sheath/ligament .......................... 0.75 0.71 0.24 0.07 1.53 1.06 000 

20551 ......... ............ A Inj tendon origin/insertion ............................ 0.75 0.68 0.34 0.07 1.50 1.16 000 

20552 ......... ............ A Inj trigger point, 1/2 muscl ........................... 0.66 0.73 0.21 0.07 1.46 0.94 000 

20553 ......... ............ A Inject trigger points, =/> 3 ............................ 0.75 0.84 0.23 0.07 1.66 1.05 000 

20600 ......... ............ A Drain/inject, joint/bursa ................................ 0.66 0.64 0.36 0.07 1.37 1.09 000 

20605 ......... ............ A Drain/inject, joint/bursa ................................ 0.68 0.75 0.37 0.07 1.50 1.12 000 

20610 ......... ............ A Drain/inject, joint/bursa ................................ 0.79 0.94 0.41 0.10 1.83 1.30 000 

20612 ......... ............ A Aspirate/inj ganglion cyst ............................. 0.70 0.71 0.34 0.07 1.48 1.11 000 

20615 ......... ............ A Treatment of bone cyst ................................ 2.28 2.54 1.83 0.23 5.05 4.34 010 

20650 ......... ............ A Insert and remove bone pin ........................ 2.23 2.42 1.94 0.34 4.99 4.51 010 

20660 ......... ............ A Apply, rem fixation device ........................... 2.51 3.07 1.70 0.58 6.16 4.79 000 

20661 ......... ............ A Application of head brace ............................ 4.88 NA 4.95 1.11 NA 10.94 090 

20662 ......... ............ A Application of pelvis brace ........................... 6.06 NA 5.43 0.98 NA 12.47 090 

20663 ......... ............ A Application of thigh brace ............................ 5.42 NA 4.76 0.93 NA 11.11 090 

20664 ......... ............ A Halo brace application ................................. 8.05 NA 7.03 1.80 NA 16.88 090 

20665 ......... ............ A Removal of fixation device .......................... 1.31 2.05 1.30 0.21 3.57 2.82 010 

20670 ......... ............ A Removal of support implant ......................... 1.74 6.69 3.93 0.28 8.71 5.95 010 

20680 ......... ............ A Removal of support implant ......................... 3.34 3.22 3.22 0.55 7.11 7.11 090 

20690 ......... ............ A Apply bone fixation device ........................... 3.51 NA 2.47 0.57 NA 6.55 090 

20692 ......... ............ A Apply bone fixation device ........................... 6.40 NA 3.73 0.72 NA 10.85 090 

20693 ......... ............ A Adjust bone fixation device .......................... 5.85 NA 5.54 1.03 NA 12.42 090 

20694 ......... ............ A Remove bone fixation device ...................... 4.15 6.86 4.49 0.69 11.70 9.33 090 

20802 ......... ............ A Replantation, arm, complete ........................ 41.09 NA 21.40 7.01 NA 69.50 090 

20805 ......... ............ A Replant forearm, complete .......................... 49.93 NA 35.06 4.76 NA 89.75 090 

20808 ......... ............ A Replantation hand, complete ....................... 61.56 NA 43.43 7.83 NA 112.82 090 

20816 ......... ............ A Replantation digit, complete ........................ 30.89 NA 39.17 3.63 NA 73.69 090 

20822 ......... ............ A Replantation digit, complete ........................ 25.55 NA 35.90 3.70 NA 65.15 090 

20824 ......... ............ A Replantation thumb, complete ..................... 30.89 NA 38.12 4.20 NA 73.21 090 

20827 ......... ............ A Replantation thumb, complete ..................... 26.37 NA 37.95 3.87 NA 68.19 090 

20838 ......... ............ A Replantation foot, complete ......................... 41.35 NA 22.70 7.06 NA 71.11 090 

20900 ......... ............ A Removal of bone for graft ............................ 5.57 7.31 5.79 0.93 13.81 12.29 090 

20902 ......... ............ A Removal of bone for graft ............................ 7.54 NA 6.86 1.28 NA 15.68 090 

20910 ......... ............ A Remove cartilage for graft ........................... 5.33 7.11 5.44 0.60 13.04 11.37 090 

20912 ......... ............ A Remove cartilage for graft ........................... 6.34 NA 6.09 0.66 NA 13.09 090 

20920 ......... ............ A Removal of fascia for graft .......................... 5.30 NA 4.37 0.65 NA 10.32 090 

20922 ......... ............ A Removal of fascia for graft .......................... 6.60 6.73 5.06 1.06 14.39 12.72 090 

20924 ......... ............ A Removal of tendon for graft ......................... 6.47 NA 5.92 0.99 NA 13.38 090 

20926 ......... ............ A Removal of tissue for graft .......................... 5.52 NA 4.93 0.88 NA 11.33 090 

20930 ......... ............ B Spinal bone allograft .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20931 ......... ............ A Spinal bone allograft .................................... 1.81 NA 0.93 0.41 NA 3.15 ZZZ 

20936 ......... ............ B Spinal bone autograft .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

20937 ......... ............ A Spinal bone autograft .................................. 2.79 NA 1.46 0.52 NA 4.77 ZZZ 

20938 ......... ............ A Spinal bone autograft .................................. 3.02 NA 1.56 0.63 NA 5.21 ZZZ 

20950 ......... ............ A Fluid pressure, muscle ................................ 1.26 1.36 1.01 0.19 2.81 2.46 000 

20955 ......... ............ A Fibula bone graft, microvasc ....................... 39.15 NA 25.01 5.25 NA 69.41 090 

20956 ......... ............ A Iliac bone graft, microvasc ........................... 39.21 NA 24.86 6.96 NA 71.03 090 

20957 ......... ............ A Mt bone graft, microvasc ............................. 40.59 NA 19.08 6.92 NA 66.59 090 

20962 ......... ............ A Other bone graft, microvasc ........................ 39.21 NA 26.41 6.26 NA 71.88 090 

20969 ......... ............ A Bone/skin graft, microvasc .......................... 43.85 NA 27.48 5.23 NA 76.56 090 

20970 ......... ............ A Bone/skin graft, iliac crest ........................... 43.00 NA 25.84 5.60 NA 74.44 090 

20972 ......... ............ A Bone/skin graft, metatarsal .......................... 42.93 21.79 20.14 7.32 72.04 70.39 090 

20973 ......... ............ A Bone/skin graft, great toe ............................ 45.69 NA 25.29 5.61 NA 76.59 090 

20974 ......... ............ A Electrical bone stimulation ........................... 0.62 0.62 0.55 0.11 1.35 1.28 000 

20975 ......... ............ A Electrical bone stimulation ........................... 2.60 NA 1.73 0.51 NA 4.84 000 

20979 ......... ............ A Us bone stimulation ..................................... 0.62 0.77 0.34 0.05 1.44 1.01 000 

20982 ......... ............ A Ablate, bone tumor(s) perq .......................... 7.27 105.35 2.99 0.69 113.31 10.95 000 

20999 ......... ............ C Musculoskeletal surgery .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21010 ......... ............ A Incision of jaw joint ...................................... 10.12 NA 7.25 0.65 NA 18.02 090 

21015 ......... ............ A Resection of facial tumor ............................. 5.28 NA 5.53 0.63 NA 11.44 090 

21025 ......... ............ A Excision of bone, lower jaw ......................... 10.04 10.20 8.21 0.95 21.19 19.20 090 

21026 ......... ............ A Excision of facial bone(s) ............................ 4.84 6.94 5.53 0.48 12.26 10.85 090 

21029 ......... ............ A Contour of face bone lesion ........................ 7.70 8.60 6.27 0.89 17.19 14.86 090 

1125

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21030 ......... ............ A Excise max/zygoma b9 tumor ..................... 4.49 6.84 4.31 0.72 12.05 9.52 090 

21031 ......... ............ A Remove exostosis, mandible ....................... 3.24 4.58 3.14 0.34 8.16 6.72 090 

21032 ......... ............ A Remove exostosis, maxilla .......................... 3.24 4.63 3.25 0.33 8.20 6.82 090 

21034 ......... ............ A Excise max/zygoma mlg tumor ................... 16.15 13.56 11.32 1.65 31.36 29.12 090 

21040 ......... ............ A Excise mandible lesion ................................ 4.49 6.87 4.14 0.23 11.59 8.86 090 

21044 ......... ............ A Removal of jaw bone lesion ........................ 11.84 NA 8.68 1.05 NA 21.57 090 

21045 ......... ............ A Extensive jaw surgery .................................. 16.15 NA 11.43 1.45 NA 29.03 090 

21046 ......... ............ A Remove mandible cyst complex .................. 12.98 NA 12.69 1.22 NA 26.89 090 

21047 ......... ............ A Excise lwr jaw cyst w/repair ........................ 18.72 NA 13.44 1.85 NA 34.01 090 

21048 ......... ............ A Remove maxilla cyst complex ..................... 13.48 NA 12.97 1.22 NA 27.67 090 

21049 ......... ............ A Excis uppr jaw cyst w/repair ........................ 17.97 NA 13.03 1.22 NA 32.22 090 

21050 ......... ............ A Removal of jaw joint .................................... 10.75 NA 10.26 1.01 NA 22.02 090 

21060 ......... ............ A Remove jaw joint cartilage .......................... 10.21 NA 9.80 1.40 NA 21.41 090 

21070 ......... ............ A Remove coronoid process ........................... 8.19 NA 7.03 0.81 NA 16.03 090 

21076 ......... ............ A Prepare face/oral prosthesis ........................ 13.40 12.71 10.17 1.64 27.75 25.21 010 

21077 ......... ............ A Prepare face/oral prosthesis ........................ 33.70 32.20 26.20 4.14 70.04 64.04 090 

21079 ......... ............ A Prepare face/oral prosthesis ........................ 22.31 22.21 17.49 1.92 46.44 41.72 090 

21080 ......... ............ A Prepare face/oral prosthesis ........................ 25.06 25.22 19.77 3.08 53.36 47.91 090 

21081 ......... ............ A Prepare face/oral prosthesis ........................ 22.85 22.95 17.79 2.26 48.06 42.90 090 

21082 ......... ............ A Prepare face/oral prosthesis ........................ 20.84 19.88 15.99 1.76 42.48 38.59 090 

21083 ......... ............ A Prepare face/oral prosthesis ........................ 19.27 19.35 14.73 2.36 40.98 36.36 090 

21084 ......... ............ A Prepare face/oral prosthesis ........................ 22.48 22.71 17.68 1.89 47.08 42.05 090 

21085 ......... ............ A Prepare face/oral prosthesis ........................ 8.99 8.52 6.88 0.78 18.29 16.65 010 

21086 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 24.30 19.60 2.24 51.42 46.72 090 

21087 ......... ............ A Prepare face/oral prosthesis ........................ 24.88 23.89 19.41 2.68 51.45 46.97 090 

21088 ......... ............ C Prepare face/oral prosthesis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

21089 ......... ............ C Prepare face/oral prosthesis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

21100 ......... ............ A Maxillofacial fixation ..................................... 4.21 5.62 4.62 0.22 10.05 9.05 090 

21110 ......... ............ A Interdental fixation ....................................... 5.20 7.02 5.66 0.34 12.56 11.20 090 

21116 ......... ............ A Injection, jaw joint x-ray ............................... 0.81 7.32 0.34 0.06 8.19 1.21 000 

21120 ......... ............ A Reconstruction of chin ................................. 4.92 8.83 5.30 0.35 14.10 10.57 090 

21121 ......... ............ A Reconstruction of chin ................................. 7.63 10.43 6.65 0.68 18.74 14.96 090 

21122 ......... ............ A Reconstruction of chin ................................. 8.51 NA 7.08 0.71 NA 16.30 090 

21123 ......... ............ A Reconstruction of chin ................................. 11.14 NA 8.26 1.40 NA 20.80 090 

21125 ......... ............ A Augmentation, lower jaw bone .................... 10.60 11.82 8.28 0.87 23.29 19.75 090 

21127 ......... ............ A Augmentation, lower jaw bone .................... 11.10 14.52 9.11 0.92 26.54 21.13 090 

21137 ......... ............ A Reduction of forehead ................................. 9.81 NA 7.44 0.64 NA 17.89 090 

21138 ......... ............ A Reduction of forehead ................................. 12.17 NA 9.31 1.77 NA 23.25 090 

21139 ......... ............ A Reduction of forehead ................................. 14.59 NA 9.78 1.23 NA 25.60 090 

21141 ......... ............ A Reconstruct midface, lefort .......................... 18.07 NA 13.88 1.97 NA 33.92 090 

21142 ......... ............ A Reconstruct midface, lefort .......................... 18.78 NA 13.08 1.40 NA 33.26 090 

21143 ......... ............ A Reconstruct midface, lefort .......................... 19.55 NA 14.09 1.09 NA 34.73 090 

21145 ......... ............ A Reconstruct midface, lefort .......................... 19.91 NA 14.15 2.52 NA 36.58 090 

21146 ......... ............ A Reconstruct midface, lefort .......................... 20.68 NA 15.59 2.57 NA 38.84 090 

21147 ......... ............ A Reconstruct midface, lefort .......................... 21.74 NA 15.29 1.83 NA 38.86 090 

21150 ......... ............ A Reconstruct midface, lefort .......................... 25.20 NA 14.12 1.31 NA 40.63 090 

21151 ......... ............ A Reconstruct midface, lefort .......................... 28.26 NA 17.92 2.39 NA 48.57 090 

21154 ......... ............ A Reconstruct midface, lefort .......................... 30.47 NA 20.18 5.86 NA 56.51 090 

21155 ......... ............ A Reconstruct midface, lefort .......................... 34.40 NA 22.30 6.61 NA 63.31 090 

21159 ......... ............ A Reconstruct midface, lefort .......................... 42.32 NA 24.47 8.13 NA 74.92 090 

21160 ......... ............ A Reconstruct midface, lefort .......................... 46.37 NA 24.41 5.29 NA 76.07 090 

21172 ......... ............ A Reconstruct orbit/forehead .......................... 27.76 NA 14.07 2.30 NA 44.13 090 

21175 ......... ............ A Reconstruct orbit/forehead .......................... 33.12 NA 18.31 6.22 NA 57.65 090 

21179 ......... ............ A Reconstruct entire forehead ........................ 22.22 NA 14.86 2.99 NA 40.07 090 

21180 ......... ............ A Reconstruct entire forehead ........................ 25.15 NA 16.07 2.59 NA 43.81 090 

21181 ......... ............ A Contour cranial bone lesion ......................... 9.89 NA 7.81 1.17 NA 18.87 090 

21182 ......... ............ A Reconstruct cranial bone ............................. 32.14 NA 19.66 3.05 NA 54.85 090 

21183 ......... ............ A Reconstruct cranial bone ............................. 35.26 NA 21.36 3.32 NA 59.94 090 

21184 ......... ............ A Reconstruct cranial bone ............................. 38.18 NA 22.55 4.97 NA 65.70 090 

21188 ......... ............ A Reconstruction of midface ........................... 22.43 NA 15.18 2.23 NA 39.84 090 

21193 ......... ............ A Reconst lwr jaw w/o graft ............................ 17.12 NA 12.97 1.85 NA 31.94 090 

21194 ......... ............ A Reconst lwr jaw w/graft ............................... 19.81 NA 14.06 1.68 NA 35.55 090 

21195 ......... ............ A Reconst lwr jaw w/o fixation ........................ 17.21 NA 13.26 1.45 NA 31.92 090 

21196 ......... ............ A Reconst lwr jaw w/fixation ........................... 18.88 NA 13.88 1.95 NA 34.71 090 

21198 ......... ............ A Reconstr lwr jaw segment ........................... 14.14 NA 10.90 1.27 NA 26.31 090 

21199 ......... ............ A Reconstr lwr jaw w/advance ........................ 15.98 NA 9.19 1.52 NA 26.69 090 

21206 ......... ............ A Reconstruct upper jaw bone ........................ 14.08 NA 10.81 1.22 NA 26.11 090 

21208 ......... ............ A Augmentation of facial bones ...................... 10.21 14.49 9.28 1.11 25.81 20.60 090 

21209 ......... ............ A Reduction of facial bones ............................ 6.71 11.89 7.23 0.72 19.32 14.66 090 

21210 ......... ............ A Face bone graft ........................................... 10.21 13.69 9.41 1.06 24.96 20.68 090 

21215 ......... ............ A Lower jaw bone graft ................................... 10.75 13.48 9.61 1.25 25.48 21.61 090 

21230 ......... ............ A Rib cartilage graft ........................................ 10.75 NA 8.57 1.16 NA 20.48 090 

21235 ......... ............ A Ear cartilage graft ........................................ 6.71 11.37 7.10 0.63 18.71 14.44 090 

21240 ......... ............ A Reconstruction of jaw joint .......................... 14.03 NA 12.70 1.39 NA 28.12 090 

21242 ......... ............ A Reconstruction of jaw joint .......................... 12.93 NA 12.21 1.69 NA 26.83 090 

1126

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21243 ......... ............ A Reconstruction of jaw joint .......................... 20.76 NA 17.87 2.23 NA 40.86 090 

21244 ......... ............ A Reconstruction of lower jaw ........................ 11.84 NA 10.06 1.15 NA 23.05 090 

21245 ......... ............ A Reconstruction of jaw .................................. 11.84 16.10 9.73 1.06 29.00 22.63 090 

21246 ......... ............ A Reconstruction of jaw .................................. 12.45 14.55 9.85 1.46 28.46 23.76 090 

21247 ......... ............ A Reconstruct lower jaw bone ........................ 22.60 NA 17.93 2.67 NA 43.20 090 

21248 ......... ............ A Reconstruction of jaw .................................. 11.46 13.02 9.31 1.22 25.70 21.99 090 

21249 ......... ............ A Reconstruction of jaw .................................. 17.49 16.58 12.66 1.68 35.75 31.83 090 

21255 ......... ............ A Reconstruct lower jaw bone ........................ 16.69 NA 12.78 1.36 NA 30.83 090 

21256 ......... ............ A Reconstruction of orbit ................................. 16.17 NA 12.17 1.25 NA 29.59 090 

21260 ......... ............ A Revise eye sockets ...................................... 16.50 NA 8.96 1.51 NA 26.97 090 

21261 ......... ............ A Revise eye sockets ...................................... 31.44 NA 19.21 2.65 NA 53.30 090 

21263 ......... ............ A Revise eye sockets ...................................... 28.38 NA 12.86 2.61 NA 43.85 090 

21267 ......... ............ A Revise eye sockets ...................................... 18.87 NA 13.22 1.63 NA 33.72 090 

21268 ......... ............ A Revise eye sockets ...................................... 24.44 NA 15.32 0.95 NA 40.71 090 

21270 ......... ............ A Augmentation, cheek bone .......................... 10.21 11.90 8.10 0.88 22.99 19.19 090 

21275 ......... ............ A Revision, orbitofacial bones ......................... 11.22 NA 8.74 1.24 NA 21.20 090 

21280 ......... ............ A Revision of eyelid ........................................ 6.02 NA 6.07 0.33 NA 12.42 090 

21282 ......... ............ A Revision of eyelid ........................................ 3.48 NA 4.68 0.25 NA 8.41 090 

21295 ......... ............ A Revision of jaw muscle/bone ....................... 1.53 NA 2.82 0.16 NA 4.51 090 

21296 ......... ............ A Revision of jaw muscle/bone ....................... 4.24 NA 4.43 0.36 NA 9.03 090 

21299 ......... ............ C Cranio/maxillofacial surgery ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21300 ......... ............ A Treatment of skull fracture ........................... 0.72 2.38 0.26 0.11 3.21 1.09 000 

21310 ......... ............ A Treatment of nose fracture .......................... 0.58 2.34 0.15 0.06 2.98 0.79 000 

21315 ......... ............ A Treatment of nose fracture .......................... 1.51 3.03 1.27 0.14 4.68 2.92 010 

21320 ......... ............ A Treatment of nose fracture .......................... 1.85 4.25 1.84 0.18 6.28 3.87 010 

21325 ......... ............ A Treatment of nose fracture .......................... 3.76 NA 3.75 0.37 NA 7.88 090 

21330 ......... ............ A Treatment of nose fracture .......................... 5.37 NA 5.28 0.58 NA 11.23 090 

21335 ......... ............ A Treatment of nose fracture .......................... 8.60 NA 6.81 0.77 NA 16.18 090 

21336 ......... ............ A Treat nasal septal fracture ........................... 5.71 NA 6.07 0.54 NA 12.32 090 

21337 ......... ............ A Treat nasal septal fracture ........................... 2.70 5.11 3.69 0.27 8.08 6.66 090 

21338 ......... ............ A Treat nasoethmoid fracture ......................... 6.45 NA 5.99 0.64 NA 13.08 090 

21339 ......... ............ A Treat nasoethmoid fracture ......................... 8.08 NA 6.75 0.92 NA 15.75 090 

21340 ......... ............ A Treatment of nose fracture .......................... 10.75 NA 8.70 1.03 NA 20.48 090 

21343 ......... ............ A Treatment of sinus fracture ......................... 12.93 NA 10.14 1.28 NA 24.35 090 

21344 ......... ............ A Treatment of sinus fracture ......................... 19.69 NA 13.71 2.07 NA 35.47 090 

21345 ......... ............ A Treat nose/jaw fracture ................................ 8.15 11.54 7.90 0.72 20.41 16.77 090 

21346 ......... ............ A Treat nose/jaw fracture ................................ 10.59 13.18 9.03 1.03 24.80 20.65 090 

21347 ......... ............ A Treat nose/jaw fracture ................................ 12.67 NA 9.77 1.37 NA 23.81 090 

21348 ......... ............ A Treat nose/jaw fracture ................................ 16.66 NA 11.31 1.81 NA 29.78 090 

21355 ......... ............ A Treat cheek bone fracture ........................... 3.76 4.70 2.37 0.35 8.81 6.48 010 

21356 ......... ............ A Treat cheek bone fracture ........................... 4.14 11.67 3.22 0.43 16.24 7.79 010 

21360 ......... ............ A Treat cheek bone fracture ........................... 6.45 13.89 6.19 0.63 20.97 13.27 090 

21365 ......... ............ A Treat cheek bone fracture ........................... 14.93 NA 11.77 1.57 NA 28.27 090 

21366 ......... ............ A Treat cheek bone fracture ........................... 17.74 NA 11.64 1.70 NA 31.08 090 

21385 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 7.07 0.77 NA 16.99 090 

21386 ......... ............ A Treat eye socket fracture ............................. 9.15 NA 7.48 0.92 NA 17.55 090 

21387 ......... ............ A Treat eye socket fracture ............................. 9.69 NA 7.54 0.94 NA 18.17 090 

21390 ......... ............ A Treat eye socket fracture ............................. 10.11 NA 8.01 0.84 NA 18.96 090 

21395 ......... ............ A Treat eye socket fracture ............................. 12.66 NA 9.32 1.31 NA 23.29 090 

21400 ......... ............ A Treat eye socket fracture ............................. 1.40 3.72 2.10 0.14 5.26 3.64 090 

21401 ......... ............ A Treat eye socket fracture ............................. 3.26 5.05 3.87 0.41 8.72 7.54 090 

21406 ......... ............ A Treat eye socket fracture ............................. 7.00 NA 6.35 0.71 NA 14.06 090 

21407 ......... ............ A Treat eye socket fracture ............................. 8.60 NA 7.14 0.81 NA 16.55 090 

21408 ......... ............ A Treat eye socket fracture ............................. 12.36 NA 9.21 1.50 NA 23.07 090 

21421 ......... ............ A Treat mouth roof fracture ............................. 5.13 9.92 6.16 0.51 15.56 11.80 090 

21422 ......... ............ A Treat mouth roof fracture ............................. 8.31 11.28 7.10 0.83 20.42 16.24 090 

21423 ......... ............ A Treat mouth roof fracture ............................. 10.38 NA 8.49 1.15 NA 20.02 090 

21431 ......... ............ A Treat craniofacial fracture ............................ 7.04 10.66 6.84 0.70 18.40 14.58 090 

21432 ......... ............ A Treat craniofacial fracture ............................ 8.60 NA 6.19 0.66 NA 15.45 090 

21433 ......... ............ A Treat craniofacial fracture ............................ 25.31 NA 16.83 2.97 NA 45.11 090 

21435 ......... ............ A Treat craniofacial fracture ............................ 17.22 NA 12.96 2.00 NA 32.18 090 

21436 ......... ............ A Treat craniofacial fracture ............................ 28.00 NA 18.42 2.80 NA 49.22 090 

21440 ......... ............ A Treat dental ridge fracture ........................... 2.70 8.05 4.11 0.27 11.02 7.08 090 

21445 ......... ............ A Treat dental ridge fracture ........................... 5.37 10.45 6.28 0.66 16.48 12.31 090 

21450 ......... ............ A Treat lower jaw fracture ............................... 2.97 10.65 3.76 0.28 13.90 7.01 090 

21451 ......... ............ A Treat lower jaw fracture ............................... 4.86 8.77 5.76 0.47 14.10 11.09 090 

21452 ......... ............ A Treat lower jaw fracture ............................... 1.98 7.85 3.56 0.17 10.00 5.71 090 

21453 ......... ............ A Treat lower jaw fracture ............................... 5.53 10.50 6.83 0.59 16.62 12.95 090 

21454 ......... ............ A Treat lower jaw fracture ............................... 6.45 NA 6.54 0.66 NA 13.65 090 

21461 ......... ............ A Treat lower jaw fracture ............................... 8.08 12.52 8.30 0.88 21.48 17.26 090 

21462 ......... ............ A Treat lower jaw fracture ............................... 9.78 14.06 9.02 0.96 24.80 19.76 090 

21465 ......... ............ A Treat lower jaw fracture ............................... 11.89 NA 10.05 1.01 NA 22.95 090 

21470 ......... ............ A Treat lower jaw fracture ............................... 15.32 NA 12.24 1.64 NA 29.20 090 

21480 ......... ............ A Reset dislocated jaw .................................... 0.61 1.95 0.19 0.06 2.62 0.86 000 

21485 ......... ............ A Reset dislocated jaw .................................... 3.98 5.94 4.80 0.37 10.29 9.15 090 

1127

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

21490 ......... ............ A Repair dislocated jaw .................................. 11.84 NA 9.90 1.58 NA 23.32 090 

21493 ......... ............ A Treat hyoid bone fracture ............................ 1.27 NA 2.84 0.12 NA 4.23 090 

21494 ......... ............ A Treat hyoid bone fracture ............................ 6.27 NA 5.70 0.53 NA 12.50 090 

21495 ......... ............ A Treat hyoid bone fracture ............................ 5.68 NA 5.99 0.49 NA 12.16 090 

21497 ......... ............ A Interdental wiring ......................................... 3.85 6.54 5.01 0.37 10.76 9.23 090 

21499 ......... ............ C Head surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21501 ......... ............ A Drain neck/chest lesion ............................... 3.80 4.70 3.95 0.43 8.93 8.18 090 

21502 ......... ............ A Drain chest lesion ........................................ 7.11 NA 5.70 0.95 NA 13.76 090 

21510 ......... ............ A Drainage of bone lesion .............................. 5.73 NA 5.72 0.81 NA 12.26 090 

21550 ......... ............ A Biopsy of neck/chest .................................... 2.06 3.64 1.74 0.16 5.86 3.96 010 

21555 ......... ............ A Remove lesion, neck/chest .......................... 4.34 5.06 3.17 0.49 9.89 8.00 090 

21556 ......... ............ A Remove lesion, neck/chest .......................... 5.56 NA 4.11 0.62 NA 10.29 090 

21557 ......... ............ A Remove tumor, neck/chest .......................... 8.87 NA 5.44 1.03 NA 15.34 090 

21600 ......... ............ A Partial removal of rib ................................... 6.88 NA 5.80 0.98 NA 13.66 090 

21610 ......... ............ A Partial removal of rib ................................... 14.59 NA 9.04 2.23 NA 25.86 090 

21615 ......... ............ A Removal of rib ............................................. 9.86 NA 6.73 1.45 NA 18.04 090 

21616 ......... ............ A Removal of rib and nerves .......................... 12.02 NA 8.05 1.58 NA 21.65 090 

21620 ......... ............ A Partial removal of sternum .......................... 6.78 NA 6.07 0.93 NA 13.78 090 

21627 ......... ............ A Sternal debridement .................................... 6.80 NA 6.46 0.99 NA 14.25 090 

21630 ......... ............ A Extensive sternum surgery .......................... 17.35 NA 11.99 2.35 NA 31.69 090 

21632 ......... ............ A Extensive sternum surgery .......................... 18.11 NA 11.18 2.61 NA 31.90 090 

21685 ......... ............ A Hyoid myotomy & suspension ..................... 12.98 NA 10.09 1.52 NA 24.59 090 

21700 ......... ............ A Revision of neck muscle .............................. 6.18 6.08 4.86 0.37 12.63 11.41 090 

21705 ......... ............ A Revision of neck muscle/rib ......................... 9.59 NA 5.63 1.11 NA 16.33 090 

21720 ......... ............ A Revision of neck muscle .............................. 5.67 5.47 4.64 0.96 12.10 11.27 090 

21725 ......... ............ A Revision of neck muscle .............................. 6.98 NA 5.52 1.09 NA 13.59 090 

21740 ......... ............ A Reconstruction of sternum ........................... 16.48 NA 8.60 2.45 NA 27.53 090 

21742 ......... ............ C Repair stern/nuss w/o scope ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21743 ......... ............ C Repair sternum/nuss w/scope ..................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21750 ......... ............ A Repair of sternum separation ...................... 10.75 NA 6.14 1.63 NA 18.52 090 

21800 ......... ............ A Treatment of rib fracture .............................. 0.96 2.10 1.40 0.11 3.17 2.47 090 

21805 ......... ............ A Treatment of rib fracture .............................. 2.75 NA 3.35 0.35 NA 6.45 090 

21810 ......... ............ A Treatment of rib fracture(s) .......................... 6.85 NA 5.03 0.72 NA 12.60 090 

21820 ......... ............ A Treat sternum fracture ................................. 1.28 2.63 1.83 0.18 4.09 3.29 090 

21825 ......... ............ A Treat sternum fracture ................................. 7.40 NA 6.69 1.01 NA 15.10 090 

21899 ......... ............ C Neck/chest surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

21920 ......... ............ A Biopsy soft tissue of back ............................ 2.06 3.28 1.49 0.14 5.48 3.69 010 

21925 ......... ............ A Biopsy soft tissue of back ............................ 4.48 6.63 3.35 0.53 11.64 8.36 090 

21930 ......... ............ A Remove lesion, back or flank ...................... 4.99 5.48 3.46 0.59 11.06 9.04 090 

21935 ......... ............ A Remove tumor, back ................................... 17.93 NA 10.20 2.26 NA 30.39 090 

22100 ......... ............ A Remove part of neck vertebra ..................... 9.72 NA 7.63 1.87 NA 19.22 090 

22101 ......... ............ A Remove part, thorax vertebra ...................... 9.80 NA 7.87 1.82 NA 19.49 090 

22102 ......... ............ A Remove part, lumbar vertebra ..................... 9.80 NA 8.08 1.76 NA 19.64 090 

22103 ......... ............ A Remove extra spine segment ...................... 2.34 NA 1.21 0.45 NA 4.00 ZZZ 

22110 ......... ............ A Remove part of neck vertebra ..................... 12.72 NA 9.27 2.65 NA 24.64 090 

22112 ......... ............ A Remove part, thorax vertebra ...................... 12.79 NA 9.33 2.36 NA 24.48 090 

22114 ......... ............ A Remove part, lumbar vertebra ..................... 12.79 NA 9.31 2.39 NA 24.49 090 

22116 ......... ............ A Remove extra spine segment ...................... 2.32 NA 1.17 0.48 NA 3.97 ZZZ 

22210 ......... ............ A Revision of neck spine ................................ 23.78 NA 15.51 5.10 NA 44.39 090 

22212 ......... ............ A Revision of thorax spine .............................. 19.39 NA 13.27 3.35 NA 36.01 090 

22214 ......... ............ A Revision of lumbar spine ............................. 19.42 NA 13.78 3.35 NA 36.55 090 

22216 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.14 1.18 NA 10.35 ZZZ 

22220 ......... ............ A Revision of neck spine ................................ 21.34 NA 13.79 4.40 NA 39.53 090 

22222 ......... ............ A Revision of thorax spine .............................. 21.49 NA 11.61 3.71 NA 36.81 090 

22224 ......... ............ A Revision of lumbar spine ............................. 21.49 NA 14.24 3.86 NA 39.59 090 

22226 ......... ............ A Revise, extra spine segment ....................... 6.03 NA 3.11 1.22 NA 10.36 ZZZ 

22305 ......... ............ A Treat spine process fracture ........................ 2.05 3.19 2.39 0.35 5.59 4.79 090 

22310 ......... ............ A Treat spine fracture ..................................... 2.61 4.88 4.11 0.45 7.94 7.17 090 

22315 ......... ............ A Treat spine fracture ..................................... 8.83 13.42 7.53 1.65 23.90 18.01 090 

22318 ......... ............ A Treat odontoid fx w/o graft .......................... 21.47 NA 13.52 5.14 NA 40.13 090 

22319 ......... ............ A Treat odontoid fx w/graft .............................. 23.96 NA 14.90 5.74 NA 44.60 090 

22325 ......... ............ A Treat spine fracture ..................................... 18.27 NA 12.15 3.15 NA 33.57 090 

22326 ......... ............ A Treat neck spine fracture ............................. 19.56 NA 12.83 4.27 NA 36.66 090 

22327 ......... ............ A Treat thorax spine fracture .......................... 19.17 NA 12.44 3.32 NA 34.93 090 

22328 ......... ............ A Treat each add spine fx ............................... 4.60 NA 2.28 0.80 NA 7.68 ZZZ 

22505 ......... ............ A Manipulation of spine ................................... 1.87 NA 0.94 0.33 NA 3.14 010 

22520 ......... ............ A Percut vertebroplasty thor ........................... 8.90 101.62 4.34 1.19 111.71 14.43 010 

22521 ......... ............ A Percut vertebroplasty lumb .......................... 8.33 89.47 4.18 1.12 98.92 13.63 010 

22522 ......... ............ A Percut vertebroplasty add’l .......................... 4.30 NA 1.69 0.40 NA 6.39 ZZZ 

22532 ......... ............ A Lat thorax spine fusion ................................ 23.96 NA 14.82 4.56 NA 43.34 090 

22533 ......... ............ A Lat lumbar spine fusion ............................... 23.09 NA 13.48 3.84 NA 40.41 090 

22534 ......... ............ A Lat thor/lumb, add’l seg ............................... 5.99 NA 3.04 1.18 NA 10.21 ZZZ 

22548 ......... ............ A Neck spine fusion ........................................ 25.78 NA 15.83 6.01 NA 47.62 090 

22554 ......... ............ A Neck spine fusion ........................................ 18.59 NA 12.32 4.23 NA 35.14 090 

22556 ......... ............ A Thorax spine fusion ..................................... 23.42 NA 14.68 4.56 NA 42.66 090 

1128

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

22558 ......... ............ A Lumbar spine fusion .................................... 22.25 NA 13.24 3.84 NA 39.33 090 

22585 ......... ............ A Additional spinal fusion ................................ 5.52 NA 2.80 1.18 NA 9.50 ZZZ 

22590 ......... ............ A Spine & skull spinal fusion .......................... 20.48 NA 13.29 4.60 NA 38.37 090 

22595 ......... ............ A Neck spinal fusion ....................................... 19.36 NA 12.80 4.37 NA 36.53 090 

22600 ......... ............ A Neck spine fusion ........................................ 16.12 NA 11.14 3.49 NA 30.75 090 

22610 ......... ............ A Thorax spine fusion ..................................... 16.00 NA 11.32 3.21 NA 30.53 090 

22612 ......... ............ A Lumbar spine fusion .................................... 20.97 NA 14.09 3.96 NA 39.02 090 

22614 ......... ............ A Spine fusion, extra segment ........................ 6.43 NA 3.36 1.25 NA 11.04 ZZZ 

22630 ......... ............ A Lumbar spine fusion .................................... 20.81 NA 13.55 4.57 NA 38.93 090 

22632 ......... ............ A Spine fusion, extra segment ........................ 5.22 NA 2.67 1.09 NA 8.98 ZZZ 

22800 ......... ............ A Fusion of spine ............................................ 18.22 NA 12.64 3.27 NA 34.13 090 

22802 ......... ............ A Fusion of spine ............................................ 30.83 NA 19.48 5.33 NA 55.64 090 

22804 ......... ............ A Fusion of spine ............................................ 36.22 NA 22.58 6.31 NA 65.11 090 

22808 ......... ............ A Fusion of spine ............................................ 26.23 NA 16.25 5.26 NA 47.74 090 

22810 ......... ............ A Fusion of spine ............................................ 30.22 NA 18.29 5.42 NA 53.93 090 

22812 ......... ............ A Fusion of spine ............................................ 32.65 NA 19.95 5.63 NA 58.23 090 

22818 ......... ............ A Kyphectomy, 1-2 segments ......................... 31.78 NA 18.86 6.04 NA 56.68 090 

22819 ......... ............ A Kyphectomy, 3 or more ............................... 36.39 NA 20.03 6.27 NA 62.69 090 

22830 ......... ............ A Exploration of spinal fusion ......................... 10.83 NA 7.89 2.09 NA 20.81 090 

22840 ......... ............ A Insert spine fixation device .......................... 12.52 NA 6.51 2.45 NA 21.48 ZZZ 

22841 ......... ............ B Insert spine fixation device .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

22842 ......... ............ A Insert spine fixation device .......................... 12.56 NA 6.53 2.46 NA 21.55 ZZZ 

22843 ......... ............ A Insert spine fixation device .......................... 13.44 NA 6.63 2.53 NA 22.60 ZZZ 

22844 ......... ............ A Insert spine fixation device .......................... 16.42 NA 8.78 2.92 NA 28.12 ZZZ 

22845 ......... ............ A Insert spine fixation device .......................... 11.94 NA 6.11 2.68 NA 20.73 ZZZ 

22846 ......... ............ A Insert spine fixation device .......................... 12.40 NA 6.36 2.73 NA 21.49 ZZZ 

22847 ......... ............ A Insert spine fixation device .......................... 13.78 NA 7.06 2.85 NA 23.69 ZZZ 

22848 ......... ............ A Insert pelv fixation device ............................ 5.99 NA 3.20 1.06 NA 10.25 ZZZ 

22849 ......... ............ A Reinsert spinal fixation ................................ 18.48 NA 11.76 3.46 NA 33.70 090 

22850 ......... ............ A Remove spine fixation device ...................... 9.51 NA 7.00 1.82 NA 18.33 090 

22851 ......... ............ A Apply spine prosth device ........................... 6.70 NA 3.37 1.34 NA 11.41 ZZZ 

22852 ......... ............ A Remove spine fixation device ...................... 9.00 NA 6.79 1.69 NA 17.48 090 

22855 ......... ............ A Remove spine fixation device ...................... 15.11 NA 9.72 3.30 NA 28.13 090 

22899 ......... ............ C Spine surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

22900 ......... ............ A Remove abdominal wall lesion .................... 5.79 NA 3.28 0.70 NA 9.77 090 

22999 ......... ............ C Abdomen surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

23000 ......... ............ A Removal of calcium deposits ....................... 4.35 5.18 4.16 0.60 10.13 9.11 090 

23020 ......... ............ A Release shoulder joint ................................. 8.92 NA 7.58 1.48 NA 17.98 090 

23030 ......... ............ A Drain shoulder lesion ................................... 3.42 3.01 2.93 0.51 6.94 6.86 010 

23031 ......... ............ A Drain shoulder bursa ................................... 2.74 2.69 2.69 0.40 5.83 5.83 010 

23035 ......... ............ A Drain shoulder bone lesion .......................... 8.60 NA 8.51 1.44 NA 18.55 090 

23040 ......... ............ A Exploratory shoulder surgery ....................... 9.19 NA 7.85 1.54 NA 18.58 090 

23044 ......... ............ A Exploratory shoulder surgery ....................... 7.11 NA 6.50 1.17 NA 14.78 090 

23065 ......... ............ A Biopsy shoulder tissues ............................... 2.27 2.81 1.54 0.17 5.25 3.98 010 

23066 ......... ............ A Biopsy shoulder tissues ............................... 4.15 5.10 4.07 0.60 9.85 8.82 090 

23075 ......... ............ A Removal of shoulder lesion ......................... 2.39 2.24 1.82 0.30 4.93 4.51 010 

23076 ......... ............ A Removal of shoulder lesion ......................... 7.62 NA 5.78 1.05 NA 14.45 090 

23077 ......... ............ A Remove tumor of shoulder .......................... 16.07 NA 10.76 2.18 NA 29.01 090 

23100 ......... ............ A Biopsy of shoulder joint ............................... 6.02 NA 5.69 0.98 NA 12.69 090 

23101 ......... ............ A Shoulder joint surgery .................................. 5.57 NA 5.39 0.93 NA 11.89 090 

23105 ......... ............ A Remove shoulder joint lining ....................... 8.22 NA 7.17 1.36 NA 16.75 090 

23106 ......... ............ A Incision of collarbone joint ........................... 5.95 NA 5.77 0.99 NA 12.71 090 

23107 ......... ............ A Explore treat shoulder joint .......................... 8.61 NA 7.39 1.44 NA 17.44 090 

23120 ......... ............ A Partial removal, collar bone ......................... 7.10 NA 6.48 1.19 NA 14.77 090 

23125 ......... ............ A Removal of collar bone ................................ 9.38 NA 7.63 1.53 NA 18.54 090 

23130 ......... ............ A Remove shoulder bone, part ....................... 7.54 NA 7.10 1.28 NA 15.92 090 

23140 ......... ............ A Removal of bone lesion ............................... 6.88 NA 5.41 0.99 NA 13.28 090 

23145 ......... ............ A Removal of bone lesion ............................... 9.08 NA 7.58 1.50 NA 18.16 090 

23146 ......... ............ A Removal of bone lesion ............................... 7.82 NA 7.13 1.34 NA 16.29 090 

23150 ......... ............ A Removal of humerus lesion ......................... 8.47 NA 6.97 1.37 NA 16.81 090 

23155 ......... ............ A Removal of humerus lesion ......................... 10.33 NA 8.46 1.45 NA 20.24 090 

23156 ......... ............ A Removal of humerus lesion ......................... 8.67 NA 7.38 1.42 NA 17.47 090 

23170 ......... ............ A Remove collar bone lesion .......................... 6.85 NA 6.36 1.01 NA 14.22 090 

23172 ......... ............ A Remove shoulder blade lesion .................... 6.89 NA 6.41 1.15 NA 14.45 090 

23174 ......... ............ A Remove humerus lesion .............................. 9.50 NA 8.37 1.57 NA 19.44 090 

23180 ......... ............ A Remove collar bone lesion .......................... 8.52 NA 9.21 1.42 NA 19.15 090 

23182 ......... ............ A Remove shoulder blade lesion .................... 8.14 NA 8.89 1.30 NA 18.33 090 

23184 ......... ............ A Remove humerus lesion .............................. 9.37 NA 9.54 1.50 NA 20.41 090 

23190 ......... ............ A Partial removal of scapula ........................... 7.23 NA 6.23 1.17 NA 14.63 090 

23195 ......... ............ A Removal of head of humerus ...................... 9.80 NA 7.76 1.66 NA 19.22 090 

23200 ......... ............ A Removal of collar bone ................................ 12.06 NA 8.97 1.79 NA 22.82 090 

23210 ......... ............ A Removal of shoulder blade .......................... 12.47 NA 9.30 1.94 NA 23.71 090 

23220 ......... ............ A Partial removal of humerus ......................... 14.54 NA 10.87 2.45 NA 27.86 090 

23221 ......... ............ A Partial removal of humerus ......................... 17.71 NA 11.84 3.03 NA 32.58 090 

23222 ......... ............ A Partial removal of humerus ......................... 23.88 NA 15.85 4.06 NA 43.79 090 

1129

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

23330 ......... ............ A Remove shoulder foreign body ................... 1.85 1.98 1.91 0.22 4.05 3.98 010 

23331 ......... ............ A Remove shoulder foreign body ................... 7.37 NA 6.79 1.23 NA 15.39 090 

23332 ......... ............ A Remove shoulder foreign body ................... 11.60 NA 9.31 1.95 NA 22.86 090 

23350 ......... ............ A Injection for shoulder x-ray .......................... 1.00 3.85 0.33 0.06 4.91 1.39 000 

23395 ......... ............ A Muscle transfer,shoulder/arm ...................... 16.82 NA 12.74 2.76 NA 32.32 090 

23397 ......... ............ A Muscle transfers .......................................... 16.11 NA 11.40 2.70 NA 30.21 090 

23400 ......... ............ A Fixation of shoulder blade ........................... 13.52 NA 10.16 2.30 NA 25.98 090 

23405 ......... ............ A Incision of tendon & muscle ........................ 8.36 NA 7.01 1.35 NA 16.72 090 

23406 ......... ............ A Incise tendon(s) & muscle(s) ....................... 10.77 NA 8.41 1.79 NA 20.97 090 

23410 ......... ............ A Repair rotator cuff, acute ............................. 12.43 NA 9.40 2.07 NA 23.90 090 

23412 ......... ............ A Repair rotator cuff, chronic .......................... 13.29 NA 9.90 2.24 NA 25.43 090 

23415 ......... ............ A Release of shoulder ligament ...................... 9.96 NA 7.97 1.68 NA 19.61 090 

23420 ......... ............ A Repair of shoulder ....................................... 13.28 NA 10.78 2.24 NA 26.30 090 

23430 ......... ............ A Repair biceps tendon ................................... 9.97 NA 8.11 1.69 NA 19.77 090 

23440 ......... ............ A Remove/transplant tendon ........................... 10.46 NA 8.29 1.77 NA 20.52 090 

23450 ......... ............ A Repair shoulder capsule .............................. 13.38 NA 9.87 2.24 NA 25.49 090 

23455 ......... ............ A Repair shoulder capsule .............................. 14.35 NA 10.45 2.42 NA 27.22 090 

23460 ......... ............ A Repair shoulder capsule .............................. 15.35 NA 11.37 2.62 NA 29.34 090 

23462 ......... ............ A Repair shoulder capsule .............................. 15.28 NA 10.78 2.61 NA 28.67 090 

23465 ......... ............ A Repair shoulder capsule .............................. 15.83 NA 11.30 1.94 NA 29.07 090 

23466 ......... ............ A Repair shoulder capsule .............................. 14.20 NA 11.27 2.41 NA 27.88 090 

23470 ......... ............ A Reconstruct shoulder joint ........................... 17.12 NA 12.13 2.89 NA 32.14 090 

23472 ......... ............ A Reconstruct shoulder joint ........................... 21.07 NA 14.27 2.86 NA 38.20 090 

23480 ......... ............ A Revision of collar bone ................................ 11.16 NA 8.77 1.88 NA 21.81 090 

23485 ......... ............ A Revision of collar bone ................................ 13.41 NA 9.91 2.22 NA 25.54 090 

23490 ......... ............ A Reinforce clavicle ......................................... 11.84 NA 8.81 1.34 NA 21.99 090 

23491 ......... ............ A Reinforce shoulder bones ............................ 14.19 NA 10.70 2.41 NA 27.30 090 

23500 ......... ............ A Treat clavicle fracture .................................. 2.08 3.66 2.57 0.31 6.05 4.96 090 

23505 ......... ............ A Treat clavicle fracture .................................. 3.68 5.33 3.76 0.60 9.61 8.04 090 

23515 ......... ............ A Treat clavicle fracture .................................. 7.40 NA 6.52 1.24 NA 15.16 090 

23520 ......... ............ A Treat clavicle dislocation ............................. 2.16 3.65 2.71 0.31 6.12 5.18 090 

23525 ......... ............ A Treat clavicle dislocation ............................. 3.59 5.27 3.88 0.53 9.39 8.00 090 

23530 ......... ............ A Treat clavicle dislocation ............................. 7.30 NA 6.03 1.03 NA 14.36 090 

23532 ......... ............ A Treat clavicle dislocation ............................. 8.00 NA 6.92 1.36 NA 16.28 090 

23540 ......... ............ A Treat clavicle dislocation ............................. 2.23 4.26 2.46 0.29 6.78 4.98 090 

23545 ......... ............ A Treat clavicle dislocation ............................. 3.25 4.50 3.38 0.47 8.22 7.10 090 

23550 ......... ............ A Treat clavicle dislocation ............................. 7.23 NA 6.38 1.13 NA 14.74 090 

23552 ......... ............ A Treat clavicle dislocation ............................. 8.44 NA 7.26 1.42 NA 17.12 090 

23570 ......... ............ A Treat shoulder blade fx ................................ 2.23 3.67 2.87 0.35 6.25 5.45 090 

23575 ......... ............ A Treat shoulder blade fx ................................ 4.05 5.76 4.24 0.64 10.45 8.93 090 

23585 ......... ............ A Treat scapula fracture .................................. 8.95 NA 7.60 1.51 NA 18.06 090 

23600 ......... ............ A Treat humerus fracture ................................ 2.93 5.73 3.82 0.47 9.13 7.22 090 

23605 ......... ............ A Treat humerus fracture ................................ 4.86 6.59 4.96 0.81 12.26 10.63 090 

23615 ......... ............ A Treat humerus fracture ................................ 9.34 NA 8.69 1.58 NA 19.61 090 

23616 ......... ............ A Treat humerus fracture ................................ 21.24 NA 14.13 3.59 NA 38.96 090 

23620 ......... ............ A Treat humerus fracture ................................ 2.40 5.20 3.23 0.39 7.99 6.02 090 

23625 ......... ............ A Treat humerus fracture ................................ 3.92 6.33 4.56 0.64 10.89 9.12 090 

23630 ......... ............ A Treat humerus fracture ................................ 7.34 NA 6.59 1.24 NA 15.17 090 

23650 ......... ............ A Treat shoulder dislocation ........................... 3.38 4.69 2.88 0.37 8.44 6.63 090 

23655 ......... ............ A Treat shoulder dislocation ........................... 4.56 NA 4.16 0.63 NA 9.35 090 

23660 ......... ............ A Treat shoulder dislocation ........................... 7.48 NA 6.36 1.22 NA 15.06 090 

23665 ......... ............ A Treat islocation/fracture ............................... 4.46 6.58 4.93 0.72 11.76 10.11 090 

23670 ......... ............ A Treat dislocation/fracture ............................. 7.89 NA 6.82 1.33 NA 16.04 090 

23675 ......... ............ A Treat dislocation/fracture ............................. 6.04 7.56 6.06 1.00 14.60 13.10 090 

23680 ......... ............ A Treat dislocation/fracture ............................. 10.04 NA 8.09 1.68 NA 19.81 090 

23700 ......... ............ A Fixation of shoulder ..................................... 2.52 NA 2.30 0.42 NA 5.24 010 

23800 ......... ............ A Fusion of shoulder joint ............................... 14.14 NA 10.46 2.38 NA 26.98 090 

23802 ......... ............ A Fusion of shoulder joint ............................... 16.58 NA 10.23 2.82 NA 29.63 090 

23900 ......... ............ A Amputation of arm & girdle .......................... 19.69 NA 11.91 2.98 NA 34.58 090 

23920 ......... ............ A Amputation at shoulder joint ........................ 14.59 NA 10.09 2.32 NA 27.00 090 

23921 ......... ............ A Amputation follow-up surgery ...................... 5.48 5.16 5.16 0.94 11.58 11.58 090 

23929 ......... ............ C Shoulder surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

23930 ......... ............ A Drainage of arm lesion ................................ 2.94 2.71 2.35 0.39 6.04 5.68 010 

23931 ......... ............ A Drainage of arm bursa ................................. 1.79 2.43 2.19 0.25 4.47 4.23 010 

23935 ......... ............ A Drain arm/elbow bone lesion ....................... 6.08 NA 6.13 1.01 NA 13.22 090 

24000 ......... ............ A Exploratory elbow surgery ........................... 5.81 NA 5.36 0.93 NA 12.10 090 

24006 ......... ............ A Release elbow joint ..................................... 9.30 NA 7.69 1.53 NA 18.52 090 

24065 ......... ............ A Biopsy arm/elbow soft tissue ....................... 2.08 2.10 1.78 0.17 4.35 4.03 010 

24066 ......... ............ A Biopsy arm/elbow soft tissue ....................... 5.20 5.76 4.27 0.74 11.70 10.21 090 

24075 ......... ............ A Remove arm/elbow lesion ........................... 3.91 5.05 3.67 0.52 9.48 8.10 090 

24076 ......... ............ A Remove arm/elbow lesion ........................... 6.29 NA 5.09 0.84 NA 12.22 090 

24077 ......... ............ A Remove tumor of arm/elbow ....................... 11.74 NA 8.65 1.59 NA 21.98 090 

24100 ......... ............ A Biopsy elbow joint lining .............................. 4.92 NA 4.49 0.75 NA 10.16 090 

24101 ......... ............ A Explore/treat elbow joint .............................. 6.12 NA 5.86 1.01 NA 12.99 090 

24102 ......... ............ A Remove elbow joint lining ............................ 8.02 NA 6.83 1.31 NA 16.16 090 

1130

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

24105 ......... ............ A Removal of elbow bursa .............................. 3.60 NA 4.35 0.59 NA 8.54 090 

24110 ......... ............ A Remove humerus lesion .............................. 7.38 NA 6.71 1.19 NA 15.28 090 

24115 ......... ............ A Remove/graft bone lesion ............................ 9.62 NA 7.35 1.39 NA 18.36 090 

24116 ......... ............ A Remove/graft bone lesion ............................ 11.79 NA 9.11 2.00 NA 22.90 090 

24120 ......... ............ A Remove elbow lesion .................................. 6.64 NA 5.88 1.05 NA 13.57 090 

24125 ......... ............ A Remove/graft bone lesion ............................ 7.88 NA 6.18 1.06 NA 15.12 090 

24126 ......... ............ A Remove/graft bone lesion ............................ 8.30 NA 6.97 1.09 NA 16.36 090 

24130 ......... ............ A Removal of head of radius .......................... 6.24 NA 5.95 1.05 NA 13.24 090 

24134 ......... ............ A Removal of arm bone lesion ....................... 9.72 NA 9.18 1.58 NA 20.48 090 

24136 ......... ............ A Remove radius bone lesion ......................... 7.98 NA 7.41 1.03 NA 16.42 090 

24138 ......... ............ A Remove elbow bone lesion ......................... 8.04 NA 7.67 1.35 NA 17.06 090 

24140 ......... ............ A Partial removal of arm bone ........................ 9.17 NA 9.49 1.48 NA 20.14 090 

24145 ......... ............ A Partial removal of radius .............................. 7.57 NA 8.15 1.22 NA 16.94 090 

24147 ......... ............ A Partial removal of elbow .............................. 7.53 NA 8.64 1.25 NA 17.42 090 

24149 ......... ............ A Radical resection of elbow .......................... 14.18 NA 11.41 2.29 NA 27.88 090 

24150 ......... ............ A Extensive humerus surgery ......................... 13.25 NA 10.10 2.18 NA 25.53 090 

24151 ......... ............ A Extensive humerus surgery ......................... 15.56 NA 11.67 2.64 NA 29.87 090 

24152 ......... ............ A Extensive radius surgery ............................. 10.04 NA 7.85 1.44 NA 19.33 090 

24153 ......... ............ A Extensive radius surgery ............................. 11.52 NA 5.83 0.77 NA 18.12 090 

24155 ......... ............ A Removal of elbow joint ................................ 11.71 NA 8.41 1.71 NA 21.83 090 

24160 ......... ............ A Remove elbow joint implant ........................ 7.82 NA 6.77 1.29 NA 15.88 090 

24164 ......... ............ A Remove radius head implant ....................... 6.22 NA 5.66 1.01 NA 12.89 090 

24200 ......... ............ A Removal of arm foreign body ...................... 1.76 1.97 1.67 0.18 3.91 3.61 010 

24201 ......... ............ A Removal of arm foreign body ...................... 4.55 5.68 4.34 0.68 10.91 9.57 090 

24220 ......... ............ A Injection for elbow x-ray .............................. 1.31 10.32 0.44 0.08 11.71 1.83 000 

24300 ......... ............ A Manipulate elbow w/anesth ......................... 3.74 NA 5.48 0.59 NA 9.81 090 

24301 ......... ............ A Muscle/tendon transfer ................................ 10.18 NA 8.18 1.57 NA 19.93 090 

24305 ......... ............ A Arm tendon lengthening .............................. 7.44 NA 6.68 1.18 NA 15.30 090 

24310 ......... ............ A Revision of arm tendon ............................... 5.97 NA 5.72 0.89 NA 12.58 090 

24320 ......... ............ A Repair of arm tendon ................................... 10.54 NA 7.74 1.21 NA 19.49 090 

24330 ......... ............ A Revision of arm muscles ............................. 9.59 NA 7.86 1.46 NA 18.91 090 

24331 ......... ............ A Revision of arm muscles ............................. 10.63 NA 8.60 1.70 NA 20.93 090 

24332 ......... ............ A Tenolysis, triceps ......................................... 7.44 NA 6.58 0.93 NA 14.95 090 

24340 ......... ............ A Repair of biceps tendon .............................. 7.88 NA 6.91 1.30 NA 16.09 090 

24341 ......... ............ A Repair arm tendon/muscle .......................... 7.89 NA 7.75 1.30 NA 16.94 090 

24342 ......... ............ A Repair of ruptured tendon ........................... 10.60 NA 8.46 1.79 NA 20.85 090 

24343 ......... ............ A Repr elbow lat ligmnt w/tiss ......................... 8.64 NA 7.93 1.36 NA 17.93 090 

24344 ......... ............ A Reconstruct elbow lat ligmnt ....................... 13.98 NA 11.31 2.21 NA 27.50 090 

24345 ......... ............ A Repr elbw med ligmnt w/tissu ..................... 8.64 NA 7.83 1.36 NA 17.83 090 

24346 ......... ............ A Reconstruct elbow med ligmnt .................... 13.98 NA 11.17 2.21 NA 27.36 090 

24350 ......... ............ A Repair of tennis elbow ................................. 5.24 NA 5.52 0.87 NA 11.63 090 

24351 ......... ............ A Repair of tennis elbow ................................. 5.90 NA 5.86 0.99 NA 12.75 090 

24352 ......... ............ A Repair of tennis elbow ................................. 6.42 NA 6.12 1.09 NA 13.63 090 

24354 ......... ............ A Repair of tennis elbow ................................. 6.47 NA 6.08 1.06 NA 13.61 090 

24356 ......... ............ A Revision of tennis elbow .............................. 6.67 NA 6.26 1.09 NA 14.02 090 

24360 ......... ............ A Reconstruct elbow joint ............................... 12.32 NA 9.35 2.04 NA 23.71 090 

24361 ......... ............ A Reconstruct elbow joint ............................... 14.06 NA 10.44 2.35 NA 26.85 090 

24362 ......... ............ A Reconstruct elbow joint ............................... 14.97 NA 9.97 2.32 NA 27.26 090 

24363 ......... ............ A Replace elbow joint ..................................... 18.46 NA 13.53 3.04 NA 35.03 090 

24365 ......... ............ A Reconstruct head of radius ......................... 8.38 NA 7.09 1.34 NA 16.81 090 

24366 ......... ............ A Reconstruct head of radius ......................... 9.12 NA 7.43 1.54 NA 18.09 090 

24400 ......... ............ A Revision of humerus .................................... 11.04 NA 8.91 1.85 NA 21.80 090 

24410 ......... ............ A Revision of humerus .................................... 14.80 NA 10.43 2.28 NA 27.51 090 

24420 ......... ............ A Revision of humerus .................................... 13.42 NA 10.66 2.20 NA 26.28 090 

24430 ......... ............ A Repair of humerus ....................................... 12.79 NA 9.75 2.17 NA 24.71 090 

24435 ......... ............ A Repair humerus with graft ........................... 13.15 NA 10.83 2.22 NA 26.20 090 

24470 ......... ............ A Revision of elbow joint ................................. 8.73 NA 7.62 1.48 NA 17.83 090 

24495 ......... ............ A Decompression of forearm .......................... 8.11 NA 9.05 1.11 NA 18.27 090 

24498 ......... ............ A Reinforce humerus ...................................... 11.90 NA 9.28 2.01 NA 23.19 090 

24500 ......... ............ A Treat humerus fracture ................................ 3.21 5.40 3.61 0.49 9.10 7.31 090 

24505 ......... ............ A Treat humerus fracture ................................ 5.16 7.29 5.28 0.87 13.32 11.31 090 

24515 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.34 1.97 NA 22.94 090 

24516 ......... ............ A Treat humerus fracture ................................ 11.63 NA 9.11 1.97 NA 22.71 090 

24530 ......... ............ A Treat humerus fracture ................................ 3.49 5.39 3.94 0.57 9.45 8.00 090 

24535 ......... ............ A Treat humerus fracture ................................ 6.86 8.39 6.40 1.16 16.41 14.42 090 

24538 ......... ............ A Treat humerus fracture ................................ 9.42 NA 8.69 1.51 NA 19.62 090 

24545 ......... ............ A Treat humerus fracture ................................ 10.44 NA 8.42 1.77 NA 20.63 090 

24546 ......... ............ A Treat humerus fracture ................................ 15.67 NA 11.31 2.63 NA 29.61 090 

24560 ......... ............ A Treat humerus fracture ................................ 2.80 5.07 3.21 0.42 8.29 6.43 090 

24565 ......... ............ A Treat humerus fracture ................................ 5.55 7.28 5.40 0.89 13.72 11.84 090 

24566 ......... ............ A Treat humerus fracture ................................ 7.78 NA 8.11 1.33 NA 17.22 090 

24575 ......... ............ A Treat humerus fracture ................................ 10.64 NA 8.30 1.74 NA 20.68 090 

24576 ......... ............ A Treat humerus fracture ................................ 2.86 4.94 3.59 0.46 8.26 6.91 090 

24577 ......... ............ A Treat humerus fracture ................................ 5.78 7.56 5.69 0.98 14.32 12.45 090 

24579 ......... ............ A Treat humerus fracture ................................ 11.58 NA 8.83 1.95 NA 22.36 090 

1131

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

24582 ......... ............ A Treat humerus fracture ................................ 8.54 NA 9.01 1.45 NA 19.00 090 

24586 ......... ............ A Treat elbow fracture ..................................... 15.19 NA 11.11 2.56 NA 28.86 090 

24587 ......... ............ A Treat elbow fracture ..................................... 15.14 NA 10.91 2.58 NA 28.63 090 

24600 ......... ............ A Treat elbow dislocation ................................ 4.22 5.57 3.52 0.59 10.38 8.33 090 

24605 ......... ............ A Treat elbow dislocation ................................ 5.41 NA 5.25 0.87 NA 11.53 090 

24615 ......... ............ A Treat elbow dislocation ................................ 9.41 NA 7.73 1.58 NA 18.72 090 

24620 ......... ............ A Treat elbow fracture ..................................... 6.97 NA 6.11 1.09 NA 14.17 090 

24635 ......... ............ A Treat elbow fracture ..................................... 13.17 NA 14.21 2.22 NA 29.60 090 

24640 ......... ............ A Treat elbow dislocation ................................ 1.20 1.93 0.87 0.13 3.26 2.20 010 

24650 ......... ............ A Treat radius fracture .................................... 2.16 4.55 2.73 0.34 7.05 5.23 090 

24655 ......... ............ A Treat radius fracture .................................... 4.39 6.76 4.69 0.70 11.85 9.78 090 

24665 ......... ............ A Treat radius fracture .................................... 8.13 NA 7.48 1.36 NA 16.97 090 

24666 ......... ............ A Treat radius fracture .................................... 9.48 NA 8.05 1.59 NA 19.12 090 

24670 ......... ............ A Treat ulnar fracture ...................................... 2.54 4.44 3.01 0.40 7.38 5.95 090 

24675 ......... ............ A Treat ulnar fracture ...................................... 4.71 6.72 4.82 0.78 12.21 10.31 090 

24685 ......... ............ A Treat ulnar fracture ...................................... 8.79 NA 7.52 1.48 NA 17.79 090 

24800 ......... ............ A Fusion of elbow joint .................................... 11.18 NA 8.71 1.70 NA 21.59 090 

24802 ......... ............ A Fusion/graft of elbow joint ........................... 13.67 NA 10.32 2.28 NA 26.27 090 

24900 ......... ............ A Amputation of upper arm ............................. 9.59 NA 7.35 1.42 NA 18.36 090 

24920 ......... ............ A Amputation of upper arm ............................. 9.53 NA 7.52 1.47 NA 18.52 090 

24925 ......... ............ A Amputation follow-up surgery ...................... 7.06 NA 6.27 1.15 NA 14.48 090 

24930 ......... ............ A Amputation follow-up surgery ...................... 10.23 NA 7.52 1.48 NA 19.23 090 

24931 ......... ............ A Amputate upper arm & implant ................... 12.70 NA 6.11 1.88 NA 20.69 090 

24935 ......... ............ A Revision of amputation ................................ 15.54 NA 8.42 1.91 NA 25.87 090 

24940 ......... ............ C Revision of upper arm ................................. 0.00 0.00 0.00 0.00 0.00 0.00 090 

24999 ......... ............ C Upper arm/elbow surgery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

25000 ......... ............ A Incision of tendon sheath ............................ 3.37 NA 6.95 0.54 NA 10.86 090 

25001 ......... ............ A Incise flexor carpi radialis ............................ 3.37 NA 4.09 0.54 NA 8.00 090 

25020 ......... ............ A Decompress forearm 1 space ..................... 5.91 NA 9.94 0.92 NA 16.77 090 

25023 ......... ............ A Decompress forearm 1 space ..................... 12.94 NA 15.45 1.83 NA 30.22 090 

25024 ......... ............ A Decompress forearm 2 spaces ................... 9.49 NA 7.52 1.50 NA 18.51 090 

25025 ......... ............ A Decompress forearm 2 spaces ................... 16.52 NA 10.00 2.63 NA 29.15 090 

25028 ......... ............ A Drainage of forearm lesion .......................... 5.24 NA 8.48 0.74 NA 14.46 090 

25031 ......... ............ A Drainage of forearm bursa .......................... 4.13 NA 8.25 0.60 NA 12.98 090 

25035 ......... ............ A Treat forearm bone lesion ........................... 7.35 NA 14.03 1.18 NA 22.56 090 

25040 ......... ............ A Explore/treat wrist joint ................................ 7.17 NA 7.34 1.16 NA 15.67 090 

25065 ......... ............ A Biopsy forearm soft tissues ......................... 1.99 2.79 2.79 0.14 4.92 4.92 010 

25066 ......... ............ A Biopsy forearm soft tissues ......................... 4.12 NA 7.24 0.59 NA 11.95 090 

25075 ......... ............ A Removel forearm lesion subcu .................... 3.73 NA 6.13 0.48 NA 10.34 090 

25076 ......... ............ A Removel forearm lesion deep ..................... 4.91 NA 9.98 0.71 NA 15.60 090 

25077 ......... ............ A Remove tumor, forearm/wrist ...................... 9.75 NA 12.68 1.33 NA 23.76 090 

25085 ......... ............ A Incision of wrist capsule .............................. 5.49 NA 7.30 0.86 NA 13.65 090 

25100 ......... ............ A Biopsy of wrist joint ...................................... 3.89 NA 5.41 0.60 NA 9.90 090 

25101 ......... ............ A Explore/treat wrist joint ................................ 4.68 NA 5.96 0.72 NA 11.36 090 

25105 ......... ............ A Remove wrist joint lining .............................. 5.84 NA 7.48 0.93 NA 14.25 090 

25107 ......... ............ A Remove wrist joint cartilage ........................ 6.42 NA 8.41 0.99 NA 15.82 090 

25110 ......... ............ A Remove wrist tendon lesion ........................ 3.91 NA 7.26 0.58 NA 11.75 090 

25111 ......... ............ A Remove wrist tendon lesion ........................ 3.38 NA 4.83 0.51 NA 8.72 090 

25112 ......... ............ A Reremove wrist tendon lesion ..................... 4.52 NA 5.43 0.65 NA 10.60 090 

25115 ......... ............ A Remove wrist/forearm lesion ....................... 8.81 NA 14.44 1.34 NA 24.59 090 

25116 ......... ............ A Remove wrist/forearm lesion ....................... 7.10 NA 13.53 1.09 NA 21.72 090 

25118 ......... ............ A Excise wrist tendon sheath .......................... 4.36 NA 5.88 0.66 NA 10.90 090 

25119 ......... ............ A Partial removal of ulna ................................. 6.03 NA 7.77 0.96 NA 14.76 090 

25120 ......... ............ A Removal of forearm lesion .......................... 6.09 NA 12.44 0.98 NA 19.51 090 

25125 ......... ............ A Remove/graft forearm lesion ....................... 7.47 NA 13.21 1.23 NA 21.91 090 

25126 ......... ............ A Remove/graft forearm lesion ....................... 7.54 NA 13.31 1.21 NA 22.06 090 

25130 ......... ............ A Removal of wrist lesion ............................... 5.25 NA 6.51 0.80 NA 12.56 090 

25135 ......... ............ A Remove & graft wrist lesion ........................ 6.88 NA 7.53 1.07 NA 15.48 090 

25136 ......... ............ A Remove & graft wrist lesion ........................ 5.96 NA 6.68 0.70 NA 13.34 090 

25145 ......... ............ A Remove forearm bone lesion ...................... 6.36 NA 12.47 0.99 NA 19.82 090 

25150 ......... ............ A Partial removal of ulna ................................. 7.08 NA 8.41 1.16 NA 16.65 090 

25151 ......... ............ A Partial removal of radius .............................. 7.38 NA 13.08 1.12 NA 21.58 090 

25170 ......... ............ A Extensive forearm surgery ........................... 11.07 NA 15.46 1.83 NA 28.36 090 

25210 ......... ............ A Removal of wrist bone ................................. 5.94 NA 6.90 0.88 NA 13.72 090 

25215 ......... ............ A Removal of wrist bones ............................... 7.88 NA 8.89 1.23 NA 18.00 090 

25230 ......... ............ A Partial removal of radius .............................. 5.22 NA 6.22 0.80 NA 12.24 090 

25240 ......... ............ A Partial removal of ulna ................................. 5.16 NA 7.09 0.83 NA 13.08 090 

25246 ......... ............ A Injection for wrist x-ray ................................ 1.45 10.05 0.48 0.08 11.58 2.01 000 

25248 ......... ............ A Remove forearm foreign body ..................... 5.13 NA 8.75 0.65 NA 14.53 090 

25250 ......... ............ A Removal of wrist prosthesis ........................ 6.59 NA 6.00 1.01 NA 13.60 090 

25251 ......... ............ A Removal of wrist prosthesis ........................ 9.56 NA 7.82 1.39 NA 18.77 090 

25259 ......... ............ A Manipulate wrist w/anesthes ....................... 3.74 NA 5.48 0.60 NA 9.82 090 

25260 ......... ............ A Repair forearm tendon/muscle .................... 7.79 NA 13.90 1.17 NA 22.86 090 

25263 ......... ............ A Repair forearm tendon/muscle .................... 7.81 NA 13.81 1.13 NA 22.75 090 

25265 ......... ............ A Repair forearm tendon/muscle .................... 9.87 NA 14.70 1.44 NA 26.01 090 

1132

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

25270 ......... ............ A Repair forearm tendon/muscle .................... 5.99 NA 12.60 0.92 NA 19.51 090 

25272 ......... ............ A Repair forearm tendon/muscle .................... 7.03 NA 13.30 1.07 NA 21.40 090 

25274 ......... ............ A Repair forearm tendon/muscle .................... 8.74 NA 14.02 1.37 NA 24.13 090 

25275 ......... ............ A Repair forearm tendon sheath ..................... 8.49 NA 7.47 1.36 NA 17.32 090 

25280 ......... ............ A Revise wrist/forearm tendon ........................ 7.21 NA 13.03 1.10 NA 21.34 090 

25290 ......... ............ A Incise wrist/forearm tendon ......................... 5.28 NA 15.53 0.80 NA 21.61 090 

25295 ......... ............ A Release wrist/forearm tendon ...................... 6.54 NA 12.59 1.04 NA 20.17 090 

25300 ......... ............ A Fusion of tendons at wrist ........................... 8.79 NA 8.52 1.29 NA 18.60 090 

25301 ......... ............ A Fusion of tendons at wrist ........................... 8.39 NA 8.16 1.30 NA 17.85 090 

25310 ......... ............ A Transplant forearm tendon .......................... 8.13 NA 13.44 1.22 NA 22.79 090 

25312 ......... ............ A Transplant forearm tendon .......................... 9.56 NA 14.32 1.47 NA 25.35 090 

25315 ......... ............ A Revise palsy hand tendon(s) ....................... 10.18 NA 14.89 1.52 NA 26.59 090 

25316 ......... ............ A Revise palsy hand tendon(s) ....................... 12.31 NA 16.66 2.10 NA 31.07 090 

25320 ......... ............ A Repair/revise wrist joint ............................... 10.75 NA 11.21 1.59 NA 23.55 090 

25332 ......... ............ A Revise wrist joint .......................................... 11.39 NA 9.06 1.76 NA 22.21 090 

25335 ......... ............ A Realignment of hand ................................... 12.86 NA 11.72 2.00 NA 26.58 090 

25337 ......... ............ A Reconstruct ulna/radioulnar ......................... 10.15 NA 11.07 1.58 NA 22.80 090 

25350 ......... ............ A Revision of radius ........................................ 8.77 NA 14.28 1.41 NA 24.46 090 

25355 ......... ............ A Revision of radius ........................................ 10.15 NA 14.90 1.74 NA 26.79 090 

25360 ......... ............ A Revision of ulna ........................................... 8.42 NA 14.17 1.41 NA 24.00 090 

25365 ......... ............ A Revise radius & ulna ................................... 12.38 NA 15.93 2.01 NA 30.32 090 

25370 ......... ............ A Revise radius or ulna ................................... 13.34 NA 16.30 2.27 NA 31.91 090 

25375 ......... ............ A Revise radius & ulna ................................... 13.02 NA 16.72 2.22 NA 31.96 090 

25390 ......... ............ A Shorten radius or ulna ................................. 10.38 NA 14.91 1.66 NA 26.95 090 

25391 ......... ............ A Lengthen radius or ulna ............................... 13.63 NA 16.87 2.09 NA 32.59 090 

25392 ......... ............ A Shorten radius & ulna .................................. 13.93 NA 16.24 2.09 NA 32.26 090 

25393 ......... ............ A Lengthen radius & ulna ............................... 15.85 NA 17.88 2.26 NA 35.99 090 

25394 ......... ............ A Repair carpal bone, shorten ........................ 10.38 NA 8.23 1.69 NA 20.30 090 

25400 ......... ............ A Repair radius or ulna ................................... 10.90 NA 15.49 1.81 NA 28.20 090 

25405 ......... ............ A Repair/graft radius or ulna ........................... 14.36 NA 17.58 2.35 NA 34.29 090 

25415 ......... ............ A Repair radius & ulna .................................... 13.33 NA 16.81 2.26 NA 32.40 090 

25420 ......... ............ A Repair/graft radius & ulna ............................ 16.31 NA 18.56 2.65 NA 37.52 090 

25425 ......... ............ A Repair/graft radius or ulna ........................... 13.19 NA 22.08 1.94 NA 37.21 090 

25426 ......... ............ A Repair/graft radius & ulna ............................ 15.80 NA 17.29 2.69 NA 35.78 090 

25430 ......... ............ A Vasc graft into carpal bone ......................... 9.24 NA 7.28 1.29 NA 17.81 090 

25431 ......... ............ A Repair nonunion carpal bone ...................... 10.42 NA 8.23 0.68 NA 19.33 090 

25440 ......... ............ A Repair/graft wrist bone ................................ 10.42 NA 9.41 1.70 NA 21.53 090 

25441 ......... ............ A Reconstruct wrist joint ................................. 12.88 NA 9.88 2.21 NA 24.97 090 

25442 ......... ............ A Reconstruct wrist joint ................................. 10.83 NA 8.77 1.50 NA 21.10 090 

25443 ......... ............ A Reconstruct wrist joint ................................. 10.37 NA 8.65 1.57 NA 20.59 090 

25444 ......... ............ A Reconstruct wrist joint ................................. 11.13 NA 9.07 1.72 NA 21.92 090 

25445 ......... ............ A Reconstruct wrist joint ................................. 9.68 NA 7.87 1.52 NA 19.07 090 

25446 ......... ............ A Wrist replacement ........................................ 16.53 NA 11.81 2.65 NA 30.99 090 

25447 ......... ............ A Repair wrist joint(s) ...................................... 10.35 NA 8.54 1.62 NA 20.51 090 

25449 ......... ............ A Remove wrist joint implant .......................... 14.47 NA 10.57 2.13 NA 27.17 090 

25450 ......... ............ A Revision of wrist joint ................................... 7.86 NA 10.41 1.06 NA 19.33 090 

25455 ......... ............ A Revision of wrist joint ................................... 9.48 NA 11.33 1.29 NA 22.10 090 

25490 ......... ............ A Reinforce radius ........................................... 9.53 NA 14.03 1.44 NA 25.00 090 

25491 ......... ............ A Reinforce ulna .............................................. 9.95 NA 14.79 1.70 NA 26.44 090 

25492 ......... ............ A Reinforce radius and ulna ........................... 12.31 NA 15.58 1.95 NA 29.84 090 

25500 ......... ............ A Treat fracture of radius ................................ 2.45 3.99 2.71 0.34 6.78 5.50 090 

25505 ......... ............ A Treat fracture of radius ................................ 5.20 7.22 5.25 0.83 13.25 11.28 090 

25515 ......... ............ A Treat fracture of radius ................................ 9.17 NA 7.47 1.47 NA 18.11 090 

25520 ......... ............ A Treat fracture of radius ................................ 6.25 7.44 5.87 1.03 14.72 13.15 090 

25525 ......... ............ A Treat fracture of radius ................................ 12.22 NA 9.94 2.03 NA 24.19 090 

25526 ......... ............ A Treat fracture of radius ................................ 12.96 NA 13.59 2.17 NA 28.72 090 

25530 ......... ............ A Treat fracture of ulna ................................... 2.09 4.14 2.80 0.33 6.56 5.22 090 

25535 ......... ............ A Treat fracture of ulna ................................... 5.13 6.85 5.17 0.82 12.80 11.12 090 

25545 ......... ............ A Treat fracture of ulna ................................... 8.89 NA 7.65 1.48 NA 18.02 090 

25560 ......... ............ A Treat fracture radius & ulna ......................... 2.44 4.04 2.64 0.33 6.81 5.41 090 

25565 ......... ............ A Treat fracture radius & ulna ......................... 5.62 7.35 5.32 0.92 13.89 11.86 090 

25574 ......... ............ A Treat fracture radius & ulna ......................... 7.00 NA 7.13 1.16 NA 15.29 090 

25575 ......... ............ A Treat fracture radius/ulna ............................ 10.43 NA 9.39 1.76 NA 21.58 090 

25600 ......... ............ A Treat fracture radius/ulna ............................ 2.63 4.47 2.94 0.41 7.51 5.98 090 

25605 ......... ............ A Treat fracture radius/ulna ............................ 5.80 8.03 6.01 0.98 14.81 12.79 090 

25611 ......... ............ A Treat fracture radius/ulna ............................ 7.76 NA 8.84 1.30 NA 17.90 090 

25620 ......... ............ A Treat fracture radius/ulna ............................ 8.54 NA 7.28 1.41 NA 17.23 090 

25622 ......... ............ A Treat wrist bone fracture ............................. 2.61 4.64 3.12 0.40 7.65 6.13 090 

25624 ......... ............ A Treat wrist bone fracture ............................. 4.52 6.98 4.90 0.74 12.24 10.16 090 

25628 ......... ............ A Treat wrist bone fracture ............................. 8.42 NA 7.81 1.37 NA 17.60 090 

25630 ......... ............ A Treat wrist bone fracture ............................. 2.88 4.57 2.94 0.45 7.90 6.27 090 

25635 ......... ............ A Treat wrist bone fracture ............................. 4.38 6.75 3.89 0.47 11.60 8.74 090 

25645 ......... ............ A Treat wrist bone fracture ............................. 7.24 NA 6.79 1.12 NA 15.15 090 

25650 ......... ............ A Treat wrist bone fracture ............................. 3.05 4.83 3.22 0.45 8.33 6.72 090 

25651 ......... ............ A Pin ulnar styloid fracture .............................. 5.35 NA 5.39 0.87 NA 11.61 090 

1133

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

25652 ......... ............ A Treat fracture ulnar styloid ........................... 7.59 NA 6.85 1.23 NA 15.67 090 

25660 ......... ............ A Treat wrist dislocation .................................. 4.75 NA 4.66 0.71 NA 10.12 090 

25670 ......... ............ A Treat wrist dislocation .................................. 7.91 NA 7.08 1.29 NA 16.28 090 

25671 ......... ............ A Pin radioulnar dislocation ............................ 5.99 NA 5.98 0.98 NA 12.95 090 

25675 ......... ............ A Treat wrist dislocation .................................. 4.66 6.49 4.61 0.69 11.84 9.96 090 

25676 ......... ............ A Treat wrist dislocation .................................. 8.03 NA 7.32 1.33 NA 16.68 090 

25680 ......... ............ A Treat wrist fracture ....................................... 5.98 NA 4.75 0.74 NA 11.47 090 

25685 ......... ............ A Treat wrist fracture ....................................... 9.77 NA 7.87 1.51 NA 19.15 090 

25690 ......... ............ A Treat wrist dislocation .................................. 5.49 NA 5.39 0.94 NA 11.82 090 

25695 ......... ............ A Treat wrist dislocation .................................. 8.33 NA 7.19 1.29 NA 16.81 090 

25800 ......... ............ A Fusion of wrist joint ...................................... 9.75 NA 9.10 1.57 NA 20.42 090 

25805 ......... ............ A Fusion/graft of wrist joint ............................. 11.26 NA 10.24 1.82 NA 23.32 090 

25810 ......... ............ A Fusion/graft of wrist joint ............................. 10.55 NA 9.88 1.65 NA 22.08 090 

25820 ......... ............ A Fusion of hand bones .................................. 7.44 NA 7.88 1.16 NA 16.48 090 

25825 ......... ............ A Fuse hand bones with graft ......................... 9.26 NA 9.22 1.45 NA 19.93 090 

25830 ......... ............ A Fusion, radioulnar jnt/ulna ........................... 10.04 NA 14.69 1.53 NA 26.26 090 

25900 ......... ............ A Amputation of forearm ................................. 9.00 NA 12.89 1.30 NA 23.19 090 

25905 ......... ............ A Amputation of forearm ................................. 9.11 NA 12.82 1.28 NA 23.21 090 

25907 ......... ............ A Amputation follow-up surgery ...................... 7.79 NA 12.21 1.22 NA 21.22 090 

25909 ......... ............ A Amputation follow-up surgery ...................... 8.95 NA 12.76 1.29 NA 23.00 090 

25915 ......... ............ A Amputation of forearm ................................. 17.05 NA 19.51 2.91 NA 39.47 090 

25920 ......... ............ A Amputate hand at wrist ................................ 8.67 NA 8.00 1.28 NA 17.95 090 

25922 ......... ............ A Amputate hand at wrist ................................ 7.41 NA 7.25 1.12 NA 15.78 090 

25924 ......... ............ A Amputation follow-up surgery ...................... 8.45 NA 8.22 1.29 NA 17.96 090 

25927 ......... ............ A Amputation of hand ..................................... 8.79 NA 12.15 1.23 NA 22.17 090 

25929 ......... ............ A Amputation follow-up surgery ...................... 7.58 NA 6.06 1.07 NA 14.71 090 

25931 ......... ............ A Amputation follow-up surgery ...................... 7.80 NA 12.06 1.06 NA 20.92 090 

25999 ......... ............ C Forearm or wrist surgery ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26010 ......... ............ A Drainage of finger abscess .......................... 1.54 5.67 1.66 0.17 7.38 3.37 010 

26011 ......... ............ A Drainage of finger abscess .......................... 2.19 9.08 2.31 0.30 11.57 4.80 010 

26020 ......... ............ A Drain hand tendon sheath ........................... 4.66 NA 5.57 0.71 NA 10.94 090 

26025 ......... ............ A Drainage of palm bursa ............................... 4.81 NA 5.36 0.72 NA 10.89 090 

26030 ......... ............ A Drainage of palm bursa(s) ........................... 5.92 NA 6.00 0.87 NA 12.79 090 

26034 ......... ............ A Treat hand bone lesion ................................ 6.22 NA 6.27 0.95 NA 13.44 090 

26035 ......... ............ A Decompress fingers/hand ............................ 9.50 NA 8.10 1.35 NA 18.95 090 

26037 ......... ............ A Decompress fingers/hand ............................ 7.24 NA 6.60 1.05 NA 14.89 090 

26040 ......... ............ A Release palm contracture ............................ 3.33 NA 3.99 0.54 NA 7.86 090 

26045 ......... ............ A Release palm contracture ............................ 5.55 NA 5.56 0.89 NA 12.00 090 

26055 ......... ............ A Incise finger tendon sheath ......................... 2.69 14.54 3.85 0.43 17.66 6.97 090 

26060 ......... ............ A Incision of finger tendon .............................. 2.81 NA 3.45 0.42 NA 6.68 090 

26070 ......... ............ A Explore/treat hand joint ................................ 3.68 NA 3.36 0.42 NA 7.46 090 

26075 ......... ............ A Explore/treat finger joint ............................... 3.78 NA 3.76 0.48 NA 8.02 090 

26080 ......... ............ A Explore/treat finger joint ............................... 4.23 NA 4.78 0.63 NA 9.64 090 

26100 ......... ............ A Biopsy hand joint lining ................................ 3.66 NA 4.10 0.54 NA 8.30 090 

26105 ......... ............ A Biopsy finger joint lining ............................... 3.70 NA 4.17 0.54 NA 8.41 090 

26110 ......... ............ A Biopsy finger joint lining ............................... 3.52 NA 3.98 0.53 NA 8.03 090 

26115 ......... ............ A Removel hand lesion subcut ....................... 3.85 13.33 4.67 0.58 17.76 9.10 090 

26116 ......... ............ A Removel hand lesion, deep ......................... 5.52 NA 5.92 0.83 NA 12.27 090 

26117 ......... ............ A Remove tumor, hand/finger ......................... 8.54 NA 7.03 1.22 NA 16.79 090 

26121 ......... ............ A Release palm contracture ............................ 7.53 NA 6.90 1.13 NA 15.56 090 

26123 ......... ............ A Release palm contracture ............................ 9.28 NA 8.74 1.41 NA 19.43 090 

26125 ......... ............ A Release palm contracture ............................ 4.60 NA 2.46 0.69 NA 7.75 ZZZ 

26130 ......... ............ A Remove wrist joint lining .............................. 5.41 NA 5.30 0.78 NA 11.49 090 

26135 ......... ............ A Revise finger joint, each .............................. 6.95 NA 6.39 1.05 NA 14.39 090 

26140 ......... ............ A Revise finger joint, each .............................. 6.16 NA 5.97 0.92 NA 13.05 090 

26145 ......... ............ A Tendon excision, palm/finger ....................... 6.31 NA 5.98 0.93 NA 13.22 090 

26160 ......... ............ A Remove tendon sheath lesion ..................... 3.15 12.69 4.04 0.47 16.31 7.66 090 

26170 ......... ............ A Removal of palm tendon, each ................... 4.76 NA 4.88 0.72 NA 10.36 090 

26180 ......... ............ A Removal of finger tendon ............................ 5.17 NA 5.35 0.77 NA 11.29 090 

26185 ......... ............ A Remove finger bone .................................... 5.24 NA 5.91 0.81 NA 11.96 090 

26200 ......... ............ A Remove hand bone lesion ........................... 5.50 NA 5.29 0.86 NA 11.65 090 

26205 ......... ............ A Remove/graft bone lesion ............................ 7.69 NA 6.84 1.15 NA 15.68 090 

26210 ......... ............ A Removal of finger lesion .............................. 5.14 NA 5.36 0.77 NA 11.27 090 

26215 ......... ............ A Remove/graft finger lesion ........................... 7.09 NA 6.26 0.93 NA 14.28 090 

26230 ......... ............ A Partial removal of hand bone ...................... 6.32 NA 5.85 1.01 NA 13.18 090 

26235 ......... ............ A Partial removal, finger bone ........................ 6.18 NA 5.75 0.94 NA 12.87 090 

26236 ......... ............ A Partial removal, finger bone ........................ 5.31 NA 5.28 0.80 NA 11.39 090 

26250 ......... ............ A Extensive hand surgery ............................... 7.54 NA 6.38 1.11 NA 15.03 090 

26255 ......... ............ A Extensive hand surgery ............................... 12.41 NA 9.35 1.27 NA 23.03 090 

26260 ......... ............ A Extensive finger surgery .............................. 7.02 NA 6.14 1.00 NA 14.16 090 

26261 ......... ............ A Extensive finger surgery .............................. 9.08 NA 6.23 1.01 NA 16.32 090 

26262 ......... ............ A Partial removal of finger .............................. 5.66 NA 5.29 0.84 NA 11.79 090 

26320 ......... ............ A Removal of implant from hand .................... 3.97 NA 4.25 0.59 NA 8.81 090 

26340 ......... ............ A Manipulate finger w/anesth .......................... 2.50 NA 4.74 0.36 NA 7.60 090 

26350 ......... ............ A Repair finger/hand tendon ........................... 5.98 NA 15.49 0.88 NA 22.35 090 

1134

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

26352 ......... ............ A Repair/graft hand tendon ............................. 7.67 NA 16.08 1.12 NA 24.87 090 

26356 ......... ............ A Repair finger/hand tendon ........................... 8.06 NA 18.91 1.19 NA 28.16 090 

26357 ......... ............ A Repair finger/hand tendon ........................... 8.57 NA 16.53 1.23 NA 26.33 090 

26358 ......... ............ A Repair/graft hand tendon ............................. 9.13 NA 17.43 1.29 NA 27.85 090 

26370 ......... ............ A Repair finger/hand tendon ........................... 7.10 NA 15.95 1.09 NA 24.14 090 

26372 ......... ............ A Repair/graft hand tendon ............................. 8.75 NA 17.32 1.28 NA 27.35 090 

26373 ......... ............ A Repair finger/hand tendon ........................... 8.15 NA 16.87 1.18 NA 26.20 090 

26390 ......... ............ A Revise hand/finger tendon ........................... 9.18 NA 13.92 1.31 NA 24.41 090 

26392 ......... ............ A Repair/graft hand tendon ............................. 10.24 NA 17.66 1.52 NA 29.42 090 

26410 ......... ............ A Repair hand tendon ..................................... 4.62 NA 12.59 0.69 NA 17.90 090 

26412 ......... ............ A Repair/graft hand tendon ............................. 6.30 NA 13.92 0.96 NA 21.18 090 

26415 ......... ............ A Excision, hand/finger tendon ....................... 8.33 NA 12.28 0.93 NA 21.54 090 

26416 ......... ............ A Graft hand or finger tendon ......................... 9.36 NA 15.21 1.45 NA 26.02 090 

26418 ......... ............ A Repair finger tendon .................................... 4.24 NA 12.95 0.60 NA 17.79 090 

26420 ......... ............ A Repair/graft finger tendon ............................ 6.76 NA 14.26 1.00 NA 22.02 090 

26426 ......... ............ A Repair finger/hand tendon ........................... 6.14 NA 13.78 0.93 NA 20.85 090 

26428 ......... ............ A Repair/graft finger tendon ............................ 7.20 NA 14.58 1.01 NA 22.79 090 

26432 ......... ............ A Repair finger tendon .................................... 4.01 NA 10.69 0.58 NA 15.28 090 

26433 ......... ............ A Repair finger tendon .................................... 4.55 NA 11.37 0.68 NA 16.60 090 

26434 ......... ............ A Repair/graft finger tendon ............................ 6.08 NA 12.06 0.86 NA 19.00 090 

26437 ......... ............ A Realignment of tendons ............................... 5.81 NA 11.98 0.89 NA 18.68 090 

26440 ......... ............ A Release palm/finger tendon ......................... 5.01 NA 14.18 0.75 NA 19.94 090 

26442 ......... ............ A Release palm & finger tendon ..................... 8.15 NA 16.61 1.13 NA 25.89 090 

26445 ......... ............ A Release hand/finger tendon ........................ 4.30 NA 13.93 0.65 NA 18.88 090 

26449 ......... ............ A Release forearm/hand tendon ..................... 6.99 NA 16.39 1.01 NA 24.39 090 

26450 ......... ............ A Incision of palm tendon ............................... 3.66 NA 7.58 0.55 NA 11.79 090 

26455 ......... ............ A Incision of finger tendon .............................. 3.63 NA 7.50 0.57 NA 11.70 090 

26460 ......... ............ A Incise hand/finger tendon ............................ 3.45 NA 7.32 0.53 NA 11.30 090 

26471 ......... ............ A Fusion of finger tendons .............................. 5.72 NA 11.65 0.88 NA 18.25 090 

26474 ......... ............ A Fusion of finger tendons .............................. 5.31 NA 11.84 0.83 NA 17.98 090 

26476 ......... ............ A Tendon lengthening ..................................... 5.17 NA 11.37 0.75 NA 17.29 090 

26477 ......... ............ A Tendon shortening ....................................... 5.14 NA 11.54 0.72 NA 17.40 090 

26478 ......... ............ A Lengthening of hand tendon ........................ 5.79 NA 12.24 0.93 NA 18.96 090 

26479 ......... ............ A Shortening of hand tendon .......................... 5.73 NA 12.08 0.92 NA 18.73 090 

26480 ......... ............ A Transplant hand tendon ............................... 6.68 NA 15.68 1.01 NA 23.37 090 

26483 ......... ............ A Transplant/graft hand tendon ...................... 8.28 NA 16.12 1.24 NA 25.64 090 

26485 ......... ............ A Transplant palm tendon ............................... 7.69 NA 16.01 1.13 NA 24.83 090 

26489 ......... ............ A Transplant/graft palm tendon ....................... 9.54 NA 12.54 1.18 NA 23.26 090 

26490 ......... ............ A Revise thumb tendon ................................... 8.40 NA 13.16 1.27 NA 22.83 090 

26492 ......... ............ A Tendon transfer with graft ........................... 9.61 NA 13.97 1.44 NA 25.02 090 

26494 ......... ............ A Hand tendon/muscle transfer ...................... 8.46 NA 13.61 1.36 NA 23.43 090 

26496 ......... ............ A Revise thumb tendon ................................... 9.58 NA 13.61 1.41 NA 24.60 090 

26497 ......... ............ A Finger tendon transfer ................................. 9.56 NA 13.96 1.41 NA 24.93 090 

26498 ......... ............ A Finger tendon transfer ................................. 13.98 NA 16.55 2.10 NA 32.63 090 

26499 ......... ............ A Revision of finger ......................................... 8.97 NA 13.50 1.13 NA 23.60 090 

26500 ......... ............ A Hand tendon reconstruction ........................ 5.95 NA 12.12 0.80 NA 18.87 090 

26502 ......... ............ A Hand tendon reconstruction ........................ 7.13 NA 12.58 1.05 NA 20.76 090 

26504 ......... ............ A Hand tendon reconstruction ........................ 7.46 NA 13.01 1.01 NA 21.48 090 

26508 ......... ............ A Release thumb contracture ......................... 6.00 NA 12.11 0.92 NA 19.03 090 

26510 ......... ............ A Thumb tendon transfer ................................ 5.42 NA 11.79 0.86 NA 18.07 090 

26516 ......... ............ A Fusion of knuckle joint ................................. 7.14 NA 12.65 1.09 NA 20.88 090 

26517 ......... ............ A Fusion of knuckle joints ............................... 8.82 NA 13.96 1.16 NA 23.94 090 

26518 ......... ............ A Fusion of knuckle joints ............................... 9.01 NA 13.77 1.36 NA 24.14 090 

26520 ......... ............ A Release knuckle contracture ....................... 5.29 NA 14.63 0.78 NA 20.70 090 

26525 ......... ............ A Release finger contracture .......................... 5.32 NA 14.74 0.80 NA 20.86 090 

26530 ......... ............ A Revise knuckle joint ..................................... 6.68 NA 6.02 1.04 NA 13.74 090 

26531 ......... ............ A Revise knuckle with implant ........................ 7.90 NA 6.99 1.22 NA 16.11 090 

26535 ......... ............ A Revise finger joint ........................................ 5.23 NA 3.69 0.80 NA 9.72 090 

26536 ......... ............ A Revise/implant finger joint ........................... 6.36 NA 9.74 0.96 NA 17.06 090 

26540 ......... ............ A Repair hand joint ......................................... 6.42 NA 12.35 0.98 NA 19.75 090 

26541 ......... ............ A Repair hand joint with graft ......................... 8.61 NA 13.83 1.35 NA 23.79 090 

26542 ......... ............ A Repair hand joint with graft ......................... 6.77 NA 12.39 1.05 NA 20.21 090 

26545 ......... ............ A Reconstruct finger joint ................................ 6.91 NA 12.79 0.95 NA 20.65 090 

26546 ......... ............ A Repair nonunion hand ................................. 8.91 NA 15.20 1.37 NA 25.48 090 

26548 ......... ............ A Reconstruct finger joint ................................ 8.02 NA 13.39 1.18 NA 22.59 090 

26550 ......... ............ A Construct thumb replacement ..................... 21.21 NA 18.16 2.17 NA 41.54 090 

26551 ......... ............ A Great toe-hand transfer ............................... 46.51 NA 33.71 7.92 NA 88.14 090 

26553 ......... ............ A Single transfer, toe-hand ............................. 46.20 NA 23.22 2.40 NA 71.82 090 

26554 ......... ............ A Double transfer, toe-hand ............................ 54.87 NA 38.02 9.36 NA 102.25 090 

26555 ......... ............ A Positional change of finger .......................... 16.61 NA 18.67 2.57 NA 37.85 090 

26556 ......... ............ A Toe joint transfer .......................................... 47.19 NA 34.50 8.04 NA 89.73 090 

26560 ......... ............ A Repair of web finger .................................... 5.37 NA 10.28 0.72 NA 16.37 090 

26561 ......... ............ A Repair of web finger .................................... 10.90 NA 12.93 0.83 NA 24.66 090 

26562 ......... ............ A Repair of web finger .................................... 14.98 NA 17.59 1.18 NA 33.75 090 

26565 ......... ............ A Correct metacarpal flaw ............................... 6.73 NA 12.46 1.01 NA 20.20 090 

1135

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

26567 ......... ............ A Correct finger deformity ............................... 6.81 NA 12.39 1.01 NA 20.21 090 

26568 ......... ............ A Lengthen metacarpal/finger ......................... 9.07 NA 16.09 1.33 NA 26.49 090 

26580 ......... ............ A Repair hand deformity ................................. 18.15 NA 13.98 1.76 NA 33.89 090 

26587 ......... ............ A Reconstruct extra finger .............................. 14.03 NA 9.05 1.35 NA 24.43 090 

26590 ......... ............ A Repair finger deformity ................................ 17.93 NA 14.40 1.59 NA 33.92 090 

26591 ......... ............ A Repair muscles of hand ............................... 3.25 NA 10.44 0.45 NA 14.14 090 

26593 ......... ............ A Release muscles of hand ............................ 5.30 NA 11.51 0.77 NA 17.58 090 

26596 ......... ............ A Excision constricting tissue .......................... 8.94 NA 9.01 1.05 NA 19.00 090 

26600 ......... ............ A Treat metacarpal fracture ............................ 1.96 4.08 2.64 0.30 6.34 4.90 090 

26605 ......... ............ A Treat metacarpal fracture ............................ 2.85 5.25 3.58 0.46 8.56 6.89 090 

26607 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.35 0.84 NA 12.54 090 

26608 ......... ............ A Treat metacarpal fracture ............................ 5.35 NA 6.35 0.88 NA 12.58 090 

26615 ......... ............ A Treat metacarpal fracture ............................ 5.32 NA 5.53 0.84 NA 11.69 090 

26641 ......... ............ A Treat thumb dislocation ............................... 3.93 5.40 3.58 0.51 9.84 8.02 090 

26645 ......... ............ A Treat thumb fracture .................................... 4.40 6.10 4.17 0.65 11.15 9.22 090 

26650 ......... ............ A Treat thumb fracture .................................... 5.71 NA 6.76 0.93 NA 13.40 090 

26665 ......... ............ A Treat thumb fracture .................................... 7.59 NA 6.80 1.17 NA 15.56 090 

26670 ......... ............ A Treat hand dislocation ................................. 3.68 4.89 3.03 0.43 9.00 7.14 090 

26675 ......... ............ A Treat hand dislocation ................................. 4.63 6.23 4.41 0.68 11.54 9.72 090 

26676 ......... ............ A Pin hand dislocation .................................... 5.51 NA 6.79 0.92 NA 13.22 090 

26685 ......... ............ A Treat hand dislocation ................................. 6.97 NA 6.26 1.15 NA 14.38 090 

26686 ......... ............ A Treat hand dislocation ................................. 7.93 NA 7.03 1.27 NA 16.23 090 

26700 ......... ............ A Treat knuckle dislocation ............................. 3.68 4.65 2.96 0.42 8.75 7.06 090 

26705 ......... ............ A Treat knuckle dislocation ............................. 4.18 6.03 4.24 0.60 10.81 9.02 090 

26706 ......... ............ A Pin knuckle dislocation ................................ 5.11 NA 5.09 0.77 NA 10.97 090 

26715 ......... ............ A Treat knuckle dislocation ............................. 5.73 NA 5.71 0.90 NA 12.34 090 

26720 ......... ............ A Treat finger fracture, each ........................... 1.66 3.89 2.60 0.24 5.79 4.50 090 

26725 ......... ............ A Treat finger fracture, each ........................... 3.33 6.09 4.04 0.52 9.94 7.89 090 

26727 ......... ............ A Treat finger fracture, each ........................... 5.22 NA 6.40 0.83 NA 12.45 090 

26735 ......... ............ A Treat finger fracture, each ........................... 5.97 NA 5.86 0.93 NA 12.76 090 

26740 ......... ............ A Treat finger fracture, each ........................... 1.94 3.56 2.69 0.29 5.79 4.92 090 

26742 ......... ............ A Treat finger fracture, each ........................... 3.84 5.81 3.85 0.59 10.24 8.28 090 

26746 ......... ............ A Treat finger fracture, each ........................... 5.80 NA 5.91 0.89 NA 12.60 090 

26750 ......... ............ A Treat finger fracture, each ........................... 1.70 3.14 2.08 0.23 5.07 4.01 090 

26755 ......... ............ A Treat finger fracture, each ........................... 3.10 4.81 3.05 0.45 8.36 6.60 090 

26756 ......... ............ A Pin finger fracture, each .............................. 4.38 NA 6.04 0.68 NA 11.10 090 

26765 ......... ............ A Treat finger fracture, each ........................... 4.16 NA 4.78 0.62 NA 9.56 090 

26770 ......... ............ A Treat finger dislocation ................................ 3.02 4.40 2.55 0.33 7.75 5.90 090 

26775 ......... ............ A Treat finger dislocation ................................ 3.70 5.85 3.82 0.52 10.07 8.04 090 

26776 ......... ............ A Pin finger dislocation ................................... 4.79 NA 6.21 0.76 NA 11.76 090 

26785 ......... ............ A Treat finger dislocation ................................ 4.20 NA 4.81 0.65 NA 9.66 090 

26820 ......... ............ A Thumb fusion with graft ............................... 8.25 NA 13.63 1.34 NA 23.22 090 

26841 ......... ............ A Fusion of thumb ........................................... 7.12 NA 13.53 1.17 NA 21.82 090 

26842 ......... ............ A Thumb fusion with graft ............................... 8.23 NA 13.71 1.33 NA 23.27 090 

26843 ......... ............ A Fusion of hand joint ..................................... 7.60 NA 12.68 1.19 NA 21.47 090 

26844 ......... ............ A Fusion/graft of hand joint ............................. 8.72 NA 13.68 1.35 NA 23.75 090 

26850 ......... ............ A Fusion of knuckle ......................................... 6.96 NA 12.56 1.07 NA 20.59 090 

26852 ......... ............ A Fusion of knuckle with graft ......................... 8.45 NA 13.25 1.27 NA 22.97 090 

26860 ......... ............ A Fusion of finger joint .................................... 4.68 NA 11.55 0.72 NA 16.95 090 

26861 ......... ............ A Fusion of finger jnt, add-on ......................... 1.74 NA 0.93 0.27 NA 2.94 ZZZ 

26862 ......... ............ A Fusion/graft of finger joint ............................ 7.36 NA 12.75 1.11 NA 21.22 090 

26863 ......... ............ A Fuse/graft added joint .................................. 3.89 NA 2.12 0.62 NA 6.63 ZZZ 

26910 ......... ............ A Amputate metacarpal bone ......................... 7.59 NA 11.70 1.09 NA 20.38 090 

26951 ......... ............ A Amputation of finger/thumb ......................... 4.58 NA 10.62 0.68 NA 15.88 090 

26952 ......... ............ A Amputation of finger/thumb ......................... 6.30 NA 12.23 0.89 NA 19.42 090 

26989 ......... ............ C Hand/finger surgery ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

26990 ......... ............ A Drainage of pelvis lesion ............................. 7.47 NA 7.63 1.11 NA 16.21 090 

26991 ......... ............ A Drainage of pelvis bursa .............................. 6.67 7.47 5.94 1.03 15.17 13.64 090 

26992 ......... ............ A Drainage of bone lesion .............................. 13.00 NA 10.86 2.11 NA 25.97 090 

27000 ......... ............ A Incision of hip tendon .................................. 5.61 NA 5.29 0.92 NA 11.82 090 

27001 ......... ............ A Incision of hip tendon .................................. 6.93 NA 6.15 1.15 NA 14.23 090 

27003 ......... ............ A Incision of hip tendon .................................. 7.33 NA 6.55 1.12 NA 15.00 090 

27005 ......... ............ A Incision of hip tendon .................................. 9.65 NA 7.85 1.64 NA 19.14 090 

27006 ......... ............ A Incision of hip tendons ................................. 9.67 NA 7.99 1.60 NA 19.26 090 

27025 ......... ............ A Incision of hip/thigh fascia ........................... 11.14 NA 8.60 1.66 NA 21.40 090 

27030 ......... ............ A Drainage of hip joint .................................... 12.99 NA 9.66 2.18 NA 24.83 090 

27033 ......... ............ A Exploration of hip joint ................................. 13.37 NA 9.93 2.26 NA 25.56 090 

27035 ......... ............ A Denervation of hip joint ................................ 16.66 NA 12.33 2.05 NA 31.04 090 

27036 ......... ............ A Excision of hip joint/muscle ......................... 12.86 NA 10.03 2.17 NA 25.06 090 

27040 ......... ............ A Biopsy of soft tissues ................................... 2.87 2.62 2.05 0.25 5.74 5.17 010 

27041 ......... ............ A Biopsy of soft tissues ................................... 9.88 NA 6.73 1.22 NA 17.83 090 

27047 ......... ............ A Remove hip/pelvis lesion ............................. 7.44 6.55 4.99 0.95 14.94 13.38 090 

27048 ......... ............ A Remove hip/pelvis lesion ............................. 6.24 NA 5.04 0.88 NA 12.16 090 

27049 ......... ............ A Remove tumor, hip/pelvis ............................ 13.64 NA 8.81 1.93 NA 24.38 090 

27050 ......... ............ A Biopsy of sacroiliac joint .............................. 4.35 NA 4.48 0.64 NA 9.47 090 

1136

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27052 ......... ............ A Biopsy of hip joint ........................................ 6.22 NA 5.89 1.03 NA 13.14 090 

27054 ......... ............ A Removal of hip joint lining ........................... 8.53 NA 7.36 1.41 NA 17.30 090 

27060 ......... ............ A Removal of ischial bursa ............................. 5.42 NA 4.84 0.72 NA 10.98 090 

27062 ......... ............ A Remove femur lesion/bursa ......................... 5.36 NA 5.22 0.89 NA 11.47 090 

27065 ......... ............ A Removal of hip bone lesion ......................... 5.89 NA 5.54 0.92 NA 12.35 090 

27066 ......... ............ A Removal of hip bone lesion ......................... 10.31 NA 8.51 1.71 NA 20.53 090 

27067 ......... ............ A Remove/graft hip bone lesion ...................... 13.81 NA 10.67 2.35 NA 26.83 090 

27070 ......... ............ A Partial removal of hip bone ......................... 10.70 NA 9.78 1.64 NA 22.12 090 

27071 ......... ............ A Partial removal of hip bone ......................... 11.44 NA 10.75 1.82 NA 24.01 090 

27075 ......... ............ A Extensive hip surgery .................................. 34.95 NA 19.68 2.68 NA 57.31 090 

27076 ......... ............ A Extensive hip surgery .................................. 22.09 NA 14.79 3.45 NA 40.33 090 

27077 ......... ............ A Extensive hip surgery .................................. 39.94 NA 23.10 3.84 NA 66.88 090 

27078 ......... ............ A Extensive hip surgery .................................. 13.42 NA 10.43 2.01 NA 25.86 090 

27079 ......... ............ A Extensive hip surgery .................................. 13.73 NA 10.09 2.24 NA 26.06 090 

27080 ......... ............ A Removal of tail bone .................................... 6.38 NA 5.08 0.96 NA 12.42 090 

27086 ......... ............ A Remove hip foreign body ............................ 1.87 2.01 1.87 0.21 4.09 3.95 010 

27087 ......... ............ A Remove hip foreign body ............................ 8.53 NA 6.71 1.31 NA 16.55 090 

27090 ......... ............ A Removal of hip prosthesis ........................... 11.13 NA 8.65 1.87 NA 21.65 090 

27091 ......... ............ A Removal of hip prosthesis ........................... 22.11 NA 13.86 3.75 NA 39.72 090 

27093 ......... ............ A Injection for hip x-ray ................................... 1.30 12.21 0.48 0.11 13.62 1.89 000 

27095 ......... ............ A Injection for hip x-ray ................................... 1.50 10.76 0.52 0.12 12.38 2.14 000 

27096 ......... ............ A Inject sacroiliac joint .................................... 1.40 9.35 0.33 0.10 10.85 1.83 000 

27097 ......... ............ A Revision of hip tendon ................................. 8.79 NA 6.47 1.47 NA 16.73 090 

27098 ......... ............ A Transfer tendon to pelvis ............................. 8.82 NA 7.10 1.50 NA 17.42 090 

27100 ......... ............ A Transfer of abdominal muscle ..................... 11.06 NA 8.73 1.89 NA 21.68 090 

27105 ......... ............ A Transfer of spinal muscle ............................ 11.75 NA 9.20 2.00 NA 22.95 090 

27110 ......... ............ A Transfer of iliopsoas muscle ........................ 13.24 NA 9.33 1.66 NA 24.23 090 

27111 ......... ............ A Transfer of iliopsoas muscle ........................ 12.13 NA 9.18 1.79 NA 23.10 090 

27120 ......... ............ A Reconstruction of hip socket ....................... 17.98 NA 11.74 2.95 NA 32.67 090 

27122 ......... ............ A Reconstruction of hip socket ....................... 14.96 NA 10.91 2.51 NA 28.38 090 

27125 ......... ............ A Partial hip replacement ................................ 14.67 NA 10.49 2.47 NA 27.63 090 

27130 ......... ............ A Total hip arthroplasty ................................... 20.09 NA 13.21 3.40 NA 36.70 090 

27132 ......... ............ A Total hip arthroplasty ................................... 23.27 NA 15.48 3.93 NA 42.68 090 

27134 ......... ............ A Revise hip joint replacement ....................... 28.48 NA 17.69 4.79 NA 50.96 090 

27137 ......... ............ A Revise hip joint replacement ....................... 21.14 NA 13.82 3.58 NA 38.54 090 

27138 ......... ............ A Revise hip joint replacement ....................... 22.14 NA 14.28 3.75 NA 40.17 090 

27140 ......... ............ A Transplant femur ridge ................................ 12.22 NA 9.41 2.01 NA 23.64 090 

27146 ......... ............ A Incision of hip bone ..................................... 17.40 NA 12.27 2.74 NA 32.41 090 

27147 ......... ............ A Revision of hip bone .................................... 20.55 NA 13.34 3.15 NA 37.04 090 

27151 ......... ............ A Incision of hip bones .................................... 22.48 NA 8.21 3.76 NA 34.45 090 

27156 ......... ............ A Revision of hip bones .................................. 24.59 NA 16.10 4.20 NA 44.89 090 

27158 ......... ............ A Revision of pelvis ......................................... 19.71 NA 11.24 3.14 NA 34.09 090 

27161 ......... ............ A Incision of neck of femur ............................. 16.68 NA 12.09 2.80 NA 31.57 090 

27165 ......... ............ A Incision/fixation of femur .............................. 17.88 NA 12.85 3.03 NA 33.76 090 

27170 ......... ............ A Repair/graft femur head/neck ...................... 16.05 NA 11.30 2.65 NA 30.00 090 

27175 ......... ............ A Treat slipped epiphysis ................................ 8.45 NA 6.58 1.44 NA 16.47 090 

27176 ......... ............ A Treat slipped epiphysis ................................ 12.03 NA 8.98 2.03 NA 23.04 090 

27177 ......... ............ A Treat slipped epiphysis ................................ 15.06 NA 10.83 2.54 NA 28.43 090 

27178 ......... ............ A Treat slipped epiphysis ................................ 11.97 NA 8.40 2.03 NA 22.40 090 

27179 ......... ............ A Revise head/neck of femur .......................... 12.96 NA 9.92 2.22 NA 25.10 090 

27181 ......... ............ A Treat slipped epiphysis ................................ 14.66 NA 10.15 2.10 NA 26.91 090 

27185 ......... ............ A Revision of femur epiphysis ........................ 9.17 NA 7.58 1.56 NA 18.31 090 

27187 ......... ............ A Reinforce hip bones ..................................... 13.52 NA 10.33 2.28 NA 26.13 090 

27193 ......... ............ A Treat pelvic ring fracture .............................. 5.55 7.10 5.74 0.93 13.58 12.22 090 

27194 ......... ............ A Treat pelvic ring fracture .............................. 9.64 8.75 7.50 1.59 19.98 18.73 090 

27200 ......... ............ A Treat tail bone fracture ................................ 1.84 3.04 2.17 0.27 5.15 4.28 090 

27202 ......... ............ A Treat tail bone fracture ................................ 7.03 NA 17.65 0.83 NA 25.51 090 

27215 ......... ............ A Treat pelvic fracture(s) ................................. 10.03 NA 7.17 1.65 NA 18.85 090 

27216 ......... ............ A Treat pelvic ring fracture .............................. 15.17 NA 9.72 2.59 NA 27.48 090 

27217 ......... ............ A Treat pelvic ring fracture .............................. 14.09 NA 10.15 2.35 NA 26.59 090 

27218 ......... ............ A Treat pelvic ring fracture .............................. 20.12 NA 11.50 3.44 NA 35.06 090 

27220 ......... ............ A Treat hip socket fracture .............................. 6.17 7.06 5.51 1.03 14.26 12.71 090 

27222 ......... ............ A Treat hip socket fracture .............................. 12.68 NA 9.88 2.13 NA 24.69 090 

27226 ......... ............ A Treat hip wall fracture .................................. 14.89 NA 7.92 2.50 NA 25.31 090 

27227 ......... ............ A Treat hip fracture(s) ..................................... 23.41 NA 15.35 3.91 NA 42.67 090 

27228 ......... ............ A Treat hip fracture(s) ..................................... 27.12 NA 17.57 4.55 NA 49.24 090 

27230 ......... ............ A Treat thigh fracture ...................................... 5.49 6.51 5.04 0.88 12.88 11.41 090 

27232 ......... ............ A Treat thigh fracture ...................................... 10.66 NA 7.18 1.75 NA 19.59 090 

27235 ......... ............ A Treat thigh fracture ...................................... 12.14 NA 9.39 2.06 NA 23.59 090 

27236 ......... ............ A Treat thigh fracture ...................................... 15.58 NA 10.93 2.63 NA 29.14 090 

27238 ......... ............ A Treat thigh fracture ...................................... 5.51 NA 5.09 0.92 NA 11.52 090 

27240 ......... ............ A Treat thigh fracture ...................................... 12.48 NA 9.37 2.04 NA 23.89 090 

27244 ......... ............ A Treat thigh fracture ...................................... 15.92 NA 11.26 2.69 NA 29.87 090 

27245 ......... ............ A Treat thigh fracture ...................................... 20.28 NA 13.70 3.44 NA 37.42 090 

27246 ......... ............ A Treat thigh fracture ...................................... 4.70 5.66 4.41 0.80 11.16 9.91 090 

1137

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27248 ......... ............ A Treat thigh fracture ...................................... 10.43 NA 8.19 1.75 NA 20.37 090 

27250 ......... ............ A Treat hip dislocation .................................... 6.94 NA 4.77 0.82 NA 12.53 090 

27252 ......... ............ A Treat hip dislocation .................................... 10.37 NA 7.39 1.65 NA 19.41 090 

27253 ......... ............ A Treat hip dislocation .................................... 12.90 NA 9.72 2.18 NA 24.80 090 

27254 ......... ............ A Treat hip dislocation .................................... 18.23 NA 12.03 3.04 NA 33.30 090 

27256 ......... ............ A Treat hip dislocation .................................... 4.11 3.43 2.09 0.59 8.13 6.79 010 

27257 ......... ............ A Treat hip dislocation .................................... 5.21 NA 2.88 0.68 NA 8.77 010 

27258 ......... ............ A Treat hip dislocation .................................... 15.41 NA 10.91 2.48 NA 28.80 090 

27259 ......... ............ A Treat hip dislocation .................................... 21.52 NA 14.16 3.61 NA 39.29 090 

27265 ......... ............ A Treat hip dislocation .................................... 5.04 NA 4.76 0.78 NA 10.58 090 

27266 ......... ............ A Treat hip dislocation .................................... 7.48 NA 6.27 1.25 NA 15.00 090 

27275 ......... ............ A Manipulation of hip joint ............................... 2.27 NA 2.13 0.37 NA 4.77 010 

27280 ......... ............ A Fusion of sacroiliac joint .............................. 13.37 NA 10.30 2.39 NA 26.06 090 

27282 ......... ............ A Fusion of pubic bones ................................. 11.32 NA 8.23 1.37 NA 20.92 090 

27284 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 14.83 2.85 NA 41.09 090 

27286 ......... ............ A Fusion of hip joint ........................................ 23.41 NA 15.81 2.86 NA 42.08 090 

27290 ......... ............ A Amputation of leg at hip .............................. 23.25 NA 14.16 3.55 NA 40.96 090 

27295 ......... ............ A Amputation of leg at hip .............................. 18.62 NA 11.54 2.83 NA 32.99 090 

27299 ......... ............ C Pelvis/hip joint surgery ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27301 ......... ............ A Drain thigh/knee lesion ................................ 6.48 7.34 5.88 0.96 14.78 13.32 090 

27303 ......... ............ A Drainage of bone lesion .............................. 8.27 NA 7.24 1.37 NA 16.88 090 

27305 ......... ............ A Incise thigh tendon & fascia ........................ 5.91 NA 5.36 0.93 NA 12.20 090 

27306 ......... ............ A Incision of thigh tendon ............................... 4.61 NA 4.80 0.75 NA 10.16 090 

27307 ......... ............ A Incision of thigh tendons .............................. 5.79 NA 5.52 0.94 NA 12.25 090 

27310 ......... ............ A Exploration of knee joint .............................. 9.26 NA 7.54 1.56 NA 18.36 090 

27315 ......... ............ A Partial removal, thigh nerve ......................... 6.96 NA 4.83 0.95 NA 12.74 090 

27320 ......... ............ A Partial removal, thigh nerve ......................... 6.29 NA 5.12 0.94 NA 12.35 090 

27323 ......... ............ A Biopsy, thigh soft tissues ............................. 2.28 2.19 1.92 0.21 4.68 4.41 010 

27324 ......... ............ A Biopsy, thigh soft tissues ............................. 4.89 NA 4.35 0.71 NA 9.95 090 

27327 ......... ............ A Removal of thigh lesion ............................... 4.46 5.34 3.91 0.60 10.40 8.97 090 

27328 ......... ............ A Removal of thigh lesion ............................... 5.56 NA 4.57 0.80 NA 10.93 090 

27329 ......... ............ A Remove tumor, thigh/knee .......................... 14.12 NA 9.51 2.03 NA 25.66 090 

27330 ......... ............ A Biopsy, knee joint lining ............................... 4.96 NA 4.61 0.80 NA 10.37 090 

27331 ......... ............ A Explore/treat knee joint ................................ 5.87 NA 5.51 0.98 NA 12.36 090 

27332 ......... ............ A Removal of knee cartilage ........................... 8.26 NA 7.08 1.39 NA 16.73 090 

27333 ......... ............ A Removal of knee cartilage ........................... 7.29 NA 6.60 1.24 NA 15.13 090 

27334 ......... ............ A Remove knee joint lining ............................. 8.69 NA 7.38 1.46 NA 17.53 090 

27335 ......... ............ A Remove knee joint lining ............................. 9.99 NA 8.18 1.70 NA 19.87 090 

27340 ......... ............ A Removal of kneecap bursa .......................... 4.17 NA 4.53 0.70 NA 9.40 090 

27345 ......... ............ A Removal of knee cyst .................................. 5.91 NA 5.61 0.98 NA 12.50 090 

27347 ......... ............ A Remove knee cyst ....................................... 5.77 NA 5.42 0.92 NA 12.11 090 

27350 ......... ............ A Removal of kneecap .................................... 8.16 NA 7.19 1.39 NA 16.74 090 

27355 ......... ............ A Remove femur lesion ................................... 7.64 NA 6.81 1.29 NA 15.74 090 

27356 ......... ............ A Remove femur lesion/graft .......................... 9.47 NA 7.88 1.56 NA 18.91 090 

27357 ......... ............ A Remove femur lesion/graft .......................... 10.51 NA 8.70 1.79 NA 21.00 090 

27358 ......... ............ A Remove femur lesion/fixation ...................... 4.73 NA 2.54 0.81 NA 8.08 ZZZ 

27360 ......... ............ A Partial removal, leg bone(s) ........................ 10.48 NA 9.95 1.71 NA 22.14 090 

27365 ......... ............ A Extensive leg surgery .................................. 16.25 NA 11.67 2.73 NA 30.65 090 

27370 ......... ............ A Injection for knee x-ray ................................ 0.96 12.01 0.32 0.07 13.04 1.35 000 

27372 ......... ............ A Removal of foreign body ............................. 5.06 6.00 4.69 0.75 11.81 10.50 090 

27380 ......... ............ A Repair of kneecap tendon ........................... 7.15 NA 7.25 1.21 NA 15.61 090 

27381 ......... ............ A Repair/graft kneecap tendon ....................... 10.32 NA 9.05 1.74 NA 21.11 090 

27385 ......... ............ A Repair of thigh muscle ................................. 7.75 NA 7.59 1.31 NA 16.65 090 

27386 ......... ............ A Repair/graft of thigh muscle ........................ 10.54 NA 9.46 1.80 NA 21.80 090 

27390 ......... ............ A Incision of thigh tendon ............................... 5.32 NA 5.26 0.83 NA 11.41 090 

27391 ......... ............ A Incision of thigh tendons .............................. 7.19 NA 6.63 1.19 NA 15.01 090 

27392 ......... ............ A Incision of thigh tendons .............................. 9.19 NA 7.72 1.48 NA 18.39 090 

27393 ......... ............ A Lengthening of thigh tendon ........................ 6.38 NA 5.85 1.09 NA 13.32 090 

27394 ......... ............ A Lengthening of thigh tendons ...................... 8.49 NA 7.28 1.41 NA 17.18 090 

27395 ......... ............ A Lengthening of thigh tendons ...................... 11.71 NA 9.38 1.97 NA 23.06 090 

27396 ......... ............ A Transplant of thigh tendon ........................... 7.85 NA 7.07 1.34 NA 16.26 090 

27397 ......... ............ A Transplants of thigh tendons ....................... 11.26 NA 9.03 1.91 NA 22.20 090 

27400 ......... ............ A Revise thigh muscles/tendons ..................... 9.01 NA 7.34 1.42 NA 17.77 090 

27403 ......... ............ A Repair of knee cartilage .............................. 8.32 NA 7.14 1.40 NA 16.86 090 

27405 ......... ............ A Repair of knee ligament .............................. 8.64 NA 7.46 1.46 NA 17.56 090 

27407 ......... ............ A Repair of knee ligament .............................. 10.26 NA 8.30 1.66 NA 20.22 090 

27409 ......... ............ A Repair of knee ligaments ............................. 12.88 NA 9.91 2.11 NA 24.90 090 

27418 ......... ............ A Repair degenerated kneecap ...................... 10.83 NA 8.85 1.82 NA 21.50 090 

27420 ......... ............ A Revision of unstable kneecap ..................... 9.82 NA 8.05 1.66 NA 19.53 090 

27422 ......... ............ A Revision of unstable kneecap ..................... 9.77 NA 8.07 1.65 NA 19.49 090 

27424 ......... ............ A Revision/removal of kneecap ...................... 9.80 NA 8.04 1.66 NA 19.50 090 

27425 ......... ............ A Lat retinacular release open ........................ 5.21 NA 5.49 0.88 NA 11.58 090 

27427 ......... ............ A Reconstruction, knee ................................... 9.35 NA 7.74 1.56 NA 18.65 090 

27428 ......... ............ A Reconstruction, knee ................................... 13.98 NA 11.10 2.35 NA 27.43 090 

27429 ......... ............ A Reconstruction, knee ................................... 15.50 NA 12.34 2.63 NA 30.47 090 

1138

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27430 ......... ............ A Revision of thigh muscles ............................ 9.66 NA 7.96 1.63 NA 19.25 090 

27435 ......... ............ A Incision of knee joint .................................... 9.48 NA 8.36 1.60 NA 19.44 090 

27437 ......... ............ A Revise kneecap ........................................... 8.45 NA 7.11 1.42 NA 16.98 090 

27438 ......... ............ A Revise kneecap with implant ....................... 11.21 NA 8.43 1.88 NA 21.52 090 

27440 ......... ............ A Revision of knee joint .................................. 10.41 NA 5.97 1.71 NA 18.09 090 

27441 ......... ............ A Revision of knee joint .................................. 10.80 NA 6.65 1.80 NA 19.25 090 

27442 ......... ............ A Revision of knee joint .................................. 11.87 NA 8.80 2.03 NA 22.70 090 

27443 ......... ............ A Revision of knee joint .................................. 10.91 NA 8.59 1.83 NA 21.33 090 

27445 ......... ............ A Revision of knee joint .................................. 17.65 NA 12.23 3.00 NA 32.88 090 

27446 ......... ............ A Revision of knee joint .................................. 15.82 NA 11.15 2.68 NA 29.65 090 

27447 ......... ............ A Total knee arthroplasty ................................ 21.45 NA 14.46 3.62 NA 39.53 090 

27448 ......... ............ A Incision of thigh ............................................ 11.04 NA 8.65 1.82 NA 21.51 090 

27450 ......... ............ A Incision of thigh ............................................ 13.96 NA 10.59 2.36 NA 26.91 090 

27454 ......... ............ A Realignment of thigh bone .......................... 17.53 NA 12.50 2.97 NA 33.00 090 

27455 ......... ............ A Realignment of knee .................................... 12.80 NA 9.87 2.15 NA 24.82 090 

27457 ......... ............ A Realignment of knee .................................... 13.43 NA 9.91 2.27 NA 25.61 090 

27465 ......... ............ A Shortening of thigh bone ............................. 13.85 NA 10.34 2.24 NA 26.43 090 

27466 ......... ............ A Lengthening of thigh bone ........................... 16.31 NA 11.87 2.32 NA 30.50 090 

27468 ......... ............ A Shorten/lengthen thighs ............................... 18.94 NA 12.45 3.23 NA 34.62 090 

27470 ......... ............ A Repair of thigh ............................................. 16.05 NA 11.83 2.70 NA 30.58 090 

27472 ......... ............ A Repair/graft of thigh ..................................... 17.69 NA 12.72 3.00 NA 33.41 090 

27475 ......... ............ A Surgery to stop leg growth .......................... 8.63 NA 7.22 1.36 NA 17.21 090 

27477 ......... ............ A Surgery to stop leg growth .......................... 9.84 NA 7.73 1.58 NA 19.15 090 

27479 ......... ............ A Surgery to stop leg growth .......................... 12.78 NA 9.86 2.18 NA 24.82 090 

27485 ......... ............ A Surgery to stop leg growth .......................... 8.83 NA 7.38 1.50 NA 17.71 090 

27486 ......... ............ A Revise/replace knee joint ............................ 19.24 NA 13.34 3.26 NA 35.84 090 

27487 ......... ............ A Revise/replace knee joint ............................ 25.23 NA 16.41 4.27 NA 45.91 090 

27488 ......... ............ A Removal of knee prosthesis ........................ 15.72 NA 11.54 2.67 NA 29.93 090 

27495 ......... ............ A Reinforce thigh ............................................. 15.53 NA 11.47 2.63 NA 29.63 090 

27496 ......... ............ A Decompression of thigh/knee ...................... 6.10 NA 5.72 0.93 NA 12.75 090 

27497 ......... ............ A Decompression of thigh/knee ...................... 7.16 NA 5.66 1.01 NA 13.83 090 

27498 ......... ............ A Decompression of thigh/knee ...................... 7.98 NA 6.11 1.17 NA 15.26 090 

27499 ......... ............ A Decompression of thigh/knee ...................... 8.99 NA 6.99 1.42 NA 17.40 090 

27500 ......... ............ A Treatment of thigh fracture .......................... 5.91 7.01 4.99 0.96 13.88 11.86 090 

27501 ......... ............ A Treatment of thigh fracture .......................... 5.91 7.57 5.66 1.00 14.48 12.57 090 

27502 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.10 1.80 NA 20.46 090 

27503 ......... ............ A Treatment of thigh fracture .......................... 10.56 NA 8.26 1.80 NA 20.62 090 

27506 ......... ............ A Treatment of thigh fracture .......................... 17.42 NA 12.70 2.81 NA 32.93 090 

27507 ......... ............ A Treatment of thigh fracture .......................... 13.97 NA 9.88 2.35 NA 26.20 090 

27508 ......... ............ A Treatment of thigh fracture .......................... 5.82 6.97 5.32 0.96 13.75 12.10 090 

27509 ......... ............ A Treatment of thigh fracture .......................... 7.70 NA 7.90 1.30 NA 16.90 090 

27510 ......... ............ A Treatment of thigh fracture .......................... 9.12 NA 7.17 1.52 NA 17.81 090 

27511 ......... ............ A Treatment of thigh fracture .......................... 13.62 NA 11.19 2.30 NA 27.11 090 

27513 ......... ............ A Treatment of thigh fracture .......................... 17.89 NA 13.83 3.03 NA 34.75 090 

27514 ......... ............ A Treatment of thigh fracture .......................... 17.27 NA 13.29 2.91 NA 33.47 090 

27516 ......... ............ A Treat thigh fx growth plate ........................... 5.36 7.27 5.38 0.89 13.52 11.63 090 

27517 ......... ............ A Treat thigh fx growth plate ........................... 8.77 8.89 7.35 1.47 19.13 17.59 090 

27519 ......... ............ A Treat thigh fx growth plate ........................... 15.00 NA 11.61 2.52 NA 29.13 090 

27520 ......... ............ A Treat kneecap fracture ................................ 2.86 5.22 3.41 0.46 8.54 6.73 090 

27524 ......... ............ A Treat kneecap fracture ................................ 9.99 NA 8.14 1.69 NA 19.82 090 

27530 ......... ............ A Treat knee fracture ...................................... 3.77 5.88 4.26 0.62 10.27 8.65 090 

27532 ......... ............ A Treat knee fracture ...................................... 7.29 7.82 6.26 1.23 16.34 14.78 090 

27535 ......... ............ A Treat knee fracture ...................................... 11.48 NA 10.09 1.94 NA 23.51 090 

27536 ......... ............ A Treat knee fracture ...................................... 15.63 NA 11.48 2.64 NA 29.75 090 

27538 ......... ............ A Treat knee fracture(s) .................................. 4.86 7.07 5.08 0.81 12.74 10.75 090 

27540 ......... ............ A Treat knee fracture ...................................... 13.08 NA 9.46 2.17 NA 24.71 090 

27550 ......... ............ A Treat knee dislocation ................................. 5.75 6.57 4.92 0.82 13.14 11.49 090 

27552 ......... ............ A Treat knee dislocation ................................. 7.89 NA 6.86 1.33 NA 16.08 090 

27556 ......... ............ A Treat knee dislocation ................................. 14.39 NA 11.66 2.42 NA 28.47 090 

27557 ......... ............ A Treat knee dislocation ................................. 16.74 NA 13.12 2.86 NA 32.72 090 

27558 ......... ............ A Treat knee dislocation ................................. 17.69 NA 13.08 3.03 NA 33.80 090 

27560 ......... ............ A Treat kneecap dislocation ............................ 3.81 5.58 3.29 0.48 9.87 7.58 090 

27562 ......... ............ A Treat kneecap dislocation ............................ 5.78 NA 4.79 0.83 NA 11.40 090 

27566 ......... ............ A Treat kneecap dislocation ............................ 12.21 NA 9.26 2.09 NA 23.56 090 

27570 ......... ............ A Fixation of knee joint ................................... 1.74 NA 1.81 0.29 NA 3.84 010 

27580 ......... ............ A Fusion of knee ............................................. 19.34 NA 14.75 3.26 NA 37.35 090 

27590 ......... ............ A Amputate leg at thigh .................................. 12.01 NA 7.10 1.63 NA 20.74 090 

27591 ......... ............ A Amputate leg at thigh .................................. 12.66 NA 8.87 1.97 NA 23.50 090 

27592 ......... ............ A Amputate leg at thigh .................................. 10.00 NA 6.59 1.41 NA 18.00 090 

27594 ......... ............ A Amputation follow-up surgery ...................... 6.91 NA 5.45 0.99 NA 13.35 090 

27596 ......... ............ A Amputation follow-up surgery ...................... 10.58 NA 7.22 1.50 NA 19.30 090 

27598 ......... ............ A Amputate lower leg at knee ......................... 10.51 NA 7.32 1.50 NA 19.33 090 

27599 ......... ............ C Leg surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

27600 ......... ............ A Decompression of lower leg ........................ 5.64 NA 4.75 0.82 NA 11.21 090 

27601 ......... ............ A Decompression of lower leg ........................ 5.63 NA 5.04 0.83 NA 11.50 090 

1139

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27602 ......... ............ A Decompression of lower leg ........................ 7.34 NA 5.33 1.03 NA 13.70 090 

27603 ......... ............ A Drain lower leg lesion .................................. 4.93 10.64 4.85 0.68 16.25 10.46 090 

27604 ......... ............ A Drain lower leg bursa .................................. 4.46 8.58 4.53 0.65 13.69 9.64 090 

27605 ......... ............ A Incision of achilles tendon ........................... 2.87 8.80 2.34 0.46 12.13 5.67 010 

27606 ......... ............ A Incision of achilles tendon ........................... 4.13 10.03 3.40 0.69 14.85 8.22 010 

27607 ......... ............ A Treat lower leg bone lesion ......................... 7.96 NA 6.58 1.30 NA 15.84 090 

27610 ......... ............ A Explore/treat ankle joint ............................... 8.33 NA 7.06 1.39 NA 16.78 090 

27612 ......... ............ A Exploration of ankle joint ............................. 7.32 NA 6.12 1.22 NA 14.66 090 

27613 ......... ............ A Biopsy lower leg soft tissue ......................... 2.17 3.77 1.76 0.19 6.13 4.12 010 

27614 ......... ............ A Biopsy lower leg soft tissue ......................... 5.65 8.78 4.63 0.75 15.18 11.03 090 

27615 ......... ............ A Remove tumor, lower leg ............................ 12.54 NA 10.56 1.68 NA 24.78 090 

27618 ......... ............ A Remove lower leg lesion ............................. 5.08 9.10 4.21 0.65 14.83 9.94 090 

27619 ......... ............ A Remove lower leg lesion ............................. 8.39 10.62 6.17 1.22 20.23 15.78 090 

27620 ......... ............ A Explore/treat ankle joint ............................... 5.97 NA 5.50 1.00 NA 12.47 090 

27625 ......... ............ A Remove ankle joint lining ............................ 8.29 NA 6.54 1.40 NA 16.23 090 

27626 ......... ............ A Remove ankle joint lining ............................ 8.90 NA 7.00 1.48 NA 17.38 090 

27630 ......... ............ A Removal of tendon lesion ............................ 4.79 8.99 4.46 0.72 14.50 9.97 090 

27635 ......... ............ A Remove lower leg bone lesion .................... 7.77 NA 6.84 1.28 NA 15.89 090 

27637 ......... ............ A Remove/graft leg bone lesion ...................... 9.84 NA 8.35 1.66 NA 19.85 090 

27638 ......... ............ A Remove/graft leg bone lesion ...................... 10.55 NA 8.39 1.77 NA 20.71 090 

27640 ......... ............ A Partial removal of tibia ................................. 11.35 NA 10.81 1.86 NA 24.02 090 

27641 ......... ............ A Partial removal of fibula ............................... 9.23 NA 8.83 1.47 NA 19.53 090 

27645 ......... ............ A Extensive lower leg surgery ........................ 14.15 NA 12.34 2.39 NA 28.88 090 

27646 ......... ............ A Extensive lower leg surgery ........................ 12.64 NA 11.34 1.87 NA 25.85 090 

27647 ......... ............ A Extensive ankle/heel surgery ....................... 12.22 NA 7.85 1.98 NA 22.05 090 

27648 ......... ............ A Injection for ankle x-ray ............................... 0.96 9.45 0.33 0.06 10.47 1.35 000 

27650 ......... ............ A Repair achilles tendon ................................. 9.68 NA 7.51 1.63 NA 18.82 090 

27652 ......... ............ A Repair/graft achilles tendon ......................... 10.31 NA 8.01 1.75 NA 20.07 090 

27654 ......... ............ A Repair of achilles tendon ............................. 10.00 NA 7.23 1.70 NA 18.93 090 

27656 ......... ............ A Repair leg fascia defect ............................... 4.56 9.93 4.01 0.58 15.07 9.15 090 

27658 ......... ............ A Repair of leg tendon, each .......................... 4.97 9.18 4.77 0.82 14.97 10.56 090 

27659 ......... ............ A Repair of leg tendon, each .......................... 6.80 11.30 5.80 1.16 19.26 13.76 090 

27664 ......... ............ A Repair of leg tendon, each .......................... 4.58 11.26 4.74 0.76 16.60 10.08 090 

27665 ......... ............ A Repair of leg tendon, each .......................... 5.39 11.05 5.18 0.90 17.34 11.47 090 

27675 ......... ............ A Repair lower leg tendons ............................. 7.17 NA 5.79 1.22 NA 14.18 090 

27676 ......... ............ A Repair lower leg tendons ............................. 8.41 NA 6.77 1.39 NA 16.57 090 

27680 ......... ............ A Release of lower leg tendon ........................ 5.73 NA 5.19 0.96 NA 11.88 090 

27681 ......... ............ A Release of lower leg tendons ...................... 6.81 NA 5.96 1.11 NA 13.88 090 

27685 ......... ............ A Revision of lower leg tendon ....................... 6.49 8.11 5.51 1.10 15.70 13.10 090 

27686 ......... ............ A Revise lower leg tendons ............................ 7.45 12.57 6.59 1.27 21.29 15.31 090 

27687 ......... ............ A Revision of calf tendon ................................ 6.23 NA 5.42 1.06 NA 12.71 090 

27690 ......... ............ A Revise lower leg tendon .............................. 8.70 NA 6.45 1.47 NA 16.62 090 

27691 ......... ............ A Revise lower leg tendon .............................. 9.95 NA 7.81 1.69 NA 19.45 090 

27692 ......... ............ A Revise additional leg tendon ....................... 1.87 NA 0.93 0.31 NA 3.11 ZZZ 

27695 ......... ............ A Repair of ankle ligament .............................. 6.50 NA 5.92 1.09 NA 13.51 090 

27696 ......... ............ A Repair of ankle ligaments ............................ 8.26 NA 6.50 1.40 NA 16.16 090 

27698 ......... ............ A Repair of ankle ligament .............................. 9.35 NA 6.98 1.58 NA 17.91 090 

27700 ......... ............ A Revision of ankle joint ................................. 9.28 NA 5.62 1.50 NA 16.40 090 

27702 ......... ............ A Reconstruct ankle joint ................................ 13.65 NA 10.32 2.32 NA 26.29 090 

27703 ......... ............ A Reconstruction, ankle joint .......................... 15.85 NA 11.09 2.70 NA 29.64 090 

27704 ......... ............ A Removal of ankle implant ............................ 7.61 NA 5.52 0.74 NA 13.87 090 

27705 ......... ............ A Incision of tibia ............................................. 10.36 NA 8.23 1.74 NA 20.33 090 

27707 ......... ............ A Incision of fibula ........................................... 4.36 NA 5.01 0.72 NA 10.09 090 

27709 ......... ............ A Incision of tibia & fibula ............................... 9.94 NA 8.16 1.68 NA 19.78 090 

27712 ......... ............ A Realignment of lower leg ............................. 14.23 NA 10.72 2.41 NA 27.36 090 

27715 ......... ............ A Revision of lower leg ................................... 14.37 NA 10.84 2.41 NA 27.62 090 

27720 ......... ............ A Repair of tibia .............................................. 11.77 NA 9.45 2.00 NA 23.22 090 

27722 ......... ............ A Repair/graft of tibia ...................................... 11.80 NA 9.21 1.99 NA 23.00 090 

27724 ......... ............ A Repair/graft of tibia ...................................... 18.17 NA 12.45 2.53 NA 33.15 090 

27725 ......... ............ A Repair of lower leg ...................................... 15.57 NA 11.88 2.65 NA 30.10 090 

27727 ......... ............ A Repair of lower leg ...................................... 13.99 NA 10.41 2.22 NA 26.62 090 

27730 ......... ............ A Repair of tibia epiphysis .............................. 7.40 17.74 6.45 0.90 26.04 14.75 090 

27732 ......... ............ A Repair of fibula epiphysis ............................ 5.31 11.60 5.00 0.76 17.67 11.07 090 

27734 ......... ............ A Repair lower leg epiphyses ......................... 8.47 NA 6.42 1.03 NA 15.92 090 

27740 ......... ............ A Repair of leg epiphyses ............................... 9.29 20.61 7.93 1.58 31.48 18.80 090 

27742 ......... ............ A Repair of leg epiphyses ............................... 10.28 12.50 7.26 1.87 24.65 19.41 090 

27745 ......... ............ A Reinforce tibia .............................................. 10.05 NA 8.21 1.66 NA 19.92 090 

27750 ......... ............ A Treatment of tibia fracture ........................... 3.19 5.37 3.77 0.52 9.08 7.48 090 

27752 ......... ............ A Treatment of tibia fracture ........................... 5.83 7.38 5.49 0.99 14.20 12.31 090 

27756 ......... ............ A Treatment of tibia fracture ........................... 6.77 NA 6.52 1.13 NA 14.42 090 

27758 ......... ............ A Treatment of tibia fracture ........................... 11.65 NA 9.19 1.83 NA 22.67 090 

27759 ......... ............ A Treatment of tibia fracture ........................... 13.74 NA 10.32 2.33 NA 26.39 090 

27760 ......... ............ A Treatment of ankle fracture ......................... 3.01 5.25 3.53 0.47 8.73 7.01 090 

27762 ......... ............ A Treatment of ankle fracture ......................... 5.24 7.12 5.16 0.86 13.22 11.26 090 

27766 ......... ............ A Treatment of ankle fracture ......................... 8.35 NA 7.16 1.41 NA 16.92 090 

1140

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

27780 ......... ............ A Treatment of fibula fracture ......................... 2.65 4.92 3.21 0.40 7.97 6.26 090 

27781 ......... ............ A Treatment of fibula fracture ......................... 4.39 6.35 4.49 0.69 11.43 9.57 090 

27784 ......... ............ A Treatment of fibula fracture ......................... 7.10 NA 6.45 1.18 NA 14.73 090 

27786 ......... ............ A Treatment of ankle fracture ......................... 2.84 5.09 3.33 0.45 8.38 6.62 090 

27788 ......... ............ A Treatment of ankle fracture ......................... 4.44 6.46 4.50 0.74 11.64 9.68 090 

27792 ......... ............ A Treatment of ankle fracture ......................... 7.65 NA 6.90 1.29 NA 15.84 090 

27808 ......... ............ A Treatment of ankle fracture ......................... 2.83 5.68 3.60 0.46 8.97 6.89 090 

27810 ......... ............ A Treatment of ankle fracture ......................... 5.12 6.95 4.99 0.86 12.93 10.97 090 

27814 ......... ............ A Treatment of ankle fracture ......................... 10.66 NA 8.55 1.81 NA 21.02 090 

27816 ......... ............ A Treatment of ankle fracture ......................... 2.89 4.99 3.40 0.45 8.33 6.74 090 

27818 ......... ............ A Treatment of ankle fracture ......................... 5.49 7.06 5.04 0.89 13.44 11.42 090 

27822 ......... ............ A Treatment of ankle fracture ......................... 10.98 NA 10.63 1.56 NA 23.17 090 

27823 ......... ............ A Treatment of ankle fracture ......................... 12.98 NA 11.49 1.99 NA 26.46 090 

27824 ......... ............ A Treat lower leg fracture ............................... 2.89 5.56 3.74 0.47 8.92 7.10 090 

27825 ......... ............ A Treat lower leg fracture ............................... 6.18 8.19 5.86 1.03 15.40 13.07 090 

27826 ......... ............ A Treat lower leg fracture ............................... 8.53 NA 8.87 1.44 NA 18.84 090 

27827 ......... ............ A Treat lower leg fracture ............................... 14.04 NA 12.71 2.36 NA 29.11 090 

27828 ......... ............ A Treat lower leg fracture ............................... 16.21 NA 13.85 2.74 NA 32.80 090 

27829 ......... ............ A Treat lower leg joint ..................................... 5.48 NA 6.77 0.93 NA 13.18 090 

27830 ......... ............ A Treat lower leg dislocation ........................... 3.78 5.12 3.83 0.53 9.43 8.14 090 

27831 ......... ............ A Treat lower leg dislocation ........................... 4.55 NA 4.43 0.74 NA 9.72 090 

27832 ......... ............ A Treat lower leg dislocation ........................... 6.48 NA 6.16 1.10 NA 13.74 090 

27840 ......... ............ A Treat ankle dislocation ................................. 4.57 NA 3.89 0.57 NA 9.03 090 

27842 ......... ............ A Treat ankle dislocation ................................. 6.20 NA 5.08 0.92 NA 12.20 090 

27846 ......... ............ A Treat ankle dislocation ................................. 9.78 NA 7.91 1.64 NA 19.33 090 

27848 ......... ............ A Treat ankle dislocation ................................. 11.18 NA 9.71 1.87 NA 22.76 090 

27860 ......... ............ A Fixation of ankle joint ................................... 2.34 NA 2.01 0.37 NA 4.72 010 

27870 ......... ............ A Fusion of ankle joint, open .......................... 13.89 NA 10.50 2.35 NA 26.74 090 

27871 ......... ............ A Fusion of tibiofibular joint ............................. 9.16 NA 7.62 1.56 NA 18.34 090 

27880 ......... ............ A Amputation of lower leg ............................... 11.83 NA 7.46 1.66 NA 20.95 090 

27881 ......... ............ A Amputation of lower leg ............................... 12.32 NA 9.01 1.92 NA 23.25 090 

27882 ......... ............ A Amputation of lower leg ............................... 8.93 NA 6.93 1.24 NA 17.10 090 

27884 ......... ............ A Amputation follow-up surgery ...................... 8.20 NA 6.10 1.15 NA 15.45 090 

27886 ......... ............ A Amputation follow-up surgery ...................... 9.31 NA 6.82 1.36 NA 17.49 090 

27888 ......... ............ A Amputation of foot at ankle ......................... 9.66 NA 7.60 1.52 NA 18.78 090 

27889 ......... ............ A Amputation of foot at ankle ......................... 9.97 NA 6.74 1.44 NA 18.15 090 

27892 ......... ............ A Decompression of leg .................................. 7.38 NA 5.85 1.04 NA 14.27 090 

27893 ......... ............ A Decompression of leg .................................. 7.34 NA 5.74 1.09 NA 14.17 090 

27894 ......... ............ A Decompression of leg .................................. 10.47 NA 7.93 1.51 NA 19.91 090 

27899 ......... ............ C Leg/ankle surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

28001 ......... ............ A Drainage of bursa of foot ............................. 2.73 5.82 3.51 0.37 8.92 6.61 010 

28002 ......... ............ A Treatment of foot infection ........................... 4.61 7.22 4.64 0.68 12.51 9.93 010 

28003 ......... ............ A Treatment of foot infection ........................... 8.40 7.68 6.04 1.24 17.32 15.68 090 

28005 ......... ............ A Treat foot bone lesion .................................. 8.67 NA 6.36 1.37 NA 16.40 090 

28008 ......... ............ A Incision of foot fascia ................................... 4.44 5.68 3.55 0.68 10.80 8.67 090 

28010 ......... ............ A Incision of toe tendon .................................. 2.84 5.53 2.91 0.47 8.84 6.22 090 

28011 ......... ............ A Incision of toe tendons ................................ 4.13 7.42 4.24 0.70 12.25 9.07 090 

28020 ......... ............ A Exploration of foot joint ................................ 5.00 7.07 4.20 0.77 12.84 9.97 090 

28022 ......... ............ A Exploration of foot joint ................................ 4.66 6.09 3.93 0.75 11.50 9.34 090 

28024 ......... ............ A Exploration of toe joint ................................. 4.37 6.20 3.99 0.60 11.17 8.96 090 

28030 ......... ............ A Removal of foot nerve ................................. 6.14 NA 3.58 1.03 NA 10.75 090 

28035 ......... ............ A Decompression of tibia nerve ...................... 5.08 5.54 4.03 0.86 11.48 9.97 090 

28043 ......... ............ A Excision of foot lesion .................................. 3.53 5.79 3.28 0.54 9.86 7.35 090 

28045 ......... ............ A Excision of foot lesion .................................. 4.71 6.12 3.71 0.75 11.58 9.17 090 

28046 ......... ............ A Resection of tumor, foot .............................. 10.16 9.42 7.34 1.36 20.94 18.86 090 

28050 ......... ............ A Biopsy of foot joint lining ............................. 4.24 5.78 3.66 0.66 10.68 8.56 090 

28052 ......... ............ A Biopsy of foot joint lining ............................. 3.93 5.97 3.56 0.62 10.52 8.11 090 

28054 ......... ............ A Biopsy of toe joint lining .............................. 3.44 5.82 3.36 0.54 9.80 7.34 090 

28060 ......... ............ A Partial removal, foot fascia .......................... 5.22 6.39 4.03 0.83 12.44 10.08 090 

28062 ......... ............ A Removal of foot fascia ................................. 6.51 7.13 4.19 1.03 14.67 11.73 090 

28070 ......... ............ A Removal of foot joint lining .......................... 5.09 5.96 3.89 0.82 11.87 9.80 090 

28072 ......... ............ A Removal of foot joint lining .......................... 4.57 6.43 4.32 0.77 11.77 9.66 090 

28080 ......... ............ A Removal of foot lesion ................................. 3.57 5.93 3.70 0.60 10.10 7.87 090 

28086 ......... ............ A Excise foot tendon sheath ........................... 4.77 9.50 4.69 0.80 15.07 10.26 090 

28088 ......... ............ A Excise foot tendon sheath ........................... 3.85 7.04 4.00 0.63 11.52 8.48 090 

28090 ......... ............ A Removal of foot lesion ................................. 4.40 6.02 3.55 0.69 11.11 8.64 090 

28092 ......... ............ A Removal of toe lesions ................................ 3.63 6.33 3.61 0.55 10.51 7.79 090 

28100 ......... ............ A Removal of ankle/heel lesion ...................... 5.65 9.21 4.81 0.92 15.78 11.38 090 

28102 ......... ............ A Remove/graft foot lesion .............................. 7.72 NA 6.05 1.17 NA 14.94 090 

28103 ......... ............ A Remove/graft foot lesion .............................. 6.49 8.41 4.76 1.07 15.97 12.32 090 

28104 ......... ............ A Removal of foot lesion ................................. 5.11 6.35 4.05 0.83 12.29 9.99 090 

28106 ......... ............ A Remove/graft foot lesion .............................. 7.15 NA 4.59 1.22 NA 12.96 090 

28107 ......... ............ A Remove/graft foot lesion .............................. 5.55 7.24 4.32 0.89 13.68 10.76 090 

28108 ......... ............ A Removal of toe lesions ................................ 4.15 5.44 3.36 0.63 10.22 8.14 090 

28110 ......... ............ A Part removal of metatarsal .......................... 4.07 6.03 3.68 0.59 10.69 8.34 090 

1141

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

28111 ......... ............ A Part removal of metatarsal .......................... 5.00 7.18 4.18 0.76 12.94 9.94 090 

28112 ......... ............ A Part removal of metatarsal .......................... 4.48 6.69 4.06 0.72 11.89 9.26 090 

28113 ......... ............ A Part removal of metatarsal .......................... 4.78 6.81 4.66 0.76 12.35 10.20 090 

28114 ......... ............ A Removal of metatarsal heads ...................... 9.78 11.93 8.52 1.64 23.35 19.94 090 

28116 ......... ............ A Revision of foot ............................................ 7.74 7.20 5.22 1.24 16.18 14.20 090 

28118 ......... ............ A Removal of heel bone ................................. 5.95 7.13 4.53 0.95 14.03 11.43 090 

28119 ......... ............ A Removal of heel spur .................................. 5.38 6.21 3.87 0.89 12.48 10.14 090 

28120 ......... ............ A Part removal of ankle/heel ........................... 5.39 8.67 5.07 0.83 14.89 11.29 090 

28122 ......... ............ A Partial removal of foot bone ........................ 7.28 7.89 5.69 1.16 16.33 14.13 090 

28124 ......... ............ A Partial removal of toe .................................. 4.80 6.08 4.06 0.78 11.66 9.64 090 

28126 ......... ............ A Partial removal of toe .................................. 3.51 5.34 3.51 0.59 9.44 7.61 090 

28130 ......... ............ A Removal of ankle bone ................................ 8.10 NA 6.70 1.34 NA 16.14 090 

28140 ......... ............ A Removal of metatarsal ................................. 6.90 8.26 5.00 1.01 16.17 12.91 090 

28150 ......... ............ A Removal of toe ............................................ 4.08 5.98 3.78 0.63 10.69 8.49 090 

28153 ......... ............ A Partial removal of toe .................................. 3.65 5.40 3.08 0.59 9.64 7.32 090 

28160 ......... ............ A Partial removal of toe .................................. 3.73 5.68 3.83 0.62 10.03 8.18 090 

28171 ......... ............ A Extensive foot surgery ................................. 9.59 NA 5.69 1.36 NA 16.64 090 

28173 ......... ............ A Extensive foot surgery ................................. 8.79 8.26 5.64 1.25 18.30 15.68 090 

28175 ......... ............ A Extensive foot surgery ................................. 6.04 6.68 4.10 0.90 13.62 11.04 090 

28190 ......... ............ A Removal of foot foreign body ...................... 1.96 6.51 3.47 0.19 8.66 5.62 010 

28192 ......... ............ A Removal of foot foreign body ...................... 4.63 6.43 3.72 0.63 11.69 8.98 090 

28193 ......... ............ A Removal of foot foreign body ...................... 5.72 6.35 4.11 0.76 12.83 10.59 090 

28200 ......... ............ A Repair of foot tendon ................................... 4.59 5.94 3.71 0.71 11.24 9.01 090 

28202 ......... ............ A Repair/graft of foot tendon ........................... 6.83 8.16 4.63 1.04 16.03 12.50 090 

28208 ......... ............ A Repair of foot tendon ................................... 4.36 5.72 3.46 0.71 10.79 8.53 090 

28210 ......... ............ A Repair/graft of foot tendon ........................... 6.34 7.12 4.19 0.93 14.39 11.46 090 

28220 ......... ............ A Release of foot tendon ................................ 4.52 5.56 3.56 0.76 10.84 8.84 090 

28222 ......... ............ A Release of foot tendons .............................. 5.61 5.95 4.23 0.93 12.49 10.77 090 

28225 ......... ............ A Release of foot tendon ................................ 3.65 5.26 3.07 0.60 9.51 7.32 090 

28226 ......... ............ A Release of foot tendons .............................. 4.52 5.61 3.85 0.75 10.88 9.12 090 

28230 ......... ............ A Incision of foot tendon(s) ............................. 4.23 5.62 3.81 0.71 10.56 8.75 090 

28232 ......... ............ A Incision of toe tendon .................................. 3.38 5.66 3.44 0.58 9.62 7.40 090 

28234 ......... ............ A Incision of foot tendon ................................. 3.36 5.81 3.47 0.55 9.72 7.38 090 

28238 ......... ............ A Revision of foot tendon ................................ 7.72 7.97 5.07 1.30 16.99 14.09 090 

28240 ......... ............ A Release of big toe ....................................... 4.35 5.59 3.63 0.74 10.68 8.72 090 

28250 ......... ............ A Revision of foot fascia ................................. 5.91 6.53 4.25 0.98 13.42 11.14 090 

28260 ......... ............ A Release of midfoot joint ............................... 7.95 7.09 5.14 1.30 16.34 14.39 090 

28261 ......... ............ A Revision of foot tendon ................................ 11.71 8.91 7.34 2.00 22.62 21.05 090 

28262 ......... ............ A Revision of foot and ankle ........................... 15.81 14.32 11.44 2.68 32.81 29.93 090 

28264 ......... ............ A Release of midfoot joint ............................... 10.33 8.51 7.82 1.76 20.60 19.91 090 

28270 ......... ............ A Release of foot contracture ......................... 4.75 5.90 4.19 0.81 11.46 9.75 090 

28272 ......... ............ A Release of toe joint, each ............................ 3.79 5.14 3.04 0.63 9.56 7.46 090 

28280 ......... ............ A Fusion of toes .............................................. 5.18 7.25 4.52 0.87 13.30 10.57 090 

28285 ......... ............ A Repair of hammertoe ................................... 4.58 5.96 3.85 0.77 11.31 9.20 090 

28286 ......... ............ A Repair of hammertoe ................................... 4.55 5.74 3.67 0.77 11.06 8.99 090 

28288 ......... ............ A Partial removal of foot bone ........................ 4.73 6.69 5.30 0.78 12.20 10.81 090 

28289 ......... ............ A Repair hallux rigidus .................................... 7.03 8.97 6.21 1.16 17.16 14.40 090 

28290 ......... ............ A Correction of bunion .................................... 5.65 7.02 5.28 0.95 13.62 11.88 090 

28292 ......... ............ A Correction of bunion .................................... 7.03 7.80 5.75 1.18 16.01 13.96 090 

28293 ......... ............ A Correction of bunion .................................... 9.14 10.84 6.01 1.54 21.52 16.69 090 

28294 ......... ............ A Correction of bunion .................................... 8.55 7.64 5.08 1.40 17.59 15.03 090 

28296 ......... ............ A Correction of bunion .................................... 9.17 8.14 5.80 1.54 18.85 16.51 090 

28297 ......... ............ A Correction of bunion .................................... 9.17 9.11 6.74 1.58 19.86 17.49 090 

28298 ......... ............ A Correction of bunion .................................... 7.93 7.31 5.40 1.35 16.59 14.68 090 

28299 ......... ............ A Correction of bunion .................................... 10.56 8.71 6.41 1.50 20.77 18.47 090 

28300 ......... ............ A Incision of heel bone ................................... 9.53 13.10 7.07 1.58 24.21 18.18 090 

28302 ......... ............ A Incision of ankle bone .................................. 9.54 13.11 6.95 1.39 24.04 17.88 090 

28304 ......... ............ A Incision of midfoot bones ............................. 9.15 8.16 5.80 1.21 18.52 16.16 090 

28305 ......... ............ A Incise/graft midfoot bones ........................... 10.48 10.90 6.80 0.66 22.04 17.94 090 

28306 ......... ............ A Incision of metatarsal ................................... 5.85 7.19 4.25 0.98 14.02 11.08 090 

28307 ......... ............ A Incision of metatarsal ................................... 6.32 11.59 5.33 0.86 18.77 12.51 090 

28308 ......... ............ A Incision of metatarsal ................................... 5.28 6.07 3.76 0.89 12.24 9.93 090 

28309 ......... ............ A Incision of metatarsals ................................. 12.76 NA 8.05 1.98 NA 22.79 090 

28310 ......... ............ A Revision of big toe ....................................... 5.42 6.24 3.96 0.92 12.58 10.30 090 

28312 ......... ............ A Revision of toe ............................................. 4.54 5.98 4.11 0.75 11.27 9.40 090 

28313 ......... ............ A Repair deformity of toe ................................ 5.00 6.43 5.45 0.82 12.25 11.27 090 

28315 ......... ............ A Removal of sesamoid bone ......................... 4.85 5.82 3.67 0.80 11.47 9.32 090 

28320 ......... ............ A Repair of foot bones .................................... 9.17 NA 6.76 1.53 NA 17.46 090 

28322 ......... ............ A Repair of metatarsals .................................. 8.33 10.13 6.33 1.41 19.87 16.07 090 

28340 ......... ............ A Resect enlarged toe tissue .......................... 6.97 7.06 4.41 1.18 15.21 12.56 090 

28341 ......... ............ A Resect enlarged toe .................................... 8.40 7.23 4.95 1.42 17.05 14.77 090 

28344 ......... ............ A Repair extra toe(s) ....................................... 4.25 6.78 3.69 0.72 11.75 8.66 090 

28345 ......... ............ A Repair webbed toe(s) .................................. 5.91 6.99 4.79 1.01 13.91 11.71 090 

28360 ......... ............ A Reconstruct cleft foot ................................... 13.32 NA 10.50 2.27 NA 26.09 090 

28400 ......... ............ A Treatment of heel fracture ........................... 2.16 4.28 2.98 0.35 6.79 5.49 090 

1142

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

28405 ......... ............ A Treatment of heel fracture ........................... 4.56 5.51 4.53 0.76 10.83 9.85 090 

28406 ......... ............ A Treatment of heel fracture ........................... 6.30 NA 6.80 1.05 NA 14.15 090 

28415 ......... ............ A Treat heel fracture ....................................... 15.95 NA 13.24 2.70 NA 31.89 090 

28420 ......... ............ A Treat/graft heel fracture ............................... 16.62 NA 12.97 2.76 NA 32.35 090 

28430 ......... ............ A Treatment of ankle fracture ......................... 2.09 4.07 2.61 0.33 6.49 5.03 090 

28435 ......... ............ A Treatment of ankle fracture ......................... 3.39 4.49 3.63 0.57 8.45 7.59 090 

28436 ......... ............ A Treatment of ankle fracture ......................... 4.70 NA 5.90 0.80 NA 11.40 090 

28445 ......... ............ A Treat ankle fracture ..................................... 15.60 NA 11.02 1.56 NA 28.18 090 

28450 ......... ............ A Treat midfoot fracture, each ........................ 1.90 4.07 2.52 0.30 6.27 4.72 090 

28455 ......... ............ A Treat midfoot fracture, each ........................ 3.09 3.97 3.41 0.52 7.58 7.02 090 

28456 ......... ............ A Treat midfoot fracture .................................. 2.68 NA 4.21 0.43 NA 7.32 090 

28465 ......... ............ A Treat midfoot fracture, each ........................ 7.00 NA 6.37 1.05 NA 14.42 090 

28470 ......... ............ A Treat metatarsal fracture ............................. 1.99 3.87 2.48 0.31 6.17 4.78 090 

28475 ......... ............ A Treat metatarsal fracture ............................. 2.97 4.05 3.19 0.49 7.51 6.65 090 

28476 ......... ............ A Treat metatarsal fracture ............................. 3.37 NA 4.99 0.55 NA 8.91 090 

28485 ......... ............ A Treat metatarsal fracture ............................. 5.70 NA 5.55 0.96 NA 12.21 090 

28490 ......... ............ A Treat big toe fracture ................................... 1.09 2.21 1.73 0.16 3.46 2.98 090 

28495 ......... ............ A Treat big toe fracture ................................... 1.58 2.50 2.06 0.23 4.31 3.87 090 

28496 ......... ............ A Treat big toe fracture ................................... 2.33 9.72 3.63 0.39 12.44 6.35 090 

28505 ......... ............ A Treat big toe fracture ................................... 3.80 9.71 4.70 0.60 14.11 9.10 090 

28510 ......... ............ A Treatment of toe fracture ............................. 1.09 1.98 1.69 0.16 3.23 2.94 090 

28515 ......... ............ A Treatment of toe fracture ............................. 1.46 2.33 1.99 0.21 4.00 3.66 090 

28525 ......... ............ A Treat toe fracture ......................................... 3.32 9.30 4.25 0.53 13.15 8.10 090 

28530 ......... ............ A Treat sesamoid bone fracture ..................... 1.06 2.08 1.46 0.16 3.30 2.68 090 

28531 ......... ............ A Treat sesamoid bone fracture ..................... 2.35 8.98 2.51 0.40 11.73 5.26 090 

28540 ......... ............ A Treat foot dislocation ................................... 2.04 2.87 2.67 0.29 5.20 5.00 090 

28545 ......... ............ A Treat foot dislocation ................................... 2.45 2.86 2.86 0.40 5.71 5.71 090 

28546 ......... ............ A Treat foot dislocation ................................... 3.20 7.89 4.84 0.55 11.64 8.59 090 

28555 ......... ............ A Repair foot dislocation ................................. 6.29 11.49 6.54 1.06 18.84 13.89 090 

28570 ......... ............ A Treat foot dislocation ................................... 1.66 2.89 2.29 0.27 4.82 4.22 090 

28575 ......... ............ A Treat foot dislocation ................................... 3.31 4.37 4.03 0.54 8.22 7.88 090 

28576 ......... ............ A Treat foot dislocation ................................... 4.16 10.15 5.51 0.68 14.99 10.35 090 

28585 ......... ............ A Repair foot dislocation ................................. 7.98 8.14 6.53 1.36 17.48 15.87 090 

28600 ......... ............ A Treat foot dislocation ................................... 1.89 3.29 2.66 0.29 5.47 4.84 090 

28605 ......... ............ A Treat foot dislocation ................................... 2.71 3.74 3.61 0.42 6.87 6.74 090 

28606 ......... ............ A Treat foot dislocation ................................... 4.89 16.02 6.01 0.82 21.73 11.72 090 

28615 ......... ............ A Repair foot dislocation ................................. 7.76 NA 7.98 1.31 NA 17.05 090 

28630 ......... ............ A Treat toe dislocation .................................... 1.70 1.22 1.12 0.21 3.13 3.03 010 

28635 ......... ............ A Treat toe dislocation .................................... 1.91 1.66 1.49 0.29 3.86 3.69 010 

28636 ......... ............ A Treat toe dislocation .................................... 2.77 6.14 3.07 0.47 9.38 6.31 010 

28645 ......... ............ A Repair toe dislocation .................................. 4.21 5.66 3.50 0.70 10.57 8.41 090 

28660 ......... ............ A Treat toe dislocation .................................... 1.23 1.61 1.16 0.13 2.97 2.52 010 

28665 ......... ............ A Treat toe dislocation .................................... 1.92 1.65 1.63 0.29 3.86 3.84 010 

28666 ......... ............ A Treat toe dislocation .................................... 2.66 5.93 2.24 0.46 9.05 5.36 010 

28675 ......... ............ A Repair of toe dislocation .............................. 2.92 8.81 3.77 0.49 12.22 7.18 090 

28705 ......... ............ A Fusion of foot bones .................................... 18.77 NA 12.43 2.57 NA 33.77 090 

28715 ......... ............ A Fusion of foot bones .................................... 13.08 NA 9.74 2.22 NA 25.04 090 

28725 ......... ............ A Fusion of foot bones .................................... 11.59 NA 8.30 1.97 NA 21.86 090 

28730 ......... ............ A Fusion of foot bones .................................... 10.74 NA 8.47 1.82 NA 21.03 090 

28735 ......... ............ A Fusion of foot bones .................................... 10.83 NA 7.86 1.82 NA 20.51 090 

28737 ......... ............ A Revision of foot bones ................................. 9.63 NA 6.87 1.64 NA 18.14 090 

28740 ......... ............ A Fusion of foot bones .................................... 8.01 11.59 6.43 1.36 20.96 15.80 090 

28750 ......... ............ A Fusion of big toe joint .................................. 7.29 12.97 6.59 1.24 21.50 15.12 090 

28755 ......... ............ A Fusion of big toe joint .................................. 4.73 6.83 3.86 0.80 12.36 9.39 090 

28760 ......... ............ A Fusion of big toe joint .................................. 7.74 8.04 5.62 1.29 17.07 14.65 090 

28800 ......... ............ A Amputation of midfoot .................................. 8.20 NA 6.04 1.18 NA 15.42 090 

28805 ......... ............ A Amputation thru metatarsal ......................... 8.38 NA 5.90 1.17 NA 15.45 090 

28810 ......... ............ A Amputation toe & metatarsal ....................... 6.20 NA 4.76 0.84 NA 11.80 090 

28820 ......... ............ A Amputation of toe ........................................ 4.40 8.50 4.10 0.62 13.52 9.12 090 

28825 ......... ............ A Partial amputation of toe ............................. 3.58 7.91 3.79 0.52 12.01 7.89 090 

28899 ......... ............ C Foot/toes surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29000 ......... ............ A Application of body cast .............................. 2.25 3.09 1.72 0.36 5.70 4.33 000 

29010 ......... ............ A Application of body cast .............................. 2.06 3.30 1.73 0.33 5.69 4.12 000 

29015 ......... ............ A Application of body cast .............................. 2.41 3.01 1.58 0.25 5.67 4.24 000 

29020 ......... ............ A Application of body cast .............................. 2.11 3.30 1.41 0.19 5.60 3.71 000 

29025 ......... ............ A Application of body cast .............................. 2.40 3.22 1.83 0.31 5.93 4.54 000 

29035 ......... ............ A Application of body cast .............................. 1.77 3.45 1.54 0.29 5.51 3.60 000 

29040 ......... ............ A Application of body cast .............................. 2.22 2.57 1.51 0.42 5.21 4.15 000 

29044 ......... ............ A Application of body cast .............................. 2.12 3.80 1.85 0.35 6.27 4.32 000 

29046 ......... ............ A Application of body cast .............................. 2.41 3.27 2.02 0.41 6.09 4.84 000 

29049 ......... ............ A Application of figure eight ............................ 0.89 1.24 0.54 0.14 2.27 1.57 000 

29055 ......... ............ A Application of shoulder cast ........................ 1.78 2.81 1.43 0.29 4.88 3.50 000 

29058 ......... ............ A Application of shoulder cast ........................ 1.31 1.50 0.73 0.17 2.98 2.21 000 

29065 ......... ............ A Application of long arm cast ........................ 0.87 1.26 0.74 0.14 2.27 1.75 000 

29075 ......... ............ A Application of forearm cast .......................... 0.77 1.20 0.67 0.13 2.10 1.57 000 

1143

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

29085 ......... ............ A Apply hand/wrist cast ................................... 0.87 1.23 0.63 0.13 2.23 1.63 000 

29086 ......... ............ A Apply finger cast .......................................... 0.62 0.93 0.51 0.07 1.62 1.20 000 

29105 ......... ............ A Apply long arm splint ................................... 0.87 1.18 0.52 0.13 2.18 1.52 000 

29125 ......... ............ A Apply forearm splint ..................................... 0.59 0.99 0.40 0.07 1.65 1.06 000 

29126 ......... ............ A Apply forearm splint ..................................... 0.77 1.19 0.46 0.07 2.03 1.30 000 

29130 ......... ............ A Application of finger splint ........................... 0.50 0.45 0.17 0.06 1.01 0.73 000 

29131 ......... ............ A Application of finger splint ........................... 0.55 0.73 0.24 0.04 1.32 0.83 000 

29200 ......... ............ A Strapping of chest ........................................ 0.65 0.75 0.36 0.05 1.45 1.06 000 

29220 ......... ............ A Strapping of low back .................................. 0.64 0.72 0.39 0.08 1.44 1.11 000 

29240 ......... ............ A Strapping of shoulder .................................. 0.71 0.86 0.37 0.06 1.63 1.14 000 

29260 ......... ............ A Strapping of elbow or wrist .......................... 0.55 0.75 0.34 0.05 1.35 0.94 000 

29280 ......... ............ A Strapping of hand or finger .......................... 0.51 0.81 0.34 0.05 1.37 0.90 000 

29305 ......... ............ A Application of hip cast ................................. 2.03 3.19 1.71 0.35 5.57 4.09 000 

29325 ......... ............ A Application of hip casts ................................ 2.32 3.37 1.89 0.37 6.06 4.58 000 

29345 ......... ............ A Application of long leg cast ......................... 1.40 1.69 1.04 0.23 3.32 2.67 000 

29355 ......... ............ A Application of long leg cast ......................... 1.53 1.65 1.10 0.24 3.42 2.87 000 

29358 ......... ............ A Apply long leg cast brace ............................ 1.43 1.96 1.07 0.23 3.62 2.73 000 

29365 ......... ............ A Application of long leg cast ......................... 1.18 1.58 0.93 0.21 2.97 2.32 000 

29405 ......... ............ A Apply short leg cast ..................................... 0.86 1.17 0.70 0.14 2.17 1.70 000 

29425 ......... ............ A Apply short leg cast ..................................... 1.01 1.18 0.72 0.17 2.36 1.90 000 

29435 ......... ............ A Apply short leg cast ..................................... 1.18 1.49 0.91 0.21 2.88 2.30 000 

29440 ......... ............ A Addition of walker to cast ............................ 0.57 0.67 0.28 0.08 1.32 0.93 000 

29445 ......... ............ A Apply rigid leg cast ...................................... 1.78 1.75 0.96 0.29 3.82 3.03 000 

29450 ......... ............ A Application of leg cast ................................. 2.08 1.45 1.10 0.16 3.69 3.34 000 

29505 ......... ............ A Application, long leg splint ........................... 0.69 1.15 0.46 0.07 1.91 1.22 000 

29515 ......... ............ A Application lower leg splint .......................... 0.73 0.85 0.47 0.08 1.66 1.28 000 

29520 ......... ............ A Strapping of hip ........................................... 0.54 0.87 0.45 0.02 1.43 1.01 000 

29530 ......... ............ A Strapping of knee ........................................ 0.57 0.80 0.35 0.05 1.42 0.97 000 

29540 ......... ............ A Strapping of ankle and/or ft ......................... 0.51 0.41 0.32 0.05 0.97 0.88 000 

29550 ......... ............ A Strapping of toes ......................................... 0.47 0.41 0.28 0.06 0.94 0.81 000 

29580 ......... ............ A Application of paste boot ............................. 0.57 0.65 0.36 0.06 1.28 0.99 000 

29590 ......... ............ A Application of foot splint .............................. 0.76 0.50 0.30 0.07 1.33 1.13 000 

29700 ......... ............ A Removal/revision of cast ............................. 0.57 0.88 0.28 0.08 1.53 0.93 000 

29705 ......... ............ A Removal/revision of cast ............................. 0.76 0.79 0.38 0.12 1.67 1.26 000 

29710 ......... ............ A Removal/revision of cast ............................. 1.34 1.49 0.70 0.21 3.04 2.25 000 

29715 ......... ............ A Removal/revision of cast ............................. 0.94 1.14 0.40 0.10 2.18 1.44 000 

29720 ......... ............ A Repair of body cast ..................................... 0.68 1.10 0.38 0.12 1.90 1.18 000 

29730 ......... ............ A Windowing of cast ....................................... 0.75 0.78 0.36 0.12 1.65 1.23 000 

29740 ......... ............ A Wedging of cast ........................................... 1.12 1.12 0.49 0.18 2.42 1.79 000 

29750 ......... ............ A Wedging of clubfoot cast ............................. 1.26 1.04 0.58 0.19 2.49 2.03 000 

29799 ......... ............ C Casting/strapping procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

29800 ......... ............ A Jaw arthroscopy/surgery .............................. 6.42 NA 7.12 1.01 NA 14.55 090 

29804 ......... ............ A Jaw arthroscopy/surgery .............................. 8.13 NA 8.41 0.80 NA 17.34 090 

29805 ......... ............ A Shoulder arthroscopy, dx ............................. 5.88 NA 5.65 1.01 NA 12.54 090 

29806 ......... ............ A Shoulder arthroscopy/surgery ...................... 14.35 NA 10.94 2.41 NA 27.70 090 

29807 ......... ............ A Shoulder arthroscopy/surgery ...................... 13.88 NA 10.78 2.34 NA 27.00 090 

29819 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.66 1.29 NA 15.56 090 

29820 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.06 NA 6.12 1.19 NA 14.37 090 

29821 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.71 NA 6.68 1.30 NA 15.69 090 

29822 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.42 NA 6.56 1.25 NA 15.23 090 

29823 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.16 NA 7.09 1.39 NA 16.64 090 

29824 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.24 NA 7.33 1.39 NA 16.96 090 

29825 ......... ............ A Shoulder arthroscopy/surgery ...................... 7.61 NA 6.64 1.28 NA 15.53 090 

29826 ......... ............ A Shoulder arthroscopy/surgery ...................... 8.98 NA 7.41 1.52 NA 17.91 090 

29827 ......... ............ A Arthroscop rotator cuff repr ......................... 15.34 NA 11.32 2.24 NA 28.90 090 

29830 ......... ............ A Elbow arthroscopy ....................................... 5.75 NA 5.25 0.95 NA 11.95 090 

29834 ......... ............ A Elbow arthroscopy/surgery .......................... 6.27 NA 5.72 1.04 NA 13.03 090 

29835 ......... ............ A Elbow arthroscopy/surgery .......................... 6.47 NA 5.77 1.06 NA 13.30 090 

29836 ......... ............ A Elbow arthroscopy/surgery .......................... 7.54 NA 6.66 1.28 NA 15.48 090 

29837 ......... ............ A Elbow arthroscopy/surgery .......................... 6.86 NA 6.02 1.16 NA 14.04 090 

29838 ......... ............ A Elbow arthroscopy/surgery .......................... 7.70 NA 6.76 1.29 NA 15.75 090 

29840 ......... ............ A Wrist arthroscopy ......................................... 5.53 NA 5.24 0.83 NA 11.60 090 

29843 ......... ............ A Wrist arthroscopy/surgery ............................ 6.00 NA 5.54 0.99 NA 12.53 090 

29844 ......... ............ A Wrist arthroscopy/surgery ............................ 6.36 NA 5.71 1.04 NA 13.11 090 

29845 ......... ............ A Wrist arthroscopy/surgery ............................ 7.51 NA 6.38 1.01 NA 14.90 090 

29846 ......... ............ A Wrist arthroscopy/surgery ............................ 6.74 NA 5.95 1.07 NA 13.76 090 

29847 ......... ............ A Wrist arthroscopy/surgery ............................ 7.07 NA 6.10 1.10 NA 14.27 090 

29848 ......... ............ A Wrist endoscopy/surgery ............................. 5.43 NA 5.49 0.87 NA 11.79 090 

29850 ......... ............ A Knee arthroscopy/surgery ............................ 8.18 NA 5.04 0.89 NA 14.11 090 

29851 ......... ............ A Knee arthroscopy/surgery ............................ 13.08 NA 9.66 2.18 NA 24.92 090 

29855 ......... ............ A Tibial arthroscopy/surgery ........................... 10.60 NA 8.60 1.81 NA 21.01 090 

29856 ......... ............ A Tibial arthroscopy/surgery ........................... 14.12 NA 10.51 2.41 NA 27.04 090 

29860 ......... ............ A Hip arthroscopy, dx ...................................... 8.04 NA 6.82 1.37 NA 16.23 090 

29861 ......... ............ A Hip arthroscopy/surgery ............................... 9.14 NA 7.22 1.56 NA 17.92 090 

29862 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.39 1.68 NA 19.96 090 

1144

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

29863 ......... ............ A Hip arthroscopy/surgery ............................... 9.89 NA 8.34 1.69 NA 19.92 090 

29870 ......... ............ A Knee arthroscopy, dx ................................... 5.06 NA 4.80 0.81 NA 10.67 090 

29871 ......... ............ A Knee arthroscopy/drainage .......................... 6.54 NA 5.76 1.06 NA 13.36 090 

29873 ......... ............ A Knee arthroscopy/surgery ............................ 5.99 NA 6.37 0.88 NA 13.24 090 

29874 ......... ............ A Knee arthroscopy/surgery ............................ 7.04 NA 5.97 1.05 NA 14.06 090 

29875 ......... ............ A Knee arthroscopy/surgery ............................ 6.30 NA 5.74 1.06 NA 13.10 090 

29876 ......... ............ A Knee arthroscopy/surgery ............................ 7.91 NA 6.88 1.34 NA 16.13 090 

29877 ......... ............ A Knee arthroscopy/surgery ............................ 7.34 NA 6.59 1.24 NA 15.17 090 

29879 ......... ............ A Knee arthroscopy/surgery ............................ 8.03 NA 6.97 1.36 NA 16.36 090 

29880 ......... ............ A Knee arthroscopy/surgery ............................ 8.49 NA 7.21 1.44 NA 17.14 090 

29881 ......... ............ A Knee arthroscopy/surgery ............................ 7.75 NA 6.82 1.31 NA 15.88 090 

29882 ......... ............ A Knee arthroscopy/surgery ............................ 8.64 NA 7.10 1.31 NA 17.05 090 

29883 ......... ............ A Knee arthroscopy/surgery ............................ 11.03 NA 8.90 1.60 NA 21.53 090 

29884 ......... ............ A Knee arthroscopy/surgery ............................ 7.32 NA 6.55 1.24 NA 15.11 090 

29885 ......... ............ A Knee arthroscopy/surgery ............................ 9.08 NA 7.81 1.53 NA 18.42 090 

29886 ......... ............ A Knee arthroscopy/surgery ............................ 7.53 NA 6.70 1.28 NA 15.51 090 

29887 ......... ............ A Knee arthroscopy/surgery ............................ 9.03 NA 7.78 1.53 NA 18.34 090 

29888 ......... ............ A Knee arthroscopy/surgery ............................ 13.88 NA 10.09 2.35 NA 26.32 090 

29889 ......... ............ A Knee arthroscopy/surgery ............................ 15.98 NA 12.23 2.54 NA 30.75 090 

29891 ......... ............ A Ankle arthroscopy/surgery ........................... 8.39 NA 7.35 1.41 NA 17.15 090 

29892 ......... ............ A Ankle arthroscopy/surgery ........................... 8.99 NA 7.59 1.52 NA 18.10 090 

29893 ......... ............ A Scope, plantar fasciotomy ........................... 5.21 6.14 3.92 0.89 12.24 10.02 090 

29894 ......... ............ A Ankle arthroscopy/surgery ........................... 7.20 NA 5.39 1.22 NA 13.81 090 

29895 ......... ............ A Ankle arthroscopy/surgery ........................... 6.98 NA 5.39 1.17 NA 13.54 090 

29897 ......... ............ A Ankle arthroscopy/surgery ........................... 7.17 NA 5.78 1.22 NA 14.17 090 

29898 ......... ............ A Ankle arthroscopy/surgery ........................... 8.31 NA 6.11 1.37 NA 15.79 090 

29899 ......... ............ A Ankle arthroscopy/surgery ........................... 13.89 NA 9.84 2.35 NA 26.08 090 

29900 ......... ............ A Mcp joint arthroscopy, dx ............................ 5.41 NA 5.69 0.90 NA 12.00 090 

29901 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.12 NA 6.09 1.03 NA 13.24 090 

29902 ......... ............ A Mcp joint arthroscopy, surg ......................... 6.69 NA 6.37 1.12 NA 14.18 090 

29999 ......... ............ C Arthroscopy of joint ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

30000 ......... ............ A Drainage of nose lesion ............................... 1.43 4.19 1.41 0.12 5.74 2.96 010 

30020 ......... ............ A Drainage of nose lesion ............................... 1.43 3.35 1.48 0.10 4.88 3.01 010 

30100 ......... ............ A Intranasal biopsy .......................................... 0.94 2.05 0.82 0.07 3.06 1.83 000 

30110 ......... ............ A Removal of nose polyp(s) ............................ 1.63 3.36 1.58 0.14 5.13 3.35 010 

30115 ......... ............ A Removal of nose polyp(s) ............................ 4.34 NA 4.02 0.37 NA 8.73 090 

30117 ......... ............ A Removal of intranasal lesion ....................... 3.16 4.38 3.28 0.27 7.81 6.71 090 

30118 ......... ............ A Removal of intranasal lesion ....................... 9.68 NA 7.27 0.80 NA 17.75 090 

30120 ......... ............ A Revision of nose .......................................... 5.26 5.53 5.48 0.49 11.28 11.23 090 

30124 ......... ............ A Removal of nose lesion ............................... 3.10 NA 3.03 0.24 NA 6.37 090 

30125 ......... ............ A Removal of nose lesion ............................... 7.15 NA 5.92 0.65 NA 13.72 090 

30130 ......... ............ A Removal of turbinate bones ........................ 3.37 NA 3.51 0.27 NA 7.15 090 

30140 ......... ............ A Removal of turbinate bones ........................ 3.42 NA 3.97 0.29 NA 7.68 090 

30150 ......... ............ A Partial removal of nose ................................ 9.13 NA 7.66 0.92 NA 17.71 090 

30160 ......... ............ A Removal of nose .......................................... 9.57 NA 7.65 0.94 NA 18.16 090 

30200 ......... ............ A Injection treatment of nose .......................... 0.78 1.70 0.77 0.07 2.55 1.62 000 

30210 ......... ............ A Nasal sinus therapy ..................................... 1.08 2.17 1.32 0.10 3.35 2.50 010 

30220 ......... ............ A Insert nasal septal button ............................ 1.54 4.50 1.54 0.13 6.17 3.21 010 

30300 ......... ............ A Remove nasal foreign body ......................... 1.04 4.84 1.96 0.08 5.96 3.08 010 

30310 ......... ............ A Remove nasal foreign body ......................... 1.96 NA 3.20 0.17 NA 5.33 010 

30320 ......... ............ A Remove nasal foreign body ......................... 4.51 NA 4.49 0.43 NA 9.43 090 

30400 ......... ............ R Reconstruction of nose ................................ 9.82 NA 9.16 0.96 NA 19.94 090 

30410 ......... ............ R Reconstruction of nose ................................ 12.96 NA 10.94 1.30 NA 25.20 090 

30420 ......... ............ R Reconstruction of nose ................................ 15.86 NA 12.42 1.50 NA 29.78 090 

30430 ......... ............ R Revision of nose .......................................... 7.20 NA 8.10 0.75 NA 16.05 090 

30435 ......... ............ R Revision of nose .......................................... 11.69 NA 10.62 1.33 NA 23.64 090 

30450 ......... ............ R Revision of nose .......................................... 18.62 NA 14.10 1.85 NA 34.57 090 

30460 ......... ............ A Revision of nose .......................................... 9.95 NA 7.75 1.03 NA 18.73 090 

30462 ......... ............ A Revision of nose .......................................... 19.54 NA 13.67 2.32 NA 35.53 090 

30465 ......... ............ A Repair nasal stenosis .................................. 11.62 NA 7.67 1.17 NA 20.46 090 

30520 ......... ............ A Repair of nasal septum ............................... 5.69 NA 5.15 0.49 NA 11.33 090 

30540 ......... ............ A Repair nasal defect ...................................... 7.74 NA 5.62 0.64 NA 14.00 090 

30545 ......... ............ A Repair nasal defect ...................................... 11.36 NA 8.64 0.96 NA 20.96 090 

30560 ......... ............ A Release of nasal adhesions ........................ 1.26 4.92 2.16 0.11 6.29 3.53 010 

30580 ......... ............ A Repair upper jaw fistula ............................... 6.68 7.17 6.12 0.60 14.45 13.40 090 

30600 ......... ............ A Repair mouth/nose fistula ............................ 6.01 6.32 5.52 0.84 13.17 12.37 090 

30620 ......... ............ A Intranasal reconstruction ............................. 5.96 NA 5.78 0.54 NA 12.28 090 

30630 ......... ............ A Repair nasal septum defect ......................... 7.11 NA 6.18 0.62 NA 13.91 090 

30801 ......... ............ A Cauterization, inner nose ............................. 1.09 2.17 2.07 0.10 3.36 3.26 010 

30802 ......... ............ A Cauterization, inner nose ............................. 2.03 2.71 2.58 0.18 4.92 4.79 010 

30901 ......... ............ A Control of nosebleed ................................... 1.21 1.36 0.33 0.11 2.68 1.65 000 

30903 ......... ............ A Control of nosebleed ................................... 1.54 2.80 0.50 0.14 4.48 2.18 000 

30905 ......... ............ A Control of nosebleed ................................... 1.97 3.57 0.76 0.18 5.72 2.91 000 

30906 ......... ............ A Repeat control of nosebleed ....................... 2.45 3.96 1.20 0.21 6.62 3.86 000 

30915 ......... ............ A Ligation, nasal sinus artery .......................... 7.19 NA 5.82 0.60 NA 13.61 090 

1145

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

30920 ......... ............ A Ligation, upper jaw artery ............................ 9.82 NA 7.49 0.83 NA 18.14 090 

30930 ......... ............ A Therapy, fracture of nose ............................ 1.26 NA 1.65 0.11 NA 3.02 010 

30999 ......... ............ C Nasal surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31000 ......... ............ A Irrigation, maxillary sinus ............................. 1.15 2.91 1.41 0.10 4.16 2.66 010 

31002 ......... ............ A Irrigation, sphenoid sinus ............................. 1.91 NA 3.29 0.17 NA 5.37 010 

31020 ......... ............ A Exploration, maxillary sinus ......................... 2.94 4.12 3.51 0.24 7.30 6.69 090 

31030 ......... ............ A Exploration, maxillary sinus ......................... 5.91 5.64 4.81 0.51 12.06 11.23 090 

31032 ......... ............ A Explore sinus, remove polyps ..................... 6.56 NA 5.60 0.57 NA 12.73 090 

31040 ......... ............ A Exploration behind upper jaw ...................... 9.41 NA 6.27 0.86 NA 16.54 090 

31050 ......... ............ A Exploration, sphenoid sinus ......................... 5.27 NA 4.50 0.47 NA 10.24 090 

31051 ......... ............ A Sphenoid sinus surgery ............................... 7.10 NA 5.86 0.66 NA 13.62 090 

31070 ......... ............ A Exploration of frontal sinus .......................... 4.27 NA 4.20 0.36 NA 8.83 090 

31075 ......... ............ A Exploration of frontal sinus .......................... 9.15 NA 7.21 0.77 NA 17.13 090 

31080 ......... ............ A Removal of frontal sinus .............................. 11.40 NA 8.44 0.94 NA 20.78 090 

31081 ......... ............ A Removal of frontal sinus .............................. 12.73 NA 9.46 2.22 NA 24.41 090 

31084 ......... ............ A Removal of frontal sinus .............................. 13.49 NA 10.04 1.16 NA 24.69 090 

31085 ......... ............ A Removal of frontal sinus .............................. 14.18 NA 10.41 1.42 NA 26.01 090 

31086 ......... ............ A Removal of frontal sinus .............................. 12.84 NA 9.86 1.09 NA 23.79 090 

31087 ......... ............ A Removal of frontal sinus .............................. 13.08 NA 9.79 1.39 NA 24.26 090 

31090 ......... ............ A Exploration of sinuses ................................. 9.52 NA 8.59 0.80 NA 18.91 090 

31200 ......... ............ A Removal of ethmoid sinus ........................... 4.96 NA 5.02 0.30 NA 10.28 090 

31201 ......... ............ A Removal of ethmoid sinus ........................... 8.36 NA 6.82 0.70 NA 15.88 090 

31205 ......... ............ A Removal of ethmoid sinus ........................... 10.22 NA 7.63 0.70 NA 18.55 090 

31225 ......... ............ A Removal of upper jaw .................................. 19.20 NA 13.74 1.66 NA 34.60 090 

31230 ......... ............ A Removal of upper jaw .................................. 21.91 NA 15.12 1.89 NA 38.92 090 

31231 ......... ............ A Nasal endoscopy, dx ................................... 1.10 3.55 0.92 0.10 4.75 2.12 000 

31233 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.18 4.49 1.51 0.19 6.86 3.88 000 

31235 ......... ............ A Nasal/sinus endoscopy, dx .......................... 2.64 5.10 1.76 0.22 7.96 4.62 000 

31237 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.98 5.40 1.91 0.25 8.63 5.14 000 

31238 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.26 5.45 2.12 0.28 8.99 5.66 000 

31239 ......... ............ A Nasal/sinus endoscopy, surg ....................... 8.69 NA 8.28 0.55 NA 17.52 010 

31240 ......... ............ A Nasal/sinus endoscopy, surg ....................... 2.61 NA 1.76 0.22 NA 4.59 000 

31254 ......... ............ A Revision of ethmoid sinus ........................... 4.64 NA 2.89 0.39 NA 7.92 000 

31255 ......... ............ A Removal of ethmoid sinus ........................... 6.95 NA 4.15 0.59 NA 11.69 000 

31256 ......... ............ A Exploration maxillary sinus .......................... 3.29 NA 2.14 0.28 NA 5.71 000 

31267 ......... ............ A Endoscopy, maxillary sinus ......................... 5.45 NA 3.34 0.46 NA 9.25 000 

31276 ......... ............ A Sinus endoscopy, surgical ........................... 8.84 NA 5.17 0.75 NA 14.76 000 

31287 ......... ............ A Nasal/sinus endoscopy, surg ....................... 3.91 NA 2.49 0.33 NA 6.73 000 

31288 ......... ............ A Nasal/sinus endoscopy, surg ....................... 4.57 NA 2.85 0.39 NA 7.81 000 

31290 ......... ............ A Nasal/sinus endoscopy, surg ....................... 17.21 NA 12.15 1.45 NA 30.81 010 

31291 ......... ............ A Nasal/sinus endoscopy, surg ....................... 18.16 NA 12.55 2.09 NA 32.80 010 

31292 ......... ............ A Nasal/sinus endoscopy, surg ....................... 14.74 NA 10.71 1.19 NA 26.64 010 

31293 ......... ............ A Nasal/sinus endoscopy, surg ....................... 16.19 NA 11.52 1.17 NA 28.88 010 

31294 ......... ............ A Nasal/sinus endoscopy, surg ....................... 19.03 NA 13.00 1.25 NA 33.28 010 

31299 ......... ............ C Sinus surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31300 ......... ............ A Removal of larynx lesion ............................. 14.27 NA 12.03 1.19 NA 27.49 090 

31320 ......... ............ A Diagnostic incision, larynx ........................... 5.25 NA 7.24 0.48 NA 12.97 090 

31360 ......... ............ A Removal of larynx ........................................ 17.05 NA 13.95 1.45 NA 32.45 090 

31365 ......... ............ A Removal of larynx ........................................ 24.12 NA 17.63 2.07 NA 43.82 090 

31367 ......... ............ A Partial removal of larynx .............................. 21.83 NA 17.41 1.89 NA 41.13 090 

31368 ......... ............ A Partial removal of larynx .............................. 27.05 NA 21.00 2.29 NA 50.34 090 

31370 ......... ............ A Partial removal of larynx .............................. 21.35 NA 17.05 1.82 NA 40.22 090 

31375 ......... ............ A Partial removal of larynx .............................. 20.18 NA 15.35 1.72 NA 37.25 090 

31380 ......... ............ A Partial removal of larynx .............................. 20.18 NA 15.31 1.69 NA 37.18 090 

31382 ......... ............ A Partial removal of larynx .............................. 20.49 NA 16.56 1.74 NA 38.79 090 

31390 ......... ............ A Removal of larynx & pharynx ...................... 27.49 NA 21.24 2.35 NA 51.08 090 

31395 ......... ............ A Reconstruct larynx & pharynx ..................... 31.04 NA 25.13 2.74 NA 58.91 090 

31400 ......... ............ A Revision of larynx ........................................ 10.29 NA 10.00 0.87 NA 21.16 090 

31420 ......... ............ A Removal of epiglottis ................................... 10.20 NA 9.80 0.86 NA 20.86 090 

31500 ......... ............ A Insert emergency airway ............................. 2.33 NA 0.55 0.18 NA 3.06 000 

31502 ......... ............ A Change of windpipe airway ......................... 0.65 1.49 0.26 0.05 2.19 0.96 000 

31505 ......... ............ A Diagnostic laryngoscopy .............................. 0.61 1.57 0.64 0.05 2.23 1.30 000 

31510 ......... ............ A Laryngoscopy with biopsy ........................... 1.92 3.42 1.28 0.18 5.52 3.38 000 

31511 ......... ............ A Remove foreign body, larynx ....................... 2.16 3.25 1.11 0.19 5.60 3.46 000 

31512 ......... ............ A Removal of larynx lesion ............................. 2.07 3.34 1.39 0.19 5.60 3.65 000 

31513 ......... ............ A Injection into vocal cord ............................... 2.10 NA 1.49 0.18 NA 3.77 000 

31515 ......... ............ A Laryngoscopy for aspiration ........................ 1.80 3.71 1.10 0.14 5.65 3.04 000 

31520 ......... ............ A Diagnostic laryngoscopy .............................. 2.56 NA 1.60 0.21 NA 4.37 000 

31525 ......... ............ A Diagnostic laryngoscopy .............................. 2.63 3.86 1.70 0.22 6.71 4.55 000 

31526 ......... ............ A Diagnostic laryngoscopy .............................. 2.57 NA 1.75 0.22 NA 4.54 000 

31527 ......... ............ A Laryngoscopy for treatment ......................... 3.27 NA 1.90 0.25 NA 5.42 000 

31528 ......... ............ A Laryngoscopy and dilation ........................... 2.37 NA 1.45 0.19 NA 4.01 000 

31529 ......... ............ A Laryngoscopy and dilation ........................... 2.68 NA 1.72 0.22 NA 4.62 000 

31530 ......... ............ A Operative laryngoscopy ............................... 3.38 NA 1.98 0.29 NA 5.65 000 

31531 ......... ............ A Operative laryngoscopy ............................... 3.58 NA 2.31 0.30 NA 6.19 000 

1146

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

31535 ......... ............ A Operative laryngoscopy ............................... 3.16 NA 2.02 0.27 NA 5.45 000 

31536 ......... ............ A Operative laryngoscopy ............................... 3.55 NA 2.29 0.30 NA 6.14 000 

31540 ......... ............ A Operative laryngoscopy ............................... 4.12 NA 2.59 0.35 NA 7.06 000 

31541 ......... ............ A Operative laryngoscopy ............................... 4.52 NA 2.81 0.39 NA 7.72 000 

31560 ......... ............ A Operative laryngoscopy ............................... 5.45 NA 3.17 0.46 NA 9.08 000 

31561 ......... ............ A Operative laryngoscopy ............................... 5.99 NA 3.38 0.51 NA 9.88 000 

31570 ......... ............ A Laryngoscopy with injection ......................... 3.86 5.74 2.42 0.29 9.89 6.57 000 

31571 ......... ............ A Laryngoscopy with injection ......................... 4.26 NA 2.63 0.36 NA 7.25 000 

31575 ......... ............ A Diagnostic laryngoscopy .............................. 1.10 1.88 0.91 0.10 3.08 2.11 000 

31576 ......... ............ A Laryngoscopy with biopsy ........................... 1.97 3.62 1.31 0.16 5.75 3.44 000 

31577 ......... ............ A Remove foreign body, larynx ....................... 2.47 3.74 1.57 0.21 6.42 4.25 000 

31578 ......... ............ A Removal of larynx lesion ............................. 2.84 4.25 1.56 0.24 7.33 4.64 000 

31579 ......... ............ A Diagnostic laryngoscopy .............................. 2.26 3.80 1.52 0.19 6.25 3.97 000 

31580 ......... ............ A Revision of larynx ........................................ 12.36 NA 11.12 1.05 NA 24.53 090 

31582 ......... ............ A Revision of larynx ........................................ 21.59 NA 17.42 1.83 NA 40.84 090 

31584 ......... ............ A Treat larynx fracture .................................... 19.61 NA 14.58 1.71 NA 35.90 090 

31585 ......... ............ A Treat larynx fracture .................................... 4.63 NA 5.59 0.36 NA 10.58 090 

31586 ......... ............ A Treat larynx fracture .................................... 8.02 NA 8.36 0.68 NA 17.06 090 

31587 ......... ............ A Revision of larynx ........................................ 11.97 NA 10.05 1.06 NA 23.08 090 

31588 ......... ............ A Revision of larynx ........................................ 13.09 NA 13.10 1.11 NA 27.30 090 

31590 ......... ............ A Reinnervate larynx ....................................... 6.96 NA 8.81 0.60 NA 16.37 090 

31595 ......... ............ A Larynx nerve surgery ................................... 8.33 NA 7.65 0.75 NA 16.73 090 

31599 ......... ............ C Larynx surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

31600 ......... ............ A Incision of windpipe ..................................... 7.17 NA 3.20 0.41 NA 10.78 000 

31601 ......... ............ A Incision of windpipe ..................................... 4.44 NA 2.41 0.47 NA 7.32 000 

31603 ......... ............ A Incision of windpipe ..................................... 4.14 NA 1.72 0.42 NA 6.28 000 

31605 ......... ............ A Incision of windpipe ..................................... 3.57 NA 1.19 0.40 NA 5.16 000 

31610 ......... ............ A Incision of windpipe ..................................... 8.75 NA 7.45 0.83 NA 17.03 090 

31611 ......... ............ A Surgery/speech prosthesis .......................... 5.63 NA 5.95 0.48 NA 12.06 090 

31612 ......... ............ A Puncture/clear windpipe .............................. 0.91 1.12 0.36 0.07 2.10 1.34 000 

31613 ......... ............ A Repair windpipe opening ............................. 4.58 NA 5.42 0.45 NA 10.45 090 

31614 ......... ............ A Repair windpipe opening ............................. 7.11 NA 7.81 0.62 NA 15.54 090 

31615 ......... ............ A Visualization of windpipe ............................. 2.09 2.63 1.20 0.17 4.89 3.46 000 

31622 ......... ............ A Dx bronchoscope/wash ............................... 2.78 4.17 0.89 0.17 7.12 3.84 000 

31623 ......... ............ A Dx bronchoscope/brush ............................... 2.88 5.05 0.89 0.17 8.10 3.94 000 

31624 ......... ............ A Dx bronchoscope/lavage ............................. 2.88 4.28 0.90 0.16 7.32 3.94 000 

31625 ......... ............ A Bronchoscopy w/biopsy(s) ........................... 3.36 5.37 1.26 0.19 8.92 4.81 000 

31628 ......... ............ A Bronchoscopy/lung bx, each ....................... 3.80 5.53 1.34 0.17 9.50 5.31 000 

31629 ......... ............ A Bronchoscopy/needle bx, each ................... 3.36 NA 1.22 0.16 NA 4.74 000 

31630 ......... ............ A Bronchoscopy dilate/fx repr ......................... 3.81 NA 2.00 0.36 NA 6.17 000 

31631 ......... ............ A Bronchoscopy, dilate w/stent ....................... 4.36 NA 2.02 0.37 NA 6.75 000 

31632 ......... ............ A Bronchoscopy/lung bx, add’l ........................ 1.03 0.76 0.32 0.17 1.96 1.52 ZZZ 

31633 ......... ............ A Bronchoscopy/needle bx add’l ..................... 1.32 0.91 0.40 0.17 2.40 1.89 ZZZ 

31635 ......... ............ A Bronchoscopy w/fb removal ........................ 3.67 NA 1.67 0.25 NA 5.59 000 

31640 ......... ............ A Bronchoscopy w/tumor excise ..................... 4.93 NA 2.35 0.45 NA 7.73 000 

31641 ......... ............ A Bronchoscopy, treat blockage ..................... 5.02 NA 2.12 0.36 NA 7.50 000 

31643 ......... ............ A Diag bronchoscope/catheter ........................ 3.49 NA 1.31 0.18 NA 4.98 000 

31645 ......... ............ A Bronchoscopy, clear airways ....................... 3.16 NA 1.20 0.16 NA 4.52 000 

31646 ......... ............ A Bronchoscopy, reclear airway ..................... 2.72 NA 1.08 0.14 NA 3.94 000 

31656 ......... ............ A Bronchoscopy, inj for x-ray .......................... 2.17 NA 0.93 0.12 NA 3.22 000 

31700 ......... ............ A Insertion of airway catheter ......................... 1.34 2.05 0.69 0.08 3.47 2.11 000 

31708 ......... ............ A Instill airway contrast dye ............................ 1.41 NA 0.58 0.07 NA 2.06 000 

31710 ......... ............ A Insertion of airway catheter ......................... 1.30 NA 0.71 0.07 NA 2.08 000 

31715 ......... ............ A Injection for bronchus x-ray ......................... 1.11 NA 0.59 0.07 NA 1.77 000 

31717 ......... ............ A Bronchial brush biopsy ................................ 2.12 2.96 0.87 0.11 5.19 3.10 000 

31720 ......... ............ A Clearance of airways ................................... 1.06 1.45 0.33 0.07 2.58 1.46 000 

31725 ......... ............ A Clearance of airways ................................... 1.96 1.87 0.58 0.12 3.95 2.66 000 

31730 ......... ............ A Intro, windpipe wire/tube .............................. 2.85 2.22 1.09 0.18 5.25 4.12 000 

31750 ......... ............ A Repair of windpipe ....................................... 13.00 NA 11.57 1.23 NA 25.80 090 

31755 ......... ............ A Repair of windpipe ....................................... 15.91 NA 14.20 1.39 NA 31.50 090 

31760 ......... ............ A Repair of windpipe ....................................... 22.32 NA 10.82 1.79 NA 34.93 090 

31766 ......... ............ A Reconstruction of windpipe ......................... 30.38 NA 13.76 3.81 NA 47.95 090 

31770 ......... ............ A Repair/graft of bronchus .............................. 22.48 NA 10.34 2.74 NA 35.56 090 

31775 ......... ............ A Reconstruct bronchus .................................. 23.50 NA 11.89 3.51 NA 38.90 090 

31780 ......... ............ A Reconstruct windpipe .................................. 17.69 NA 11.14 1.87 NA 30.70 090 

31781 ......... ............ A Reconstruct windpipe .................................. 23.49 NA 12.22 2.46 NA 38.17 090 

31785 ......... ............ A Remove windpipe lesion .............................. 17.20 NA 10.26 1.64 NA 29.10 090 

31786 ......... ............ A Remove windpipe lesion .............................. 23.94 NA 13.20 2.65 NA 39.79 090 

31800 ......... ............ A Repair of windpipe injury ............................. 7.42 NA 4.88 0.81 NA 13.11 090 

31805 ......... ............ A Repair of windpipe injury ............................. 13.11 NA 7.29 1.75 NA 22.15 090 

31820 ......... ............ A Closure of windpipe lesion .......................... 4.48 5.52 4.93 0.42 10.42 9.83 090 

31825 ......... ............ A Repair of windpipe defect ............................ 6.80 7.61 7.06 0.60 15.01 14.46 090 

31830 ......... ............ A Revise windpipe scar ................................... 4.49 5.68 5.30 0.43 10.60 10.22 090 

31899 ......... ............ C Airways surgical procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

32000 ......... ............ A Drainage of chest ........................................ 1.54 3.13 0.48 0.08 4.75 2.10 000 

1147

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

32002 ......... ............ A Treatment of collapsed lung ........................ 2.19 3.32 0.84 0.13 5.64 3.16 000 

32005 ......... ............ A Treat lung lining chemically ......................... 2.19 6.58 0.70 0.21 8.98 3.10 000 

32020 ......... ............ A Insertion of chest tube ................................. 3.97 NA 1.45 0.43 NA 5.85 000 

32035 ......... ............ A Exploration of chest ..................................... 8.66 NA 5.91 1.23 NA 15.80 090 

32036 ......... ............ A Exploration of chest ..................................... 9.67 NA 6.49 1.45 NA 17.61 090 

32095 ......... ............ A Biopsy through chest wall ............................ 8.35 NA 5.42 1.19 NA 14.96 090 

32100 ......... ............ A Exploration/biopsy of chest .......................... 15.22 NA 7.88 1.75 NA 24.85 090 

32110 ......... ............ A Explore/repair chest ..................................... 22.97 NA 10.81 1.97 NA 35.75 090 

32120 ......... ............ A Re-exploration of chest ................................ 11.52 NA 7.13 1.71 NA 20.36 090 

32124 ......... ............ A Explore chest free adhesions ...................... 12.70 NA 7.27 1.82 NA 21.79 090 

32140 ......... ............ A Removal of lung lesion(s) ............................ 13.91 NA 7.75 2.03 NA 23.69 090 

32141 ......... ............ A Remove/treat lung lesions ........................... 13.98 NA 7.62 2.07 NA 23.67 090 

32150 ......... ............ A Removal of lung lesion(s) ............................ 14.13 NA 7.68 1.93 NA 23.74 090 

32151 ......... ............ A Remove lung foreign body .......................... 14.19 NA 8.07 1.80 NA 24.06 090 

32160 ......... ............ A Open chest heart massage ......................... 9.29 NA 5.32 1.22 NA 15.83 090 

32200 ......... ............ A Drain, open, lung lesion ............................... 15.27 NA 8.66 1.76 NA 25.69 090 

32201 ......... ............ A Drain, percut, lung lesion ............................. 3.99 NA 1.30 0.22 NA 5.51 000 

32215 ......... ............ A Treat chest lining ......................................... 11.31 NA 6.96 1.62 NA 19.89 090 

32220 ......... ............ A Release of lung ............................................ 23.96 NA 13.02 2.88 NA 39.86 090 

32225 ......... ............ A Partial release of lung .................................. 13.94 NA 7.72 2.05 NA 23.71 090 

32310 ......... ............ A Removal of chest lining ............................... 13.42 NA 7.46 1.99 NA 22.87 090 

32320 ......... ............ A Free/remove chest lining ............................. 23.96 NA 12.22 3.02 NA 39.20 090 

32400 ......... ............ A Needle biopsy chest lining ........................... 1.76 1.70 0.55 0.08 3.54 2.39 000 

32402 ......... ............ A Open biopsy chest lining ............................. 7.55 NA 5.17 1.10 NA 13.82 090 

32405 ......... ............ A Biopsy, lung or mediastinum ....................... 1.93 2.14 0.63 0.11 4.18 2.67 000 

32420 ......... ............ A Puncture/clear lung ...................................... 2.18 NA 0.83 0.13 NA 3.14 000 

32440 ......... ............ A Removal of lung ........................................... 24.96 NA 12.96 3.09 NA 41.01 090 

32442 ......... ............ A Sleeve pneumonectomy .............................. 26.20 NA 14.82 3.76 NA 44.78 090 

32445 ......... ............ A Removal of lung ........................................... 25.05 NA 14.13 3.75 NA 42.93 090 

32480 ......... ............ A Partial removal of lung ................................. 23.71 NA 12.12 2.70 NA 38.53 090 

32482 ......... ............ A Bilobectomy ................................................. 24.96 NA 12.97 2.83 NA 40.76 090 

32484 ......... ............ A Segmentectomy ........................................... 20.66 NA 11.44 3.06 NA 35.16 090 

32486 ......... ............ A Sleeve lobectomy ........................................ 23.88 NA 13.30 3.62 NA 40.80 090 

32488 ......... ............ A Completion pneumonectomy ....................... 25.67 NA 13.84 3.84 NA 43.35 090 

32491 ......... ............ R Lung volume reduction ................................ 21.22 NA 12.68 3.21 NA 37.11 090 

32500 ......... ............ A Partial removal of lung ................................. 21.97 NA 12.40 2.13 NA 36.50 090 

32501 ......... ............ A Repair bronchus add-on .............................. 4.68 NA 1.54 0.68 NA 6.90 ZZZ 

32520 ......... ............ A Remove lung & revise chest ....................... 21.65 NA 11.36 3.27 NA 36.28 090 

32522 ......... ............ A Remove lung & revise chest ....................... 24.16 NA 12.17 3.43 NA 39.76 090 

32525 ......... ............ A Remove lung & revise chest ....................... 26.46 NA 12.86 3.92 NA 43.24 090 

32540 ......... ............ A Removal of lung lesion ................................ 14.62 NA 9.68 2.22 NA 26.52 090 

32601 ......... ............ A Thoracoscopy, diagnostic ............................ 5.45 NA 2.42 0.76 NA 8.63 000 

32602 ......... ............ A Thoracoscopy, diagnostic ............................ 5.95 NA 2.58 0.84 NA 9.37 000 

32603 ......... ............ A Thoracoscopy, diagnostic ............................ 7.80 NA 3.09 0.92 NA 11.81 000 

32604 ......... ............ A Thoracoscopy, diagnostic ............................ 8.77 NA 3.53 1.17 NA 13.47 000 

32605 ......... ............ A Thoracoscopy, diagnostic ............................ 6.92 NA 2.97 1.04 NA 10.93 000 

32606 ......... ............ A Thoracoscopy, diagnostic ............................ 8.39 NA 3.39 1.19 NA 12.97 000 

32650 ......... ............ A Thoracoscopy, surgical ................................ 10.73 NA 6.80 1.51 NA 19.04 090 

32651 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.26 1.81 NA 21.96 090 

32652 ......... ............ A Thoracoscopy, surgical ................................ 18.63 NA 10.19 2.77 NA 31.59 090 

32653 ......... ............ A Thoracoscopy, surgical ................................ 12.85 NA 7.01 1.87 NA 21.73 090 

32654 ......... ............ A Thoracoscopy, surgical ................................ 12.42 NA 7.57 1.82 NA 21.81 090 

32655 ......... ............ A Thoracoscopy, surgical ................................ 13.08 NA 7.27 1.85 NA 22.20 090 

32656 ......... ............ A Thoracoscopy, surgical ................................ 12.89 NA 7.97 1.94 NA 22.80 090 

32657 ......... ............ A Thoracoscopy, surgical ................................ 13.63 NA 7.72 1.98 NA 23.33 090 

32658 ......... ............ A Thoracoscopy, surgical ................................ 11.61 NA 7.38 1.77 NA 20.76 090 

32659 ......... ............ A Thoracoscopy, surgical ................................ 11.57 NA 7.49 1.68 NA 20.74 090 

32660 ......... ............ A Thoracoscopy, surgical ................................ 17.40 NA 9.52 2.52 NA 29.44 090 

32661 ......... ............ A Thoracoscopy, surgical ................................ 13.23 NA 7.83 2.00 NA 23.06 090 

32662 ......... ............ A Thoracoscopy, surgical ................................ 16.42 NA 8.85 2.42 NA 27.69 090 

32663 ......... ............ A Thoracoscopy, surgical ................................ 18.44 NA 10.81 2.75 NA 32.00 090 

32664 ......... ............ A Thoracoscopy, surgical ................................ 14.18 NA 7.67 2.05 NA 23.90 090 

32665 ......... ............ A Thoracoscopy, surgical ................................ 15.52 NA 8.17 2.16 NA 25.85 090 

32800 ......... ............ A Repair lung hernia ....................................... 13.67 NA 7.49 1.82 NA 22.98 090 

32810 ......... ............ A Close chest after drainage .......................... 13.03 NA 7.59 1.87 NA 22.49 090 

32815 ......... ............ A Close bronchial fistula ................................. 23.12 NA 11.04 3.43 NA 37.59 090 

32820 ......... ............ A Reconstruct injured chest ............................ 21.45 NA 12.29 2.79 NA 36.53 090 

32850 ......... ............ X Donor pneumonectomy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

32851 ......... ............ A Lung transplant, single ................................ 38.57 NA 27.97 5.91 NA 72.45 090 

32852 ......... ............ A Lung transplant with bypass ........................ 41.74 NA 33.35 6.24 NA 81.33 090 

32853 ......... ............ A Lung transplant, double ............................... 47.74 NA 31.96 7.39 NA 87.09 090 

32854 ......... ............ A Lung transplant with bypass ........................ 50.90 NA 34.97 7.73 NA 93.60 090 

32900 ......... ............ A Removal of rib(s) ......................................... 20.24 NA 9.95 2.92 NA 33.11 090 

32905 ......... ............ A Revise & repair chest wall ........................... 20.72 NA 10.19 3.06 NA 33.97 090 

32906 ......... ............ A Revise & repair chest wall ........................... 26.73 NA 12.14 3.98 NA 42.85 090 

1148

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

32940 ......... ............ A Revision of lung ........................................... 19.40 NA 9.53 2.98 NA 31.91 090 

32960 ......... ............ A Therapeutic pneumothorax .......................... 1.84 1.76 0.57 0.14 3.74 2.55 000 

32997 ......... ............ A Total lung lavage ......................................... 5.99 NA 1.91 0.66 NA 8.56 000 

32999 ......... ............ C Chest surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

33010 ......... ............ A Drainage of heart sac .................................. 2.24 NA 0.96 0.16 NA 3.36 000 

33011 ......... ............ A Repeat drainage of heart sac ...................... 2.24 NA 1.00 0.16 NA 3.40 000 

33015 ......... ............ A Incision of heart sac .................................... 6.79 NA 4.98 0.77 NA 12.54 090 

33020 ......... ............ A Incision of heart sac .................................... 12.59 NA 6.84 1.81 NA 21.24 090 

33025 ......... ............ A Incision of heart sac .................................... 12.07 NA 6.39 1.81 NA 20.27 090 

33030 ......... ............ A Partial removal of heart sac ........................ 18.68 NA 9.59 2.89 NA 31.16 090 

33031 ......... ............ A Partial removal of heart sac ........................ 21.76 NA 10.10 3.35 NA 35.21 090 

33050 ......... ............ A Removal of heart sac lesion ........................ 14.34 NA 7.90 2.09 NA 24.33 090 

33120 ......... ............ A Removal of heart lesion ............................... 24.52 NA 11.68 3.69 NA 39.89 090 

33130 ......... ............ A Removal of heart lesion ............................... 21.36 NA 10.18 3.03 NA 34.57 090 

33140 ......... ............ A Heart revascularize (tmr) ............................. 19.97 NA 10.94 2.74 NA 33.65 090 

33141 ......... ............ A Heart tmr w/other procedure ....................... 4.83 NA 1.59 0.66 NA 7.08 ZZZ 

33200 ......... ............ A Insertion of heart pacemaker ....................... 12.46 NA 6.98 1.41 NA 20.85 090 

33201 ......... ............ A Insertion of heart pacemaker ....................... 10.16 NA 6.73 1.46 NA 18.35 090 

33206 ......... ............ A Insertion of heart pacemaker ....................... 6.66 NA 4.57 0.60 NA 11.83 090 

33207 ......... ............ A Insertion of heart pacemaker ....................... 8.03 NA 4.76 0.69 NA 13.48 090 

33208 ......... ............ A Insertion of heart pacemaker ....................... 8.12 NA 4.86 0.65 NA 13.63 090 

33210 ......... ............ A Insertion of heart electrode .......................... 3.30 NA 1.25 0.21 NA 4.76 000 

33211 ......... ............ A Insertion of heart electrode .......................... 3.39 NA 1.32 0.21 NA 4.92 000 

33212 ......... ............ A Insertion of pulse generator ......................... 5.51 NA 3.42 0.53 NA 9.46 090 

33213 ......... ............ A Insertion of pulse generator ......................... 6.36 NA 3.78 0.55 NA 10.69 090 

33214 ......... ............ A Upgrade of pacemaker system ................... 7.74 NA 4.99 0.63 NA 13.36 090 

33215 ......... ............ A Reposition pacing-defib lead ....................... 4.75 NA 3.18 0.43 NA 8.36 090 

33216 ......... ............ A Insert lead pace-defib, one .......................... 5.77 NA 4.30 0.43 NA 10.50 090 

33217 ......... ............ A Insert lead pace-defib, dual ......................... 5.74 NA 4.33 0.43 NA 10.50 090 

33218 ......... ............ A Repair lead pace-defib, one ........................ 5.43 NA 4.37 0.48 NA 10.28 090 

33220 ......... ............ A Repair lead pace-defib, dual ....................... 5.51 NA 4.34 0.47 NA 10.32 090 

33222 ......... ............ A Revise pocket, pacemaker .......................... 4.95 NA 4.36 0.47 NA 9.78 090 

33223 ......... ............ A Revise pocket, pacing-defib ........................ 6.45 NA 4.64 0.53 NA 11.62 090 

33224 ......... ............ A Insert pacing lead & connect ....................... 9.04 NA 4.02 0.43 NA 13.49 000 

33225 ......... ............ A L ventric pacing lead add-on ....................... 8.33 NA 3.23 0.43 NA 11.99 ZZZ 

33226 ......... ............ A Reposition l ventric lead .............................. 8.68 NA 3.88 0.43 NA 12.99 000 

33233 ......... ............ A Removal of pacemaker system ................... 3.29 NA 3.31 0.27 NA 6.87 090 

33234 ......... ............ A Removal of pacemaker system ................... 7.81 NA 4.95 0.68 NA 13.44 090 

33235 ......... ............ A Removal pacemaker electrode .................... 9.39 NA 6.86 0.82 NA 17.07 090 

33236 ......... ............ A Remove electrode/thoracotomy ................... 12.58 NA 7.48 1.80 NA 21.86 090 

33237 ......... ............ A Remove electrode/thoracotomy ................... 13.69 NA 7.84 1.89 NA 23.42 090 

33238 ......... ............ A Remove electrode/thoracotomy ................... 15.20 NA 8.26 1.88 NA 25.34 090 

33240 ......... ............ A Insert pulse generator .................................. 7.59 NA 4.66 0.64 NA 12.89 090 

33241 ......... ............ A Remove pulse generator ............................. 3.24 NA 2.99 0.25 NA 6.48 090 

33243 ......... ............ A Remove eltrd/thoracotomy ........................... 22.61 NA 11.50 3.05 NA 37.16 090 

33244 ......... ............ A Remove eltrd, transven ............................... 13.74 NA 8.96 1.27 NA 23.97 090 

33245 ......... ............ A Insert epic eltrd pace-defib .......................... 14.28 NA 8.03 1.54 NA 23.85 090 

33246 ......... ............ A Insert epic eltrd/generator ............................ 20.68 NA 10.41 2.68 NA 33.77 090 

33249 ......... ............ A Eltrd/insert pace-defib .................................. 14.21 NA 8.49 0.96 NA 23.66 090 

33250 ......... ............ A Ablate heart dysrhythm focus ...................... 21.82 NA 11.13 1.22 NA 34.17 090 

33251 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.74 2.91 NA 39.49 090 

33253 ......... ............ A Reconstruct atria .......................................... 31.01 NA 13.91 4.44 NA 49.36 090 

33261 ......... ............ A Ablate heart dysrhythm focus ...................... 24.84 NA 11.85 3.40 NA 40.09 090 

33282 ......... ............ A Implant pat-active ht record ......................... 4.16 NA 4.11 0.47 NA 8.74 090 

33284 ......... ............ A Remove pat-active ht record ....................... 2.50 NA 3.58 0.28 NA 6.36 090 

33300 ......... ............ A Repair of heart wound ................................. 17.89 NA 9.31 2.30 NA 29.50 090 

33305 ......... ............ A Repair of heart wound ................................. 21.41 NA 10.70 3.23 NA 35.34 090 

33310 ......... ............ A Exploratory heart surgery ............................ 18.48 NA 9.65 2.73 NA 30.86 090 

33315 ......... ............ A Exploratory heart surgery ............................ 22.34 NA 10.95 3.50 NA 36.79 090 

33320 ......... ............ A Repair major blood vessel(s) ....................... 16.76 NA 8.30 2.00 NA 27.06 090 

33321 ......... ............ A Repair major vessel ..................................... 20.17 NA 9.86 3.26 NA 33.29 090 

33322 ......... ............ A Repair major blood vessel(s) ....................... 20.59 NA 10.44 3.03 NA 34.06 090 

33330 ......... ............ A Insert major vessel graft .............................. 21.40 NA 10.35 3.00 NA 34.75 090 

33332 ......... ............ A Insert major vessel graft .............................. 23.92 NA 10.59 2.95 NA 37.46 090 

33335 ......... ............ A Insert major vessel graft .............................. 29.96 NA 13.42 4.57 NA 47.95 090 

33400 ......... ............ A Repair of aortic valve ................................... 28.46 NA 15.73 3.73 NA 47.92 090 

33401 ......... ............ A Valvuloplasty, open ...................................... 23.87 NA 13.57 3.27 NA 40.71 090 

33403 ......... ............ A Valvuloplasty, w/cp bypass .......................... 24.85 NA 14.37 2.99 NA 42.21 090 

33404 ......... ............ A Prepare heart-aorta conduit ......................... 28.50 NA 14.58 3.99 NA 47.07 090 

33405 ......... ............ A Replacement of aortic valve ........................ 34.95 NA 18.36 4.66 NA 57.97 090 

33406 ......... ............ A Replacement of aortic valve ........................ 37.44 NA 19.20 4.91 NA 61.55 090 

33410 ......... ............ A Replacement of aortic valve ........................ 32.41 NA 16.66 4.96 NA 54.03 090 

33411 ......... ............ A Replacement of aortic valve ........................ 36.20 NA 18.83 5.02 NA 60.05 090 

33412 ......... ............ A Replacement of aortic valve ........................ 41.94 NA 20.50 5.62 NA 68.06 090 

33413 ......... ............ A Replacement of aortic valve ........................ 43.43 NA 20.91 5.14 NA 69.48 090 

1149

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

33414 ......... ............ A Repair of aortic valve ................................... 30.30 NA 14.23 4.57 NA 49.10 090 

33415 ......... ............ A Revision, subvalvular tissue ........................ 27.11 NA 12.11 3.92 NA 43.14 090 

33416 ......... ............ A Revise ventricle muscle ............................... 30.30 NA 13.59 4.64 NA 48.53 090 

33417 ......... ............ A Repair of aortic valve ................................... 28.49 NA 13.71 4.32 NA 46.52 090 

33420 ......... ............ A Revision of mitral valve ............................... 22.67 NA 9.66 1.79 NA 34.12 090 

33422 ......... ............ A Revision of mitral valve ............................... 25.90 NA 13.71 3.98 NA 43.59 090 

33425 ......... ............ A Repair of mitral valve ................................... 26.96 NA 13.10 3.62 NA 43.68 090 

33426 ......... ............ A Repair of mitral valve ................................... 32.95 NA 17.21 4.67 NA 54.83 090 

33427 ......... ............ A Repair of mitral valve ................................... 39.94 NA 19.44 5.19 NA 64.57 090 

33430 ......... ............ A Replacement of mitral valve ........................ 33.45 NA 17.37 4.76 NA 55.58 090 

33460 ......... ............ A Revision of tricuspid valve ........................... 23.56 NA 11.38 3.64 NA 38.58 090 

33463 ......... ............ A Valvuloplasty, tricuspid ................................ 25.58 NA 12.99 3.82 NA 42.39 090 

33464 ......... ............ A Valvuloplasty, tricuspid ................................ 27.29 NA 13.60 4.19 NA 45.08 090 

33465 ......... ............ A Replace tricuspid valve ................................ 28.75 NA 13.05 4.35 NA 46.15 090 

33468 ......... ............ A Revision of tricuspid valve ........................... 30.07 NA 13.76 4.82 NA 48.65 090 

33470 ......... ............ A Revision of pulmonary valve ....................... 20.78 NA 10.78 3.39 NA 34.95 090 

33471 ......... ............ A Valvotomy, pulmonary valve ........................ 22.22 NA 9.82 3.62 NA 35.66 090 

33472 ......... ............ A Revision of pulmonary valve ....................... 22.22 NA 11.97 3.52 NA 37.71 090 

33474 ......... ............ A Revision of pulmonary valve ....................... 23.01 NA 10.95 3.43 NA 37.39 090 

33475 ......... ............ A Replacement, pulmonary valve ................... 32.95 NA 15.48 3.18 NA 51.61 090 

33476 ......... ............ A Revision of heart chamber .......................... 25.73 NA 12.03 2.89 NA 40.65 090 

33478 ......... ............ A Revision of heart chamber .......................... 26.70 NA 13.13 4.29 NA 44.12 090 

33496 ......... ............ A Repair, prosth valve clot .............................. 27.21 NA 12.83 4.15 NA 44.19 090 

33500 ......... ............ A Repair heart vessel fistula ........................... 25.51 NA 11.54 3.38 NA 40.43 090 

33501 ......... ............ A Repair heart vessel fistula ........................... 17.75 NA 8.34 2.47 NA 28.56 090 

33502 ......... ............ A Coronary artery correction ........................... 21.01 NA 11.15 3.03 NA 35.19 090 

33503 ......... ............ A Coronary artery graft ................................... 21.75 NA 9.83 1.71 NA 33.29 090 

33504 ......... ............ A Coronary artery graft ................................... 24.62 NA 11.91 3.67 NA 40.20 090 

33505 ......... ............ A Repair artery w/tunnel ................................. 26.80 NA 13.02 1.83 NA 41.65 090 

33506 ......... ............ A Repair artery, translocation ......................... 35.45 NA 14.66 3.85 NA 53.96 090 

33508 ......... ............ A Endoscopic vein harvest .............................. 0.31 NA 0.10 0.04 NA 0.45 ZZZ 

33510 ......... ............ A CABG, vein, single ...................................... 28.96 NA 16.41 3.78 NA 49.15 090 

33511 ......... ............ A CABG, vein, two .......................................... 29.96 NA 17.15 4.03 NA 51.14 090 

33512 ......... ............ A CABG, vein, three ........................................ 31.75 NA 17.68 4.46 NA 53.89 090 

33513 ......... ............ A CABG, vein, four .......................................... 31.95 NA 17.86 4.81 NA 54.62 090 

33514 ......... ............ A CABG, vein, five .......................................... 32.70 NA 18.14 5.27 NA 56.11 090 

33516 ......... ............ A Cabg, vein, six or more ............................... 34.95 NA 18.88 5.57 NA 59.40 090 

33517 ......... ............ A CABG, artery-vein, single ............................ 2.57 NA 0.84 0.39 NA 3.80 ZZZ 

33518 ......... ............ A CABG, artery-vein, two ................................ 4.84 NA 1.59 0.74 NA 7.17 ZZZ 

33519 ......... ............ A CABG, artery-vein, three ............................. 7.11 NA 2.33 1.07 NA 10.51 ZZZ 

33521 ......... ............ A CABG, artery-vein, four ............................... 9.39 NA 3.08 1.42 NA 13.89 ZZZ 

33522 ......... ............ A CABG, artery-vein, five ................................ 11.65 NA 3.82 1.79 NA 17.26 ZZZ 

33523 ......... ............ A Cabg, art-vein, six or more .......................... 13.93 NA 4.55 2.15 NA 20.63 ZZZ 

33530 ......... ............ A Coronary artery, bypass/reop ...................... 5.85 NA 1.91 0.88 NA 8.64 ZZZ 

33533 ......... ............ A CABG, arterial, single .................................. 29.96 NA 16.54 3.91 NA 50.41 090 

33534 ......... ............ A CABG, arterial, two ...................................... 32.15 NA 17.79 4.38 NA 54.32 090 

33535 ......... ............ A CABG, arterial, three ................................... 34.45 NA 18.22 4.79 NA 57.46 090 

33536 ......... ............ A Cabg, arterial, four or more ......................... 37.44 NA 18.38 3.97 NA 59.79 090 

33542 ......... ............ A Removal of heart lesion ............................... 28.81 NA 13.08 4.35 NA 46.24 090 

33545 ......... ............ A Repair of heart damage ............................... 36.72 NA 15.73 5.31 NA 57.76 090 

33572 ......... ............ A Open coronary endarterectomy ................... 4.44 NA 1.46 0.66 NA 6.56 ZZZ 

33600 ......... ............ A Closure of valve ........................................... 29.47 NA 12.62 2.77 NA 44.86 090 

33602 ......... ............ A Closure of valve ........................................... 28.50 NA 12.54 3.50 NA 44.54 090 

33606 ......... ............ A Anastomosis/artery-aorta ............................. 30.69 NA 13.75 4.33 NA 48.77 090 

33608 ......... ............ A Repair anomaly w/conduit ........................... 31.04 NA 14.19 5.03 NA 50.26 090 

33610 ......... ............ A Repair by enlargement ................................ 30.56 NA 14.20 4.85 NA 49.61 090 

33611 ......... ............ A Repair double ventricle ................................ 33.95 NA 14.23 3.96 NA 52.14 090 

33612 ......... ............ A Repair double ventricle ................................ 34.95 NA 15.25 5.36 NA 55.56 090 

33615 ......... ............ A Repair, modified fontan ............................... 33.95 NA 15.14 3.80 NA 52.89 090 

33617 ......... ............ A Repair single ventricle ................................. 36.94 NA 16.11 4.93 NA 57.98 090 

33619 ......... ............ A Repair single ventricle ................................. 44.93 NA 20.94 5.68 NA 71.55 090 

33641 ......... ............ A Repair heart septum defect ......................... 21.36 NA 9.64 3.22 NA 34.22 090 

33645 ......... ............ A Revision of heart veins ................................ 24.78 NA 11.84 3.94 NA 40.56 090 

33647 ......... ............ A Repair heart septum defects ....................... 28.69 NA 13.86 4.06 NA 46.61 090 

33660 ......... ............ A Repair of heart defects ................................ 29.96 NA 13.58 3.40 NA 46.94 090 

33665 ......... ............ A Repair of heart defects ................................ 28.56 NA 13.91 4.60 NA 47.07 090 

33670 ......... ............ A Repair of heart chambers ............................ 34.95 NA 13.39 2.63 NA 50.97 090 

33681 ......... ............ A Repair heart septum defect ......................... 30.56 NA 14.77 4.26 NA 49.59 090 

33684 ......... ............ A Repair heart septum defect ......................... 29.61 NA 13.71 4.55 NA 47.87 090 

33688 ......... ............ A Repair heart septum defect ......................... 30.57 NA 10.58 4.69 NA 45.84 090 

33690 ......... ............ A Reinforce pulmonary artery ......................... 19.52 NA 10.32 3.09 NA 32.93 090 

33692 ......... ............ A Repair of heart defects ................................ 30.70 NA 14.02 4.55 NA 49.27 090 

33694 ......... ............ A Repair of heart defects ................................ 33.95 NA 14.32 5.15 NA 53.42 090 

33697 ......... ............ A Repair of heart defects ................................ 35.95 NA 14.95 5.48 NA 56.38 090 

33702 ......... ............ A Repair of heart defects ................................ 26.50 NA 12.65 4.16 NA 43.31 090 

1150

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

33710 ......... ............ A Repair of heart defects ................................ 29.67 NA 14.08 4.64 NA 48.39 090 

33720 ......... ............ A Repair of heart defect .................................. 26.52 NA 12.36 3.87 NA 42.75 090 

33722 ......... ............ A Repair of heart defect .................................. 28.37 NA 13.94 4.58 NA 46.89 090 

33730 ......... ............ A Repair heart-vein defect(s) .......................... 34.20 NA 14.23 3.44 NA 51.87 090 

33732 ......... ............ A Repair heart-vein defect .............................. 28.12 NA 13.50 3.35 NA 44.97 090 

33735 ......... ............ A Revision of heart chamber .......................... 21.36 NA 10.08 1.35 NA 32.79 090 

33736 ......... ............ A Revision of heart chamber .......................... 23.48 NA 11.95 3.26 NA 38.69 090 

33737 ......... ............ A Revision of heart chamber .......................... 21.73 NA 11.02 3.53 NA 36.28 090 

33750 ......... ............ A Major vessel shunt ....................................... 21.38 NA 10.31 2.10 NA 33.79 090 

33755 ......... ............ A Major vessel shunt ....................................... 21.76 NA 8.86 3.53 NA 34.15 090 

33762 ......... ............ A Major vessel shunt ....................................... 21.76 NA 10.24 1.92 NA 33.92 090 

33764 ......... ............ A Major vessel shunt & graft ........................... 21.76 NA 10.31 2.33 NA 34.40 090 

33766 ......... ............ A Major vessel shunt ....................................... 22.73 NA 11.73 3.67 NA 38.13 090 

33767 ......... ............ A Major vessel shunt ....................................... 24.46 NA 11.81 3.79 NA 40.06 090 

33770 ......... ............ A Repair great vessels defect ......................... 36.94 NA 14.77 5.42 NA 57.13 090 

33771 ......... ............ A Repair great vessels defect ......................... 34.60 NA 12.48 5.63 NA 52.71 090 

33774 ......... ............ A Repair great vessels defect ......................... 30.93 NA 14.23 5.04 NA 50.20 090 

33775 ......... ............ A Repair great vessels defect ......................... 32.15 NA 14.28 5.23 NA 51.66 090 

33776 ......... ............ A Repair great vessels defect ......................... 33.99 NA 15.88 5.52 NA 55.39 090 

33777 ......... ............ A Repair great vessels defect ......................... 33.41 NA 14.95 5.44 NA 53.80 090 

33778 ......... ............ A Repair great vessels defect ......................... 39.94 NA 16.98 5.83 NA 62.75 090 

33779 ......... ............ A Repair great vessels defect ......................... 36.16 NA 15.49 2.89 NA 54.54 090 

33780 ......... ............ A Repair great vessels defect ......................... 41.69 NA 19.13 6.28 NA 67.10 090 

33781 ......... ............ A Repair great vessels defect ......................... 36.40 NA 13.56 5.92 NA 55.88 090 

33786 ......... ............ A Repair arterial trunk ..................................... 38.94 NA 16.79 5.66 NA 61.39 090 

33788 ......... ............ A Revision of pulmonary artery ....................... 26.58 NA 12.03 4.00 NA 42.61 090 

33800 ......... ............ A Aortic suspension ........................................ 16.22 NA 8.21 1.34 NA 25.77 090 

33802 ......... ............ A Repair vessel defect .................................... 17.63 NA 9.30 1.88 NA 28.81 090 

33803 ......... ............ A Repair vessel defect .................................... 19.57 NA 9.84 3.17 NA 32.58 090 

33813 ......... ............ A Repair septal defect ..................................... 20.62 NA 10.99 3.35 NA 34.96 090 

33814 ......... ............ A Repair septal defect ..................................... 25.73 NA 12.73 3.04 NA 41.50 090 

33820 ......... ............ A Revise major vessel .................................... 16.27 NA 8.39 2.53 NA 27.19 090 

33822 ......... ............ A Revise major vessel .................................... 17.29 NA 9.03 2.81 NA 29.13 090 

33824 ......... ............ A Revise major vessel .................................... 19.49 NA 10.06 3.15 NA 32.70 090 

33840 ......... ............ A Remove aorta constriction ........................... 20.60 NA 10.36 2.85 NA 33.81 090 

33845 ......... ............ A Remove aorta constriction ........................... 22.09 NA 11.42 3.50 NA 37.01 090 

33851 ......... ............ A Remove aorta constriction ........................... 21.24 NA 10.78 3.45 NA 35.47 090 

33852 ......... ............ A Repair septal defect ..................................... 23.67 NA 11.45 3.85 NA 38.97 090 

33853 ......... ............ A Repair septal defect ..................................... 31.67 NA 14.92 5.10 NA 51.69 090 

33860 ......... ............ A Ascending aortic graft .................................. 37.94 NA 16.55 5.19 NA 59.68 090 

33861 ......... ............ A Ascending aortic graft .................................. 41.94 NA 17.81 5.11 NA 64.86 090 

33863 ......... ............ A Ascending aortic graft .................................. 44.93 NA 18.80 5.55 NA 69.28 090 

33870 ......... ............ A Transverse aortic arch graft ........................ 43.93 NA 18.49 6.14 NA 68.56 090 

33875 ......... ............ A Thoracic aortic graft ..................................... 33.01 NA 14.18 4.92 NA 52.11 090 

33877 ......... ............ A Thoracoabdominal graft ............................... 42.54 NA 16.43 6.11 NA 65.08 090 

33910 ......... ............ A Remove lung artery emboli ......................... 24.55 NA 11.52 3.69 NA 39.76 090 

33915 ......... ............ A Remove lung artery emboli ......................... 20.99 NA 9.68 1.45 NA 32.12 090 

33916 ......... ............ A Surgery of great vessel ............................... 25.79 NA 11.43 3.67 NA 40.89 090 

33917 ......... ............ A Repair pulmonary artery .............................. 24.46 NA 12.27 3.82 NA 40.55 090 

33918 ......... ............ A Repair pulmonary atresia ............................ 26.41 NA 12.19 4.12 NA 42.72 090 

33919 ......... ............ A Repair pulmonary atresia ............................ 39.94 NA 17.62 4.20 NA 61.76 090 

33920 ......... ............ A Repair pulmonary atresia ............................ 31.90 NA 13.92 4.35 NA 50.17 090 

33922 ......... ............ A Transect pulmonary artery ........................... 23.48 NA 10.98 2.77 NA 37.23 090 

33924 ......... ............ A Remove pulmonary shunt ............................ 5.49 NA 1.85 0.89 NA 8.23 ZZZ 

33930 ......... ............ X Removal of donor heart/lung ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33935 ......... ............ R Transplantation, heart/lung .......................... 60.87 NA 29.07 9.83 NA 99.77 090 

33940 ......... ............ X Removal of donor heart ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

33945 ......... ............ R Transplantation of heart ............................... 42.04 NA 21.66 6.54 NA 70.24 090 

33960 ......... ............ A External circulation assist ............................ 19.33 NA 4.93 2.58 NA 26.84 000 

33961 ......... ............ A External circulation assist ............................ 10.91 NA 3.63 1.77 NA 16.31 ZZZ 

33967 ......... ............ A Insert ia percut device ................................. 4.84 NA 1.85 0.34 NA 7.03 000 

33968 ......... ............ A Remove aortic assist device ........................ 0.64 NA 0.23 0.08 NA 0.95 000 

33970 ......... ............ A Aortic circulation assist ................................ 6.74 NA 2.29 0.84 NA 9.87 000 

33971 ......... ............ A Aortic circulation assist ................................ 9.68 NA 6.07 1.17 NA 16.92 090 

33973 ......... ............ A Insert balloon device .................................... 9.75 NA 3.32 1.22 NA 14.29 000 

33974 ......... ............ A Remove intra-aortic balloon ......................... 14.39 NA 7.95 1.79 NA 24.13 090 

33975 ......... ............ A Implant ventricular device ............................ 20.97 NA 6.31 2.07 NA 29.35 XXX 

33976 ......... ............ A Implant ventricular device ............................ 22.97 NA 7.58 3.40 NA 33.95 XXX 

33977 ......... ............ A Remove ventricular device .......................... 19.26 NA 11.13 2.94 NA 33.33 090 

33978 ......... ............ A Remove ventricular device .......................... 21.70 NA 11.80 3.21 NA 36.71 090 

33979 ......... ............ A Insert intracorporeal device ......................... 45.93 NA 14.97 4.80 NA 65.70 XXX 

33980 ......... ............ A Remove intracorporeal device ..................... 56.17 NA 25.52 5.55 NA 87.24 090 

33999 ......... ............ C Cardiac surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

34001 ......... ............ A Removal of artery clot ................................. 12.89 NA 6.75 1.76 NA 21.40 090 

34051 ......... ............ A Removal of artery clot ................................. 15.19 NA 7.82 2.29 NA 25.30 090 

1151

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

34101 ......... ............ A Removal of artery clot ................................. 9.99 NA 5.38 1.34 NA 16.71 090 

34111 ......... ............ A Removal of arm artery clot .......................... 9.99 NA 5.38 1.03 NA 16.40 090 

34151 ......... ............ A Removal of artery clot ................................. 24.96 NA 10.45 2.22 NA 37.63 090 

34201 ......... ............ A Removal of artery clot ................................. 10.01 NA 5.45 1.23 NA 16.69 090 

34203 ......... ............ A Removal of leg artery clot ........................... 16.48 NA 8.09 1.65 NA 26.22 090 

34401 ......... ............ A Removal of vein clot .................................... 24.96 NA 10.72 1.45 NA 37.13 090 

34421 ......... ............ A Removal of vein clot .................................... 11.98 NA 6.33 1.15 NA 19.46 090 

34451 ......... ............ A Removal of vein clot .................................... 26.96 NA 11.49 1.92 NA 40.37 090 

34471 ......... ............ A Removal of vein clot .................................... 10.16 NA 5.35 1.09 NA 16.60 090 

34490 ......... ............ A Removal of vein clot .................................... 9.85 NA 5.46 0.88 NA 16.19 090 

34501 ......... ............ A Repair valve, femoral vein ........................... 15.98 NA 8.55 1.65 NA 26.18 090 

34502 ......... ............ A Reconstruct vena cava ................................ 26.91 NA 12.34 3.61 NA 42.86 090 

34510 ......... ............ A Transposition of vein valve .......................... 18.92 NA 9.48 1.93 NA 30.33 090 

34520 ......... ............ A Cross-over vein graft ................................... 17.92 NA 8.72 1.70 NA 28.34 090 

34530 ......... ............ A Leg vein fusion ............................................ 16.62 NA 8.65 2.48 NA 27.75 090 

34800 ......... ............ A Endovasc abdo repair w/tube ...................... 20.72 NA 9.21 1.80 NA 31.73 090 

34802 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.83 1.99 NA 34.79 090 

34804 ......... ............ A Endovasc abdo repr w/device ..................... 22.97 NA 9.84 1.99 NA 34.80 090 

34805 ......... ............ A Endovasc abdo repair w/pros ...................... 21.85 NA 9.46 1.99 NA 33.30 090 

34808 ......... ............ A Endovasc abdo occlud device ..................... 4.12 NA 1.38 0.35 NA 5.85 ZZZ 

34812 ......... ............ A Xpose for endoprosth, femorl ...................... 6.74 NA 2.24 0.59 NA 9.57 000 

34813 ......... ............ A Femoral endovas graft add-on .................... 4.79 NA 1.58 0.41 NA 6.78 ZZZ 

34820 ......... ............ A Xpose for endoprosth, iliac .......................... 9.74 NA 3.25 0.84 NA 13.83 000 

34825 ......... ............ A Endovasc extend prosth, init ....................... 11.98 NA 6.17 1.04 NA 19.19 090 

34826 ......... ............ A Endovasc exten prosth, add’l ...................... 4.12 NA 1.38 0.35 NA 5.85 ZZZ 

34830 ......... ............ A Open aortic tube prosth repr ....................... 32.54 NA 13.76 2.82 NA 49.12 090 

34831 ......... ............ A Open aortoiliac prosth repr .......................... 35.29 NA 11.80 3.05 NA 50.14 090 

34832 ......... ............ A Open aortofemor prosth repr ....................... 35.29 NA 14.68 3.05 NA 53.02 090 

34833 ......... ............ A Xpose for endoprosth, iliac .......................... 11.98 NA 4.51 0.84 NA 17.33 000 

34834 ......... ............ A Xpose, endoprosth, brachial ........................ 5.34 NA 2.23 0.59 NA 8.16 000 

34900 ......... ............ A Endovasc iliac repr w/graft .......................... 16.36 NA 7.82 1.80 NA 25.98 090 

35001 ......... ............ A Repair defect of artery ................................. 19.61 NA 9.59 2.94 NA 32.14 090 

35002 ......... ............ A Repair artery rupture, neck .......................... 20.97 NA 9.74 2.20 NA 32.91 090 

35005 ......... ............ A Repair defect of artery ................................. 18.09 NA 8.89 1.63 NA 28.61 090 

35011 ......... ............ A Repair defect of artery ................................. 17.97 NA 8.02 1.57 NA 27.56 090 

35013 ......... ............ A Repair artery rupture, arm ........................... 21.97 NA 9.73 2.30 NA 34.00 090 

35021 ......... ............ A Repair defect of artery ................................. 19.62 NA 9.50 2.33 NA 31.45 090 

35022 ......... ............ A Repair artery rupture, chest ......................... 23.15 NA 10.10 2.40 NA 35.65 090 

35045 ......... ............ A Repair defect of arm artery ......................... 17.54 NA 7.58 1.51 NA 26.63 090 

35081 ......... ............ A Repair defect of artery ................................. 27.97 NA 11.51 3.86 NA 43.34 090 

35082 ......... ............ A Repair artery rupture, aorta ......................... 38.44 NA 15.35 4.91 NA 58.70 090 

35091 ......... ............ A Repair defect of artery ................................. 35.35 NA 13.63 4.93 NA 53.91 090 

35092 ......... ............ A Repair artery rupture, aorta ......................... 44.93 NA 17.70 5.20 NA 67.83 090 

35102 ......... ............ A Repair defect of artery ................................. 30.71 NA 12.41 4.15 NA 47.27 090 

35103 ......... ............ A Repair artery rupture, groin ......................... 40.44 NA 15.92 4.57 NA 60.93 090 

35111 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.51 2.18 NA 37.65 090 

35112 ......... ............ A Repair artery rupture,spleen ........................ 29.96 NA 12.01 2.35 NA 44.32 090 

35121 ......... ............ A Repair defect of artery ................................. 29.96 NA 12.42 3.53 NA 45.91 090 

35122 ......... ............ A Repair artery rupture, belly .......................... 34.95 NA 13.86 4.27 NA 53.08 090 

35131 ......... ............ A Repair defect of artery ................................. 24.96 NA 10.80 2.54 NA 38.30 090 

35132 ......... ............ A Repair artery rupture, groin ......................... 29.96 NA 12.42 2.99 NA 45.37 090 

35141 ......... ............ A Repair defect of artery ................................. 19.97 NA 8.95 1.99 NA 30.91 090 

35142 ......... ............ A Repair artery rupture, thigh ......................... 23.27 NA 10.40 2.11 NA 35.78 090 

35151 ......... ............ A Repair defect of artery ................................. 22.61 NA 10.04 2.33 NA 34.98 090 

35152 ......... ............ A Repair artery rupture, knee ......................... 25.58 NA 11.43 2.33 NA 39.34 090 

35161 ......... ............ A Repair defect of artery ................................. 18.73 NA 9.19 2.67 NA 30.59 090 

35162 ......... ............ A Repair artery rupture ................................... 19.75 NA 9.61 2.67 NA 32.03 090 

35180 ......... ............ A Repair blood vessel lesion .......................... 13.60 NA 6.98 1.74 NA 22.32 090 

35182 ......... ............ A Repair blood vessel lesion .......................... 29.96 NA 12.85 2.27 NA 45.08 090 

35184 ......... ............ A Repair blood vessel lesion .......................... 17.97 NA 8.34 1.62 NA 27.93 090 

35188 ......... ............ A Repair blood vessel lesion .......................... 14.26 NA 7.67 1.85 NA 23.78 090 

35189 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 12.00 2.56 NA 42.52 090 

35190 ......... ............ A Repair blood vessel lesion .......................... 12.73 NA 6.50 1.60 NA 20.83 090 

35201 ......... ............ A Repair blood vessel lesion .......................... 16.12 NA 8.02 1.41 NA 25.55 090 

35206 ......... ............ A Repair blood vessel lesion .......................... 13.23 NA 6.61 1.25 NA 21.09 090 

35207 ......... ............ A Repair blood vessel lesion .......................... 10.13 NA 7.51 1.39 NA 19.03 090 

35211 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.70 3.41 NA 36.20 090 

35216 ......... ............ A Repair blood vessel lesion .......................... 18.72 NA 9.04 2.62 NA 30.38 090 

35221 ......... ............ A Repair blood vessel lesion .......................... 24.35 NA 9.98 2.16 NA 36.49 090 

35226 ......... ............ A Repair blood vessel lesion .......................... 14.48 NA 7.52 1.01 NA 23.01 090 

35231 ......... ............ A Repair blood vessel lesion .......................... 19.97 NA 9.81 1.59 NA 31.37 090 

35236 ......... ............ A Repair blood vessel lesion .......................... 17.08 NA 7.95 1.44 NA 26.47 090 

35241 ......... ............ A Repair blood vessel lesion .......................... 23.09 NA 11.20 3.50 NA 37.79 090 

35246 ......... ............ A Repair blood vessel lesion .......................... 26.41 NA 11.51 2.68 NA 40.60 090 

35251 ......... ............ A Repair blood vessel lesion .......................... 30.15 NA 11.84 2.26 NA 44.25 090 

1152

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

35256 ......... ............ A Repair blood vessel lesion .......................... 18.33 NA 8.43 1.59 NA 28.35 090 

35261 ......... ............ A Repair blood vessel lesion .......................... 17.77 NA 8.05 1.62 NA 27.44 090 

35266 ......... ............ A Repair blood vessel lesion .......................... 14.89 NA 7.06 1.40 NA 23.35 090 

35271 ......... ............ A Repair blood vessel lesion .......................... 22.09 NA 10.59 3.34 NA 36.02 090 

35276 ......... ............ A Repair blood vessel lesion .......................... 24.21 NA 11.28 2.86 NA 38.35 090 

35281 ......... ............ A Repair blood vessel lesion .......................... 27.96 NA 11.75 2.20 NA 41.91 090 

35286 ......... ............ A Repair blood vessel lesion .......................... 16.14 NA 8.12 1.64 NA 25.90 090 

35301 ......... ............ A Rechanneling of artery ................................ 18.67 NA 8.50 2.69 NA 29.86 090 

35311 ......... ............ A Rechanneling of artery ................................ 26.96 NA 11.79 3.32 NA 42.07 090 

35321 ......... ............ A Rechanneling of artery ................................ 15.98 NA 7.41 1.64 NA 25.03 090 

35331 ......... ............ A Rechanneling of artery ................................ 26.16 NA 11.28 3.27 NA 40.71 090 

35341 ......... ............ A Rechanneling of artery ................................ 25.07 NA 10.91 3.46 NA 39.44 090 

35351 ......... ............ A Rechanneling of artery ................................ 22.97 NA 9.64 2.76 NA 35.37 090 

35355 ......... ............ A Rechanneling of artery ................................ 18.47 NA 8.12 2.17 NA 28.76 090 

35361 ......... ............ A Rechanneling of artery ................................ 28.16 NA 11.75 3.21 NA 43.12 090 

35363 ......... ............ A Rechanneling of artery ................................ 30.15 NA 12.63 3.34 NA 46.12 090 

35371 ......... ............ A Rechanneling of artery ................................ 14.70 NA 6.99 1.59 NA 23.28 090 

35372 ......... ............ A Rechanneling of artery ................................ 17.97 NA 8.08 1.85 NA 27.90 090 

35381 ......... ............ A Rechanneling of artery ................................ 15.79 NA 7.85 2.17 NA 25.81 090 

35390 ......... ............ A Reoperation, carotid add-on ........................ 3.19 NA 1.07 0.46 NA 4.72 ZZZ 

35400 ......... ............ A Angioscopy .................................................. 3.00 NA 1.12 0.41 NA 4.53 ZZZ 

35450 ......... ............ A Repair arterial blockage ............................... 10.05 NA 4.04 1.01 NA 15.10 000 

35452 ......... ............ A Repair arterial blockage ............................... 6.90 NA 3.17 0.92 NA 10.99 000 

35454 ......... ............ A Repair arterial blockage ............................... 6.03 NA 2.84 0.81 NA 9.68 000 

35456 ......... ............ A Repair arterial blockage ............................... 7.34 NA 3.29 0.99 NA 11.62 000 

35458 ......... ............ A Repair arterial blockage ............................... 9.48 NA 4.01 1.31 NA 14.80 000 

35459 ......... ............ A Repair arterial blockage ............................... 8.62 NA 3.64 1.16 NA 13.42 000 

35460 ......... ............ A Repair venous blockage .............................. 6.03 NA 2.68 0.80 NA 9.51 000 

35470 ......... ............ A Repair arterial blockage ............................... 8.62 NA 3.85 0.60 NA 13.07 000 

35471 ......... ............ A Repair arterial blockage ............................... 10.05 NA 4.45 0.60 NA 15.10 000 

35472 ......... ............ A Repair arterial blockage ............................... 6.90 NA 3.24 0.47 NA 10.61 000 

35473 ......... ............ A Repair arterial blockage ............................... 6.03 NA 2.92 0.41 NA 9.36 000 

35474 ......... ............ A Repair arterial blockage ............................... 7.35 NA 2.88 0.48 NA 10.71 000 

35475 ......... ............ R Repair arterial blockage ............................... 9.48 NA 4.06 0.57 NA 14.11 000 

35476 ......... ............ A Repair venous blockage .............................. 6.03 NA 2.85 0.33 NA 9.21 000 

35480 ......... ............ A Atherectomy, open ....................................... 11.06 NA 4.51 1.36 NA 16.93 000 

35481 ......... ............ A Atherectomy, open ....................................... 7.60 NA 3.48 1.01 NA 12.09 000 

35482 ......... ............ A Atherectomy, open ....................................... 6.64 NA 3.09 0.90 NA 10.63 000 

35483 ......... ............ A Atherectomy, open ....................................... 8.09 NA 3.54 0.98 NA 12.61 000 

35484 ......... ............ A Atherectomy, open ....................................... 10.42 NA 4.23 1.36 NA 16.01 000 

35485 ......... ............ A Atherectomy, open ....................................... 9.48 NA 4.06 1.28 NA 14.82 000 

35490 ......... ............ A Atherectomy, percutaneous ......................... 11.06 NA 4.71 0.66 NA 16.43 000 

35491 ......... ............ A Atherectomy, percutaneous ......................... 7.60 NA 3.30 0.59 NA 11.49 000 

35492 ......... ............ A Atherectomy, percutaneous ......................... 6.64 NA 3.19 0.52 NA 10.35 000 

35493 ......... ............ A Atherectomy, percutaneous ......................... 8.09 NA 3.81 0.57 NA 12.47 000 

35494 ......... ............ A Atherectomy, percutaneous ......................... 10.42 NA 4.40 0.58 NA 15.40 000 

35495 ......... ............ A Atherectomy, percutaneous ......................... 9.48 NA 4.39 0.62 NA 14.49 000 

35500 ......... ............ A Harvest vein for bypass ............................... 6.44 NA 2.03 0.76 NA 9.23 ZZZ 

35501 ......... ............ A Artery bypass graft ...................................... 19.16 NA 8.51 2.81 NA 30.48 090 

35506 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.51 2.81 NA 31.96 090 

35507 ......... ............ A Artery bypass graft ...................................... 19.64 NA 9.46 2.74 NA 31.84 090 

35508 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.48 2.82 NA 30.92 090 

35509 ......... ............ A Artery bypass graft ...................................... 18.04 NA 8.80 2.56 NA 29.40 090 

35510 ......... ............ A Artery bypass graft ...................................... 22.97 NA 10.17 2.10 NA 35.24 090 

35511 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.39 2.10 NA 32.66 090 

35512 ......... ............ A Artery bypass graft ...................................... 22.47 NA 10.00 2.10 NA 34.57 090 

35515 ......... ............ A Artery bypass graft ...................................... 18.62 NA 9.33 2.73 NA 30.68 090 

35516 ......... ............ A Artery bypass graft ...................................... 16.30 NA 6.84 2.27 NA 25.41 090 

35518 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.02 2.15 NA 32.34 090 

35521 ......... ............ A Artery bypass graft ...................................... 22.17 NA 9.87 2.20 NA 34.24 090 

35522 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.74 2.10 NA 33.57 090 

35525 ......... ............ A Artery bypass graft ...................................... 20.60 NA 9.35 2.10 NA 32.05 090 

35526 ......... ............ A Artery bypass graft ...................................... 29.91 NA 12.56 2.63 NA 45.10 090 

35531 ......... ............ A Artery bypass graft ...................................... 36.15 NA 14.54 3.51 NA 54.20 090 

35533 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.77 2.83 NA 42.56 090 

35536 ......... ............ A Artery bypass graft ...................................... 31.65 NA 13.00 3.16 NA 47.81 090 

35541 ......... ............ A Artery bypass graft ...................................... 25.76 NA 11.25 3.30 NA 40.31 090 

35546 ......... ............ A Artery bypass graft ...................................... 25.50 NA 10.91 3.43 NA 39.84 090 

35548 ......... ............ A Artery bypass graft ...................................... 21.54 NA 9.46 2.95 NA 33.95 090 

35549 ......... ............ A Artery bypass graft ...................................... 23.31 NA 10.42 3.34 NA 37.07 090 

35551 ......... ............ A Artery bypass graft ...................................... 26.63 NA 11.56 3.85 NA 42.04 090 

35556 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.77 2.99 NA 34.49 090 

35558 ......... ............ A Artery bypass graft ...................................... 21.17 NA 9.59 1.91 NA 32.67 090 

35560 ......... ............ A Artery bypass graft ...................................... 31.95 NA 13.37 3.29 NA 48.61 090 

35563 ......... ............ A Artery bypass graft ...................................... 24.16 NA 10.57 2.03 NA 36.76 090 

1153

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

35565 ......... ............ A Artery bypass graft ...................................... 23.17 NA 10.17 2.06 NA 35.40 090 

35566 ......... ............ A Artery bypass graft ...................................... 26.88 NA 11.45 3.64 NA 41.97 090 

35571 ......... ............ A Artery bypass graft ...................................... 24.02 NA 10.91 2.58 NA 37.51 090 

35572 ......... ............ A Harvest femoropopliteal vein ....................... 6.81 NA 2.34 0.76 NA 9.91 ZZZ 

35582 ......... ............ A Vein bypass graft ......................................... 27.09 NA 11.62 3.75 NA 42.46 090 

35583 ......... ............ A Vein bypass graft ......................................... 22.34 NA 10.21 3.05 NA 35.60 090 

35585 ......... ............ A Vein bypass graft ......................................... 28.35 NA 12.32 3.87 NA 44.54 090 

35587 ......... ............ A Vein bypass graft ......................................... 24.71 NA 11.54 2.62 NA 38.87 090 

35600 ......... ............ A Harvest artery for cabg ................................ 4.94 NA 1.63 0.72 NA 7.29 ZZZ 

35601 ......... ............ A Artery bypass graft ...................................... 17.47 NA 8.66 2.51 NA 28.64 090 

35606 ......... ............ A Artery bypass graft ...................................... 18.68 NA 9.06 2.62 NA 30.36 090 

35612 ......... ............ A Artery bypass graft ...................................... 15.74 NA 7.92 2.07 NA 25.73 090 

35616 ......... ............ A Artery bypass graft ...................................... 15.68 NA 8.14 2.22 NA 26.04 090 

35621 ......... ............ A Artery bypass graft ...................................... 19.97 NA 8.71 2.03 NA 30.71 090 

35623 ......... ............ A Bypass graft, not vein .................................. 23.96 NA 10.54 2.30 NA 36.80 090 

35626 ......... ............ A Artery bypass graft ...................................... 27.71 NA 12.03 3.49 NA 43.23 090 

35631 ......... ............ A Artery bypass graft ...................................... 33.95 NA 13.88 3.41 NA 51.24 090 

35636 ......... ............ A Artery bypass graft ...................................... 29.46 NA 12.35 2.86 NA 44.67 090 

35641 ......... ............ A Artery bypass graft ...................................... 24.53 NA 11.11 3.41 NA 39.05 090 

35642 ......... ............ A Artery bypass graft ...................................... 17.95 NA 8.72 2.22 NA 28.89 090 

35645 ......... ............ A Artery bypass graft ...................................... 17.44 NA 8.31 2.30 NA 28.05 090 

35646 ......... ............ A Artery bypass graft ...................................... 30.95 NA 13.15 4.38 NA 48.48 090 

35647 ......... ............ A Artery bypass graft ...................................... 27.96 NA 11.82 3.96 NA 43.74 090 

35650 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.40 1.98 NA 29.35 090 

35651 ......... ............ A Artery bypass graft ...................................... 25.00 NA 10.89 3.05 NA 38.94 090 

35654 ......... ............ A Artery bypass graft ...................................... 24.96 NA 10.70 2.53 NA 38.19 090 

35656 ......... ............ A Artery bypass graft ...................................... 19.50 NA 8.64 2.67 NA 30.81 090 

35661 ......... ............ A Artery bypass graft ...................................... 18.97 NA 8.96 1.81 NA 29.74 090 

35663 ......... ............ A Artery bypass graft ...................................... 21.97 NA 10.02 1.87 NA 33.86 090 

35665 ......... ............ A Artery bypass graft ...................................... 20.97 NA 9.48 2.12 NA 32.57 090 

35666 ......... ............ A Artery bypass graft ...................................... 22.16 NA 10.72 2.64 NA 35.52 090 

35671 ......... ............ A Artery bypass graft ...................................... 19.30 NA 9.43 2.03 NA 30.76 090 

35681 ......... ............ A Composite bypass graft ............................... 1.60 NA 0.53 0.22 NA 2.35 ZZZ 

35682 ......... ............ A Composite bypass graft ............................... 7.19 NA 2.40 1.00 NA 10.59 ZZZ 

35683 ......... ............ A Composite bypass graft ............................... 8.49 NA 2.83 1.18 NA 12.50 ZZZ 

35685 ......... ............ A Bypass graft patency/patch ......................... 4.04 NA 1.35 0.30 NA 5.69 ZZZ 

35686 ......... ............ A Bypass graft/av fist patency ........................ 3.34 NA 1.13 0.25 NA 4.72 ZZZ 

35691 ......... ............ A Arterial transposition .................................... 18.02 NA 8.45 2.48 NA 28.95 090 

35693 ......... ............ A Arterial transposition .................................... 15.34 NA 7.76 2.17 NA 25.27 090 

35694 ......... ............ A Arterial transposition .................................... 19.13 NA 8.64 2.57 NA 30.34 090 

35695 ......... ............ A Arterial transposition .................................... 19.13 NA 8.60 2.64 NA 30.37 090 

35697 ......... ............ A Reimplant artery each ................................. 3.00 NA 1.03 0.41 NA 4.44 ZZZ 

35700 ......... ............ A Reoperation, bypass graft ........................... 3.08 NA 1.03 0.43 NA 4.54 ZZZ 

35701 ......... ............ A Exploration, carotid artery ............................ 8.49 NA 5.18 0.77 NA 14.44 090 

35721 ......... ............ A Exploration, femoral artery .......................... 7.17 NA 4.48 0.71 NA 12.36 090 

35741 ......... ............ A Exploration popliteal artery .......................... 7.99 NA 4.71 0.72 NA 13.42 090 

35761 ......... ............ A Exploration of artery/vein ............................. 5.36 NA 4.07 0.72 NA 10.15 090 

35800 ......... ............ A Explore neck vessels ................................... 7.01 NA 4.68 0.95 NA 12.64 090 

35820 ......... ............ A Explore chest vessels .................................. 12.86 NA 7.20 1.94 NA 22.00 090 

35840 ......... ............ A Explore abdominal vessels .......................... 9.76 NA 5.31 1.28 NA 16.35 090 

35860 ......... ............ A Explore limb vessels .................................... 5.54 NA 4.06 0.76 NA 10.36 090 

35870 ......... ............ A Repair vessel graft defect ............................ 22.14 NA 9.81 2.98 NA 34.93 090 

35875 ......... ............ A Removal of clot in graft ............................... 10.11 NA 5.24 1.17 NA 16.52 090 

35876 ......... ............ A Removal of clot in graft ............................... 16.97 NA 7.59 2.27 NA 26.83 090 

35879 ......... ............ A Revise graft w/vein ...................................... 15.98 NA 7.75 1.63 NA 25.36 090 

35881 ......... ............ A Revise graft w/vein ...................................... 17.97 NA 8.75 1.74 NA 28.46 090 

35901 ......... ............ A Excision, graft, neck .................................... 8.18 NA 5.36 1.09 NA 14.63 090 

35903 ......... ............ A Excision, graft, extremity ............................. 9.38 NA 6.01 1.24 NA 16.63 090 

35905 ......... ............ A Excision, graft, thorax .................................. 31.20 NA 13.26 2.59 NA 47.05 090 

35907 ......... ............ A Excision, graft, abdomen ............................. 34.95 NA 14.11 2.62 NA 51.68 090 

36000 ......... ............ A Place needle in vein .................................... 0.18 0.60 0.05 0.01 0.79 0.24 XXX 

36002 ......... ............ A Pseudoaneurysm injection trt ...................... 1.96 2.91 0.99 0.12 4.99 3.07 000 

36005 ......... ............ A Injection ext venography .............................. 0.95 8.47 0.32 0.05 9.47 1.32 000 

36010 ......... ............ A Place catheter in vein .................................. 2.43 NA 0.79 0.19 NA 3.41 XXX 

36011 ......... ............ A Place catheter in vein .................................. 3.14 NA 1.03 0.21 NA 4.38 XXX 

36012 ......... ............ A Place catheter in vein .................................. 3.51 NA 1.15 0.21 NA 4.87 XXX 

36013 ......... ............ A Place catheter in artery ............................... 2.52 NA 0.66 0.21 NA 3.39 XXX 

36014 ......... ............ A Place catheter in artery ............................... 3.02 NA 0.99 0.17 NA 4.18 XXX 

36015 ......... ............ A Place catheter in artery ............................... 3.51 NA 1.15 0.19 NA 4.85 XXX 

36100 ......... ............ A Establish access to artery ........................... 3.02 NA 1.10 0.22 NA 4.34 XXX 

36120 ......... ............ A Establish access to artery ........................... 2.01 NA 0.65 0.13 NA 2.79 XXX 

36140 ......... ............ A Establish access to artery ........................... 2.01 NA 0.64 0.14 NA 2.79 XXX 

36145 ......... ............ A Artery to vein shunt ..................................... 2.01 NA 0.66 0.12 NA 2.79 XXX 

36160 ......... ............ A Establish access to aorta ............................ 2.52 NA 0.85 0.24 NA 3.61 XXX 

36200 ......... ............ A Place catheter in aorta ................................ 3.02 NA 1.02 0.18 NA 4.22 XXX 

1154

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

36215 ......... ............ A Place catheter in artery ............................... 4.67 NA 1.58 0.27 NA 6.52 XXX 

36216 ......... ............ A Place catheter in artery ............................... 5.27 NA 1.76 0.29 NA 7.32 XXX 

36217 ......... ............ A Place catheter in artery ............................... 6.29 NA 2.14 0.39 NA 8.82 XXX 

36218 ......... ............ A Place catheter in artery ............................... 1.01 NA 0.35 0.06 NA 1.42 ZZZ 

36245 ......... ............ A Place catheter in artery ............................... 4.67 NA 1.65 0.28 NA 6.60 XXX 

36246 ......... ............ A Place catheter in artery ............................... 5.27 NA 1.79 0.31 NA 7.37 XXX 

36247 ......... ............ A Place catheter in artery ............................... 6.29 NA 2.10 0.39 NA 8.78 XXX 

36248 ......... ............ A Place catheter in artery ............................... 1.01 NA 0.35 0.07 NA 1.43 ZZZ 

36260 ......... ............ A Insertion of infusion pump ........................... 9.70 NA 4.90 1.21 NA 15.81 090 

36261 ......... ............ A Revision of infusion pump ........................... 5.44 NA 3.66 0.60 NA 9.70 090 

36262 ......... ............ A Removal of infusion pump ........................... 4.01 NA 2.77 0.52 NA 7.30 090 

36299 ......... ............ C Vessel injection procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

36400 ......... ............ A Bl draw < 3 yrs fem/jugular ......................... 0.38 0.29 0.09 0.01 0.68 0.48 XXX 

36405 ......... ............ A Bl draw < 3 yrs scalp vein ........................... 0.31 0.27 0.08 0.01 0.59 0.40 XXX 

36406 ......... ............ A Bl draw < 3 yrs other vein ........................... 0.18 0.30 0.05 0.01 0.49 0.24 XXX 

36410 ......... ............ A Non-routine bl draw > 3 yrs ......................... 0.18 0.30 0.05 0.01 0.49 0.24 XXX 

36415 ......... ............ I Routine venipuncture ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

36416 ......... ............ I Capillary blood draw .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

36420 ......... ............ A Vein access cutdown < 1 yr ........................ 1.01 3.06 0.28 0.11 4.18 1.40 XXX 

36425 ......... ............ A Vein access cutdown > 1 yr ........................ 0.76 NA 0.22 0.06 NA 1.04 XXX 

36430 ......... ............ A Blood transfusion service ............................ 0.00 1.01 NA 0.06 1.07 NA XXX 

36440 ......... ............ A Bl push transfuse, 2 yr or < ......................... 1.03 NA 0.30 0.10 NA 1.43 XXX 

36450 ......... ............ A Bl exchange/transfuse, nb ........................... 2.23 NA 0.71 0.19 NA 3.13 XXX 

36455 ......... ............ A Bl exchange/transfuse non-nb ..................... 2.43 NA 1.02 0.12 NA 3.57 XXX 

36460 ......... ............ A Transfusion service, fetal ............................. 6.58 NA 2.25 0.68 NA 9.51 XXX 

36468 ......... ............ R Injection(s), spider veins .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

36469 ......... ............ R Injection(s), spider veins .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

36470 ......... ............ A Injection therapy of vein .............................. 1.09 2.72 0.44 0.12 3.93 1.65 010 

36471 ......... ............ A Injection therapy of veins ............................. 1.57 3.07 0.60 0.18 4.82 2.35 010 

36481 ......... ............ A Insertion of catheter, vein ............................ 6.98 7.51 2.73 0.48 14.97 10.19 000 

36488 ......... ............ D Insertion of catheter, vein ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

36489 ......... ............ D Insertion of catheter, vein ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

36490 ......... ............ D Insertion of catheter, vein ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

36491 ......... ............ D Insertion of catheter, vein ............................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

36493 ......... ............ D Repositioning of cvc .................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

36500 ......... ............ A Insertion of catheter, vein ............................ 3.51 NA 1.37 0.17 NA 5.05 000 

36510 ......... ............ A Insertion of catheter, vein ............................ 1.09 3.74 0.61 0.07 4.90 1.77 000 

36511 ......... ............ A Apheresis wbc ............................................. 1.74 NA 0.71 0.07 NA 2.52 000 

36512 ......... ............ A Apheresis rbc ............................................... 1.74 NA 0.71 0.07 NA 2.52 000 

36513 ......... ............ A Apheresis platelets ...................................... 1.74 NA 0.71 0.07 NA 2.52 000 

36514 ......... ............ A Apheresis plasma ........................................ 1.74 NA 0.71 0.07 NA 2.52 000 

36515 ......... ............ A Apheresis, adsorp/reinfuse .......................... 1.74 NA 0.73 0.07 NA 2.54 000 

36516 ......... ............ A Apheresis, selective ..................................... 1.22 NA 0.51 0.07 NA 1.80 000 

36522 ......... ............ A Photopheresis .............................................. 1.67 30.33 1.13 0.08 32.08 2.88 000 

36530 ......... ............ D Insertion of infusion pump ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36531 ......... ............ D Revision of infusion pump ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36532 ......... ............ D Removal of infusion pump ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36533 ......... ............ D Insertion of access device ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36534 ......... ............ D Revision of access device ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36535 ......... ............ D Removal of access device ........................... 0.00 0.00 0.00 0.00 0.00 0.00 010 

36536 ......... ............ D Remove cva device obstruct ....................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

36537 ......... ............ D Remove cva lumen obstruct ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

36540 ......... ............ B Collect blood venous device ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

36550 ......... ............ A Declot vascular device ................................. 0.00 0.39 NA 0.37 0.76 NA XXX 

36555 ......... ............ A Insert non-tunnel cv cath ............................. 2.68 6.00 0.82 0.21 8.89 3.71 000 

36556 ......... ............ A Insert non-tunnel cv cath ............................. 2.50 5.85 0.74 0.10 8.45 3.34 000 

36557 ......... ............ A Insert tunneled cv cath ................................ 5.09 13.56 2.58 0.59 19.24 8.26 010 

36558 ......... ............ A Insert tunneled cv cath ................................ 4.79 13.45 2.47 0.59 18.83 7.85 010 

36560 ......... ............ A Insert tunneled cv cath ................................ 6.24 29.19 2.96 0.59 36.02 9.79 010 

36561 ......... ............ A Insert tunneled cv cath ................................ 5.99 29.11 2.87 0.59 35.69 9.45 010 

36563 ......... ............ A Insert tunneled cv cath ................................ 6.19 38.09 2.98 0.68 44.96 9.85 010 

36565 ......... ............ A Insert tunneled cv cath ................................ 5.99 22.15 2.87 0.59 28.73 9.45 010 

36566 ......... ............ A Insert tunneled cv cath ................................ 6.49 22.95 3.04 0.59 30.03 10.12 010 

36568 ......... ............ A Insert tunneled cv cath ................................ 1.92 8.19 0.59 0.21 10.32 2.72 000 

36569 ......... ............ A Insert tunneled cv cath ................................ 1.82 7.39 0.57 0.16 9.37 2.55 000 

36570 ......... ............ A Insert tunneled cv cath ................................ 5.31 40.27 2.64 0.59 46.17 8.54 010 

36571 ......... ............ A Insert tunneled cv cath ................................ 5.29 35.64 2.63 0.59 41.52 8.51 010 

36575 ......... ............ A Repair tunneled cv cath ............................... 0.67 3.35 0.26 0.59 4.61 1.52 000 

36576 ......... ............ A Repair tunneled cv cath ............................... 3.19 7.71 1.76 0.59 11.49 5.54 010 

36578 ......... ............ A Replace tunneled cv cath ............................ 3.49 10.54 2.20 0.59 14.62 6.28 010 

36580 ......... ............ A Replace tunneled cv cath ............................ 1.31 6.76 0.41 0.16 8.23 1.88 000 

36581 ......... ............ A Replace tunneled cv cath ............................ 3.43 13.27 1.84 0.59 17.29 5.86 010 

36582 ......... ............ A Replace tunneled cv cath ............................ 5.19 26.63 2.76 0.59 32.41 8.54 010 

36583 ......... ............ A Replace tunneled cv cath ............................ 5.24 13.13 2.77 0.59 18.96 8.60 010 

36584 ......... ............ A Replace tunneled cv cath ............................ 1.20 7.23 0.54 0.16 8.59 1.90 000 

1155

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

36585 ......... ............ A Replace tunneled cv cath ............................ 4.79 35.46 2.62 0.59 40.84 8.00 010 

36589 ......... ............ A Removal tunneled cv cath ........................... 2.27 2.20 1.41 0.25 4.72 3.93 010 

36590 ......... ............ A Removal tunneled cv cath ........................... 3.30 6.41 1.64 0.41 10.12 5.35 010 

36595 ......... ............ A Mech remov tunneled cv cath ..................... 3.59 19.71 1.46 0.28 23.58 5.33 000 

36596 ......... ............ A Mech remov tunneled cv cath ..................... 0.75 4.39 0.49 0.05 5.19 1.29 000 

36597 ......... ............ A Reposition venous catheter ......................... 1.21 3.18 0.43 0.07 4.46 1.71 000 

36600 ......... ............ A Withdrawal of arterial blood ......................... 0.32 0.48 0.09 0.02 0.82 0.43 XXX 

36620 ......... ............ A Insertion catheter, artery .............................. 1.15 NA 0.24 0.07 NA 1.46 000 

36625 ......... ............ A Insertion catheter, artery .............................. 2.11 NA 0.52 0.19 NA 2.82 000 

36640 ......... ............ A Insertion catheter, artery .............................. 2.10 NA 1.05 0.22 NA 3.37 000 

36660 ......... ............ A Insertion catheter, artery .............................. 1.40 NA 0.44 0.10 NA 1.94 000 

36680 ......... ............ A Insert needle, bone cavity ........................... 1.20 NA 0.49 0.10 NA 1.79 000 

36800 ......... ............ A Insertion of cannula ..................................... 2.43 NA 1.81 0.21 NA 4.45 000 

36810 ......... ............ A Insertion of cannula ..................................... 3.96 NA 1.69 0.48 NA 6.13 000 

36815 ......... ............ A Insertion of cannula ..................................... 2.62 NA 1.17 0.31 NA 4.10 000 

36819 ......... ............ A Av fusion/uppr arm vein ............................... 13.98 NA 6.40 1.88 NA 22.26 090 

36820 ......... ............ A Av fusion/forearm vein ................................. 13.98 NA 6.40 1.88 NA 22.26 090 

36821 ......... ............ A Av fusion direct any site .............................. 8.92 NA 4.71 1.17 NA 14.80 090 

36822 ......... ............ A Insertion of cannula(s) ................................. 5.41 NA 4.49 0.76 NA 10.66 090 

36823 ......... ............ A Insertion of cannula(s) ................................. 20.97 NA 9.48 2.63 NA 33.08 090 

36825 ......... ............ A Artery-vein autograft .................................... 9.83 NA 5.14 1.31 NA 16.28 090 

36830 ......... ............ A Artery-vein nonautograft .............................. 11.98 NA 5.30 1.59 NA 18.87 090 

36831 ......... ............ A Open thrombect av fistula ........................... 7.99 NA 3.97 0.95 NA 12.91 090 

36832 ......... ............ A Av fistula revision, open .............................. 10.48 NA 4.79 1.36 NA 16.63 090 

36833 ......... ............ A Av fistula revision ......................................... 11.93 NA 5.25 1.56 NA 18.74 090 

36834 ......... ............ A Repair A-V aneurysm .................................. 9.92 NA 4.81 1.28 NA 16.01 090 

36835 ......... ............ A Artery to vein shunt ..................................... 7.14 NA 4.39 0.96 NA 12.49 090 

36838 ......... ............ A Dist revas ligation, hemo ............................. 20.60 NA 9.36 2.99 NA 32.95 090 

36860 ......... ............ A External cannula declotting ......................... 2.01 2.49 1.35 0.12 4.62 3.48 000 

36861 ......... ............ A Cannula declotting ....................................... 2.52 NA 1.48 0.17 NA 4.17 000 

36870 ......... ............ A Percut thrombect av fistula .......................... 5.15 46.98 3.14 0.28 52.41 8.57 090 

37140 ......... ............ A Revision of circulation .................................. 23.56 NA 10.50 1.46 NA 35.52 090 

37145 ......... ............ A Revision of circulation .................................. 24.57 NA 10.93 2.99 NA 38.49 090 

37160 ......... ............ A Revision of circulation .................................. 21.57 NA 9.30 2.61 NA 33.48 090 

37180 ......... ............ A Revision of circulation .................................. 24.57 NA 10.35 3.17 NA 38.09 090 

37181 ......... ............ A Splice spleen/kidney veins .......................... 26.64 NA 11.06 3.22 NA 40.92 090 

37182 ......... ............ A Insert hepatic shunt (tips) ............................ 16.97 NA 6.27 1.80 NA 25.04 000 

37183 ......... ............ A Remove hepatic shunt (tips) ........................ 7.99 NA 3.08 0.52 NA 11.59 000 

37195 ......... ............ A Thrombolytic therapy, stroke ....................... 0.00 8.08 NA 0.46 8.54 NA XXX 

37200 ......... ............ A Transcatheter biopsy ................................... 4.55 NA 1.50 0.23 NA 6.28 000 

37201 ......... ............ A Transcatheter therapy infuse ....................... 4.99 NA 2.52 0.29 NA 7.80 000 

37202 ......... ............ A Transcatheter therapy infuse ....................... 5.67 NA 3.03 0.46 NA 9.16 000 

37203 ......... ............ A Transcatheter retrieval ................................. 5.02 NA 2.53 0.28 NA 7.83 000 

37204 ......... ............ A Transcatheter occlusion ............................... 18.11 NA 5.93 1.10 NA 25.14 000 

37205 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.74 0.52 NA 12.53 000 

37206 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.44 0.27 NA 5.83 ZZZ 

37207 ......... ............ A Transcatheter stent ...................................... 8.27 NA 3.17 1.07 NA 12.51 000 

37208 ......... ............ A Transcatheter stent add-on ......................... 4.12 NA 1.39 0.53 NA 6.04 ZZZ 

37209 ......... ............ A Exchange arterial catheter ........................... 2.27 NA 0.75 0.13 NA 3.15 000 

37250 ......... ............ A Iv us first vessel add-on .............................. 2.10 NA 0.75 0.21 NA 3.06 ZZZ 

37251 ......... ............ A Iv us each add vessel add-on ..................... 1.60 NA 0.55 0.17 NA 2.32 ZZZ 

37500 ......... ............ A Endoscopy ligate perf veins ........................ 10.98 NA 7.12 0.48 NA 18.58 090 

37501 ......... ............ C Vascular endoscopy procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

37565 ......... ............ A Ligation of neck vein .................................... 10.86 NA 5.65 0.54 NA 17.05 090 

37600 ......... ............ A Ligation of neck artery ................................. 11.23 NA 6.67 0.48 NA 18.38 090 

37605 ......... ............ A Ligation of neck artery ................................. 13.09 NA 6.94 0.93 NA 20.96 090 

37606 ......... ............ A Ligation of neck artery ................................. 6.27 NA 4.59 0.95 NA 11.81 090 

37607 ......... ............ A Ligation of a-v fistula ................................... 6.15 NA 3.59 0.81 NA 10.55 090 

37609 ......... ............ A Temporal artery procedure .......................... 3.00 4.70 1.98 0.25 7.95 5.23 010 

37615 ......... ............ A Ligation of neck artery ................................. 5.72 NA 4.12 0.69 NA 10.53 090 

37616 ......... ............ A Ligation of chest artery ................................ 16.47 NA 8.15 2.33 NA 26.95 090 

37617 ......... ............ A Ligation of abdomen artery .......................... 22.03 NA 9.22 2.04 NA 33.29 090 

37618 ......... ............ A Ligation of extremity artery .......................... 4.83 NA 3.59 0.65 NA 9.07 090 

37620 ......... ............ A Revision of major vein ................................. 10.54 NA 5.72 0.90 NA 17.16 090 

37650 ......... ............ A Revision of major vein ................................. 7.79 NA 4.72 0.68 NA 13.19 090 

37660 ......... ............ A Revision of major vein ................................. 20.97 NA 9.10 1.41 NA 31.48 090 

37700 ......... ............ A Revise leg vein ............................................ 3.72 NA 2.81 0.48 NA 7.01 090 

37720 ......... ............ A Removal of leg vein ..................................... 5.65 NA 3.73 0.74 NA 10.12 090 

37730 ......... ............ A Removal of leg veins ................................... 7.32 NA 4.28 0.93 NA 12.53 090 

37735 ......... ............ A Removal of leg veins/lesion ......................... 10.51 NA 5.54 1.41 NA 17.46 090 

37760 ......... ............ A Ligation, leg veins, open .............................. 10.45 NA 5.38 1.34 NA 17.17 090 

37765 ......... ............ A Phleb veins - extrem - to 20 ........................ 7.34 NA 4.55 0.48 NA 12.37 090 

37766 ......... ............ A Phleb veins - extrem 20+ ............................ 9.29 NA 5.26 0.48 NA 15.03 090 

37780 ......... ............ A Revision of leg vein ..................................... 3.83 NA 2.88 0.49 NA 7.20 090 

37785 ......... ............ A Ligate/divide/excise vein .............................. 3.83 5.14 2.64 0.49 9.46 6.96 090 

1156

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

37788 ......... ............ A Revascularization, penis .............................. 21.98 NA 9.29 1.63 NA 32.90 090 

37790 ......... ............ A Penile venous occlusion .............................. 8.33 NA 4.53 0.76 NA 13.62 090 

37799 ......... ............ C Vascular surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38100 ......... ............ A Removal of spleen, total .............................. 14.48 NA 6.23 1.57 NA 22.28 090 

38101 ......... ............ A Removal of spleen, partial ........................... 15.29 NA 6.58 1.66 NA 23.53 090 

38102 ......... ............ A Removal of spleen, total .............................. 4.79 NA 1.65 0.59 NA 7.03 ZZZ 

38115 ......... ............ A Repair of ruptured spleen ............................ 15.80 NA 6.70 1.69 NA 24.19 090 

38120 ......... ............ A Laparoscopy, splenectomy .......................... 16.97 NA 7.43 2.09 NA 26.49 090 

38129 ......... ............ C Laparoscope proc, spleen ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38200 ......... ............ A Injection for spleen x-ray ............................. 2.64 NA 0.89 0.14 NA 3.67 000 

38204 ......... ............ B Bl donor search management ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38205 ......... ............ R Harvest allogenic stem cells ........................ 1.50 NA 0.67 0.06 NA 2.23 000 

38206 ......... ............ R Harvest auto stem cells ............................... 1.50 NA 0.67 0.06 NA 2.23 000 

38207 ......... ............ I Cryopreserve stem cells .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38208 ......... ............ I Thaw preserved stem cells .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38209 ......... ............ I Wash harvest stem cells ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38210 ......... ............ I T-cell depletion of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38211 ......... ............ I Tumor cell deplete of harvst ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38212 ......... ............ I Rbc depletion of harvest .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38213 ......... ............ I Platelet deplete of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38214 ......... ............ I Volume deplete of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38215 ......... ............ I Harvest stem cell concentrte ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38220 ......... ............ A Bone marrow aspiration ............................... 1.08 3.98 0.52 0.04 5.10 1.64 XXX 

38221 ......... ............ A Bone marrow biopsy .................................... 1.37 4.19 0.65 0.05 5.61 2.07 XXX 

38230 ......... ............ R Bone marrow collection ............................... 4.53 NA 3.08 0.30 NA 7.91 010 

38240 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.03 0.10 NA 3.37 XXX 

38241 ......... ............ R Bone marrow/stem transplant ...................... 2.24 NA 1.04 0.10 NA 3.38 XXX 

38242 ......... ............ A Lymphocyte infuse transplant ...................... 1.71 NA 0.77 0.06 NA 2.54 000 

38300 ......... ............ A Drainage, lymph node lesion ....................... 1.99 4.42 2.07 0.18 6.59 4.24 010 

38305 ......... ............ A Drainage, lymph node lesion ....................... 5.99 5.98 4.38 0.43 12.40 10.80 090 

38308 ......... ............ A Incision of lymph channels .......................... 6.44 5.71 3.75 0.62 12.77 10.81 090 

38380 ......... ............ A Thoracic duct procedure .............................. 7.45 NA 5.71 0.82 NA 13.98 090 

38381 ......... ............ A Thoracic duct procedure .............................. 12.86 NA 6.94 1.91 NA 21.71 090 

38382 ......... ............ A Thoracic duct procedure .............................. 10.06 NA 5.83 1.30 NA 17.19 090 

38500 ......... ............ A Biopsy/removal, lymph nodes ...................... 3.74 3.78 2.10 0.34 7.86 6.18 010 

38505 ......... ............ A Needle biopsy, lymph nodes ....................... 1.14 2.13 0.78 0.11 3.38 2.03 000 

38510 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.42 5.65 3.51 0.46 12.53 10.39 010 

38520 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.66 NA 4.11 0.63 NA 11.40 090 

38525 ......... ............ A Biopsy/removal, lymph nodes ...................... 6.06 NA 3.36 0.58 NA 10.00 090 

38530 ......... ............ A Biopsy/removal, lymph nodes ...................... 7.97 NA 4.46 0.76 NA 13.19 090 

38542 ......... ............ A Explore deep node(s), neck ........................ 5.90 NA 4.51 0.60 NA 11.01 090 

38550 ......... ............ A Removal, neck/armpit lesion ....................... 6.91 NA 3.99 0.83 NA 11.73 090 

38555 ......... ............ A Removal, neck/armpit lesion ....................... 14.12 NA 8.62 1.76 NA 24.50 090 

38562 ......... ............ A Removal, pelvic lymph nodes ...................... 10.47 NA 5.83 1.17 NA 17.47 090 

38564 ......... ............ A Removal, abdomen lymph nodes ................ 10.81 NA 5.30 1.28 NA 17.39 090 

38570 ......... ............ A Laparoscopy, lymph node biop ................... 9.24 NA 3.94 1.07 NA 14.25 010 

38571 ......... ............ A Laparoscopy, lymphadenectomy ................. 14.66 NA 5.60 0.96 NA 21.22 010 

38572 ......... ............ A Laparoscopy, lymphadenectomy ................. 16.57 NA 7.04 1.59 NA 25.20 010 

38589 ......... ............ C Laparoscope proc, lymphatic ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

38700 ......... ............ A Removal of lymph nodes, neck ................... 8.23 NA 8.09 0.72 NA 17.04 090 

38720 ......... ............ A Removal of lymph nodes, neck ................... 13.59 NA 11.07 1.24 NA 25.90 090 

38724 ......... ............ A Removal of lymph nodes, neck ................... 14.52 NA 11.57 1.33 NA 27.42 090 

38740 ......... ............ A Remove armpit lymph nodes ....................... 10.01 NA 5.01 0.83 NA 15.85 090 

38745 ......... ............ A Remove armpit lymph nodes ....................... 13.08 NA 6.19 1.09 NA 20.36 090 

38746 ......... ............ A Remove thoracic lymph nodes .................... 4.88 NA 1.62 0.66 NA 7.16 ZZZ 

38747 ......... ............ A Remove abdominal lymph nodes ................ 4.88 NA 1.68 0.60 NA 7.16 ZZZ 

38760 ......... ............ A Remove groin lymph nodes ......................... 12.93 NA 6.20 1.06 NA 20.19 090 

38765 ......... ............ A Remove groin lymph nodes ......................... 19.95 NA 8.92 1.81 NA 30.68 090 

38770 ......... ............ A Remove pelvis lymph nodes ....................... 13.21 NA 5.81 1.19 NA 20.21 090 

38780 ......... ............ A Remove abdomen lymph nodes .................. 16.57 NA 8.27 1.93 NA 26.77 090 

38790 ......... ............ A Inject for lymphatic x-ray ............................. 1.29 11.24 0.79 0.11 12.64 2.19 000 

38792 ......... ............ A Identify sentinel node ................................... 0.52 NA 0.44 0.05 NA 1.01 000 

38794 ......... ............ A Access thoracic lymph duct ......................... 4.44 NA 3.40 0.21 NA 8.05 090 

38999 ......... ............ C Blood/lymph system procedure ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39000 ......... ............ A Exploration of chest ..................................... 6.09 NA 4.70 0.88 NA 11.67 090 

39010 ......... ............ A Exploration of chest ..................................... 11.77 NA 6.67 1.76 NA 20.20 090 

39200 ......... ............ A Removal chest lesion .................................. 13.60 NA 6.82 1.99 NA 22.41 090 

39220 ......... ............ A Removal chest lesion .................................. 17.39 NA 8.55 2.53 NA 28.47 090 

39400 ......... ............ A Visualization of chest ................................... 5.60 NA 4.87 0.83 NA 11.30 010 

39499 ......... ............ C Chest procedure .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

39501 ......... ............ A Repair diaphragm laceration ....................... 13.17 NA 6.52 1.66 NA 21.35 090 

39502 ......... ............ A Repair paraesophageal hernia .................... 16.31 NA 7.20 2.03 NA 25.54 090 

39503 ......... ............ A Repair of diaphragm hernia ......................... 94.86 NA 33.56 4.25 NA 132.67 090 

39520 ......... ............ A Repair of diaphragm hernia ......................... 16.08 NA 8.11 2.21 NA 26.40 090 

39530 ......... ............ A Repair of diaphragm hernia ......................... 15.39 NA 7.20 2.00 NA 24.59 090 

1157

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

39531 ......... ............ A Repair of diaphragm hernia ......................... 16.40 NA 7.45 2.21 NA 26.06 090 

39540 ......... ............ A Repair of diaphragm hernia ......................... 13.30 NA 6.29 1.66 NA 21.25 090 

39541 ......... ............ A Repair of diaphragm hernia ......................... 14.39 NA 6.65 1.83 NA 22.87 090 

39545 ......... ............ A Revision of diaphragm ................................. 13.35 NA 7.62 1.87 NA 22.84 090 

39560 ......... ............ A Resect diaphragm, simple ........................... 11.98 NA 6.35 1.63 NA 19.96 090 

39561 ......... ............ A Resect diaphragm, complex ........................ 17.47 NA 9.40 2.38 NA 29.25 090 

39599 ......... ............ C Diaphragm surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

40490 ......... ............ A Biopsy of lip ................................................. 1.22 1.85 0.61 0.07 3.14 1.90 000 

40500 ......... ............ A Partial excision of lip .................................... 4.27 6.08 4.90 0.37 10.72 9.54 090 

40510 ......... ............ A Partial excision of lip .................................... 4.69 6.82 4.79 0.46 11.97 9.94 090 

40520 ......... ............ A Partial excision of lip .................................... 4.66 7.33 5.03 0.51 12.50 10.20 090 

40525 ......... ............ A Reconstruct lip with flap .............................. 7.54 NA 6.90 0.82 NA 15.26 090 

40527 ......... ............ A Reconstruct lip with flap .............................. 9.12 NA 7.85 0.99 NA 17.96 090 

40530 ......... ............ A Partial removal of lip .................................... 5.39 6.57 5.19 0.57 12.53 11.15 090 

40650 ......... ............ A Repair lip ...................................................... 3.63 5.55 3.80 0.37 9.55 7.80 090 

40652 ......... ............ A Repair lip ...................................................... 4.25 6.50 5.23 0.47 11.22 9.95 090 

40654 ......... ............ A Repair lip ...................................................... 5.30 7.16 5.96 0.58 13.04 11.84 090 

40700 ......... ............ A Repair cleft lip/nasal .................................... 12.77 NA 9.51 1.12 NA 23.40 090 

40701 ......... ............ A Repair cleft lip/nasal .................................... 15.83 NA 11.79 1.64 NA 29.26 090 

40702 ......... ............ A Repair cleft lip/nasal .................................... 13.02 NA 8.47 1.22 NA 22.71 090 

40720 ......... ............ A Repair cleft lip/nasal .................................... 13.53 NA 10.50 1.58 NA 25.61 090 

40761 ......... ............ A Repair cleft lip/nasal .................................... 14.70 NA 10.82 1.70 NA 27.22 090 

40799 ......... ............ C Lip surgery procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

40800 ......... ............ A Drainage of mouth lesion ............................ 1.17 2.21 1.14 0.11 3.49 2.42 010 

40801 ......... ............ A Drainage of mouth lesion ............................ 2.53 3.17 2.03 0.22 5.92 4.78 010 

40804 ......... ............ A Removal, foreign body, mouth .................... 1.24 2.55 1.12 0.11 3.90 2.47 010 

40805 ......... ............ A Removal, foreign body, mouth .................... 2.69 3.39 1.98 0.21 6.29 4.88 010 

40806 ......... ............ A Incision of lip fold ......................................... 0.31 1.37 0.95 0.02 1.70 1.28 000 

40808 ......... ............ A Biopsy of mouth lesion ................................ 0.96 2.29 1.08 0.08 3.33 2.12 010 

40810 ......... ............ A Excision of mouth lesion .............................. 1.31 2.38 1.21 0.11 3.80 2.63 010 

40812 ......... ............ A Excise/repair mouth lesion .......................... 2.31 3.24 1.78 0.21 5.76 4.30 010 

40814 ......... ............ A Excise/repair mouth lesion .......................... 3.41 4.74 3.29 0.31 8.46 7.01 090 

40816 ......... ............ A Excision of mouth lesion .............................. 3.66 4.91 3.39 0.33 8.90 7.38 090 

40818 ......... ............ A Excise oral mucosa for graft ........................ 2.41 5.16 3.53 0.17 7.74 6.11 090 

40819 ......... ............ A Excise lip or cheek fold ............................... 2.41 4.38 2.92 0.21 7.00 5.54 090 

40820 ......... ............ A Treatment of mouth lesion ........................... 1.28 2.69 2.35 0.10 4.07 3.73 010 

40830 ......... ............ A Repair mouth laceration .............................. 1.76 3.07 2.51 0.17 5.00 4.44 010 

40831 ......... ............ A Repair mouth laceration .............................. 2.46 3.61 3.08 0.25 6.32 5.79 010 

40840 ......... ............ R Reconstruction of mouth .............................. 8.72 8.58 7.36 0.95 18.25 17.03 090 

40842 ......... ............ R Reconstruction of mouth .............................. 8.72 8.68 7.10 0.78 18.18 16.60 090 

40843 ......... ............ R Reconstruction of mouth .............................. 12.08 10.87 8.61 1.01 23.96 21.70 090 

40844 ......... ............ R Reconstruction of mouth .............................. 15.99 13.82 11.75 1.97 31.78 29.71 090 

40845 ......... ............ R Reconstruction of mouth .............................. 18.55 15.82 13.55 1.77 36.14 33.87 090 

40899 ......... ............ C Mouth surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41000 ......... ............ A Drainage of mouth lesion ............................ 1.30 2.47 1.40 0.11 3.88 2.81 010 

41005 ......... ............ A Drainage of mouth lesion ............................ 1.26 2.67 1.62 0.11 4.04 2.99 010 

41006 ......... ............ A Drainage of mouth lesion ............................ 3.24 4.38 3.44 0.30 7.92 6.98 090 

41007 ......... ............ A Drainage of mouth lesion ............................ 3.10 4.16 3.31 0.27 7.53 6.68 090 

41008 ......... ............ A Drainage of mouth lesion ............................ 3.36 4.53 3.49 0.29 8.18 7.14 090 

41009 ......... ............ A Drainage of mouth lesion ............................ 3.58 4.86 3.85 0.30 8.74 7.73 090 

41010 ......... ............ A Incision of tongue fold ................................. 1.06 3.46 3.46 0.07 4.59 4.59 010 

41015 ......... ............ A Drainage of mouth lesion ............................ 3.95 5.36 4.06 0.35 9.66 8.36 090 

41016 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.45 4.07 0.34 9.85 8.47 090 

41017 ......... ............ A Drainage of mouth lesion ............................ 4.06 5.36 4.14 0.39 9.81 8.59 090 

41018 ......... ............ A Drainage of mouth lesion ............................ 5.09 5.80 4.25 0.42 11.31 9.76 090 

41100 ......... ............ A Biopsy of tongue .......................................... 1.63 2.56 1.42 0.14 4.33 3.19 010 

41105 ......... ............ A Biopsy of tongue .......................................... 1.42 2.46 1.31 0.12 4.00 2.85 010 

41108 ......... ............ A Biopsy of floor of mouth .............................. 1.05 2.20 1.12 0.10 3.35 2.27 010 

41110 ......... ............ A Excision of tongue lesion ............................. 1.51 2.52 1.33 0.13 4.16 2.97 010 

41112 ......... ............ A Excision of tongue lesion ............................. 2.73 4.25 2.71 0.24 7.22 5.68 090 

41113 ......... ............ A Excision of tongue lesion ............................. 3.19 4.60 2.98 0.28 8.07 6.45 090 

41114 ......... ............ A Excision of tongue lesion ............................. 8.46 8.75 6.31 0.77 17.98 15.54 090 

41115 ......... ............ A Excision of tongue fold ................................ 1.74 3.43 2.57 0.16 5.33 4.47 010 

41116 ......... ............ A Excision of mouth lesion .............................. 2.44 4.22 2.77 0.21 6.87 5.42 090 

41120 ......... ............ A Partial removal of tongue ............................ 9.76 NA 7.58 0.84 NA 18.18 090 

41130 ......... ............ A Partial removal of tongue ............................ 11.13 NA 8.36 0.98 NA 20.47 090 

41135 ......... ............ A Tongue and neck surgery ............................ 23.06 NA 14.83 2.00 NA 39.89 090 

41140 ......... ............ A Removal of tongue ...................................... 25.46 NA 16.06 2.23 NA 43.75 090 

41145 ......... ............ A Tongue removal, neck surgery .................... 30.01 NA 19.18 2.54 NA 51.73 090 

41150 ......... ............ A Tongue, mouth, jaw surgery ........................ 23.01 NA 15.49 2.01 NA 40.51 090 

41153 ......... ............ A Tongue, mouth, neck surgery ...................... 23.73 NA 15.96 2.06 NA 41.75 090 

41155 ......... ............ A Tongue, jaw, & neck surgery ....................... 27.68 NA 17.99 2.44 NA 48.11 090 

41250 ......... ............ A Repair tongue laceration ............................. 1.91 3.07 1.62 0.18 5.16 3.71 010 

41251 ......... ............ A Repair tongue laceration ............................. 2.27 3.58 1.93 0.22 6.07 4.42 010 

41252 ......... ............ A Repair tongue laceration ............................. 2.97 4.16 2.28 0.28 7.41 5.53 010 

1158

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

41500 ......... ............ A Fixation of tongue ........................................ 3.70 NA 3.63 0.31 NA 7.64 090 

41510 ......... ............ A Tongue to lip surgery ................................... 3.41 NA 3.10 0.29 NA 6.80 090 

41520 ......... ............ A Reconstruction, tongue fold ......................... 2.73 4.07 3.22 0.23 7.03 6.18 090 

41599 ......... ............ C Tongue and mouth surgery ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

41800 ......... ............ A Drainage of gum lesion ............................... 1.17 2.66 1.44 0.11 3.94 2.72 010 

41805 ......... ............ A Removal foreign body, gum ........................ 1.24 2.73 2.33 0.11 4.08 3.68 010 

41806 ......... ............ A Removal foreign body,jawbone ................... 2.69 3.62 3.14 0.27 6.58 6.10 010 

41820 ......... ............ R Excision, gum, each quadrant ..................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41821 ......... ............ R Excision of gum flap .................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41822 ......... ............ R Excision of gum lesion ................................. 2.31 4.09 1.33 0.29 6.69 3.93 010 

41823 ......... ............ R Excision of gum lesion ................................. 3.30 5.82 4.10 0.35 9.47 7.75 090 

41825 ......... ............ A Excision of gum lesion ................................. 1.31 3.27 2.35 0.12 4.70 3.78 010 

41826 ......... ............ A Excision of gum lesion ................................. 2.31 3.85 2.89 0.21 6.37 5.41 010 

41827 ......... ............ A Excision of gum lesion ................................. 3.41 5.61 3.84 0.30 9.32 7.55 090 

41828 ......... ............ R Excision of gum lesion ................................. 3.09 4.38 3.35 0.27 7.74 6.71 010 

41830 ......... ............ R Removal of gum tissue ................................ 3.34 4.91 3.57 0.28 8.53 7.19 010 

41850 ......... ............ R Treatment of gum lesion .............................. 0.00 0.00 0.00 0.00 0.00 0.00 000 

41870 ......... ............ R Gum graft ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

41872 ......... ............ R Repair gum .................................................. 2.59 4.63 3.53 0.22 7.44 6.34 090 

41874 ......... ............ R Repair tooth socket ...................................... 3.09 4.68 3.29 0.28 8.05 6.66 090 

41899 ......... ............ C Dental surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42000 ......... ............ A Drainage mouth roof lesion ......................... 1.23 2.72 1.25 0.12 4.07 2.60 010 

42100 ......... ............ A Biopsy roof of mouth ................................... 1.31 2.27 1.36 0.12 3.70 2.79 010 

42104 ......... ............ A Excision lesion, mouth roof ......................... 1.64 2.76 1.55 0.14 4.54 3.33 010 

42106 ......... ............ A Excision lesion, mouth roof ......................... 2.10 3.72 2.81 0.19 6.01 5.10 010 

42107 ......... ............ A Excision lesion, mouth roof ......................... 4.43 6.07 4.18 0.39 10.89 9.00 090 

42120 ......... ............ A Remove palate/lesion .................................. 6.16 NA 5.56 0.53 NA 12.25 090 

42140 ......... ............ A Excision of uvula .......................................... 1.62 2.48 2.37 0.14 4.24 4.13 090 

42145 ......... ............ A Repair palate, pharynx/uvula ....................... 8.04 NA 6.61 0.68 NA 15.33 090 

42160 ......... ............ A Treatment mouth roof lesion ....................... 1.80 3.59 2.65 0.16 5.55 4.61 010 

42180 ......... ............ A Repair palate ............................................... 2.50 3.38 2.12 0.23 6.11 4.85 010 

42182 ......... ............ A Repair palate ............................................... 3.82 4.23 3.06 0.33 8.38 7.21 010 

42200 ......... ............ A Reconstruct cleft palate ............................... 11.98 NA 9.01 1.17 NA 22.16 090 

42205 ......... ............ A Reconstruct cleft palate ............................... 13.27 NA 9.35 0.99 NA 23.61 090 

42210 ......... ............ A Reconstruct cleft palate ............................... 14.48 NA 10.52 1.50 NA 26.50 090 

42215 ......... ............ A Reconstruct cleft palate ............................... 8.81 NA 7.55 1.16 NA 17.52 090 

42220 ......... ............ A Reconstruct cleft palate ............................... 7.01 NA 5.64 0.49 NA 13.14 090 

42225 ......... ............ A Reconstruct cleft palate ............................... 9.53 NA 7.66 0.90 NA 18.09 090 

42226 ......... ............ A Lengthening of palate .................................. 9.99 NA 7.88 0.88 NA 18.75 090 

42227 ......... ............ A Lengthening of palate .................................. 9.51 NA 7.34 0.84 NA 17.69 090 

42235 ......... ............ A Repair palate ............................................... 7.86 NA 5.35 0.59 NA 13.80 090 

42260 ......... ............ A Repair nose to lip fistula .............................. 9.79 9.23 7.44 1.03 20.05 18.26 090 

42280 ......... ............ A Preparation, palate mold ............................. 1.54 2.00 0.88 0.14 3.68 2.56 010 

42281 ......... ............ A Insertion, palate prosthesis .......................... 1.93 2.92 1.88 0.17 5.02 3.98 010 

42299 ......... ............ C Palate/uvula surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42300 ......... ............ A Drainage of salivary gland ........................... 1.93 2.95 1.83 0.18 5.06 3.94 010 

42305 ......... ............ A Drainage of salivary gland ........................... 6.06 NA 4.95 0.55 NA 11.56 090 

42310 ......... ............ A Drainage of salivary gland ........................... 1.56 2.34 1.54 0.13 4.03 3.23 010 

42320 ......... ............ A Drainage of salivary gland ........................... 2.35 3.52 2.11 0.21 6.08 4.67 010 

42325 ......... ............ A Create salivary cyst drain ............................ 2.75 3.54 2.23 0.21 6.50 5.19 090 

42326 ......... ............ A Create salivary cyst drain ............................ 3.77 4.54 3.10 0.41 8.72 7.28 090 

42330 ......... ............ A Removal of salivary stone ........................... 2.21 3.30 1.86 0.19 5.70 4.26 010 

42335 ......... ............ A Removal of salivary stone ........................... 3.31 3.90 3.36 0.28 7.49 6.95 090 

42340 ......... ............ A Removal of salivary stone ........................... 4.59 5.14 4.27 0.41 10.14 9.27 090 

42400 ......... ............ A Biopsy of salivary gland ............................... 0.78 1.75 0.72 0.07 2.60 1.57 000 

42405 ......... ............ A Biopsy of salivary gland ............................... 3.29 4.17 2.48 0.29 7.75 6.06 010 

42408 ......... ............ A Excision of salivary cyst .............................. 4.53 5.05 4.06 0.41 9.99 9.00 090 

42409 ......... ............ A Drainage of salivary cyst ............................. 2.81 3.55 3.09 0.24 6.60 6.14 090 

42410 ......... ............ A Excise parotid gland/lesion .......................... 9.33 NA 6.64 0.93 NA 16.90 090 

42415 ......... ............ A Excise parotid gland/lesion .......................... 16.86 NA 11.26 1.52 NA 29.64 090 

42420 ......... ............ A Excise parotid gland/lesion .......................... 19.56 NA 12.77 1.75 NA 34.08 090 

42425 ......... ............ A Excise parotid gland/lesion .......................... 13.00 NA 9.07 1.18 NA 23.25 090 

42426 ......... ............ A Excise parotid gland/lesion .......................... 21.23 NA 13.43 1.89 NA 36.55 090 

42440 ......... ............ A Excise submaxillary gland ........................... 6.96 NA 5.06 0.62 NA 12.64 090 

42450 ......... ............ A Excise sublingual gland ............................... 4.61 5.66 4.24 0.41 10.68 9.26 090 

42500 ......... ............ A Repair salivary duct ..................................... 4.29 5.46 4.18 0.36 10.11 8.83 090 

42505 ......... ............ A Repair salivary duct ..................................... 6.17 6.90 5.36 0.53 13.60 12.06 090 

42507 ......... ............ A Parotid duct diversion .................................. 6.10 NA 5.20 0.80 NA 12.10 090 

42508 ......... ............ A Parotid duct diversion .................................. 9.09 NA 7.02 0.77 NA 16.88 090 

42509 ......... ............ A Parotid duct diversion .................................. 11.52 NA 8.42 1.50 NA 21.44 090 

42510 ......... ............ A Parotid duct diversion .................................. 8.14 NA 6.11 0.69 NA 14.94 090 

42550 ......... ............ A Injection for salivary x-ray ............................ 1.25 13.05 0.41 0.07 14.37 1.73 000 

42600 ......... ............ A Closure of salivary fistula ............................ 4.81 5.83 4.52 0.41 11.05 9.74 090 

42650 ......... ............ A Dilation of salivary duct ............................... 0.77 1.17 0.71 0.07 2.01 1.55 000 

42660 ......... ............ A Dilation of salivary duct ............................... 1.13 1.48 0.84 0.08 2.69 2.05 000 

1159

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

42665 ......... ............ A Ligation of salivary duct ............................... 2.53 3.56 2.96 0.21 6.30 5.70 090 

42699 ......... ............ C Salivary surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

42700 ......... ............ A Drainage of tonsil abscess .......................... 1.62 2.74 1.73 0.14 4.50 3.49 010 

42720 ......... ............ A Drainage of throat abscess ......................... 5.41 5.04 3.82 0.47 10.92 9.70 010 

42725 ......... ............ A Drainage of throat abscess ......................... 10.70 NA 8.00 0.96 NA 19.66 090 

42800 ......... ............ A Biopsy of throat ............................................ 1.39 2.23 1.40 0.12 3.74 2.91 010 

42802 ......... ............ A Biopsy of throat ............................................ 1.54 4.38 1.94 0.13 6.05 3.61 010 

42804 ......... ............ A Biopsy of upper nose/throat ........................ 1.24 3.97 1.79 0.11 5.32 3.14 010 

42806 ......... ............ A Biopsy of upper nose/throat ........................ 1.58 4.11 1.92 0.14 5.83 3.64 010 

42808 ......... ............ A Excise pharynx lesion .................................. 2.30 3.17 1.93 0.21 5.68 4.44 010 

42809 ......... ............ A Remove pharynx foreign body .................... 1.81 2.36 1.36 0.16 4.33 3.33 010 

42810 ......... ............ A Excision of neck cyst ................................... 3.25 4.84 3.37 0.30 8.39 6.92 090 

42815 ......... ............ A Excision of neck cyst ................................... 7.06 NA 5.42 0.64 NA 13.12 090 

42820 ......... ............ A Remove tonsils and adenoids ..................... 3.90 NA 3.47 0.34 NA 7.71 090 

42821 ......... ............ A Remove tonsils and adenoids ..................... 4.28 NA 3.68 0.36 NA 8.32 090 

42825 ......... ............ A Removal of tonsils ....................................... 3.41 NA 3.32 0.29 NA 7.02 090 

42826 ......... ............ A Removal of tonsils ....................................... 3.37 NA 3.21 0.28 NA 6.86 090 

42830 ......... ............ A Removal of adenoids ................................... 2.57 NA 2.62 0.22 NA 5.41 090 

42831 ......... ............ A Removal of adenoids ................................... 2.71 NA 2.86 0.23 NA 5.80 090 

42835 ......... ............ A Removal of adenoids ................................... 2.30 NA 2.62 0.21 NA 5.13 090 

42836 ......... ............ A Removal of adenoids ................................... 3.18 NA 3.14 0.27 NA 6.59 090 

42842 ......... ............ A Extensive surgery of throat .......................... 8.75 NA 6.74 0.74 NA 16.23 090 

42844 ......... ............ A Extensive surgery of throat .......................... 14.29 NA 10.03 1.25 NA 25.57 090 

42845 ......... ............ A Extensive surgery of throat .......................... 24.25 NA 16.11 2.12 NA 42.48 090 

42860 ......... ............ A Excision of tonsil tags .................................. 2.22 NA 2.58 0.19 NA 4.99 090 

42870 ......... ............ A Excision of lingual tonsil .............................. 5.39 NA 4.79 0.46 NA 10.64 090 

42890 ......... ............ A Partial removal of pharynx ........................... 12.92 NA 9.34 1.10 NA 23.36 090 

42892 ......... ............ A Revision of pharyngeal walls ....................... 15.81 NA 10.89 1.37 NA 28.07 090 

42894 ......... ............ A Revision of pharyngeal walls ....................... 22.85 NA 15.07 1.98 NA 39.90 090 

42900 ......... ............ A Repair throat wound .................................... 5.24 NA 3.70 0.47 NA 9.41 010 

42950 ......... ............ A Reconstruction of throat .............................. 8.09 NA 6.60 0.70 NA 15.39 090 

42953 ......... ............ A Repair throat, esophagus ............................ 8.95 NA 7.53 0.88 NA 17.36 090 

42955 ......... ............ A Surgical opening of throat ........................... 7.38 NA 5.58 0.76 NA 13.72 090 

42960 ......... ............ A Control throat bleeding ................................ 2.33 NA 2.00 0.21 NA 4.54 010 

42961 ......... ............ A Control throat bleeding ................................ 5.58 NA 4.85 0.48 NA 10.91 090 

42962 ......... ............ A Control throat bleeding ................................ 7.13 NA 5.73 0.62 NA 13.48 090 

42970 ......... ............ A Control nose/throat bleeding ....................... 5.42 NA 3.61 0.45 NA 9.48 090 

42971 ......... ............ A Control nose/throat bleeding ....................... 6.20 NA 4.97 0.54 NA 11.71 090 

42972 ......... ............ A Control nose/throat bleeding ....................... 7.19 NA 5.47 0.65 NA 13.31 090 

42999 ......... ............ C Throat surgery procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43020 ......... ............ A Incision of esophagus .................................. 8.08 NA 5.70 0.84 NA 14.62 090 

43030 ......... ............ A Throat muscle surgery ................................. 7.68 NA 5.82 0.72 NA 14.22 090 

43045 ......... ............ A Incision of esophagus .................................. 20.09 NA 10.76 2.59 NA 33.44 090 

43100 ......... ............ A Excision of esophagus lesion ...................... 9.18 NA 6.27 0.95 NA 16.40 090 

43101 ......... ............ A Excision of esophagus lesion ...................... 16.22 NA 7.94 2.18 NA 26.34 090 

43107 ......... ............ A Removal of esophagus ................................ 39.94 NA 17.14 3.97 NA 61.05 090 

43108 ......... ............ A Removal of esophagus ................................ 34.14 NA 14.30 4.56 NA 53.00 090 

43112 ......... ............ A Removal of esophagus ................................ 43.43 NA 18.24 4.43 NA 66.10 090 

43113 ......... ............ A Removal of esophagus ................................ 35.22 NA 15.20 5.22 NA 55.64 090 

43116 ......... ............ A Partial removal of esophagus ...................... 31.17 NA 16.81 3.16 NA 51.14 090 

43117 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.38 4.23 NA 60.55 090 

43118 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 13.87 4.29 NA 51.31 090 

43121 ......... ............ A Partial removal of esophagus ...................... 29.15 NA 12.75 4.15 NA 46.05 090 

43122 ......... ............ A Partial removal of esophagus ...................... 39.94 NA 16.49 3.94 NA 60.37 090 

43123 ......... ............ A Partial removal of esophagus ...................... 33.15 NA 14.18 4.78 NA 52.11 090 

43124 ......... ............ A Removal of esophagus ................................ 27.28 NA 13.16 3.56 NA 44.00 090 

43130 ......... ............ A Removal of esophagus pouch ..................... 11.73 NA 7.62 1.28 NA 20.63 090 

43135 ......... ............ A Removal of esophagus pouch ..................... 16.08 NA 8.16 2.23 NA 26.47 090 

43200 ......... ............ A Esophagus endoscopy ................................ 1.59 4.01 1.10 0.13 5.73 2.82 000 

43201 ......... ............ A Esoph scope w/submucous inj .................... 2.09 4.70 1.27 0.14 6.93 3.50 000 

43202 ......... ............ A Esophagus endoscopy, biopsy .................... 1.89 5.38 0.96 0.14 7.41 2.99 000 

43204 ......... ............ A Esoph scope w/sclerosis inj ........................ 3.76 NA 1.54 0.22 NA 5.52 000 

43205 ......... ............ A Esophagus endoscopy/ligation .................... 3.78 NA 1.55 0.21 NA 5.54 000 

43215 ......... ............ A Esophagus endoscopy ................................ 2.60 NA 1.22 0.21 NA 4.03 000 

43216 ......... ............ A Esophagus endoscopy/lesion ...................... 2.40 NA 1.18 0.18 NA 3.76 000 

43217 ......... ............ A Esophagus endoscopy ................................ 2.90 6.79 1.21 0.21 9.90 4.32 000 

43219 ......... ............ A Esophagus endoscopy ................................ 2.80 NA 1.37 0.19 NA 4.36 000 

43220 ......... ............ A Esoph endoscopy, dilation ........................... 2.10 NA 0.99 0.14 NA 3.23 000 

43226 ......... ............ A Esoph endoscopy, dilation ........................... 2.34 NA 1.06 0.14 NA 3.54 000 

43227 ......... ............ A Esoph endoscopy, repair ............................. 3.59 NA 1.47 0.22 NA 5.28 000 

43228 ......... ............ A Esoph endoscopy, ablation ......................... 3.76 NA 1.58 0.30 NA 5.64 000 

43231 ......... ............ A Esoph endoscopy w/us exam ...................... 3.19 NA 1.33 0.24 NA 4.76 000 

43232 ......... ............ A Esoph endoscopy w/us fn bx ...................... 4.47 NA 1.84 0.31 NA 6.62 000 

43234 ......... ............ A Upper GI endoscopy, exam ......................... 2.01 5.21 0.90 0.16 7.38 3.07 000 

43235 ......... ............ A Uppr gi endoscopy, diagnosis ..................... 2.39 5.04 1.07 0.16 7.59 3.62 000 

1160

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

43236 ......... ............ A Uppr gi scope w/submuc inj ........................ 2.92 6.32 1.26 0.17 9.41 4.35 000 

43237 ......... ............ A Endoscopic us exam, esoph ....................... 3.98 NA 1.61 0.27 NA 5.86 000 

43238 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 5.02 NA 1.97 0.27 NA 7.26 000 

43239 ......... ............ A Upper GI endoscopy, biopsy ....................... 2.87 5.58 1.23 0.17 8.62 4.27 000 

43240 ......... ............ A Esoph endoscope w/drain cyst .................... 6.85 NA 2.65 0.43 NA 9.93 000 

43241 ......... ............ A Upper GI endoscopy with tube .................... 2.59 NA 1.14 0.17 NA 3.90 000 

43242 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 7.30 NA 2.78 0.35 NA 10.43 000 

43243 ......... ............ A Upper gi endoscopy & inject ....................... 4.56 NA 1.84 0.25 NA 6.65 000 

43244 ......... ............ A Upper GI endoscopy/ligation ....................... 5.04 NA 2.01 0.25 NA 7.30 000 

43245 ......... ............ A Uppr gi scope dilate strictr ........................... 3.18 NA 1.34 0.22 NA 4.74 000 

43246 ......... ............ A Place gastrostomy tube ............................... 4.32 NA 1.74 0.29 NA 6.35 000 

43247 ......... ............ A Operative upper GI endoscopy ................... 3.38 NA 1.42 0.21 NA 5.01 000 

43248 ......... ............ A Uppr gi endoscopy/guide wire ..................... 3.15 NA 1.35 0.18 NA 4.68 000 

43249 ......... ............ A Esoph endoscopy, dilation ........................... 2.90 NA 1.25 0.18 NA 4.33 000 

43250 ......... ............ A Upper GI endoscopy/tumor ......................... 3.20 NA 1.35 0.21 NA 4.76 000 

43251 ......... ............ A Operative upper GI endoscopy ................... 3.69 NA 1.53 0.23 NA 5.45 000 

43255 ......... ............ A Operative upper GI endoscopy ................... 4.81 NA 1.92 0.24 NA 6.97 000 

43256 ......... ............ A Uppr gi endoscopy w stent .......................... 4.34 NA 1.77 0.28 NA 6.39 000 

43258 ......... ............ A Operative upper GI endoscopy ................... 4.54 NA 1.84 0.27 NA 6.65 000 

43259 ......... ............ A Endoscopic ultrasound exam ...................... 5.19 NA 2.04 0.27 NA 7.50 000 

43260 ......... ............ A Endo cholangiopancreatograph ................... 5.95 NA 2.31 0.33 NA 8.59 000 

43261 ......... ............ A Endo cholangiopancreatograph ................... 6.26 NA 2.42 0.35 NA 9.03 000 

43262 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.81 0.41 NA 10.60 000 

43263 ......... ............ A Endo cholangiopancreatograph ................... 7.28 NA 2.78 0.34 NA 10.40 000 

43264 ......... ............ A Endo cholangiopancreatograph ................... 8.89 NA 3.35 0.49 NA 12.73 000 

43265 ......... ............ A Endo cholangiopancreatograph ................... 10.00 NA 3.73 0.51 NA 14.24 000 

43267 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.80 0.41 NA 10.59 000 

43268 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.90 0.41 NA 10.69 000 

43269 ......... ............ A Endo cholangiopancreatograph ................... 8.20 NA 3.10 0.34 NA 11.64 000 

43271 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.80 0.41 NA 10.59 000 

43272 ......... ............ A Endo cholangiopancreatograph ................... 7.38 NA 2.81 0.41 NA 10.60 000 

43280 ......... ............ A Laparoscopy, fundoplasty ............................ 17.22 NA 7.33 2.12 NA 26.67 090 

43289 ......... ............ C Laparoscope proc, esoph ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43300 ......... ............ A Repair of esophagus ................................... 9.13 NA 6.51 1.03 NA 16.67 090 

43305 ......... ............ A Repair esophagus and fistula ...................... 17.36 NA 10.78 1.64 NA 29.78 090 

43310 ......... ............ A Repair of esophagus ................................... 25.35 NA 11.15 3.84 NA 40.34 090 

43312 ......... ............ A Repair esophagus and fistula ...................... 28.38 NA 12.00 4.08 NA 44.46 090 

43313 ......... ............ A Esophagoplasty congenital .......................... 45.21 NA 20.15 6.55 NA 71.91 090 

43314 ......... ............ A Tracheo-esophagoplasty cong .................... 50.19 NA 22.05 6.67 NA 78.91 090 

43320 ......... ............ A Fuse esophagus & stomach ........................ 19.90 NA 9.27 1.92 NA 31.09 090 

43324 ......... ............ A Revise esophagus & stomach ..................... 20.54 NA 8.82 2.07 NA 31.43 090 

43325 ......... ............ A Revise esophagus & stomach ..................... 20.03 NA 8.84 1.99 NA 30.86 090 

43326 ......... ............ A Revise esophagus & stomach ..................... 19.71 NA 9.34 2.22 NA 31.27 090 

43330 ......... ............ A Repair of esophagus ................................... 19.74 NA 8.59 1.83 NA 30.16 090 

43331 ......... ............ A Repair of esophagus ................................... 20.10 NA 9.83 2.33 NA 32.26 090 

43340 ......... ............ A Fuse esophagus & intestine ........................ 19.58 NA 9.03 1.85 NA 30.46 090 

43341 ......... ............ A Fuse esophagus & intestine ........................ 20.82 NA 10.06 2.58 NA 33.46 090 

43350 ......... ............ A Surgical opening, esophagus ...................... 15.76 NA 8.50 1.39 NA 25.65 090 

43351 ......... ............ A Surgical opening, esophagus ...................... 18.32 NA 9.85 1.82 NA 29.99 090 

43352 ......... ............ A Surgical opening, esophagus ...................... 15.24 NA 8.45 1.54 NA 25.23 090 

43360 ......... ............ A Gastrointestinal repair .................................. 35.65 NA 15.15 3.62 NA 54.42 090 

43361 ......... ............ A Gastrointestinal repair .................................. 40.44 NA 16.98 4.25 NA 61.67 090 

43400 ......... ............ A Ligate esophagus veins ............................... 21.17 NA 9.43 1.19 NA 31.79 090 

43401 ......... ............ A Esophagus surgery for veins ....................... 22.06 NA 9.56 2.09 NA 33.71 090 

43405 ......... ............ A Ligate/staple esophagus .............................. 19.98 NA 9.62 1.97 NA 31.57 090 

43410 ......... ............ A Repair esophagus wound ............................ 13.45 NA 7.69 1.39 NA 22.53 090 

43415 ......... ............ A Repair esophagus wound ............................ 24.96 NA 11.80 2.32 NA 39.08 090 

43420 ......... ............ A Repair esophagus opening .......................... 14.33 NA 7.48 1.04 NA 22.85 090 

43425 ......... ............ A Repair esophagus opening .......................... 21.00 NA 10.03 2.45 NA 33.48 090 

43450 ......... ............ A Dilate esophagus ......................................... 1.38 2.52 0.73 0.08 3.98 2.19 000 

43453 ......... ............ A Dilate esophagus ......................................... 1.51 5.95 0.78 0.10 7.56 2.39 000 

43456 ......... ............ A Dilate esophagus ......................................... 2.57 13.75 1.15 0.17 16.49 3.89 000 

43458 ......... ............ A Dilate esophagus ......................................... 3.06 6.55 1.33 0.21 9.82 4.60 000 

43460 ......... ............ A Pressure treatment esophagus ................... 3.79 NA 1.49 0.25 NA 5.53 000 

43496 ......... ............ C Free jejunum flap, microvasc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

43499 ......... ............ C Esophagus surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43500 ......... ............ A Surgical opening of stomach ....................... 11.03 NA 5.00 1.01 NA 17.04 090 

43501 ......... ............ A Surgical repair of stomach ........................... 20.01 NA 8.36 1.87 NA 30.24 090 

43502 ......... ............ A Surgical repair of stomach ........................... 23.10 NA 9.51 2.21 NA 34.82 090 

43510 ......... ............ A Surgical opening of stomach ....................... 13.06 NA 6.59 1.09 NA 20.74 090 

43520 ......... ............ A Incision of pyloric muscle ............................ 9.98 NA 5.30 1.01 NA 16.29 090 

43600 ......... ............ A Biopsy of stomach ....................................... 1.91 NA 1.03 0.13 NA 3.07 000 

43605 ......... ............ A Biopsy of stomach ....................................... 11.96 NA 5.32 1.12 NA 18.40 090 

43610 ......... ............ A Excision of stomach lesion .......................... 14.58 NA 6.20 1.37 NA 22.15 090 

43611 ......... ............ A Excision of stomach lesion .......................... 17.81 NA 7.61 1.66 NA 27.08 090 

1161

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

43620 ......... ............ A Removal of stomach .................................... 29.99 NA 11.87 2.76 NA 44.62 090 

43621 ......... ............ A Removal of stomach .................................... 30.68 NA 12.06 2.85 NA 45.59 090 

43622 ......... ............ A Removal of stomach .................................... 32.48 NA 12.66 2.99 NA 48.13 090 

43631 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.21 2.40 NA 34.17 090 

43632 ......... ............ A Removal of stomach, partial ........................ 22.56 NA 9.21 2.41 NA 34.18 090 

43633 ......... ............ A Removal of stomach, partial ........................ 23.07 NA 9.37 2.47 NA 34.91 090 

43634 ......... ............ A Removal of stomach, partial ........................ 25.08 NA 10.14 2.63 NA 37.85 090 

43635 ......... ............ A Removal of stomach, partial ........................ 2.06 NA 0.70 0.25 NA 3.01 ZZZ 

43638 ......... ............ A Removal of stomach, partial ........................ 28.96 NA 11.94 2.70 NA 43.60 090 

43639 ......... ............ A Removal of stomach, partial ........................ 29.61 NA 11.74 2.79 NA 44.14 090 

43640 ......... ............ A Vagotomy & pylorus repair .......................... 16.99 NA 7.30 1.82 NA 26.11 090 

43641 ......... ............ A Vagotomy & pylorus repair .......................... 17.24 NA 7.41 1.85 NA 26.50 090 

43651 ......... ............ A Laparoscopy, vagus nerve .......................... 10.13 NA 4.80 1.24 NA 16.17 090 

43652 ......... ............ A Laparoscopy, vagus nerve .......................... 12.13 NA 5.40 1.51 NA 19.04 090 

43653 ......... ............ A Laparoscopy, gastrostomy ........................... 7.72 NA 4.22 0.94 NA 12.88 090 

43659 ......... ............ C Laparoscope proc, stom .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

43750 ......... ............ A Place gastrostomy tube ............................... 4.48 NA 2.72 0.40 NA 7.60 010 

43752 ......... ............ A Nasal/orogastric w/stent .............................. 0.68 0.26 0.26 0.02 0.96 0.96 000 

43760 ......... ............ A Change gastrostomy tube ........................... 1.10 1.65 0.45 0.08 2.83 1.63 000 

43761 ......... ............ A Reposition gastrostomy tube ....................... 2.01 NA 0.79 0.12 NA 2.92 000 

43800 ......... ............ A Reconstruction of pylorus ............................ 13.67 NA 5.94 1.29 NA 20.90 090 

43810 ......... ............ A Fusion of stomach and bowel ..................... 14.63 NA 6.23 1.33 NA 22.19 090 

43820 ......... ............ A Fusion of stomach and bowel ..................... 15.35 NA 6.45 1.42 NA 23.22 090 

43825 ......... ............ A Fusion of stomach and bowel ..................... 19.19 NA 8.06 1.81 NA 29.06 090 

43830 ......... ............ A Place gastrostomy tube ............................... 9.52 NA 4.88 0.83 NA 15.23 090 

43831 ......... ............ A Place gastrostomy tube ............................... 7.83 NA 4.54 0.98 NA 13.35 090 

43832 ......... ............ A Place gastrostomy tube ............................... 15.58 NA 6.90 1.36 NA 23.84 090 

43840 ......... ............ A Repair of stomach lesion ............................. 15.54 NA 6.81 1.45 NA 23.80 090 

43842 ......... ............ A Gastroplasty for obesity ............................... 18.44 NA 8.15 1.82 NA 28.41 090 

43843 ......... ............ A Gastroplasty for obesity ............................... 18.62 NA 8.12 1.85 NA 28.59 090 

43846 ......... ............ A Gastric bypass for obesity ........................... 24.01 NA 10.37 2.36 NA 36.74 090 

43847 ......... ............ A Gastric bypass for obesity ........................... 26.88 NA 11.32 2.58 NA 40.78 090 

43848 ......... ............ A Revision gastroplasty ................................... 29.35 NA 12.25 2.88 NA 44.48 090 

43850 ......... ............ A Revise stomach-bowel fusion ...................... 24.68 NA 9.87 2.38 NA 36.93 090 

43855 ......... ............ A Revise stomach-bowel fusion ...................... 26.12 NA 10.38 2.42 NA 38.92 090 

43860 ......... ............ A Revise stomach-bowel fusion ...................... 24.96 NA 10.03 2.45 NA 37.44 090 

43865 ......... ............ A Revise stomach-bowel fusion ...................... 26.48 NA 10.56 2.59 NA 39.63 090 

43870 ......... ............ A Repair stomach opening .............................. 9.68 NA 4.55 0.86 NA 15.09 090 

43880 ......... ............ A Repair stomach-bowel fistula ...................... 24.61 NA 9.97 2.34 NA 36.92 090 

43999 ......... ............ C Stomach surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44005 ......... ............ A Freeing of bowel adhesion .......................... 16.21 NA 6.77 1.68 NA 24.66 090 

44010 ......... ............ A Incision of small bowel ................................ 12.50 NA 5.50 1.27 NA 19.27 090 

44015 ......... ............ A Insert needle cath bowel ............................. 2.62 NA 0.89 0.30 NA 3.81 ZZZ 

44020 ......... ............ A Explore small intestine ................................. 13.97 NA 5.98 1.45 NA 21.40 090 

44021 ......... ............ A Decompress small bowel ............................. 14.06 NA 6.02 1.42 NA 21.50 090 

44025 ......... ............ A Incision of large bowel ................................. 14.26 NA 6.07 1.46 NA 21.79 090 

44050 ......... ............ A Reduce bowel obstruction ........................... 14.01 NA 6.00 1.39 NA 21.40 090 

44055 ......... ............ A Correct malrotation of bowel ....................... 21.97 NA 8.78 1.59 NA 32.34 090 

44100 ......... ............ A Biopsy of bowel ........................................... 2.01 NA 1.10 0.14 NA 3.25 000 

44110 ......... ............ A Excise intestine lesion(s) ............................. 11.79 NA 5.27 1.21 NA 18.27 090 

44111 ......... ............ A Excision of bowel lesion(s) .......................... 14.27 NA 6.17 1.47 NA 21.91 090 

44120 ......... ............ A Removal of small intestine .......................... 16.97 NA 7.12 1.76 NA 25.85 090 

44121 ......... ............ A Removal of small intestine .......................... 4.44 NA 1.53 0.55 NA 6.52 ZZZ 

44125 ......... ............ A Removal of small intestine .......................... 17.51 NA 7.31 1.80 NA 26.62 090 

44126 ......... ............ A Enterectomy w/o taper, cong ....................... 35.45 NA 14.16 0.43 NA 50.04 090 

44127 ......... ............ A Enterectomy w/taper, cong .......................... 40.94 NA 15.79 0.49 NA 57.22 090 

44128 ......... ............ A Enterectomy cong, add-on .......................... 4.44 NA 1.54 0.54 NA 6.52 ZZZ 

44130 ......... ............ A Bowel to bowel fusion .................................. 14.47 NA 6.26 1.48 NA 22.21 090 

44132 ......... ............ R Enterectomy, cadaver donor ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44133 ......... ............ R Enterectomy, live donor ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44135 ......... ............ R Intestine transplnt, cadaver ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44136 ......... ............ R Intestine transplant, live ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

44139 ......... ............ A Mobilization of colon .................................... 2.23 NA 0.76 0.25 NA 3.24 ZZZ 

44140 ......... ............ A Partial removal of colon ............................... 20.97 NA 8.69 2.58 NA 32.24 090 

44141 ......... ............ A Partial removal of colon ............................... 19.48 NA 10.15 2.35 NA 31.98 090 

44143 ......... ............ A Partial removal of colon ............................... 22.96 NA 10.80 2.44 NA 36.20 090 

44144 ......... ............ A Partial removal of colon ............................... 21.50 NA 9.69 2.28 NA 33.47 090 

44145 ......... ............ A Partial removal of colon ............................... 26.38 NA 10.87 2.68 NA 39.93 090 

44146 ......... ............ A Partial removal of colon ............................... 27.50 NA 12.98 2.65 NA 43.13 090 

44147 ......... ............ A Partial removal of colon ............................... 20.68 NA 8.74 2.10 NA 31.52 090 

44150 ......... ............ A Removal of colon ......................................... 23.91 NA 12.16 2.47 NA 38.54 090 

44151 ......... ............ A Removal of colon/ileostomy ......................... 26.84 NA 13.54 2.38 NA 42.76 090 

44152 ......... ............ A Removal of colon/ileostomy ......................... 27.79 NA 11.68 2.85 NA 42.32 090 

44153 ......... ............ A Removal of colon/ileostomy ......................... 30.54 NA 14.56 2.81 NA 47.91 090 

44155 ......... ............ A Removal of colon/ileostomy ......................... 27.82 NA 13.44 2.73 NA 43.99 090 

1162

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

44156 ......... ............ A Removal of colon/ileostomy ......................... 30.74 NA 15.20 2.64 NA 48.58 090 

44160 ......... ............ A Removal of colon ......................................... 18.59 NA 7.80 2.24 NA 28.63 090 

44200 ......... ............ A Laparoscopy, enterolysis ............................. 14.42 NA 6.23 1.76 NA 22.41 090 

44201 ......... ............ A Laparoscopy, jejunostomy ........................... 9.77 NA 4.70 1.17 NA 15.64 090 

44202 ......... ............ A Lap resect s/intestine singl .......................... 22.01 NA 8.98 2.61 NA 33.60 090 

44203 ......... ............ A Lap resect s/intestine, addl .......................... 4.44 NA 1.50 0.55 NA 6.49 ZZZ 

44204 ......... ............ A Laparo partial colectomy ............................. 25.04 NA 10.00 3.08 NA 38.12 090 

44205 ......... ............ A Lap colectomy part w/ileum ......................... 22.20 NA 8.88 2.69 NA 33.77 090 

44206 ......... ............ A Lap part colectomy w/stoma ........................ 26.96 NA 11.37 2.44 NA 40.77 090 

44207 ......... ............ A L colectomy/coloproctostomy ...................... 29.96 NA 11.59 2.68 NA 44.23 090 

44208 ......... ............ A L colectomy/coloproctostomy ...................... 31.95 NA 13.27 2.65 NA 47.87 090 

44210 ......... ............ A Laparo total proctocolectomy ...................... 27.96 NA 12.03 2.47 NA 42.46 090 

44211 ......... ............ A Laparo total proctocolectomy ...................... 34.95 NA 14.74 2.81 NA 52.50 090 

44212 ......... ............ A Laparo total proctocolectomy ...................... 32.45 NA 13.88 2.73 NA 49.06 090 

44238 ......... ............ C Laparoscope proc, intestine ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44239 ......... ............ C Laparoscope proc, rectum ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44300 ......... ............ A Open bowel to skin ...................................... 12.09 NA 5.53 1.06 NA 18.68 090 

44310 ......... ............ A Ileostomy/jejunostomy ................................. 15.93 NA 6.73 1.36 NA 24.02 090 

44312 ......... ............ A Revision of ileostomy ................................... 8.01 NA 4.03 0.65 NA 12.69 090 

44314 ......... ............ A Revision of ileostomy ................................... 15.03 NA 6.60 1.19 NA 22.82 090 

44316 ......... ............ A Devise bowel pouch .................................... 21.06 NA 8.60 1.70 NA 31.36 090 

44320 ......... ............ A Colostomy .................................................... 17.61 NA 7.71 1.54 NA 26.86 090 

44322 ......... ............ A Colostomy with biopsies .............................. 11.96 NA 8.70 1.42 NA 22.08 090 

44340 ......... ............ A Revision of colostomy .................................. 7.71 NA 4.31 0.68 NA 12.70 090 

44345 ......... ............ A Revision of colostomy .................................. 15.41 NA 6.93 1.34 NA 23.68 090 

44346 ......... ............ A Revision of colostomy .................................. 16.96 NA 7.43 1.45 NA 25.84 090 

44360 ......... ............ A Small bowel endoscopy ............................... 2.59 NA 1.12 0.17 NA 3.88 000 

44361 ......... ............ A Small bowel endoscopy/biopsy ................... 2.87 NA 1.21 0.18 NA 4.26 000 

44363 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.40 0.23 NA 5.12 000 

44364 ......... ............ A Small bowel endoscopy ............................... 3.73 NA 1.52 0.25 NA 5.50 000 

44365 ......... ............ A Small bowel endoscopy ............................... 3.31 NA 1.38 0.22 NA 4.91 000 

44366 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.76 0.27 NA 6.43 000 

44369 ......... ............ A Small bowel endoscopy ............................... 4.51 NA 1.76 0.28 NA 6.55 000 

44370 ......... ............ A Small bowel endoscopy/stent ...................... 4.79 NA 1.99 0.25 NA 7.03 000 

44372 ......... ............ A Small bowel endoscopy ............................... 4.40 NA 1.75 0.33 NA 6.48 000 

44373 ......... ............ A Small bowel endoscopy ............................... 3.49 NA 1.45 0.23 NA 5.17 000 

44376 ......... ............ A Small bowel endoscopy ............................... 5.25 NA 2.04 0.35 NA 7.64 000 

44377 ......... ............ A Small bowel endoscopy/biopsy ................... 5.52 NA 2.15 0.34 NA 8.01 000 

44378 ......... ............ A Small bowel endoscopy ............................... 7.12 NA 2.71 0.45 NA 10.28 000 

44379 ......... ............ A S bowel endoscope w/stent ......................... 7.46 NA 2.93 0.46 NA 10.85 000 

44380 ......... ............ A Small bowel endoscopy ............................... 1.05 NA 0.56 0.10 NA 1.71 000 

44382 ......... ............ A Small bowel endoscopy ............................... 1.27 NA 0.65 0.11 NA 2.03 000 

44383 ......... ............ A Ileoscopy w/stent ......................................... 2.94 NA 1.28 0.16 NA 4.38 000 

44385 ......... ............ A Endoscopy of bowel pouch ......................... 1.82 4.98 0.96 0.14 6.94 2.92 000 

44386 ......... ............ A Endoscopy, bowel pouch/biop ..................... 2.12 6.51 1.12 0.18 8.81 3.42 000 

44388 ......... ............ A Colonoscopy ................................................ 2.82 5.14 1.16 0.22 8.18 4.20 000 

44389 ......... ............ A Colonoscopy with biopsy ............................. 3.13 6.49 1.28 0.22 9.84 4.63 000 

44390 ......... ............ A Colonoscopy for foreign body ...................... 3.82 6.76 1.51 0.27 10.85 5.60 000 

44391 ......... ............ A Colonoscopy for bleeding ............................ 4.31 8.61 1.72 0.28 13.20 6.31 000 

44392 ......... ............ A Colonoscopy & polypectomy ....................... 3.81 6.53 1.52 0.28 10.62 5.61 000 

44393 ......... ............ A Colonoscopy, lesion removal ....................... 4.83 6.90 1.88 0.33 12.06 7.04 000 

44394 ......... ............ A Colonoscopy w/snare .................................. 4.42 7.75 1.75 0.31 12.48 6.48 000 

44397 ......... ............ A Colonoscopy w/stent .................................... 4.70 NA 2.06 0.34 NA 7.10 000 

44500 ......... ............ A Intro, gastrointestinal tube ........................... 0.49 NA 0.36 0.02 NA 0.87 000 

44602 ......... ............ A Suture, small intestine ................................. 16.01 NA 6.42 1.29 NA 23.72 090 

44603 ......... ............ A Suture, small intestine ................................. 18.63 NA 7.31 1.68 NA 27.62 090 

44604 ......... ............ A Suture, large intestine .................................. 16.01 NA 6.49 1.71 NA 24.21 090 

44605 ......... ............ A Repair of bowel lesion ................................. 19.50 NA 8.46 1.86 NA 29.82 090 

44615 ......... ............ A Intestinal stricturoplasty ............................... 15.91 NA 6.72 1.68 NA 24.31 090 

44620 ......... ............ A Repair bowel opening .................................. 12.18 NA 5.36 1.27 NA 18.81 090 

44625 ......... ............ A Repair bowel opening .................................. 15.03 NA 6.35 1.57 NA 22.95 090 

44626 ......... ............ A Repair bowel opening .................................. 25.32 NA 9.87 3.05 NA 38.24 090 

44640 ......... ............ A Repair bowel-skin fistula .............................. 21.62 NA 8.62 1.76 NA 32.00 090 

44650 ......... ............ A Repair bowel fistula ..................................... 22.54 NA 8.93 1.80 NA 33.27 090 

44660 ......... ............ A Repair bowel-bladder fistula ........................ 21.33 NA 8.40 1.37 NA 31.10 090 

44661 ......... ............ A Repair bowel-bladder fistula ........................ 24.77 NA 9.60 1.85 NA 36.22 090 

44680 ......... ............ A Surgical revision, intestine ........................... 15.38 NA 6.48 1.65 NA 23.51 090 

44700 ......... ............ A Suspend bowel w/prosthesis ....................... 16.09 NA 6.69 1.46 NA 24.24 090 

44701 ......... ............ A Intraop colon lavage add-on ........................ 3.10 NA 1.06 0.25 NA 4.41 ZZZ 

44799 ......... ............ C Unlisted procedure intestine ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44800 ......... ............ A Excision of bowel pouch .............................. 11.21 NA 5.43 1.34 NA 17.98 090 

44820 ......... ............ A Excision of mesentery lesion ....................... 12.07 NA 5.53 1.24 NA 18.84 090 

44850 ......... ............ A Repair of mesentery .................................... 10.72 NA 5.04 1.19 NA 16.95 090 

44899 ......... ............ C Bowel surgery procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

44900 ......... ............ A Drain app abscess, open ............................. 10.12 NA 4.74 1.01 NA 15.87 090 

1163

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

44901 ......... ............ A Drain app abscess, percut ........................... 3.37 NA 1.12 0.21 NA 4.70 000 

44950 ......... ............ A Appendectomy ............................................. 9.99 NA 4.35 1.06 NA 15.40 090 

44955 ......... ............ A Appendectomy add-on ................................. 1.53 NA 0.53 0.19 NA 2.25 ZZZ 

44960 ......... ............ A Appendectomy ............................................. 12.32 NA 5.38 1.31 NA 19.01 090 

44970 ......... ............ A Laparoscopy, appendectomy ....................... 8.69 NA 4.23 1.06 NA 13.98 090 

44979 ......... ............ C Laparoscope proc, app ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

45000 ......... ............ A Drainage of pelvic abscess ......................... 4.51 NA 2.98 0.45 NA 7.94 090 

45005 ......... ............ A Drainage of rectal abscess .......................... 1.99 4.84 1.69 0.22 7.05 3.90 010 

45020 ......... ............ A Drainage of rectal abscess .......................... 4.71 NA 3.31 0.49 NA 8.51 090 

45100 ......... ............ A Biopsy of rectum .......................................... 3.67 NA 2.39 0.40 NA 6.46 090 

45108 ......... ............ A Removal of anorectal lesion ........................ 4.75 NA 2.91 0.55 NA 8.21 090 

45110 ......... ............ A Removal of rectum ...................................... 27.96 NA 12.50 2.73 NA 43.19 090 

45111 ......... ............ A Partial removal of rectum ............................ 16.46 NA 7.21 1.93 NA 25.60 090 

45112 ......... ............ A Removal of rectum ...................................... 30.49 NA 11.82 2.83 NA 45.14 090 

45113 ......... ............ A Partial proctectomy ...................................... 30.53 NA 12.69 2.57 NA 45.79 090 

45114 ......... ............ A Partial removal of rectum ............................ 27.28 NA 11.01 2.75 NA 41.04 090 

45116 ......... ............ A Partial removal of rectum ............................ 24.54 NA 10.08 2.41 NA 37.03 090 

45119 ......... ............ A Remove rectum w/reservoir ......................... 30.79 NA 12.54 2.57 NA 45.90 090 

45120 ......... ............ A Removal of rectum ...................................... 24.56 NA 10.19 2.75 NA 37.50 090 

45121 ......... ............ A Removal of rectum and colon ..................... 27.00 NA 11.18 3.21 NA 41.39 090 

45123 ......... ............ A Partial proctectomy ...................................... 16.68 NA 6.90 1.25 NA 24.83 090 

45126 ......... ............ A Pelvic exenteration ...................................... 45.09 NA 19.38 3.90 NA 68.37 090 

45130 ......... ............ A Excision of rectal prolapse .......................... 16.42 NA 6.80 1.35 NA 24.57 090 

45135 ......... ............ A Excision of rectal prolapse .......................... 19.25 NA 8.48 1.83 NA 29.56 090 

45136 ......... ............ A Excise ileoanal reservior .............................. 27.26 NA 12.52 3.28 NA 43.06 090 

45150 ......... ............ A Excision of rectal stricture ........................... 5.66 NA 2.98 0.55 NA 9.19 090 

45160 ......... ............ A Excision of rectal lesion ............................... 15.30 NA 6.68 1.29 NA 23.27 090 

45170 ......... ............ A Excision of rectal lesion ............................... 11.47 NA 5.27 1.07 NA 17.81 090 

45190 ......... ............ A Destruction, rectal tumor ............................. 9.73 NA 4.68 0.92 NA 15.33 090 

45300 ......... ............ A Proctosigmoidoscopy dx .............................. 0.38 1.47 0.31 0.06 1.91 0.75 000 

45303 ......... ............ A Proctosigmoidoscopy dilate ......................... 0.44 19.04 0.35 0.07 19.55 0.86 000 

45305 ......... ............ A Proctosigmoidoscopy w/bx .......................... 1.01 2.58 0.52 0.11 3.70 1.64 000 

45307 ......... ............ A Proctosigmoidoscopy fb ............................... 0.94 3.00 0.50 0.18 4.12 1.62 000 

45308 ......... ............ A Proctosigmoidoscopy removal ..................... 0.83 1.94 0.46 0.16 2.93 1.45 000 

45309 ......... ............ A Proctosigmoidoscopy removal ..................... 2.01 2.77 0.86 0.21 4.99 3.08 000 

45315 ......... ............ A Proctosigmoidoscopy removal ..................... 1.40 2.80 0.65 0.24 4.44 2.29 000 

45317 ......... ............ A Proctosigmoidoscopy bleed ......................... 1.50 2.38 0.68 0.24 4.12 2.42 000 

45320 ......... ............ A Proctosigmoidoscopy ablate ........................ 1.58 2.84 0.73 0.24 4.66 2.55 000 

45321 ......... ............ A Proctosigmoidoscopy volvul ........................ 1.17 NA 0.58 0.21 NA 1.96 000 

45327 ......... ............ A Proctosigmoidoscopy w/stent ...................... 1.65 NA 0.70 0.12 NA 2.47 000 

45330 ......... ............ A Diagnostic sigmoidoscopy ........................... 0.96 2.20 0.52 0.06 3.22 1.54 000 

45331 ......... ............ A Sigmoidoscopy and biopsy .......................... 1.15 2.91 0.63 0.08 4.14 1.86 000 

45332 ......... ............ A Sigmoidoscopy w/fb removal ....................... 1.79 4.86 0.85 0.13 6.78 2.77 000 

45333 ......... ............ A Sigmoidoscopy & polypectomy .................... 1.79 4.72 0.85 0.14 6.65 2.78 000 

45334 ......... ............ A Sigmoidoscopy for bleeding ........................ 2.73 NA 1.18 0.19 NA 4.10 000 

45335 ......... ............ A Sigmoidoscopy w/submuc inj ...................... 1.46 3.44 0.68 0.08 4.98 2.22 000 

45337 ......... ............ A Sigmoidoscopy & decompress .................... 2.36 NA 1.05 0.18 NA 3.59 000 

45338 ......... ............ A Sigmoidoscopy w/tumr remove ................... 2.34 5.03 1.05 0.18 7.55 3.57 000 

45339 ......... ............ A Sigmoidoscopy w/ablate tumr ...................... 3.14 3.34 1.32 0.21 6.69 4.67 000 

45340 ......... ............ A Sig w/balloon dilation ................................... 1.89 6.72 0.83 0.08 8.69 2.80 000 

45341 ......... ............ A Sigmoidoscopy w/ultrasound ....................... 2.60 NA 1.12 0.24 NA 3.96 000 

45342 ......... ............ A Sigmoidoscopy w/us guide bx ..................... 4.05 NA 1.60 0.28 NA 5.93 000 

45345 ......... ............ A Sigmoidoscopy w/stent ................................ 2.92 NA 1.20 0.18 NA 4.30 000 

45355 ......... ............ A Surgical colonoscopy ................................... 3.51 NA 1.40 0.31 NA 5.22 000 

45378 ......... ............ A Diagnostic colonoscopy ............................... 3.69 6.04 1.58 0.24 9.97 5.51 000 

45378 ......... 53 ....... A Diagnostic colonoscopy ............................... 0.96 2.20 0.52 0.06 3.22 1.54 000 

45379 ......... ............ A Colonoscopy w/fb removal .......................... 4.68 7.56 1.86 0.30 12.54 6.84 000 

45380 ......... ............ A Colonoscopy and biopsy ............................. 4.43 7.07 1.78 0.25 11.75 6.46 000 

45381 ......... ............ A Colonoscopy, submucous inj ....................... 4.19 8.14 1.69 0.25 12.58 6.13 000 

45382 ......... ............ A Colonoscopy/control bleeding ...................... 5.68 9.72 2.23 0.33 15.73 8.24 000 

45383 ......... ............ A Lesion removal colonoscopy ....................... 5.86 7.85 2.27 0.39 14.10 8.52 000 

45384 ......... ............ A Lesion remove colonoscopy ........................ 4.69 6.69 1.87 0.29 11.67 6.85 000 

45385 ......... ............ A Lesion removal colonoscopy ....................... 5.30 7.69 2.08 0.34 13.33 7.72 000 

45386 ......... ............ A Colonoscopy dilate stricture ........................ 4.57 13.65 1.83 0.25 18.47 6.65 000 

45387 ......... ............ A Colonoscopy w/stent .................................... 5.90 NA 2.35 0.40 NA 8.65 000 

45500 ......... ............ A Repair of rectum .......................................... 7.28 NA 3.59 0.68 NA 11.55 090 

45505 ......... ............ A Repair of rectum .......................................... 7.57 NA 3.87 0.60 NA 12.04 090 

45520 ......... ............ A Treatment of rectal prolapse ....................... 0.55 0.85 0.19 0.05 1.45 0.79 000 

45540 ......... ............ A Correct rectal prolapse ................................ 16.25 NA 6.86 1.41 NA 24.52 090 

45541 ......... ............ A Correct rectal prolapse ................................ 13.38 NA 6.00 1.06 NA 20.44 090 

45550 ......... ............ A Repair rectum/remove sigmoid .................... 22.97 NA 9.29 1.91 NA 34.17 090 

45560 ......... ............ A Repair of rectocele ...................................... 10.56 NA 5.12 0.88 NA 16.56 090 

45562 ......... ............ A Exploration/repair of rectum ........................ 15.36 NA 7.05 1.39 NA 23.80 090 

45563 ......... ............ A Exploration/repair of rectum ........................ 23.43 NA 10.61 2.22 NA 36.26 090 

45800 ......... ............ A Repair rect/bladder fistula ............................ 17.74 NA 7.50 1.37 NA 26.61 090 

1164

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

45805 ......... ............ A Repair fistula w/colostomy ........................... 20.75 NA 9.60 1.77 NA 32.12 090 

45820 ......... ............ A Repair rectourethral fistula .......................... 18.45 NA 7.70 1.41 NA 27.56 090 

45825 ......... ............ A Repair fistula w/colostomy ........................... 21.22 NA 9.91 1.17 NA 32.30 090 

45900 ......... ............ A Reduction of rectal prolapse ........................ 2.61 NA 1.52 0.21 NA 4.34 010 

45905 ......... ............ A Dilation of anal sphincter ............................. 2.30 NA 1.43 0.17 NA 3.90 010 

45910 ......... ............ A Dilation of rectal narrowing .......................... 2.80 NA 1.66 0.17 NA 4.63 010 

45915 ......... ............ A Remove rectal obstruction ........................... 3.14 4.73 1.17 0.21 8.08 4.52 010 

45999 ......... ............ C Rectum surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

46020 ......... ............ A Placement of seton ...................................... 2.90 2.28 1.86 0.27 5.45 5.03 010 

46030 ......... ............ A Removal of rectal marker ............................ 1.23 1.35 0.71 0.13 2.71 2.07 010 

46040 ......... ............ A Incision of rectal abscess ............................ 4.95 5.30 3.17 0.58 10.83 8.70 090 

46045 ......... ............ A Incision of rectal abscess ............................ 4.31 NA 2.92 0.48 NA 7.71 090 

46050 ......... ............ A Incision of anal abscess .............................. 1.19 2.57 0.86 0.13 3.89 2.18 010 

46060 ......... ............ A Incision of rectal abscess ............................ 5.68 NA 3.30 0.63 NA 9.61 090 

46070 ......... ............ A Incision of anal septum ................................ 2.71 NA 1.88 0.33 NA 4.92 090 

46080 ......... ............ A Incision of anal sphincter ............................. 2.49 2.39 1.13 0.28 5.16 3.90 010 

46083 ......... ............ A Incise external hemorrhoid .......................... 1.40 2.50 0.95 0.14 4.04 2.49 010 

46200 ......... ............ A Removal of anal fissure ............................... 3.41 3.64 2.43 0.36 7.41 6.20 090 

46210 ......... ............ A Removal of anal crypt .................................. 2.67 4.81 2.14 0.31 7.79 5.12 090 

46211 ......... ............ A Removal of anal crypts ................................ 4.24 5.08 2.95 0.45 9.77 7.64 090 

46220 ......... ............ A Removal of anal tag .................................... 1.56 2.27 0.94 0.17 4.00 2.67 010 

46221 ......... ............ A Ligation of hemorrhoid(s) ............................. 2.04 1.62 1.12 0.14 3.80 3.30 010 

46230 ......... ............ A Removal of anal tags ................................... 2.57 3.04 1.28 0.27 5.88 4.12 010 

46250 ......... ............ A Hemorrhoidectomy ....................................... 3.88 4.86 2.46 0.52 9.26 6.86 090 

46255 ......... ............ A Hemorrhoidectomy ....................................... 4.59 5.40 2.67 0.62 10.61 7.88 090 

46257 ......... ............ A Remove hemorrhoids & fissure ................... 5.39 NA 2.91 0.71 NA 9.01 090 

46258 ......... ............ A Remove hemorrhoids & fistula .................... 5.72 NA 3.31 0.77 NA 9.80 090 

46260 ......... ............ A Hemorrhoidectomy ....................................... 6.36 NA 3.26 0.82 NA 10.44 090 

46261 ......... ............ A Remove hemorrhoids & fissure ................... 7.07 NA 3.66 0.84 NA 11.57 090 

46262 ......... ............ A Remove hemorrhoids & fistula .................... 7.49 NA 3.79 0.92 NA 12.20 090 

46270 ......... ............ A Removal of anal fistula ................................ 3.71 4.66 2.38 0.43 8.80 6.52 090 

46275 ......... ............ A Removal of anal fistula ................................ 4.55 4.36 2.57 0.48 9.39 7.60 090 

46280 ......... ............ A Removal of anal fistula ................................ 5.97 NA 3.31 0.60 NA 9.88 090 

46285 ......... ............ A Removal of anal fistula ................................ 4.08 3.59 2.35 0.41 8.08 6.84 090 

46288 ......... ............ A Repair anal fistula ........................................ 7.12 NA 3.72 0.72 NA 11.56 090 

46320 ......... ............ A Removal of hemorrhoid clot ........................ 1.61 2.12 0.85 0.17 3.90 2.63 010 

46500 ......... ............ A Injection into hemorrhoid(s) ......................... 1.61 2.79 0.62 0.14 4.54 2.37 010 

46600 ......... ............ A Diagnostic anoscopy .................................... 0.50 1.58 0.38 0.05 2.13 0.93 000 

46604 ......... ............ A Anoscopy and dilation ................................. 1.31 9.30 0.64 0.11 10.72 2.06 000 

46606 ......... ............ A Anoscopy and biopsy .................................. 0.81 3.83 0.44 0.08 4.72 1.33 000 

46608 ......... ............ A Anoscopy, remove for body ......................... 1.51 4.42 0.68 0.16 6.09 2.35 000 

46610 ......... ............ A Anoscopy, remove lesion ............................ 1.32 4.08 0.63 0.14 5.54 2.09 000 

46611 ......... ............ A Anoscopy ..................................................... 1.81 3.35 0.80 0.18 5.34 2.79 000 

46612 ......... ............ A Anoscopy, remove lesions ........................... 2.34 5.19 1.00 0.22 7.75 3.56 000 

46614 ......... ............ A Anoscopy, control bleeding ......................... 2.01 2.28 0.87 0.17 4.46 3.05 000 

46615 ......... ............ A Anoscopy ..................................................... 2.68 2.52 1.10 0.28 5.48 4.06 000 

46700 ......... ............ A Repair of anal stricture ................................ 9.12 NA 4.24 0.68 NA 14.04 090 

46705 ......... ............ A Repair of anal stricture ................................ 6.89 NA 3.75 0.88 NA 11.52 090 

46706 ......... ............ A Repr of anal fistula w/glue ........................... 2.39 NA 1.24 0.21 NA 3.84 010 

46715 ......... ............ A Repair of anovaginal fistula ......................... 7.19 NA 3.64 0.92 NA 11.75 090 

46716 ......... ............ A Repair of anovaginal fistula ......................... 15.05 NA 7.98 1.57 NA 24.60 090 

46730 ......... ............ A Construction of absent anus ........................ 26.71 NA 12.04 2.45 NA 41.20 090 

46735 ......... ............ A Construction of absent anus ........................ 32.12 NA 13.58 3.18 NA 48.88 090 

46740 ......... ............ A Construction of absent anus ........................ 29.96 NA 13.21 2.40 NA 45.57 090 

46742 ......... ............ A Repair of imperforated anus ........................ 35.75 NA 17.54 3.17 NA 56.46 090 

46744 ......... ............ A Repair of cloacal anomaly ........................... 52.55 NA 21.17 2.74 NA 76.46 090 

46746 ......... ............ A Repair of cloacal anomaly ........................... 58.13 NA 25.20 3.03 NA 86.36 090 

46748 ......... ............ A Repair of cloacal anomaly ........................... 64.11 NA 23.81 3.34 NA 91.26 090 

46750 ......... ............ A Repair of anal sphincter .............................. 10.23 NA 5.10 0.83 NA 16.16 090 

46751 ......... ............ A Repair of anal sphincter .............................. 8.76 NA 5.51 0.94 NA 15.21 090 

46753 ......... ............ A Reconstruction of anus ................................ 8.28 NA 3.88 0.70 NA 12.86 090 

46754 ......... ............ A Removal of suture from anus ...................... 2.20 3.59 1.70 0.14 5.93 4.04 010 

46760 ......... ............ A Repair of anal sphincter .............................. 14.41 NA 7.11 1.04 NA 22.56 090 

46761 ......... ............ A Repair of anal sphincter .............................. 13.82 NA 6.06 1.01 NA 20.89 090 

46762 ......... ............ A Implant artificial sphincter ............................ 12.69 NA 5.56 0.86 NA 19.11 090 

46900 ......... ............ A Destruction, anal lesion(s) ........................... 1.91 3.54 0.79 0.16 5.61 2.86 010 

46910 ......... ............ A Destruction, anal lesion(s) ........................... 1.86 2.68 1.10 0.17 4.71 3.13 010 

46916 ......... ............ A Cryosurgery, anal lesion(s) .......................... 1.86 3.12 1.40 0.11 5.09 3.37 010 

46917 ......... ............ A Laser surgery, anal lesions ......................... 1.86 9.17 1.12 0.19 11.22 3.17 010 

46922 ......... ............ A Excision of anal lesion(s) ............................. 1.86 3.32 1.09 0.21 5.39 3.16 010 

46924 ......... ............ A Destruction, anal lesion(s) ........................... 2.76 8.69 1.36 0.24 11.69 4.36 010 

46934 ......... ............ A Destruction of hemorrhoids ......................... 3.50 5.01 2.70 0.31 8.82 6.51 090 

46935 ......... ............ A Destruction of hemorrhoids ......................... 2.43 3.45 1.21 0.21 6.09 3.85 010 

46936 ......... ............ A Destruction of hemorrhoids ......................... 3.68 4.45 2.26 0.36 8.49 6.30 090 

46937 ......... ............ A Cryotherapy of rectal lesion ......................... 2.69 2.73 1.22 0.14 5.56 4.05 010 

1165

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

46938 ......... ............ A Cryotherapy of rectal lesion ......................... 4.65 4.22 2.70 0.48 9.35 7.83 090 

46940 ......... ............ A Treatment of anal fissure ............................. 2.32 1.99 1.09 0.21 4.52 3.62 010 

46942 ......... ............ A Treatment of anal fissure ............................. 2.04 1.84 1.02 0.17 4.05 3.23 010 

46945 ......... ............ A Ligation of hemorrhoids ............................... 1.84 3.54 1.88 0.21 5.59 3.93 090 

46946 ......... ............ A Ligation of hemorrhoids ............................... 2.58 4.17 1.85 0.27 7.02 4.70 090 

46999 ......... ............ C Anus surgery procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47000 ......... ............ A Needle biopsy of liver .................................. 1.90 3.26 0.63 0.11 5.27 2.64 000 

47001 ......... ............ A Needle biopsy, liver add-on ......................... 1.90 NA 0.65 0.22 NA 2.77 ZZZ 

47010 ......... ............ A Open drainage, liver lesion .......................... 15.99 NA 8.55 0.78 NA 25.32 090 

47011 ......... ............ A Percut drain, liver lesion .............................. 3.69 NA 1.21 0.21 NA 5.11 000 

47015 ......... ............ A Inject/aspirate liver cyst ............................... 15.09 NA 7.56 1.04 NA 23.69 090 

47100 ......... ............ A Wedge biopsy of liver .................................. 11.65 NA 6.10 0.90 NA 18.65 090 

47120 ......... ............ A Partial removal of liver ................................. 35.45 NA 15.28 2.76 NA 53.49 090 

47122 ......... ............ A Extensive removal of liver ........................... 55.05 NA 21.62 4.34 NA 81.01 090 

47125 ......... ............ A Partial removal of liver ................................. 49.12 NA 19.67 3.84 NA 72.63 090 

47130 ......... ............ A Partial removal of liver ................................. 53.27 NA 21.14 4.19 NA 78.60 090 

47133 ......... ............ C Removal of donor liver ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47134 ......... ............ D Partial removal, donor liver .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47135 ......... ............ R Transplantation of liver ................................ 81.40 NA 32.07 9.81 NA 123.28 090 

47136 ......... ............ R Transplantation of liver ................................ 68.50 NA 27.50 8.36 NA 104.36 090 

47140 ......... ............ A Partial removal, donor liver .......................... 54.92 NA 22.74 4.80 NA 82.46 090 

47141 ......... ............ A Partial removal, donor liver .......................... 67.40 NA 27.39 4.80 NA 99.59 090 

47142 ......... ............ A Partial removal, donor liver .......................... 74.89 NA 29.97 4.80 NA 109.66 090 

47300 ......... ............ A Surgery for liver lesion ................................. 15.06 NA 7.29 1.17 NA 23.52 090 

47350 ......... ............ A Repair liver wound ....................................... 19.53 NA 8.93 1.51 NA 29.97 090 

47360 ......... ............ A Repair liver wound ....................................... 26.88 NA 11.67 2.06 NA 40.61 090 

47361 ......... ............ A Repair liver wound ....................................... 47.05 NA 18.64 3.75 NA 69.44 090 

47362 ......... ............ A Repair liver wound ....................................... 18.48 NA 8.80 1.47 NA 28.75 090 

47370 ......... ............ A Laparo ablate liver tumor rf ......................... 19.66 NA 8.18 1.03 NA 28.87 090 

47371 ......... ............ A Laparo ablate liver cryosurg ........................ 19.66 NA 8.19 1.03 NA 28.88 090 

47379 ......... ............ C Laparoscope procedure, liver ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47380 ......... ............ A Open ablate liver tumor rf ............................ 22.97 NA 9.39 1.03 NA 33.39 090 

47381 ......... ............ A Open ablate liver tumor cryo ....................... 23.24 NA 9.65 1.03 NA 33.92 090 

47382 ......... ............ A Percut ablate liver rf .................................... 15.17 NA 6.10 1.37 NA 22.64 010 

47399 ......... ............ C Liver surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47400 ......... ............ A Incision of liver duct ..................................... 32.44 NA 13.55 2.20 NA 48.19 090 

47420 ......... ............ A Incision of bile duct ...................................... 19.85 NA 8.82 2.05 NA 30.72 090 

47425 ......... ............ A Incision of bile duct ...................................... 19.80 NA 8.87 1.93 NA 30.60 090 

47460 ......... ............ A Incise bile duct sphincter ............................. 18.01 NA 8.42 1.50 NA 27.93 090 

47480 ......... ............ A Incision of gallbladder .................................. 10.80 NA 5.97 1.03 NA 17.80 090 

47490 ......... ............ A Incision of gallbladder .................................. 7.22 NA 5.83 0.40 NA 13.45 090 

47500 ......... ............ A Injection for liver x-rays ............................... 1.96 NA 0.64 0.11 NA 2.71 000 

47505 ......... ............ A Injection for liver x-rays ............................... 0.76 2.60 0.25 0.04 3.40 1.05 000 

47510 ......... ............ A Insert catheter, bile duct .............................. 7.82 NA 5.01 0.43 NA 13.26 090 

47511 ......... ............ A Insert bile duct drain .................................... 10.48 NA 5.09 0.57 NA 16.14 090 

47525 ......... ............ A Change bile duct catheter ........................... 5.54 NA 3.26 0.29 NA 9.09 010 

47530 ......... ............ A Revise/reinsert bile tube .............................. 5.84 NA 4.32 0.35 NA 10.51 090 

47550 ......... ............ A Bile duct endoscopy add-on ........................ 3.02 NA 1.03 0.36 NA 4.41 ZZZ 

47552 ......... ............ A Biliary endoscopy thru skin .......................... 6.03 NA 2.40 0.51 NA 8.94 000 

47553 ......... ............ A Biliary endoscopy thru skin .......................... 6.34 NA 2.60 0.36 NA 9.30 000 

47554 ......... ............ A Biliary endoscopy thru skin .......................... 9.05 NA 3.38 0.89 NA 13.32 000 

47555 ......... ............ A Biliary endoscopy thru skin .......................... 7.55 NA 3.01 0.42 NA 10.98 000 

47556 ......... ............ A Biliary endoscopy thru skin .......................... 8.55 NA 3.33 0.46 NA 12.34 000 

47560 ......... ............ A Laparoscopy w/cholangio ............................ 4.88 NA 1.83 0.59 NA 7.30 000 

47561 ......... ............ A Laparo w/cholangio/biopsy .......................... 5.17 NA 2.13 0.59 NA 7.89 000 

47562 ......... ............ A Laparoscopic cholecystectomy .................... 11.07 NA 5.00 1.36 NA 17.43 090 

47563 ......... ............ A Laparo cholecystectomy/graph .................... 11.92 NA 5.32 1.46 NA 18.70 090 

47564 ......... ............ A Laparo cholecystectomy/explr ..................... 14.21 NA 5.97 1.74 NA 21.92 090 

47570 ......... ............ A Laparo cholecystoenterostomy .................... 12.56 NA 5.39 1.54 NA 19.49 090 

47579 ......... ............ C Laparoscope proc, biliary ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

47600 ......... ............ A Removal of gallbladder ................................ 13.56 NA 6.20 1.40 NA 21.16 090 

47605 ......... ............ A Removal of gallbladder ................................ 14.67 NA 6.55 1.51 NA 22.73 090 

47610 ......... ............ A Removal of gallbladder ................................ 18.79 NA 7.99 1.94 NA 28.72 090 

47612 ......... ............ A Removal of gallbladder ................................ 18.75 NA 7.94 1.93 NA 28.62 090 

47620 ......... ............ A Removal of gallbladder ................................ 20.61 NA 8.59 2.13 NA 31.33 090 

47630 ......... ............ A Remove bile duct stone ............................... 9.10 NA 4.80 0.55 NA 14.45 090 

47700 ......... ............ A Exploration of bile ducts .............................. 15.60 NA 7.48 1.69 NA 24.77 090 

47701 ......... ............ A Bile duct revision ......................................... 27.77 NA 11.58 3.62 NA 42.97 090 

47711 ......... ............ A Excision of bile duct tumor .......................... 23.00 NA 10.01 2.39 NA 35.40 090 

47712 ......... ............ A Excision of bile duct tumor .......................... 30.19 NA 12.50 3.22 NA 45.91 090 

47715 ......... ............ A Excision of bile duct cyst ............................. 18.77 NA 8.49 1.92 NA 29.18 090 

47716 ......... ............ A Fusion of bile duct cyst ................................ 16.42 NA 7.88 1.70 NA 26.00 090 

47720 ......... ............ A Fuse gallbladder & bowel ............................ 15.89 NA 7.54 1.65 NA 25.08 090 

47721 ......... ............ A Fuse upper gi structures .............................. 19.09 NA 8.63 1.97 NA 29.69 090 

47740 ......... ............ A Fuse gallbladder & bowel ............................ 18.45 NA 8.45 1.92 NA 28.82 090 

1166

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

47741 ......... ............ A Fuse gallbladder & bowel ............................ 21.31 NA 9.35 2.20 NA 32.86 090 

47760 ......... ............ A Fuse bile ducts and bowel ........................... 25.81 NA 10.92 2.67 NA 39.40 090 

47765 ......... ............ A Fuse liver ducts & bowel ............................. 24.84 NA 10.89 2.63 NA 38.36 090 

47780 ......... ............ A Fuse bile ducts and bowel ........................... 26.46 NA 11.28 2.74 NA 40.48 090 

47785 ......... ............ A Fuse bile ducts and bowel ........................... 31.13 NA 13.01 3.24 NA 47.38 090 

47800 ......... ............ A Reconstruction of bile ducts ........................ 23.27 NA 10.13 2.35 NA 35.75 090 

47801 ......... ............ A Placement, bile duct support ....................... 15.15 NA 8.33 0.83 NA 24.31 090 

47802 ......... ............ A Fuse liver duct & intestine ........................... 21.52 NA 9.76 2.22 NA 33.50 090 

47900 ......... ............ A Suture bile duct injury .................................. 19.87 NA 8.93 1.99 NA 30.79 090 

47999 ......... ............ C Bile tract surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

48000 ......... ............ A Drainage of abdomen .................................. 28.03 NA 11.58 1.59 NA 41.20 090 

48001 ......... ............ A Placement of drain, pancreas ...................... 35.40 NA 13.95 2.29 NA 51.64 090 

48005 ......... ............ A Resect/debride pancreas ............................. 42.11 NA 16.63 2.73 NA 61.47 090 

48020 ......... ............ A Removal of pancreatic stone ....................... 15.68 NA 7.35 1.64 NA 24.67 090 

48100 ......... ............ A Biopsy of pancreas, open ............................ 12.21 NA 5.65 1.30 NA 19.16 090 

48102 ......... ............ A Needle biopsy, pancreas ............................. 4.67 9.04 2.45 0.24 13.95 7.36 010 

48120 ......... ............ A Removal of pancreas lesion ........................ 15.83 NA 6.90 1.63 NA 24.36 090 

48140 ......... ............ A Partial removal of pancreas ......................... 22.91 NA 9.60 2.56 NA 35.07 090 

48145 ......... ............ A Partial removal of pancreas ......................... 23.98 NA 9.91 2.71 NA 36.60 090 

48146 ......... ............ A Pancreatectomy ........................................... 26.36 NA 12.09 2.93 NA 41.38 090 

48148 ......... ............ A Removal of pancreatic duct ......................... 17.31 NA 7.68 1.94 NA 26.93 090 

48150 ......... ............ A Partial removal of pancreas ......................... 47.93 NA 19.65 5.34 NA 72.92 090 

48152 ......... ............ A Pancreatectomy ........................................... 43.68 NA 18.35 4.91 NA 66.94 090 

48153 ......... ............ A Pancreatectomy ........................................... 47.82 NA 19.74 5.31 NA 72.87 090 

48154 ......... ............ A Pancreatectomy ........................................... 44.03 NA 18.38 4.95 NA 67.36 090 

48155 ......... ............ A Removal of pancreas ................................... 24.60 NA 11.82 2.77 NA 39.19 090 

48160 ......... ............ N Pancreas removal/transplant ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48180 ......... ............ A Fuse pancreas and bowel ........................... 24.68 NA 10.22 2.70 NA 37.60 090 

48400 ......... ............ A Injection, intraop add-on .............................. 1.95 NA 0.64 0.12 NA 2.71 ZZZ 

48500 ......... ............ A Surgery of pancreatic cyst ........................... 15.26 NA 7.40 1.63 NA 24.29 090 

48510 ......... ............ A Drain pancreatic pseudocyst ....................... 14.29 NA 7.54 1.29 NA 23.12 090 

48511 ......... ............ A Drain pancreatic pseudocyst ....................... 3.99 NA 1.31 0.21 NA 5.51 000 

48520 ......... ............ A Fuse pancreas cyst and bowel .................... 15.57 NA 6.75 1.70 NA 24.02 090 

48540 ......... ............ A Fuse pancreas cyst and bowel .................... 19.69 NA 8.16 2.20 NA 30.05 090 

48545 ......... ............ A Pancreatorrhaphy ........................................ 18.15 NA 8.05 1.94 NA 28.14 090 

48547 ......... ............ A Duodenal exclusion ..................................... 25.79 NA 10.55 2.77 NA 39.11 090 

48550 ......... ............ X Donor pancreatectomy ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

48554 ......... ............ R Transpl allograft pancreas ........................... 34.12 NA 17.32 3.98 NA 55.42 090 

48556 ......... ............ A Removal, allograft pancreas ........................ 15.69 NA 8.29 1.83 NA 25.81 090 

48999 ......... ............ C Pancreas surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49000 ......... ............ A Exploration of abdomen ............................... 11.66 NA 5.42 1.41 NA 18.49 090 

49002 ......... ............ A Reopening of abdomen ............................... 10.47 NA 5.07 1.28 NA 16.82 090 

49010 ......... ............ A Exploration behind abdomen ....................... 12.26 NA 5.95 1.47 NA 19.68 090 

49020 ......... ............ A Drain abdominal abscess ............................ 22.81 NA 10.24 1.58 NA 34.63 090 

49021 ......... ............ A Drain abdominal abscess ............................ 3.37 NA 1.12 0.19 NA 4.68 000 

49040 ......... ............ A Drain, open, abdom abscess ....................... 13.50 NA 6.47 1.01 NA 20.98 090 

49041 ......... ............ A Drain, percut, abdom abscess ..................... 3.99 NA 1.31 0.22 NA 5.52 000 

49060 ......... ............ A Drain, open, retrop abscess ........................ 15.84 NA 7.48 0.93 NA 24.25 090 

49061 ......... ............ A Drain, percut, retroper absc ......................... 3.69 NA 1.21 0.21 NA 5.11 000 

49062 ......... ............ A Drain to peritoneal cavity ............................. 11.34 NA 5.50 1.30 NA 18.14 090 

49080 ......... ............ A Puncture, peritoneal cavity .......................... 1.35 4.20 0.45 0.08 5.63 1.88 000 

49081 ......... ............ A Removal of abdominal fluid ......................... 1.26 2.62 0.57 0.07 3.95 1.90 000 

49085 ......... ............ A Remove abdomen foreign body .................. 12.12 NA 5.56 1.06 NA 18.74 090 

49180 ......... ............ A Biopsy, abdominal mass .............................. 1.73 3.32 0.56 0.10 5.15 2.39 000 

49200 ......... ............ A Removal of abdominal lesion ...................... 10.23 NA 5.08 1.11 NA 16.42 090 

49201 ......... ............ A Remove abdom lesion, complex ................. 14.82 NA 7.10 1.77 NA 23.69 090 

49215 ......... ............ A Excise sacral spine tumor ........................... 33.45 NA 14.09 2.99 NA 50.53 090 

49220 ......... ............ A Multiple surgery, abdomen .......................... 14.86 NA 6.69 1.82 NA 23.37 090 

49250 ......... ............ A Excision of umbilicus ................................... 8.34 NA 4.33 1.01 NA 13.68 090 

49255 ......... ............ A Removal of omentum .................................. 11.12 NA 5.66 1.35 NA 18.13 090 

49320 ......... ............ A Diag laparo separate proc ........................... 5.09 NA 2.64 0.60 NA 8.33 010 

49321 ......... ............ A Laparoscopy, biopsy .................................... 5.39 NA 2.65 0.64 NA 8.68 010 

49322 ......... ............ A Laparoscopy, aspiration ............................... 5.69 NA 2.99 0.69 NA 9.37 010 

49323 ......... ............ A Laparo drain lymphocele ............................. 9.47 NA 4.52 1.06 NA 15.05 090 

49329 ......... ............ C Laparo proc, abdm/per/oment ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49400 ......... ............ A Air injection into abdomen ........................... 1.88 NA 0.79 0.13 NA 2.80 000 

49419 ......... ............ A Insrt abdom cath for chemotx ...................... 6.64 NA 3.56 0.66 NA 10.86 090 

49420 ......... ............ A Insert abdom drain, temp ............................ 2.22 NA 1.12 0.16 NA 3.50 000 

49421 ......... ............ A Insert abdom drain, perm ............................ 5.53 NA 3.20 0.66 NA 9.39 090 

49422 ......... ............ A Remove perm cannula/catheter .................. 6.24 NA 2.91 0.76 NA 9.91 010 

49423 ......... ............ A Exchange drainage catheter ........................ 1.46 NA 0.67 0.08 NA 2.21 000 

49424 ......... ............ A Assess cyst, contrast inject ......................... 0.76 NA 0.44 0.04 NA 1.24 000 

49425 ......... ............ A Insert abdomen-venous drain ...................... 11.35 NA 5.65 1.46 NA 18.46 090 

49426 ......... ............ A Revise abdomen-venous shunt ................... 9.62 NA 4.82 1.12 NA 15.56 090 

49427 ......... ............ A Injection, abdominal shunt ........................... 0.89 NA 0.48 0.06 NA 1.43 000 

1167

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

49428 ......... ............ A Ligation of shunt .......................................... 6.05 NA 3.29 0.37 NA 9.71 010 

49429 ......... ............ A Removal of shunt ......................................... 7.39 NA 3.44 0.98 NA 11.81 010 

49491 ......... ............ A Rpr hern preemie reduc .............................. 11.11 NA 5.07 1.33 NA 17.51 090 

49492 ......... ............ A Rpr ing hern premie, blocked ...................... 14.01 NA 6.14 1.77 NA 21.92 090 

49495 ......... ............ A Rpr ing hernia baby, reduc .......................... 5.88 NA 3.00 0.70 NA 9.58 090 

49496 ......... ............ A Rpr ing hernia baby, blocked ...................... 8.78 NA 4.37 1.11 NA 14.26 090 

49500 ......... ............ A Rpr ing hernia, init, reduce .......................... 5.47 NA 3.15 0.55 NA 9.17 090 

49501 ......... ............ A Rpr ing hernia, init blocked .......................... 8.87 NA 4.24 0.92 NA 14.03 090 

49505 ......... ............ A Prp i/hern init reduc>5 yr ............................. 7.59 4.10 3.87 0.78 12.47 12.24 090 

49507 ......... ............ A Prp i/hern init block>5 yr ............................. 9.56 NA 4.54 1.00 NA 15.10 090 

49520 ......... ............ A Rerepair ing hernia, reduce ......................... 9.62 NA 4.49 1.01 NA 15.12 090 

49521 ......... ............ A Rerepair ing hernia, blocked ....................... 11.95 NA 5.28 1.25 NA 18.48 090 

49525 ......... ............ A Repair ing hernia, sliding ............................. 8.56 NA 4.13 0.89 NA 13.58 090 

49540 ......... ............ A Repair lumbar hernia ................................... 10.37 NA 4.81 1.09 NA 16.27 090 

49550 ......... ............ A Rpr rem hernia, init, reduce ......................... 8.62 NA 4.16 0.90 NA 13.68 090 

49553 ......... ............ A Rpr fem hernia, init blocked ........................ 9.43 NA 4.46 1.00 NA 14.89 090 

49555 ......... ............ A Rerepair fem hernia, reduce ........................ 9.02 NA 4.32 0.95 NA 14.29 090 

49557 ......... ............ A Rerepair fem hernia, blocked ...................... 11.13 NA 5.03 1.17 NA 17.33 090 

49560 ......... ............ A Rpr ventral hern init, reduc .......................... 11.55 NA 5.21 1.21 NA 17.97 090 

49561 ......... ............ A Rpr ventral hern init, block .......................... 14.23 NA 6.11 1.48 NA 21.82 090 

49565 ......... ............ A Rerepair ventrl hern, reduce ........................ 11.55 NA 5.28 1.21 NA 18.04 090 

49566 ......... ............ A Rerepair ventrl hern, block .......................... 14.38 NA 6.18 1.50 NA 22.06 090 

49568 ......... ............ A Hernia repair w/mesh .................................. 4.88 NA 1.68 0.60 NA 7.16 ZZZ 

49570 ......... ............ A Rpr epigastric hern, reduce ......................... 5.68 NA 3.20 0.60 NA 9.48 090 

49572 ......... ............ A Rpr epigastric hern, blocked ........................ 6.72 NA 3.50 0.70 NA 10.92 090 

49580 ......... ............ A Rpr umbil hern, reduc < 5 yr ....................... 4.10 NA 2.64 0.41 NA 7.15 090 

49582 ......... ............ A Rpr umbil hern, block < 5 yr ........................ 6.64 NA 3.53 0.69 NA 10.86 090 

49585 ......... ............ A Rpr umbil hern, reduc > 5 yr ....................... 6.22 NA 3.35 0.64 NA 10.21 090 

49587 ......... ............ A Rpr umbil hern, block > 5 yr ........................ 7.55 NA 3.78 0.78 NA 12.11 090 

49590 ......... ............ A Repair spigilian hernia ................................. 8.53 NA 4.13 0.89 NA 13.55 090 

49600 ......... ............ A Repair umbilical lesion ................................. 10.94 NA 5.39 1.36 NA 17.69 090 

49605 ......... ............ A Repair umbilical lesion ................................. 75.89 NA 28.65 3.10 NA 107.64 090 

49606 ......... ............ A Repair umbilical lesion ................................. 18.57 NA 7.77 2.68 NA 29.02 090 

49610 ......... ............ A Repair umbilical lesion ................................. 10.48 NA 5.26 0.93 NA 16.67 090 

49611 ......... ............ A Repair umbilical lesion ................................. 8.91 NA 7.25 0.78 NA 16.94 090 

49650 ......... ............ A Laparo hernia repair initial ........................... 6.26 NA 3.23 0.77 NA 10.26 090 

49651 ......... ............ A Laparo hernia repair recur ........................... 8.23 NA 4.09 1.01 NA 13.33 090 

49659 ......... ............ C Laparo proc, hernia repair ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

49900 ......... ............ A Repair of abdominal wall ............................. 12.26 NA 6.28 1.48 NA 20.02 090 

49904 ......... ............ A Omental flap, extra-abdom .......................... 19.97 NA 15.52 2.30 NA 37.79 090 

49905 ......... ............ A Omental flap, intra-abdom ........................... 6.54 NA 2.30 0.74 NA 9.58 ZZZ 

49906 ......... ............ C Free omental flap, microvasc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

49999 ......... ............ C Abdomen surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50010 ......... ............ A Exploration of kidney ................................... 10.96 NA 5.42 0.95 NA 17.33 090 

50020 ......... ............ A Renal abscess, open drain .......................... 14.64 NA 8.81 0.96 NA 24.41 090 

50021 ......... ............ A Renal abscess, percut drain ........................ 3.37 NA 1.11 0.18 NA 4.66 000 

50040 ......... ............ A Drainage of kidney ....................................... 14.92 NA 8.42 0.99 NA 24.33 090 

50045 ......... ............ A Exploration of kidney ................................... 15.44 NA 6.80 1.28 NA 23.52 090 

50060 ......... ............ A Removal of kidney stone ............................. 19.27 NA 8.03 1.37 NA 28.67 090 

50065 ......... ............ A Incision of kidney ......................................... 20.76 NA 6.24 1.36 NA 28.36 090 

50070 ......... ............ A Incision of kidney ......................................... 20.29 NA 8.42 1.45 NA 30.16 090 

50075 ......... ............ A Removal of kidney stone ............................. 25.30 NA 10.19 1.82 NA 37.31 090 

50080 ......... ............ A Removal of kidney stone ............................. 14.69 NA 7.85 1.04 NA 23.58 090 

50081 ......... ............ A Removal of kidney stone ............................. 21.77 NA 10.35 1.57 NA 33.69 090 

50100 ......... ............ A Revise kidney blood vessels ....................... 16.07 NA 7.99 1.98 NA 26.04 090 

50120 ......... ............ A Exploration of kidney ................................... 15.89 NA 6.97 1.25 NA 24.11 090 

50125 ......... ............ A Explore and drain kidney ............................. 16.50 NA 7.12 1.29 NA 24.91 090 

50130 ......... ............ A Removal of kidney stone ............................. 17.26 NA 7.38 1.25 NA 25.89 090 

50135 ......... ............ A Exploration of kidney ................................... 19.15 NA 7.98 1.42 NA 28.55 090 

50200 ......... ............ A Biopsy of kidney .......................................... 2.63 NA 0.90 0.14 NA 3.67 000 

50205 ......... ............ A Biopsy of kidney .......................................... 11.29 NA 5.24 1.13 NA 17.66 090 

50220 ......... ............ A Remove kidney, open .................................. 17.12 NA 7.44 1.40 NA 25.96 090 

50225 ......... ............ A Removal kidney open, complex .................. 20.20 NA 8.36 1.52 NA 30.08 090 

50230 ......... ............ A Removal kidney open, radical ..................... 22.04 NA 8.83 1.63 NA 32.50 090 

50234 ......... ............ A Removal of kidney & ureter ......................... 22.37 NA 9.04 1.65 NA 33.06 090 

50236 ......... ............ A Removal of kidney & ureter ......................... 24.82 NA 11.41 1.81 NA 38.04 090 

50240 ......... ............ A Partial removal of kidney ............................. 21.97 NA 10.50 1.64 NA 34.11 090 

50280 ......... ............ A Removal of kidney lesion ............................ 15.65 NA 6.89 1.19 NA 23.73 090 

50290 ......... ............ A Removal of kidney lesion ............................ 14.71 NA 6.65 1.34 NA 22.70 090 

50300 ......... ............ X Removal of donor kidney ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

50320 ......... ............ A Removal of donor kidney ............................. 22.18 NA 9.96 2.15 NA 34.29 090 

50340 ......... ............ A Removal of kidney ....................................... 12.13 NA 6.93 1.39 NA 20.45 090 

50360 ......... ............ A Transplantation of kidney ............................ 31.48 NA 15.76 3.58 NA 50.82 090 

50365 ......... ............ A Transplantation of kidney ............................ 36.75 NA 18.55 4.23 NA 59.53 090 

50370 ......... ............ A Remove transplanted kidney ....................... 13.70 NA 7.52 1.52 NA 22.74 090 

1168

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

50380 ......... ............ A Reimplantation of kidney ............................. 20.73 NA 13.26 2.17 NA 36.16 090 

50390 ......... ............ A Drainage of kidney lesion ............................ 1.96 NA 0.64 0.11 NA 2.71 000 

50392 ......... ............ A Insert kidney drain ....................................... 3.37 NA 1.11 0.18 NA 4.66 000 

50393 ......... ............ A Insert ureteral tube ...................................... 4.15 NA 1.35 0.22 NA 5.72 000 

50394 ......... ............ A Injection for kidney x-ray ............................. 0.76 2.54 0.25 0.05 3.35 1.06 000 

50395 ......... ............ A Create passage to kidney ............................ 3.37 NA 1.10 0.19 NA 4.66 000 

50396 ......... ............ A Measure kidney pressure ............................ 2.09 NA 0.86 0.12 NA 3.07 000 

50398 ......... ............ A Change kidney tube ..................................... 1.46 1.19 0.47 0.08 2.73 2.01 000 

50400 ......... ............ A Revision of kidney/ureter ............................. 19.47 NA 7.72 1.46 NA 28.65 090 

50405 ......... ............ A Revision of kidney/ureter ............................. 23.89 NA 10.41 1.75 NA 36.05 090 

50500 ......... ............ A Repair of kidney wound ............................... 19.54 NA 8.77 1.75 NA 30.06 090 

50520 ......... ............ A Close kidney-skin fistula .............................. 17.20 NA 8.75 1.52 NA 27.47 090 

50525 ......... ............ A Repair renal-abdomen fistula ...................... 22.24 NA 10.16 1.82 NA 34.22 090 

50526 ......... ............ A Repair renal-abdomen fistula ...................... 23.98 NA 10.88 1.95 NA 36.81 090 

50540 ......... ............ A Revision of horseshoe kidney ..................... 19.90 NA 8.55 1.54 NA 29.99 090 

50541 ......... ............ A Laparo ablate renal cyst .............................. 15.98 NA 6.41 1.19 NA 23.58 090 

50542 ......... ............ A Laparo ablate renal mass ............................ 19.97 NA 8.13 1.64 NA 29.74 090 

50543 ......... ............ A Laparo partial nephrectomy ......................... 25.46 NA 10.27 1.64 NA 37.37 090 

50544 ......... ............ A Laparoscopy, pyeloplasty ............................ 22.37 NA 8.47 1.70 NA 32.54 090 

50545 ......... ............ A Laparo radical nephrectomy ........................ 23.96 NA 9.12 1.85 NA 34.93 090 

50546 ......... ............ A Laparoscopic nephrectomy .......................... 20.45 NA 8.30 1.65 NA 30.40 090 

50547 ......... ............ A Laparo removal donor kidney ...................... 25.46 NA 10.44 2.46 NA 38.36 090 

50548 ......... ............ A Laparo remove w/ ureter ............................. 24.36 NA 9.11 1.80 NA 35.27 090 

50549 ......... ............ C Laparoscope proc, renal .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50551 ......... ............ A Kidney endoscopy ....................................... 5.59 4.92 1.80 0.40 10.91 7.79 000 

50553 ......... ............ A Kidney endoscopy ....................................... 5.98 18.59 1.95 0.42 24.99 8.35 000 

50555 ......... ............ A Kidney endoscopy & biopsy ........................ 6.52 19.17 2.11 0.46 26.15 9.09 000 

50557 ......... ............ A Kidney endoscopy & treatment ................... 6.61 20.04 2.12 0.47 27.12 9.20 000 

50559 ......... ............ A Renal endoscopy/radiotracer ....................... 6.77 NA 2.19 0.33 NA 9.29 000 

50561 ......... ............ A Kidney endoscopy & treatment ................... 7.58 17.69 2.44 0.53 25.80 10.55 000 

50562 ......... ............ A Renal scope w/tumor resect ........................ 10.90 NA 3.84 1.01 NA 15.75 090 

50570 ......... ............ A Kidney endoscopy ....................................... 9.53 NA 3.06 0.68 NA 13.27 000 

50572 ......... ............ A Kidney endoscopy ....................................... 10.33 NA 3.33 0.77 NA 14.43 000 

50574 ......... ............ A Kidney endoscopy & biopsy ........................ 11.00 NA 3.57 0.78 NA 15.35 000 

50575 ......... ............ A Kidney endoscopy ....................................... 13.96 NA 4.48 1.01 NA 19.45 000 

50576 ......... ............ A Kidney endoscopy & treatment ................... 10.97 NA 3.51 0.80 NA 15.28 000 

50578 ......... ............ A Renal endoscopy/radiotracer ....................... 11.33 NA 3.64 0.81 NA 15.78 000 

50580 ......... ............ A Kidney endoscopy & treatment ................... 11.84 NA 3.80 0.84 NA 16.48 000 

50590 ......... ............ A Fragmenting of kidney stone ....................... 9.08 10.77 5.03 0.65 20.50 14.76 090 

50600 ......... ............ A Exploration of ureter .................................... 15.82 NA 6.99 1.19 NA 24.00 090 

50605 ......... ............ A Insert ureteral support ................................. 15.44 NA 7.00 1.36 NA 23.80 090 

50610 ......... ............ A Removal of ureter stone .............................. 15.90 NA 7.24 1.30 NA 24.44 090 

50620 ......... ............ A Removal of ureter stone .............................. 15.14 NA 6.62 1.10 NA 22.86 090 

50630 ......... ............ A Removal of ureter stone .............................. 14.92 NA 6.56 1.09 NA 22.57 090 

50650 ......... ............ A Removal of ureter ........................................ 17.38 NA 7.50 1.29 NA 26.17 090 

50660 ......... ............ A Removal of ureter ........................................ 19.52 NA 8.24 1.44 NA 29.20 090 

50684 ......... ............ A Injection for ureter x-ray .............................. 0.76 15.38 0.25 0.05 16.19 1.06 000 

50686 ......... ............ A Measure ureter pressure ............................. 1.51 4.56 0.65 0.11 6.18 2.27 000 

50688 ......... ............ A Change of ureter tube ................................. 1.17 NA 1.75 0.07 NA 2.99 010 

50690 ......... ............ A Injection for ureter x-ray .............................. 1.16 15.84 0.37 0.07 17.07 1.60 000 

50700 ......... ............ A Revision of ureter ........................................ 15.19 NA 7.30 1.04 NA 23.53 090 

50715 ......... ............ A Release of ureter ......................................... 18.87 NA 9.03 2.03 NA 29.93 090 

50722 ......... ............ A Release of ureter ......................................... 16.33 NA 8.03 1.70 NA 26.06 090 

50725 ......... ............ A Release/revise ureter ................................... 18.46 NA 8.31 1.74 NA 28.51 090 

50727 ......... ............ A Revise ureter ............................................... 8.17 NA 5.20 0.62 NA 13.99 090 

50728 ......... ............ A Revise ureter ............................................... 12.00 NA 6.72 1.06 NA 19.78 090 

50740 ......... ............ A Fusion of ureter & kidney ............................ 18.39 NA 7.96 1.80 NA 28.15 090 

50750 ......... ............ A Fusion of ureter & kidney ............................ 19.48 NA 8.27 1.50 NA 29.25 090 

50760 ......... ............ A Fusion of ureters .......................................... 18.39 NA 7.95 1.51 NA 27.85 090 

50770 ......... ............ A Splicing of ureters ........................................ 19.48 NA 8.25 1.51 NA 29.24 090 

50780 ......... ............ A Reimplant ureter in bladder ......................... 18.33 NA 7.86 1.45 NA 27.64 090 

50782 ......... ............ A Reimplant ureter in bladder ......................... 19.51 NA 9.83 1.36 NA 30.70 090 

50783 ......... ............ A Reimplant ureter in bladder ......................... 20.52 NA 9.35 1.63 NA 31.50 090 

50785 ......... ............ A Reimplant ureter in bladder ......................... 20.49 NA 8.58 1.57 NA 30.64 090 

50800 ......... ............ A Implant ureter in bowel ................................ 14.50 NA 6.99 1.11 NA 22.60 090 

50810 ......... ............ A Fusion of ureter & bowel ............................. 20.02 NA 9.57 2.15 NA 31.74 090 

50815 ......... ............ A Urine shunt to intestine ................................ 19.90 NA 8.93 1.58 NA 30.41 090 

50820 ......... ............ A Construct bowel bladder .............................. 21.86 NA 9.14 1.66 NA 32.66 090 

50825 ......... ............ A Construct bowel bladder .............................. 28.14 NA 11.65 2.18 NA 41.97 090 

50830 ......... ............ A Revise urine flow ......................................... 31.23 NA 12.66 2.65 NA 46.54 090 

50840 ......... ............ A Replace ureter by bowel .............................. 19.97 NA 8.93 1.52 NA 30.42 090 

50845 ......... ............ A Appendico-vesicostomy ............................... 20.86 NA 8.87 1.52 NA 31.25 090 

50860 ......... ............ A Transplant ureter to skin .............................. 15.34 NA 6.89 1.22 NA 23.45 090 

50900 ......... ............ A Repair of ureter ............................................ 13.60 NA 6.36 1.18 NA 21.14 090 

50920 ......... ............ A Closure ureter/skin fistula ............................ 14.31 NA 6.79 1.01 NA 22.11 090 

1169

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

50930 ......... ............ A Closure ureter/bowel fistula ......................... 18.69 NA 8.19 1.89 NA 28.77 090 

50940 ......... ............ A Release of ureter ......................................... 14.49 NA 6.63 1.25 NA 22.37 090 

50945 ......... ............ A Laparoscopy ureterolithotomy ..................... 16.97 NA 6.96 1.39 NA 25.32 090 

50947 ......... ............ A Laparo new ureter/bladder .......................... 24.46 NA 9.66 2.40 NA 36.52 090 

50948 ......... ............ A Laparo new ureter/bladder .......................... 22.47 NA 8.62 2.21 NA 33.30 090 

50949 ......... ............ C Laparoscope proc, ureter ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

50951 ......... ............ A Endoscopy of ureter .................................... 5.83 5.34 1.87 0.42 11.59 8.12 000 

50953 ......... ............ A Endoscopy of ureter .................................... 6.23 18.61 2.00 0.45 25.29 8.68 000 

50955 ......... ............ A Ureter endoscopy & biopsy ......................... 6.74 20.51 2.22 0.46 27.71 9.42 000 

50957 ......... ............ A Ureter endoscopy & treatment .................... 6.78 18.26 2.18 0.48 25.52 9.44 000 

50959 ......... ............ A Ureter endoscopy & tracer .......................... 4.39 NA 1.37 0.22 NA 5.98 000 

50961 ......... ............ A Ureter endoscopy & treatment .................... 6.04 25.47 1.94 0.42 31.93 8.40 000 

50970 ......... ............ A Ureter endoscopy ........................................ 7.13 NA 2.30 0.52 NA 9.95 000 

50972 ......... ............ A Ureter endoscopy & catheter ....................... 6.88 NA 2.27 0.47 NA 9.62 000 

50974 ......... ............ A Ureter endoscopy & biopsy ......................... 9.16 NA 2.93 0.64 NA 12.73 000 

50976 ......... ............ A Ureter endoscopy & treatment .................... 9.03 NA 2.91 0.64 NA 12.58 000 

50978 ......... ............ A Ureter endoscopy & tracer .......................... 5.09 NA 1.67 0.36 NA 7.12 000 

50980 ......... ............ A Ureter endoscopy & treatment .................... 6.84 NA 2.20 0.49 NA 9.53 000 

51000 ......... ............ A Drainage of bladder ..................................... 0.78 1.98 0.24 0.06 2.82 1.08 000 

51005 ......... ............ A Drainage of bladder ..................................... 1.02 4.80 0.34 0.10 5.92 1.46 000 

51010 ......... ............ A Drainage of bladder ..................................... 3.52 5.74 1.89 0.28 9.54 5.69 010 

51020 ......... ............ A Incise & treat bladder .................................. 6.70 NA 3.98 0.51 NA 11.19 090 

51030 ......... ............ A Incise & treat bladder .................................. 6.76 NA 4.09 0.51 NA 11.36 090 

51040 ......... ............ A Incise & drain bladder .................................. 4.39 NA 2.87 0.33 NA 7.59 090 

51045 ......... ............ A Incise bladder/drain ureter ........................... 6.76 NA 4.06 0.57 NA 11.39 090 

51050 ......... ............ A Removal of bladder stone ........................... 6.91 NA 3.75 0.51 NA 11.17 090 

51060 ......... ............ A Removal of ureter stone .............................. 8.84 NA 4.62 0.65 NA 14.11 090 

51065 ......... ............ A Remove ureter calculus ............................... 8.84 NA 4.47 0.64 NA 13.95 090 

51080 ......... ............ A Drainage of bladder abscess ....................... 5.95 NA 3.66 0.42 NA 10.03 090 

51500 ......... ............ A Removal of bladder cyst .............................. 10.12 NA 5.08 1.06 NA 16.26 090 

51520 ......... ............ A Removal of bladder lesion ........................... 9.28 NA 4.79 0.70 NA 14.77 090 

51525 ......... ............ A Removal of bladder lesion ........................... 13.95 NA 6.25 1.03 NA 21.23 090 

51530 ......... ............ A Removal of bladder lesion ........................... 12.36 NA 5.87 0.99 NA 19.22 090 

51535 ......... ............ A Repair of ureter lesion ................................. 12.55 NA 6.23 1.09 NA 19.87 090 

51550 ......... ............ A Partial removal of bladder ........................... 15.64 NA 6.86 1.27 NA 23.77 090 

51555 ......... ............ A Partial removal of bladder ........................... 21.20 NA 8.81 1.65 NA 31.66 090 

51565 ......... ............ A Revise bladder & ureter(s) .......................... 21.59 NA 9.12 1.69 NA 32.40 090 

51570 ......... ............ A Removal of bladder ..................................... 24.20 NA 9.94 1.92 NA 36.06 090 

51575 ......... ............ A Removal of bladder & nodes ....................... 30.40 NA 12.26 2.27 NA 44.93 090 

51580 ......... ............ A Remove bladder/revise tract ........................ 31.03 NA 12.73 2.34 NA 46.10 090 

51585 ......... ............ A Removal of bladder & nodes ....................... 35.18 NA 13.93 2.63 NA 51.74 090 

51590 ......... ............ A Remove bladder/revise tract ........................ 32.61 NA 12.84 2.42 NA 47.87 090 

51595 ......... ............ A Remove bladder/revise tract ........................ 37.08 NA 14.36 2.69 NA 54.13 090 

51596 ......... ............ A Remove bladder/create pouch .................... 39.46 NA 15.47 2.88 NA 57.81 090 

51597 ......... ............ A Removal of pelvic structures ....................... 38.29 NA 15.07 3.00 NA 56.36 090 

51600 ......... ............ A Injection for bladder x-ray ............................ 0.88 5.85 0.29 0.05 6.78 1.22 000 

51605 ......... ............ A Preparation for bladder xray ........................ 0.64 10.80 0.35 0.05 11.49 1.04 000 

51610 ......... ............ A Injection for bladder x-ray ............................ 1.05 1.72 0.60 0.06 2.83 1.71 000 

51700 ......... ............ A Irrigation of bladder ...................................... 0.88 1.65 0.28 0.06 2.59 1.22 000 

51701 ......... ............ A Insert bladder catheter ................................. 0.50 1.64 0.19 0.04 2.18 0.73 000 

51702 ......... ............ A Insert temp bladder cath .............................. 0.50 2.34 0.26 0.04 2.88 0.80 000 

51703 ......... ............ A Insert bladder cath, complex ....................... 1.47 3.05 0.57 0.11 4.63 2.15 000 

51705 ......... ............ A Change of bladder tube ............................... 1.02 2.34 0.61 0.07 3.43 1.70 010 

51710 ......... ............ A Change of bladder tube ............................... 1.49 3.43 0.77 0.11 5.03 2.37 010 

51715 ......... ............ A Endoscopic injection/implant ....................... 3.73 4.01 1.35 0.29 8.03 5.37 000 

51720 ......... ............ A Treatment of bladder lesion ......................... 1.96 1.79 0.71 0.14 3.89 2.81 000 

51725 ......... ............ A Simple cystometrogram ............................... 1.51 5.77 NA 0.16 7.44 NA 000 

51725 ......... 26 ....... A Simple cystometrogram ............................... 1.51 0.49 0.49 0.12 2.12 2.12 000 

51725 ......... TC ...... A Simple cystometrogram ............................... 0.00 5.28 NA 0.04 5.32 NA 000 

51726 ......... ............ A Complex cystometrogram ............................ 1.71 7.84 NA 0.18 9.73 NA 000 

51726 ......... 26 ....... A Complex cystometrogram ............................ 1.71 0.56 0.56 0.13 2.40 2.40 000 

51726 ......... TC ...... A Complex cystometrogram ............................ 0.00 7.28 NA 0.05 7.33 NA 000 

51736 ......... ............ A Urine flow measurement .............................. 0.61 0.58 NA 0.06 1.25 NA 000 

51736 ......... 26 ....... A Urine flow measurement .............................. 0.61 0.20 0.20 0.05 0.86 0.86 000 

51736 ......... TC ...... A Urine flow measurement .............................. 0.00 0.38 NA 0.01 0.39 NA 000 

51741 ......... ............ A Electro-uroflowmetry, first ............................ 1.14 0.80 NA 0.10 2.04 NA 000 

51741 ......... 26 ....... A Electro-uroflowmetry, first ............................ 1.14 0.37 0.37 0.08 1.59 1.59 000 

51741 ......... TC ...... A Electro-uroflowmetry, first ............................ 0.00 0.43 NA 0.02 0.45 NA 000 

51772 ......... ............ A Urethra pressure profile ............................... 1.61 5.78 NA 0.19 7.58 NA 000 

51772 ......... 26 ....... A Urethra pressure profile ............................... 1.61 0.55 0.55 0.14 2.30 2.30 000 

51772 ......... TC ...... A Urethra pressure profile ............................... 0.00 5.23 NA 0.05 5.28 NA 000 

51784 ......... ............ A Anal/urinary muscle study ........................... 1.53 4.11 NA 0.16 5.80 NA 000 

51784 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.12 2.15 2.15 000 

51784 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 3.61 NA 0.04 3.65 NA 000 

51785 ......... ............ A Anal/urinary muscle study ........................... 1.53 4.62 NA 0.15 6.30 NA 000 

1170

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

51785 ......... 26 ....... A Anal/urinary muscle study ........................... 1.53 0.50 0.50 0.11 2.14 2.14 000 

51785 ......... TC ...... A Anal/urinary muscle study ........................... 0.00 4.12 NA 0.04 4.16 NA 000 

51792 ......... ............ A Urinary reflex study ...................................... 1.10 5.98 NA 0.24 7.32 NA 000 

51792 ......... 26 ....... A Urinary reflex study ...................................... 1.10 0.41 0.41 0.11 1.62 1.62 000 

51792 ......... TC ...... A Urinary reflex study ...................................... 0.00 5.57 NA 0.13 5.70 NA 000 

51795 ......... ............ A Urine voiding pressure study ....................... 1.53 7.62 NA 0.22 9.37 NA 000 

51795 ......... 26 ....... A Urine voiding pressure study ....................... 1.53 0.50 0.50 0.12 2.15 2.15 000 

51795 ......... TC ...... A Urine voiding pressure study ....................... 0.00 7.12 NA 0.10 7.22 NA 000 

51797 ......... ............ A Intraabdominal pressure test ....................... 1.60 5.95 NA 0.17 7.72 NA 000 

51797 ......... 26 ....... A Intraabdominal pressure test ....................... 1.60 0.52 0.52 0.12 2.24 2.24 000 

51797 ......... TC ...... A Intraabdominal pressure test ....................... 0.00 5.43 NA 0.05 5.48 NA 000 

51798 ......... ............ A Us urine capacity measure .......................... 0.00 0.36 NA 0.08 0.44 NA XXX 

51800 ......... ............ A Revision of bladder/urethra ......................... 17.39 NA 7.69 1.41 NA 26.49 090 

51820 ......... ............ A Revision of urinary tract ............................... 17.86 NA 8.46 1.75 NA 28.07 090 

51840 ......... ............ A Attach bladder/urethra ................................. 10.69 NA 5.57 1.05 NA 17.31 090 

51841 ......... ............ A Attach bladder/urethra ................................. 13.01 NA 6.37 1.25 NA 20.63 090 

51845 ......... ............ A Repair bladder neck .................................... 9.72 NA 4.87 0.75 NA 15.34 090 

51860 ......... ............ A Repair of bladder wound ............................. 12.00 NA 5.90 1.07 NA 18.97 090 

51865 ......... ............ A Repair of bladder wound ............................. 15.02 NA 6.83 1.22 NA 23.07 090 

51880 ......... ............ A Repair of bladder opening ........................... 7.65 NA 4.07 0.65 NA 12.37 090 

51900 ......... ............ A Repair bladder/vagina lesion ....................... 12.95 NA 6.22 1.05 NA 20.22 090 

51920 ......... ............ A Close bladder-uterus fistula ......................... 11.79 NA 5.75 1.04 NA 18.58 090 

51925 ......... ............ A Hysterectomy/bladder repair ........................ 15.56 NA 8.62 1.79 NA 25.97 090 

51940 ......... ............ A Correction of bladder defect ........................ 28.39 NA 12.36 2.38 NA 43.13 090 

51960 ......... ............ A Revision of bladder & bowel ........................ 22.98 NA 9.87 1.70 NA 34.55 090 

51980 ......... ............ A Construct bladder opening .......................... 11.34 NA 5.49 0.89 NA 17.72 090 

51990 ......... ............ A Laparo urethral suspension ......................... 12.48 NA 6.18 1.23 NA 19.89 090 

51992 ......... ............ A Laparo sling operation ................................. 13.99 NA 6.24 1.12 NA 21.35 090 

52000 ......... ............ A Cystoscopy .................................................. 2.01 3.38 0.76 0.14 5.53 2.91 000 

52001 ......... ............ A Cystoscopy, removal of clots ....................... 5.44 5.18 1.87 0.39 11.01 7.70 000 

52005 ......... ............ A Cystoscopy & ureter catheter ...................... 2.37 5.98 0.90 0.18 8.53 3.45 000 

52007 ......... ............ A Cystoscopy and biopsy ................................ 3.02 NA 1.15 0.22 NA 4.39 000 

52010 ......... ............ A Cystoscopy & duct catheter ......................... 3.02 NA 1.13 0.22 NA 4.37 000 

52204 ......... ............ A Cystoscopy .................................................. 2.37 3.63 0.91 0.18 6.18 3.46 000 

52214 ......... ............ A Cystoscopy and treatment ........................... 3.70 NA 1.33 0.27 NA 5.30 000 

52224 ......... ............ A Cystoscopy and treatment ........................... 3.14 NA 1.15 0.22 NA 4.51 000 

52234 ......... ............ A Cystoscopy and treatment ........................... 4.62 NA 1.63 0.33 NA 6.58 000 

52235 ......... ............ A Cystoscopy and treatment ........................... 5.44 NA 1.90 0.39 NA 7.73 000 

52240 ......... ............ A Cystoscopy and treatment ........................... 9.71 NA 3.30 0.70 NA 13.71 000 

52250 ......... ............ A Cystoscopy and radiotracer ......................... 4.49 NA 1.66 0.33 NA 6.48 000 

52260 ......... ............ A Cystoscopy and treatment ........................... 3.91 NA 1.43 0.28 NA 5.62 000 

52265 ......... ............ A Cystoscopy and treatment ........................... 2.94 3.75 1.12 0.22 6.91 4.28 000 

52270 ......... ............ A Cystoscopy & revise urethra ....................... 3.36 NA 1.25 0.24 NA 4.85 000 

52275 ......... ............ A Cystoscopy & revise urethra ....................... 4.69 NA 1.67 0.34 NA 6.70 000 

52276 ......... ............ A Cystoscopy and treatment ........................... 4.99 NA 1.79 0.36 NA 7.14 000 

52277 ......... ............ A Cystoscopy and treatment ........................... 6.16 NA 2.26 0.46 NA 8.88 000 

52281 ......... ............ A Cystoscopy and treatment ........................... 2.80 7.43 1.08 0.21 10.44 4.09 000 

52282 ......... ............ A Cystoscopy, implant stent ............................ 6.39 NA 2.24 0.46 NA 9.09 000 

52283 ......... ............ A Cystoscopy and treatment ........................... 3.73 4.03 1.39 0.27 8.03 5.39 000 

52285 ......... ............ A Cystoscopy and treatment ........................... 3.60 4.10 1.34 0.27 7.97 5.21 000 

52290 ......... ............ A Cystoscopy and treatment ........................... 4.58 NA 1.66 0.33 NA 6.57 000 

52300 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.91 0.39 NA 7.60 000 

52301 ......... ............ A Cystoscopy and treatment ........................... 5.50 NA 2.00 0.47 NA 7.97 000 

52305 ......... ............ A Cystoscopy and treatment ........................... 5.30 NA 1.86 0.37 NA 7.53 000 

52310 ......... ............ A Cystoscopy and treatment ........................... 2.81 3.53 1.04 0.21 6.55 4.06 000 

52315 ......... ............ A Cystoscopy and treatment ........................... 5.20 NA 1.84 0.37 NA 7.41 000 

52317 ......... ............ A Remove bladder stone ................................ 6.71 NA 2.28 0.48 NA 9.47 000 

52318 ......... ............ A Remove bladder stone ................................ 9.18 NA 3.10 0.65 NA 12.93 000 

52320 ......... ............ A Cystoscopy and treatment ........................... 4.69 NA 1.64 0.34 NA 6.67 000 

52325 ......... ............ A Cystoscopy, stone removal ......................... 6.15 NA 2.11 0.45 NA 8.71 000 

52327 ......... ............ A Cystoscopy, inject material .......................... 5.18 NA 1.83 0.39 NA 7.40 000 

52330 ......... ............ A Cystoscopy and treatment ........................... 5.03 NA 1.76 0.36 NA 7.15 000 

52332 ......... ............ A Cystoscopy and treatment ........................... 2.83 NA 1.06 0.21 NA 4.10 000 

52334 ......... ............ A Create passage to kidney ............................ 4.82 NA 1.76 0.34 NA 6.92 000 

52341 ......... ............ A Cysto w/ureter stricture tx ............................ 5.99 NA 2.22 0.45 NA 8.66 000 

52342 ......... ............ A Cysto w/up stricture tx ................................. 6.49 NA 2.35 0.48 NA 9.32 000 

52343 ......... ............ A Cysto w/renal stricture tx ............................. 7.19 NA 2.59 0.53 NA 10.31 000 

52344 ......... ............ A Cysto/uretero, stone remove ....................... 7.69 NA 2.80 0.57 NA 11.06 000 

52345 ......... ............ A Cysto/uretero w/up stricture ......................... 8.19 NA 2.96 0.60 NA 11.75 000 

52346 ......... ............ A Cystouretero w/renal strict ........................... 9.22 NA 3.29 0.69 NA 13.20 000 

52347 ......... ............ A Cystoscopy, resect ducts ............................. 5.27 NA 1.71 0.40 NA 7.38 000 

52351 ......... ............ A Cystouretero & or pyeloscope ..................... 5.85 NA 2.14 0.43 NA 8.42 000 

52352 ......... ............ A Cystouretero w/stone remove ...................... 6.87 NA 2.51 0.51 NA 9.89 000 

52353 ......... ............ A Cystouretero w/lithotripsy ............................ 7.96 NA 2.86 0.59 NA 11.41 000 

52354 ......... ............ A Cystouretero w/biopsy ................................. 7.33 NA 2.67 0.54 NA 10.54 000 

1171

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

52355 ......... ............ A Cystouretero w/excise tumor ....................... 8.81 NA 3.15 0.66 NA 12.62 000 

52400 ......... ............ A Cystouretero w/congen repr ........................ 9.67 NA 3.78 0.72 NA 14.17 090 

52450 ......... ............ A Incision of prostate ...................................... 7.63 NA 3.71 0.55 NA 11.89 090 

52500 ......... ............ A Revision of bladder neck ............................. 8.46 NA 3.96 0.60 NA 13.02 090 

52510 ......... ............ A Dilation prostatic urethra .............................. 6.71 NA 3.14 0.48 NA 10.33 090 

52601 ......... ............ A Prostatectomy (TURP) ................................. 12.35 NA 5.15 0.89 NA 18.39 090 

52606 ......... ............ A Control postop bleeding ............................... 8.12 NA 3.58 0.59 NA 12.29 090 

52612 ......... ............ A Prostatectomy, first stage ............................ 7.97 NA 3.77 0.58 NA 12.32 090 

52614 ......... ............ A Prostatectomy, second stage ...................... 6.83 NA 3.38 0.49 NA 10.70 090 

52620 ......... ............ A Remove residual prostate ............................ 6.60 NA 3.01 0.47 NA 10.08 090 

52630 ......... ............ A Remove prostate regrowth .......................... 7.25 NA 3.22 0.52 NA 10.99 090 

52640 ......... ............ A Relieve bladder contracture ......................... 6.61 NA 2.98 0.47 NA 10.06 090 

52647 ......... ............ A Laser surgery of prostate ............................ 10.34 76.71 4.57 0.74 87.79 15.65 090 

52648 ......... ............ A Laser surgery of prostate ............................ 11.19 NA 4.84 0.80 NA 16.83 090 

52700 ......... ............ A Drainage of prostate abscess ...................... 6.79 NA 3.21 0.49 NA 10.49 090 

53000 ......... ............ A Incision of urethra ........................................ 2.28 NA 1.57 0.16 NA 4.01 010 

53010 ......... ............ A Incision of urethra ........................................ 3.63 NA 3.02 0.24 NA 6.89 090 

53020 ......... ............ A Incision of urethra ........................................ 1.77 3.10 0.67 0.13 5.00 2.57 000 

53025 ......... ............ A Incision of urethra ........................................ 1.13 3.87 0.51 0.08 5.08 1.72 000 

53040 ......... ............ A Drainage of urethra abscess ....................... 6.39 11.28 6.33 0.49 18.16 13.21 090 

53060 ......... ............ A Drainage of urethra abscess ....................... 2.63 NA 1.45 0.28 NA 4.36 010 

53080 ......... ............ A Drainage of urinary leakage ........................ 6.28 NA 6.17 0.51 NA 12.96 090 

53085 ......... ............ A Drainage of urinary leakage ........................ 10.25 NA 7.63 0.81 NA 18.69 090 

53200 ......... ............ A Biopsy of urethra ......................................... 2.59 4.29 0.98 0.21 7.09 3.78 000 

53210 ......... ............ A Removal of urethra ...................................... 12.55 NA 5.98 0.98 NA 19.51 090 

53215 ......... ............ A Removal of urethra ...................................... 15.56 NA 6.77 1.12 NA 23.45 090 

53220 ......... ............ A Treatment of urethra lesion ......................... 6.99 NA 3.84 0.53 NA 11.36 090 

53230 ......... ............ A Removal of urethra lesion ........................... 9.57 NA 4.84 0.72 NA 15.13 090 

53235 ......... ............ A Removal of urethra lesion ........................... 10.12 NA 5.02 0.72 NA 15.86 090 

53240 ......... ............ A Surgery for urethra pouch ........................... 6.44 NA 3.64 0.51 NA 10.59 090 

53250 ......... ............ A Removal of urethra gland ............................ 5.88 NA 3.38 0.42 NA 9.68 090 

53260 ......... ............ A Treatment of urethra lesion ......................... 2.98 3.28 1.80 0.28 6.54 5.06 010 

53265 ......... ............ A Treatment of urethra lesion ......................... 3.12 NA 1.84 0.24 NA 5.20 010 

53270 ......... ............ A Removal of urethra gland ............................ 3.09 NA 1.87 0.25 NA 5.21 010 

53275 ......... ............ A Repair of urethra defect ............................... 4.52 NA 2.28 0.34 NA 7.14 010 

53400 ......... ............ A Revise urethra, stage 1 ............................... 12.75 NA 6.10 1.03 NA 19.88 090 

53405 ......... ............ A Revise urethra, stage 2 ............................... 14.46 NA 6.45 1.10 NA 22.01 090 

53410 ......... ............ A Reconstruction of urethra ............................ 16.42 NA 7.20 1.19 NA 24.81 090 

53415 ......... ............ A Reconstruction of urethra ............................ 19.38 NA 7.47 1.40 NA 28.25 090 

53420 ......... ............ A Reconstruct urethra, stage 1 ....................... 14.06 NA 6.45 1.09 NA 21.60 090 

53425 ......... ............ A Reconstruct urethra, stage 2 ....................... 15.96 NA 7.05 1.17 NA 24.18 090 

53430 ......... ............ A Reconstruction of urethra ............................ 16.32 NA 7.13 1.22 NA 24.67 090 

53431 ......... ............ A Reconstruct urethra/bladder ........................ 19.86 NA 8.17 1.57 NA 29.60 090 

53440 ......... ............ A Male sling procedure ................................... 13.60 NA 6.04 0.88 NA 20.52 090 

53442 ......... ............ A Remove/revise male sling ........................... 11.55 NA 5.51 0.66 NA 17.72 090 

53444 ......... ............ A Insert tandem cuff ........................................ 13.38 NA 5.91 1.06 NA 20.35 090 

53445 ......... ............ A Insert uro/ves nck sphincter ........................ 14.04 NA 7.26 1.01 NA 22.31 090 

53446 ......... ............ A Remove uro sphincter ................................. 10.21 NA 5.27 0.81 NA 16.29 090 

53447 ......... ............ A Remove/replace ur sphincter ....................... 13.47 NA 6.48 0.95 NA 20.90 090 

53448 ......... ............ A Remov/replc ur sphinctr comp ..................... 21.12 NA 9.13 1.68 NA 31.93 090 

53449 ......... ............ A Repair uro sphincter .................................... 9.69 NA 4.85 0.69 NA 15.23 090 

53450 ......... ............ A Revision of urethra ...................................... 6.13 NA 3.40 0.45 NA 9.98 090 

53460 ......... ............ A Revision of urethra ...................................... 7.11 NA 3.82 0.52 NA 11.45 090 

53500 ......... ............ A Urethrlys, transvag w/ scope ....................... 12.19 NA 6.19 0.89 NA 19.27 090 

53502 ......... ............ A Repair of urethra injury ................................ 7.62 NA 4.11 0.60 NA 12.33 090 

53505 ......... ............ A Repair of urethra injury ................................ 7.62 NA 3.99 0.55 NA 12.16 090 

53510 ......... ............ A Repair of urethra injury ................................ 10.09 NA 5.29 0.72 NA 16.10 090 

53515 ......... ............ A Repair of urethra injury ................................ 13.29 NA 6.05 1.00 NA 20.34 090 

53520 ......... ............ A Repair of urethra defect ............................... 8.67 NA 4.60 0.64 NA 13.91 090 

53600 ......... ............ A Dilate urethra stricture ................................. 1.21 1.17 0.43 0.08 2.46 1.72 000 

53601 ......... ............ A Dilate urethra stricture ................................. 0.98 1.30 0.38 0.07 2.35 1.43 000 

53605 ......... ............ A Dilate urethra stricture ................................. 1.28 NA 0.41 0.10 NA 1.79 000 

53620 ......... ............ A Dilate urethra stricture ................................. 1.62 2.04 0.60 0.12 3.78 2.34 000 

53621 ......... ............ A Dilate urethra stricture ................................. 1.35 2.13 0.50 0.10 3.58 1.95 000 

53660 ......... ............ A Dilation of urethra ........................................ 0.71 1.34 0.33 0.05 2.10 1.09 000 

53661 ......... ............ A Dilation of urethra ........................................ 0.72 1.34 0.30 0.05 2.11 1.07 000 

53665 ......... ............ A Dilation of urethra ........................................ 0.76 NA 0.26 0.06 NA 1.08 000 

53850 ......... ............ A Prostatic microwave thermotx ..................... 9.44 97.84 4.30 0.68 107.96 14.42 090 

53852 ......... ............ A Prostatic rf thermotx .................................... 9.87 93.04 4.69 0.70 103.61 15.26 090 

53853 ......... ............ A Prostatic water thermother .......................... 5.23 57.88 3.18 0.33 63.44 8.74 090 

53899 ......... ............ C Urology surgery procedure .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54000 ......... ............ A Slitting of prepuce ........................................ 1.54 NA 1.33 0.12 NA 2.99 010 

54001 ......... ............ A Slitting of prepuce ........................................ 2.19 4.30 1.51 0.17 6.66 3.87 010 

54015 ......... ............ A Drain penis lesion ........................................ 5.31 NA 2.59 0.40 NA 8.30 010 

54050 ......... ............ A Destruction, penis lesion(s) ......................... 1.24 1.69 1.05 0.08 3.01 2.37 010 

1172

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

54055 ......... ............ A Destruction, penis lesion(s) ......................... 1.22 1.60 0.80 0.08 2.90 2.10 010 

54056 ......... ............ A Cryosurgery, penis lesion(s) ........................ 1.24 2.48 1.35 0.07 3.79 2.66 010 

54057 ......... ............ A Laser surg, penis lesion(s) .......................... 1.24 NA 0.87 0.10 NA 2.21 010 

54060 ......... ............ A Excision of penis lesion(s) ........................... 1.93 3.88 1.45 0.14 5.95 3.52 010 

54065 ......... ............ A Destruction, penis lesion(s) ......................... 2.42 NA 1.72 0.16 NA 4.30 010 

54100 ......... ............ A Biopsy of penis ............................................ 1.90 2.87 0.82 0.12 4.89 2.84 000 

54105 ......... ............ A Biopsy of penis ............................................ 3.49 NA 1.96 0.25 NA 5.70 010 

54110 ......... ............ A Treatment of penis lesion ............................ 10.11 NA 5.64 0.72 NA 16.47 090 

54111 ......... ............ A Treat penis lesion, graft ............................... 13.55 NA 6.69 0.95 NA 21.19 090 

54112 ......... ............ A Treat penis lesion, graft ............................... 15.84 NA 7.69 1.13 NA 24.66 090 

54115 ......... ............ A Treatment of penis lesion ............................ 6.14 8.53 4.47 0.47 15.14 11.08 090 

54120 ......... ............ A Partial removal of penis ............................... 9.96 NA 5.60 0.72 NA 16.28 090 

54125 ......... ............ A Removal of penis ......................................... 13.51 NA 6.75 0.98 NA 21.24 090 

54130 ......... ............ A Remove penis & nodes ............................... 20.11 NA 9.10 1.44 NA 30.65 090 

54135 ......... ............ A Remove penis & nodes ............................... 26.32 NA 11.10 1.91 NA 39.33 090 

54150 ......... ............ A Circumcision ................................................ 1.81 NA 0.97 0.21 NA 2.99 010 

54152 ......... ............ A Circumcision ................................................ 2.31 NA 1.20 0.19 NA 3.70 010 

54160 ......... ............ A Circumcision ................................................ 2.48 NA 1.11 0.19 NA 3.78 010 

54161 ......... ............ A Circumcision ................................................ 3.27 NA 1.57 0.24 NA 5.08 010 

54162 ......... ............ A Lysis penil circumic lesion ........................... 3.00 NA 2.00 0.24 NA 5.24 010 

54163 ......... ............ A Repair of circumcision ................................. 3.00 NA 2.01 0.24 NA 5.25 010 

54164 ......... ............ A Frenulotomy of penis ................................... 2.50 NA 1.85 0.19 NA 4.54 010 

54200 ......... ............ A Treatment of penis lesion ............................ 1.06 1.85 0.99 0.07 2.98 2.12 010 

54205 ......... ............ A Treatment of penis lesion ............................ 7.92 NA 4.83 0.57 NA 13.32 090 

54220 ......... ............ A Treatment of penis lesion ............................ 2.42 3.94 0.96 0.18 6.54 3.56 000 

54230 ......... ............ A Prepare penis study ..................................... 1.34 1.12 0.62 0.10 2.56 2.06 000 

54231 ......... ............ A Dynamic cavernosometry ............................ 2.04 1.40 0.87 0.17 3.61 3.08 000 

54235 ......... ............ A Penile injection ............................................. 1.19 0.98 0.58 0.08 2.25 1.85 000 

54240 ......... ............ A Penis study .................................................. 1.31 1.01 NA 0.16 2.48 NA 000 

54240 ......... 26 ....... A Penis study .................................................. 1.31 0.42 0.42 0.10 1.83 1.83 000 

54240 ......... TC ...... A Penis study .................................................. 0.00 0.59 NA 0.06 0.65 NA 000 

54250 ......... ............ A Penis study .................................................. 2.22 0.93 NA 0.19 3.34 NA 000 

54250 ......... 26 ....... A Penis study .................................................. 2.22 0.71 0.71 0.17 3.10 3.10 000 

54250 ......... TC ...... A Penis study .................................................. 0.00 0.22 NA 0.02 0.24 NA 000 

54300 ......... ............ A Revision of penis ......................................... 10.39 NA 5.75 0.77 NA 16.91 090 

54304 ......... ............ A Revision of penis ......................................... 12.47 NA 6.54 0.89 NA 19.90 090 

54308 ......... ............ A Reconstruction of urethra ............................ 11.81 NA 6.17 0.84 NA 18.82 090 

54312 ......... ............ A Reconstruction of urethra ............................ 13.55 NA 7.20 0.98 NA 21.73 090 

54316 ......... ............ A Reconstruction of urethra ............................ 16.79 NA 8.15 1.21 NA 26.15 090 

54318 ......... ............ A Reconstruction of urethra ............................ 11.23 NA 6.00 1.39 NA 18.62 090 

54322 ......... ............ A Reconstruction of urethra ............................ 12.99 NA 6.63 0.93 NA 20.55 090 

54324 ......... ............ A Reconstruction of urethra ............................ 16.29 NA 8.22 1.24 NA 25.75 090 

54326 ......... ............ A Reconstruction of urethra ............................ 15.70 NA 8.00 1.12 NA 24.82 090 

54328 ......... ............ A Revise penis/urethra .................................... 15.63 NA 7.45 1.11 NA 24.19 090 

54332 ......... ............ A Revise penis/urethra .................................... 17.05 NA 7.93 1.22 NA 26.20 090 

54336 ......... ............ A Revise penis/urethra .................................... 20.01 NA 10.71 2.29 NA 33.01 090 

54340 ......... ............ A Secondary urethral surgery ......................... 8.90 NA 5.25 0.87 NA 15.02 090 

54344 ......... ............ A Secondary urethral surgery ......................... 15.92 NA 7.97 1.33 NA 25.22 090 

54348 ......... ............ A Secondary urethral surgery ......................... 17.12 NA 8.60 1.23 NA 26.95 090 

54352 ......... ............ A Reconstruct urethra/penis ............................ 24.70 NA 11.50 1.95 NA 38.15 090 

54360 ......... ............ A Penis plastic surgery ................................... 11.91 NA 6.19 0.87 NA 18.97 090 

54380 ......... ............ A Repair penis ................................................. 13.16 NA 6.83 1.40 NA 21.39 090 

54385 ......... ............ A Repair penis ................................................. 15.37 NA 8.49 0.86 NA 24.72 090 

54390 ......... ............ A Repair penis and bladder ............................ 21.58 NA 9.61 1.54 NA 32.73 090 

54400 ......... ............ A Insert semi-rigid prosthesis .......................... 8.98 NA 4.47 0.64 NA 14.09 090 

54401 ......... ............ A Insert self-contd prosthesis .......................... 10.26 NA 5.83 0.74 NA 16.83 090 

54405 ......... ............ A Insert multi-comp penis pros ....................... 13.41 NA 6.06 0.96 NA 20.43 090 

54406 ......... ............ A Remove muti-comp penis pros .................... 12.08 NA 5.46 0.90 NA 18.44 090 

54408 ......... ............ A Repair multi-comp penis pros ...................... 12.73 NA 5.77 0.95 NA 19.45 090 

54410 ......... ............ A Remove/replace penis prosth ...................... 15.48 NA 6.66 1.16 NA 23.30 090 

54411 ......... ............ A Remov/replc penis pros, comp .................... 15.98 NA 7.09 0.96 NA 24.03 090 

54415 ......... ............ A Remove self-contd penis pros ..................... 8.19 NA 4.22 0.65 NA 13.06 090 

54416 ......... ............ A Remv/repl penis contain pros ...................... 10.85 NA 5.41 0.66 NA 16.92 090 

54417 ......... ............ A Remv/replc penis pros, compl ..................... 14.17 NA 6.21 0.66 NA 21.04 090 

54420 ......... ............ A Revision of penis ......................................... 11.40 NA 5.71 0.87 NA 17.98 090 

54430 ......... ............ A Revision of penis ......................................... 10.13 NA 5.25 0.72 NA 16.10 090 

54435 ......... ............ A Revision of penis ......................................... 6.11 NA 3.73 0.43 NA 10.27 090 

54440 ......... ............ C Repair of penis ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 090 

54450 ......... ............ A Preputial stretching ...................................... 1.12 1.11 0.47 0.08 2.31 1.67 000 

54500 ......... ............ A Biopsy of testis ............................................ 1.31 0.61 0.56 0.10 2.02 1.97 000 

54505 ......... ............ A Biopsy of testis ............................................ 3.45 NA 1.93 0.25 NA 5.63 010 

54512 ......... ............ A Excise lesion testis ...................................... 8.57 NA 4.15 0.68 NA 13.40 090 

54520 ......... ............ A Removal of testis ......................................... 5.22 NA 2.85 0.40 NA 8.47 090 

54522 ......... ............ A Orchiectomy, partial ..................................... 9.49 NA 4.91 0.75 NA 15.15 090 

54530 ......... ............ A Removal of testis ......................................... 8.57 NA 4.31 0.64 NA 13.52 090 

1173

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

54535 ......... ............ A Extensive testis surgery ............................... 12.14 NA 5.66 1.00 NA 18.80 090 

54550 ......... ............ A Exploration for testis .................................... 7.77 NA 3.90 0.59 NA 12.26 090 

54560 ......... ............ A Exploration for testis .................................... 11.11 NA 5.28 0.95 NA 17.34 090 

54600 ......... ............ A Reduce testis torsion ................................... 7.00 NA 3.61 0.54 NA 11.15 090 

54620 ......... ............ A Suspension of testis .................................... 4.89 NA 2.47 0.37 NA 7.73 010 

54640 ......... ............ A Suspension of testis .................................... 6.89 NA 3.80 0.59 NA 11.28 090 

54650 ......... ............ A Orchiopexy (Fowler-Stephens) .................... 11.43 NA 5.52 0.98 NA 17.93 090 

54660 ......... ............ A Revision of testis ......................................... 5.10 NA 3.05 0.42 NA 8.57 090 

54670 ......... ............ A Repair testis injury ....................................... 6.40 NA 3.61 0.49 NA 10.50 090 

54680 ......... ............ A Relocation of testis(es) ................................ 12.63 NA 6.29 1.13 NA 20.05 090 

54690 ......... ............ A Laparoscopy, orchiectomy ........................... 10.94 NA 5.06 1.19 NA 17.19 090 

54692 ......... ............ A Laparoscopy, orchiopexy ............................. 12.86 NA 5.45 1.05 NA 19.36 090 

54699 ......... ............ C Laparoscope proc, testis ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

54700 ......... ............ A Drainage of scrotum .................................... 3.42 NA 1.95 0.28 NA 5.65 010 

54800 ......... ............ A Biopsy of epididymis .................................... 2.33 0.95 0.90 0.17 3.45 3.40 000 

54820 ......... ............ A Exploration of epididymis ............................. 5.13 NA 3.00 0.40 NA 8.53 090 

54830 ......... ............ A Remove epididymis lesion ........................... 5.37 NA 3.08 0.41 NA 8.86 090 

54840 ......... ............ A Remove epididymis lesion ........................... 5.19 NA 2.84 0.37 NA 8.40 090 

54860 ......... ............ A Removal of epididymis ................................ 6.31 NA 3.37 0.46 NA 10.14 090 

54861 ......... ............ A Removal of epididymis ................................ 8.89 NA 4.38 0.63 NA 13.90 090 

54900 ......... ............ A Fusion of spermatic ducts ........................... 13.18 NA 5.86 1.62 NA 20.66 090 

54901 ......... ............ A Fusion of spermatic ducts ........................... 17.91 NA 7.56 2.21 NA 27.68 090 

55000 ......... ............ A Drainage of hydrocele ................................. 1.43 2.11 0.65 0.12 3.66 2.20 000 

55040 ......... ............ A Removal of hydrocele .................................. 5.35 NA 2.96 0.42 NA 8.73 090 

55041 ......... ............ A Removal of hydroceles ................................ 7.73 NA 4.04 0.60 NA 12.37 090 

55060 ......... ............ A Repair of hydrocele ..................................... 5.51 NA 3.13 0.45 NA 9.09 090 

55100 ......... ............ A Drainage of scrotum abscess ...................... 2.13 3.77 1.59 0.18 6.08 3.90 010 

55110 ......... ............ A Explore scrotum ........................................... 5.69 NA 3.18 0.43 NA 9.30 090 

55120 ......... ............ A Removal of scrotum lesion .......................... 5.08 5.76 2.98 0.40 11.24 8.46 090 

55150 ......... ............ A Removal of scrotum ..................................... 7.21 NA 3.96 0.57 NA 11.74 090 

55175 ......... ............ A Revision of scrotum ..................................... 5.23 NA 3.06 0.40 NA 8.69 090 

55180 ......... ............ A Revision of scrotum ..................................... 10.70 NA 5.46 0.87 NA 17.03 090 

55200 ......... ............ A Incision of sperm duct ................................. 4.23 5.53 2.41 0.30 10.06 6.94 090 

55250 ......... ............ A Removal of sperm duct(s) ........................... 3.29 9.07 2.78 0.25 12.61 6.32 090 

55300 ......... ............ A Prepare, sperm duct x-ray ........................... 3.50 NA 1.31 0.24 NA 5.05 000 

55400 ......... ............ A Repair of sperm duct ................................... 8.48 NA 4.17 0.60 NA 13.25 090 

55450 ......... ............ A Ligation of sperm duct ................................. 4.11 7.21 1.87 0.29 11.61 6.27 010 

55500 ......... ............ A Removal of hydrocele .................................. 5.58 NA 3.15 0.52 NA 9.25 090 

55520 ......... ............ A Removal of sperm cord lesion ..................... 6.02 NA 3.31 0.68 NA 10.01 090 

55530 ......... ............ A Revise spermatic cord veins ....................... 5.65 NA 3.07 0.43 NA 9.15 090 

55535 ......... ............ A Revise spermatic cord veins ....................... 6.55 NA 3.45 0.51 NA 10.51 090 

55540 ......... ............ A Revise hernia & sperm veins ...................... 7.66 NA 3.86 0.89 NA 12.41 090 

55550 ......... ............ A Laparo ligate spermatic vein ....................... 6.56 NA 3.32 0.57 NA 10.45 090 

55559 ......... ............ C Laparo proc, spermatic cord ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55600 ......... ............ A Incise sperm duct pouch ............................. 6.37 NA 3.39 0.46 NA 10.22 090 

55605 ......... ............ A Incise sperm duct pouch ............................. 7.95 NA 4.36 0.65 NA 12.96 090 

55650 ......... ............ A Remove sperm duct pouch ......................... 11.78 NA 5.35 0.87 NA 18.00 090 

55680 ......... ............ A Remove sperm pouch lesion ....................... 5.18 NA 3.03 0.37 NA 8.58 090 

55700 ......... ............ A Biopsy of prostate ........................................ 1.57 4.33 0.71 0.12 6.02 2.40 000 

55705 ......... ............ A Biopsy of prostate ........................................ 4.56 NA 2.32 0.31 NA 7.19 010 

55720 ......... ............ A Drainage of prostate abscess ...................... 7.63 NA 3.95 0.53 NA 12.11 090 

55725 ......... ............ A Drainage of prostate abscess ...................... 8.67 NA 4.62 0.62 NA 13.91 090 

55801 ......... ............ A Removal of prostate .................................... 17.77 NA 7.38 1.30 NA 26.45 090 

55810 ......... ............ A Extensive prostate surgery .......................... 22.55 NA 8.71 1.63 NA 32.89 090 

55812 ......... ............ A Extensive prostate surgery .......................... 27.47 NA 11.14 2.04 NA 40.65 090 

55815 ......... ............ A Extensive prostate surgery .......................... 30.41 NA 12.07 2.22 NA 44.70 090 

55821 ......... ............ A Removal of prostate .................................... 14.23 NA 6.32 1.03 NA 21.58 090 

55831 ......... ............ A Removal of prostate .................................... 15.60 NA 6.77 1.13 NA 23.50 090 

55840 ......... ............ A Extensive prostate surgery .......................... 22.66 NA 9.44 1.65 NA 33.75 090 

55842 ......... ............ A Extensive prostate surgery .......................... 24.34 NA 10.01 1.79 NA 36.14 090 

55845 ......... ............ A Extensive prostate surgery .......................... 28.51 NA 11.11 2.06 NA 41.68 090 

55859 ......... ............ A Percut/needle insert, pros ............................ 12.50 NA 5.91 0.89 NA 19.30 090 

55860 ......... ............ A Surgical exposure, prostate ......................... 14.43 NA 6.44 0.99 NA 21.86 090 

55862 ......... ............ A Extensive prostate surgery .......................... 18.36 NA 7.96 1.37 NA 27.69 090 

55865 ......... ............ A Extensive prostate surgery .......................... 22.84 NA 9.38 1.65 NA 33.87 090 

55866 ......... ............ A Laparo radical prostatectomy ...................... 30.69 NA 11.81 1.65 NA 44.15 090 

55870 ......... ............ A Electroejaculation ......................................... 2.58 1.54 1.09 0.17 4.29 3.84 000 

55873 ......... ............ A Cryoablate prostate ..................................... 19.44 NA 9.02 1.23 NA 29.69 090 

55899 ......... ............ C Genital surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

55970 ......... ............ N Sex transformation, M to F .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

55980 ......... ............ N Sex transformation, F to M .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

56405 ......... ............ A I & D of vulva/perineum ............................... 1.44 1.33 1.15 0.17 2.94 2.76 010 

56420 ......... ............ A Drainage of gland abscess .......................... 1.39 2.29 1.09 0.16 3.84 2.64 010 

56440 ......... ............ A Surgery for vulva lesion ............................... 2.84 NA 1.71 0.34 NA 4.89 010 

56441 ......... ............ A Lysis of labial lesion(s) ................................ 1.97 1.83 1.42 0.21 4.01 3.60 010 

1174

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

56501 ......... ............ A Destroy, vulva lesions, sim .......................... 1.53 1.79 1.25 0.18 3.50 2.96 010 

56515 ......... ............ A Destroy vulva lesion/s compl ....................... 2.76 2.55 1.81 0.22 5.53 4.79 010 

56605 ......... ............ A Biopsy of vulva/perineum ............................ 1.10 1.09 0.46 0.13 2.32 1.69 000 

56606 ......... ............ A Biopsy of vulva/perineum ............................ 0.55 0.49 0.22 0.07 1.11 0.84 ZZZ 

56620 ......... ............ A Partial removal of vulva ............................... 7.46 NA 4.84 0.92 NA 13.22 090 

56625 ......... ............ A Complete removal of vulva .......................... 8.39 NA 5.39 1.01 NA 14.79 090 

56630 ......... ............ A Extensive vulva surgery ............................... 12.34 NA 6.96 1.48 NA 20.78 090 

56631 ......... ............ A Extensive vulva surgery ............................... 16.18 NA 8.96 1.97 NA 27.11 090 

56632 ......... ............ A Extensive vulva surgery ............................... 20.26 NA 9.62 2.45 NA 32.33 090 

56633 ......... ............ A Extensive vulva surgery ............................... 16.45 NA 8.70 2.00 NA 27.15 090 

56634 ......... ............ A Extensive vulva surgery ............................... 17.85 NA 9.59 2.15 NA 29.59 090 

56637 ......... ............ A Extensive vulva surgery ............................... 21.94 NA 11.23 2.63 NA 35.80 090 

56640 ......... ............ A Extensive vulva surgery ............................... 22.14 NA 10.80 2.73 NA 35.67 090 

56700 ......... ............ A Partial removal of hymen ............................. 2.52 NA 1.73 0.29 NA 4.54 010 

56720 ......... ............ A Incision of hymen ......................................... 0.68 NA 0.39 0.08 NA 1.15 000 

56740 ......... ............ A Remove vagina gland lesion ....................... 4.56 NA 2.47 0.45 NA 7.48 010 

56800 ......... ............ A Repair of vagina .......................................... 3.88 NA 2.19 0.45 NA 6.52 010 

56805 ......... ............ A Repair clitoris ............................................... 18.83 NA 9.43 2.20 NA 30.46 090 

56810 ......... ............ A Repair of perineum ...................................... 4.12 NA 2.30 0.49 NA 6.91 010 

56820 ......... ............ A Exam of vulva w/scope ................................ 1.50 1.34 0.63 0.12 2.96 2.25 000 

56821 ......... ............ A Exam/biopsy of vulva w/scope .................... 2.05 1.78 0.90 0.16 3.99 3.11 000 

57000 ......... ............ A Exploration of vagina ................................... 2.97 NA 1.73 0.34 NA 5.04 010 

57010 ......... ............ A Drainage of pelvic abscess ......................... 6.02 NA 3.85 0.69 NA 10.56 090 

57020 ......... ............ A Drainage of pelvic fluid ................................ 1.50 0.95 0.59 0.18 2.63 2.27 000 

57022 ......... ............ A I & d vaginal hematoma, pp ........................ 2.56 NA 1.50 0.29 NA 4.35 010 

57023 ......... ............ A I & d vag hematoma, non-ob ....................... 4.74 NA 2.59 0.29 NA 7.62 010 

57061 ......... ............ A Destroy vag lesions, simple ......................... 1.25 1.66 1.12 0.16 3.07 2.53 010 

57065 ......... ............ A Destroy vag lesions, complex ...................... 2.61 2.30 1.68 0.31 5.22 4.60 010 

57100 ......... ............ A Biopsy of vagina .......................................... 1.20 1.10 0.48 0.12 2.42 1.80 000 

57105 ......... ............ A Biopsy of vagina .......................................... 1.69 1.93 1.32 0.21 3.83 3.22 010 

57106 ......... ............ A Remove vagina wall, partial ........................ 6.35 NA 4.20 0.70 NA 11.25 090 

57107 ......... ............ A Remove vagina tissue, part ......................... 22.97 NA 10.50 2.62 NA 36.09 090 

57109 ......... ............ A Vaginectomy partial w/nodes ....................... 26.96 NA 11.34 2.38 NA 40.68 090 

57110 ......... ............ A Remove vagina wall, complete .................... 14.27 NA 7.31 1.72 NA 23.30 090 

57111 ......... ............ A Remove vagina tissue, compl ..................... 26.96 NA 12.64 3.27 NA 42.87 090 

57112 ......... ............ A Vaginectomy w/nodes, compl ...................... 28.96 NA 12.19 2.64 NA 43.79 090 

57120 ......... ............ A Closure of vagina ......................................... 7.40 NA 4.64 0.90 NA 12.94 090 

57130 ......... ............ A Remove vagina lesion ................................. 2.43 2.17 1.55 0.28 4.88 4.26 010 

57135 ......... ............ A Remove vagina lesion ................................. 2.67 2.27 1.66 0.31 5.25 4.64 010 

57150 ......... ............ A Treat vagina infection .................................. 0.55 1.11 0.22 0.07 1.73 0.84 000 

57155 ......... ............ A Insert uteri tandems/ovoids ......................... 6.26 NA 4.17 0.71 NA 11.14 090 

57160 ......... ............ A Insert pessary/other device ......................... 0.89 1.09 0.38 0.11 2.09 1.38 000 

57170 ......... ............ A Fitting of diaphragm/cap .............................. 0.91 1.49 0.34 0.11 2.51 1.36 000 

57180 ......... ............ A Treat vaginal bleeding ................................. 1.58 2.18 1.29 0.19 3.95 3.06 010 

57200 ......... ............ A Repair of vagina .......................................... 3.93 NA 2.91 0.46 NA 7.30 090 

57210 ......... ............ A Repair vagina/perineum ............................... 5.16 NA 3.44 0.60 NA 9.20 090 

57220 ......... ............ A Revision of urethra ...................................... 4.30 NA 3.12 0.51 NA 7.93 090 

57230 ......... ............ A Repair of urethral lesion .............................. 5.63 NA 3.42 0.60 NA 9.65 090 

57240 ......... ............ A Repair bladder & vagina .............................. 6.06 NA 3.84 0.64 NA 10.54 090 

57250 ......... ............ A Repair rectum & vagina ............................... 5.52 NA 3.59 0.65 NA 9.76 090 

57260 ......... ............ A Repair of vagina .......................................... 8.26 NA 4.86 1.00 NA 14.12 090 

57265 ......... ............ A Extensive repair of vagina ........................... 11.32 NA 6.06 1.37 NA 18.75 090 

57268 ......... ............ A Repair of bowel bulge .................................. 6.75 NA 4.21 0.80 NA 11.76 090 

57270 ......... ............ A Repair of bowel pouch ................................. 12.09 NA 6.28 1.41 NA 19.78 090 

57280 ......... ............ A Suspension of vagina .................................. 15.02 NA 7.39 1.74 NA 24.15 090 

57282 ......... ............ A Repair of vaginal prolapse ........................... 8.85 NA 5.32 1.04 NA 15.21 090 

57284 ......... ............ A Repair paravaginal defect ............................ 12.68 NA 7.17 1.41 NA 21.26 090 

57287 ......... ............ A Revise/remove sling repair .......................... 10.69 NA 5.52 0.89 NA 17.10 090 

57288 ......... ............ A Repair bladder defect .................................. 13.00 NA 5.95 1.04 NA 19.99 090 

57289 ......... ............ A Repair bladder & vagina .............................. 11.56 NA 6.07 1.15 NA 18.78 090 

57291 ......... ............ A Construction of vagina ................................. 7.94 NA 4.96 0.94 NA 13.84 090 

57292 ......... ............ A Construct vagina with graft .......................... 13.07 NA 6.98 1.56 NA 21.61 090 

57300 ......... ............ A Repair rectum-vagina fistula ........................ 7.60 NA 4.30 0.84 NA 12.74 090 

57305 ......... ............ A Repair rectum-vagina fistula ........................ 13.75 NA 6.30 1.60 NA 21.65 090 

57307 ......... ............ A Fistula repair & colostomy ........................... 15.91 NA 7.07 1.92 NA 24.90 090 

57308 ......... ............ A Fistula repair, transperine ............................ 9.93 NA 5.15 1.10 NA 16.18 090 

57310 ......... ............ A Repair urethrovaginal lesion ........................ 6.77 NA 3.90 0.54 NA 11.21 090 

57311 ......... ............ A Repair urethrovaginal lesion ........................ 7.97 NA 4.18 0.62 NA 12.77 090 

57320 ......... ............ A Repair bladder-vagina lesion ....................... 8.00 NA 4.43 0.72 NA 13.15 090 

57330 ......... ............ A Repair bladder-vagina lesion ....................... 12.33 NA 5.78 1.04 NA 19.15 090 

57335 ......... ............ A Repair vagina ............................................... 18.70 NA 9.10 2.00 NA 29.80 090 

57400 ......... ............ A Dilation of vagina ......................................... 2.27 NA 1.13 0.27 NA 3.67 000 

57410 ......... ............ A Pelvic examination ....................................... 1.75 2.02 0.89 0.17 3.94 2.81 000 

57415 ......... ............ A Remove vaginal foreign body ...................... 2.17 NA 1.43 0.23 NA 3.83 010 

57420 ......... ............ A Exam of vagina w/scope ............................. 1.60 1.38 0.67 0.12 3.10 2.39 000 

1175

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

57421 ......... ............ A Exam/biopsy of vag w/scope ....................... 2.20 1.87 0.96 0.16 4.23 3.32 000 

57425 ......... ............ A Laparoscopy, surg, colpopexy ..................... 15.73 NA 6.69 1.74 NA 24.16 090 

57452 ......... ............ A Exam of cervix w/scope ............................... 1.50 1.40 0.63 0.12 3.02 2.25 000 

57454 ......... ............ A Bx/curett of cervix w/scope .......................... 2.33 1.76 1.00 0.16 4.25 3.49 000 

57455 ......... ............ A Biopsy of cervix w/scope ............................. 1.99 1.75 0.87 0.16 3.90 3.02 000 

57456 ......... ............ A Endocerv curettage w/scope ....................... 1.85 1.68 0.82 0.16 3.69 2.83 000 

57460 ......... ............ A Bx of cervix w/scope, leep ........................... 2.83 6.03 1.22 0.34 9.20 4.39 000 

57461 ......... ............ A Conz of cervix w/scope, leep ...................... 3.43 6.30 1.41 0.34 10.07 5.18 000 

57500 ......... ............ A Biopsy of cervix ........................................... 0.97 2.66 0.47 0.12 3.75 1.56 000 

57505 ......... ............ A Endocervical curettage ................................ 1.14 1.47 1.10 0.14 2.75 2.38 010 

57510 ......... ............ A Cauterization of cervix ................................. 1.90 1.57 1.05 0.22 3.69 3.17 010 

57511 ......... ............ A Cryocautery of cervix ................................... 1.90 1.84 1.38 0.22 3.96 3.50 010 

57513 ......... ............ A Laser surgery of cervix ................................ 1.90 1.87 1.41 0.23 4.00 3.54 010 

57520 ......... ............ A Conization of cervix ..................................... 4.03 4.88 2.77 0.49 9.40 7.29 090 

57522 ......... ............ A Conization of cervix ..................................... 3.35 4.35 2.67 0.41 8.11 6.43 090 

57530 ......... ............ A Removal of cervix ........................................ 4.78 NA 3.43 0.58 NA 8.79 090 

57531 ......... ............ A Removal of cervix, radical ........................... 27.96 NA 13.23 2.97 NA 44.16 090 

57540 ......... ............ A Removal of residual cervix .......................... 12.20 NA 6.27 1.46 NA 19.93 090 

57545 ......... ............ A Remove cervix/repair pelvis ........................ 13.01 NA 6.70 1.57 NA 21.28 090 

57550 ......... ............ A Removal of residual cervix .......................... 5.52 NA 3.86 0.66 NA 10.04 090 

57555 ......... ............ A Remove cervix/repair vagina ....................... 8.94 NA 5.14 1.07 NA 15.15 090 

57556 ......... ............ A Remove cervix, repair bowel ....................... 8.36 NA 4.88 0.96 NA 14.20 090 

57700 ......... ............ A Revision of cervix ........................................ 3.54 NA 3.10 0.40 NA 7.04 090 

57720 ......... ............ A Revision of cervix ........................................ 4.12 NA 3.15 0.49 NA 7.76 090 

57800 ......... ............ A Dilation of cervical canal .............................. 0.77 0.76 0.47 0.10 1.63 1.34 000 

57820 ......... ............ A D & c of residual cervix ............................... 1.67 1.49 1.14 0.21 3.37 3.02 010 

58100 ......... ............ A Biopsy of uterus lining ................................. 1.53 1.33 0.72 0.08 2.94 2.33 000 

58120 ......... ............ A Dilation and curettage .................................. 3.27 2.31 1.87 0.40 5.98 5.54 010 

58140 ......... ............ A Myomectomy abdom method ...................... 14.58 NA 7.13 1.76 NA 23.47 090 

58145 ......... ............ A Myomectomy vag method ........................... 8.03 NA 4.84 0.96 NA 13.83 090 

58146 ......... ............ A Myomectomy abdom complex ..................... 18.97 NA 8.79 1.76 NA 29.52 090 

58150 ......... ............ A Total hysterectomy ...................................... 15.22 NA 7.52 1.89 NA 24.63 090 

58152 ......... ............ A Total hysterectomy ...................................... 20.57 NA 9.89 1.83 NA 32.29 090 

58180 ......... ............ A Partial hysterectomy .................................... 15.27 NA 7.49 1.86 NA 24.62 090 

58200 ......... ............ A Extensive hysterectomy ............................... 21.56 NA 10.05 2.59 NA 34.20 090 

58210 ......... ............ A Extensive hysterectomy ............................... 28.81 NA 13.27 3.51 NA 45.59 090 

58240 ......... ............ A Removal of pelvis contents ......................... 38.33 NA 17.72 4.53 NA 60.58 090 

58260 ......... ............ A Vaginal hysterectomy .................................. 12.96 NA 6.72 1.48 NA 21.16 090 

58262 ......... ............ A Vag hyst including t/o .................................. 14.75 NA 7.40 1.71 NA 23.86 090 

58263 ......... ............ A Vag hyst w/t/o & vag repair ......................... 16.04 NA 7.90 1.87 NA 25.81 090 

58267 ......... ............ A Vag hyst w/urinary repair ............................. 17.01 NA 8.42 1.82 NA 27.25 090 

58270 ......... ............ A Vag hyst w/enterocele repair ....................... 14.24 NA 7.10 1.65 NA 22.99 090 

58275 ......... ............ A Hysterectomy/revise vagina ......................... 15.74 NA 7.80 1.82 NA 25.36 090 

58280 ......... ............ A Hysterectomy/revise vagina ......................... 16.98 NA 8.28 1.86 NA 27.12 090 

58285 ......... ............ A Extensive hysterectomy ............................... 22.23 NA 10.02 2.27 NA 34.52 090 

58290 ......... ............ A Vag hyst complex ........................................ 18.97 NA 8.92 1.48 NA 29.37 090 

58291 ......... ............ A Vag hyst incl t/o, complex ........................... 20.76 NA 9.89 1.71 NA 32.36 090 

58292 ......... ............ A Vag hyst t/o & repair, compl ........................ 22.05 NA 10.40 1.87 NA 34.32 090 

58293 ......... ............ A Vag hyst w/uro repair, compl ....................... 23.03 NA 10.91 1.82 NA 35.76 090 

58294 ......... ............ A Vag hyst w/enterocele, compl ..................... 20.25 NA 9.68 1.65 NA 31.58 090 

58300 ......... ............ N Insert intrauterine device ............................. +1.01 1.42 0.38 0.12 2.55 1.51 XXX 

58301 ......... ............ A Remove intrauterine device ......................... 1.27 1.33 0.48 0.16 2.76 1.91 000 

58321 ......... ............ A Artificial insemination ................................... 0.92 1.15 0.37 0.12 2.19 1.41 000 

58322 ......... ............ A Artificial insemination ................................... 1.10 1.21 0.41 0.13 2.44 1.64 000 

58323 ......... ............ A Sperm washing ............................................ 0.23 0.24 0.09 0.02 0.49 0.34 000 

58340 ......... ............ A Catheter for hysterography .......................... 0.88 6.08 0.65 0.10 7.06 1.63 000 

58345 ......... ............ A Reopen fallopian tube .................................. 4.65 NA 2.44 0.43 NA 7.52 010 

58346 ......... ............ A Insert heyman uteri capsule ........................ 6.74 NA 3.93 0.77 NA 11.44 090 

58350 ......... ............ A Reopen fallopian tube .................................. 1.01 1.50 0.93 0.12 2.63 2.06 010 

58353 ......... ............ A Endometr ablate, thermal ............................ 3.55 36.26 2.05 0.45 40.26 6.05 010 

58400 ......... ............ A Suspension of uterus ................................... 6.35 NA 3.97 0.75 NA 11.07 090 

58410 ......... ............ A Suspension of uterus ................................... 12.71 NA 6.48 1.31 NA 20.50 090 

58520 ......... ............ A Repair of ruptured uterus ............................ 11.90 NA 6.07 1.41 NA 19.38 090 

58540 ......... ............ A Revision of uterus ........................................ 14.62 NA 6.98 1.54 NA 23.14 090 

58545 ......... ............ A Laparoscopic myomectomy ......................... 14.58 NA 7.19 1.75 NA 23.52 090 

58546 ......... ............ A Laparo-myomectomy, complex .................... 18.97 NA 8.98 1.75 NA 29.70 090 

58550 ......... ............ A Laparo-asst vag hysterectomy .................... 14.17 NA 7.31 1.74 NA 23.22 090 

58552 ......... ............ A Laparo-vag hyst incl t/o ............................... 15.98 NA 8.02 1.74 NA 25.74 090 

58553 ......... ............ A Laparo-vag hyst, complex ........................... 18.97 NA 8.97 1.48 NA 29.42 090 

58554 ......... ............ A Laparo-vag hyst w/t/o, compl ...................... 21.97 NA 10.46 1.48 NA 33.91 090 

58555 ......... ............ A Hysteroscopy, dx, sep proc ......................... 3.33 2.10 1.46 0.41 5.84 5.20 000 

58558 ......... ............ A Hysteroscopy, biopsy ................................... 4.74 NA 2.06 0.59 NA 7.39 000 

58559 ......... ............ A Hysteroscopy, lysis ...................................... 6.16 NA 2.62 0.75 NA 9.53 000 

58560 ......... ............ A Hysteroscopy, resect septum ...................... 6.99 NA 2.97 0.86 NA 10.82 000 

58561 ......... ............ A Hysteroscopy, remove myoma .................... 9.99 NA 4.18 1.23 NA 15.40 000 

1176

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

58562 ......... ............ A Hysteroscopy, remove fb ............................. 5.20 NA 2.21 0.63 NA 8.04 000 

58563 ......... ............ A Hysteroscopy, ablation ................................ 6.16 NA 2.63 0.75 NA 9.54 000 

58578 ......... ............ C Laparo proc, uterus ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58579 ......... ............ C Hysteroscope procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58600 ......... ............ A Division of fallopian tube ............................. 5.59 NA 3.36 0.47 NA 9.42 090 

58605 ......... ............ A Division of fallopian tube ............................. 4.99 NA 3.15 0.40 NA 8.54 090 

58611 ......... ............ A Ligate oviduct(s) add-on .............................. 1.45 NA 0.57 0.08 NA 2.10 ZZZ 

58615 ......... ............ A Occlude fallopian tube(s) ............................. 3.89 NA 2.72 0.48 NA 7.09 010 

58660 ......... ............ A Laparoscopy, lysis ....................................... 11.27 NA 5.28 1.37 NA 17.92 090 

58661 ......... ............ A Laparoscopy, remove adnexa ..................... 11.03 NA 5.14 1.35 NA 17.52 010 

58662 ......... ............ A Laparoscopy, excise lesions ........................ 11.77 NA 5.80 1.42 NA 18.99 090 

58670 ......... ............ A Laparoscopy, tubal cautery ......................... 5.59 NA 3.28 0.66 NA 9.53 090 

58671 ......... ............ A Laparoscopy, tubal block ............................. 5.59 NA 3.30 0.68 NA 9.57 090 

58672 ......... ............ A Laparoscopy, fimbrioplasty .......................... 12.86 NA 6.23 1.47 NA 20.56 090 

58673 ......... ............ A Laparoscopy, salpingostomy ....................... 13.72 NA 6.63 1.69 NA 22.04 090 

58679 ......... ............ C Laparo proc, oviduct-ovary .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

58700 ......... ............ A Removal of fallopian tube ............................ 12.03 NA 6.01 0.77 NA 18.81 090 

58720 ......... ............ A Removal of ovary/tube(s) ............................ 11.34 NA 5.81 1.37 NA 18.52 090 

58740 ......... ............ A Revise fallopian tube(s) ............................... 13.98 NA 7.16 0.71 NA 21.85 090 

58750 ......... ............ A Repair oviduct .............................................. 14.82 NA 7.41 1.83 NA 24.06 090 

58752 ......... ............ A Revise ovarian tube(s) ................................. 14.82 NA 6.99 1.82 NA 23.63 090 

58760 ......... ............ A Remove tubal obstruction ............................ 13.11 NA 6.75 1.62 NA 21.48 090 

58770 ......... ............ A Create new tubal opening ........................... 13.95 NA 6.95 1.71 NA 22.61 090 

58800 ......... ............ A Drainage of ovarian cyst(s) ......................... 4.13 4.49 2.99 0.43 9.05 7.55 090 

58805 ......... ............ A Drainage of ovarian cyst(s) ......................... 5.87 NA 3.55 0.68 NA 10.10 090 

58820 ......... ............ A Drain ovary abscess, open .......................... 4.21 NA 3.34 0.35 NA 7.90 090 

58822 ......... ............ A Drain ovary abscess, percut ........................ 10.11 NA 5.24 1.11 NA 16.46 090 

58823 ......... ............ A Drain pelvic abscess, percut ....................... 3.37 NA 1.12 0.22 NA 4.71 000 

58825 ......... ............ A Transposition, ovary(s) ................................ 10.96 NA 5.82 0.75 NA 17.53 090 

58900 ......... ............ A Biopsy of ovary(s) ........................................ 5.98 NA 3.61 0.68 NA 10.27 090 

58920 ......... ............ A Partial removal of ovary(s) .......................... 11.34 NA 5.62 0.82 NA 17.78 090 

58925 ......... ............ A Removal of ovarian cyst(s) .......................... 11.34 NA 5.71 1.37 NA 18.42 090 

58940 ......... ............ A Removal of ovary(s) .................................... 7.28 NA 4.13 0.88 NA 12.29 090 

58943 ......... ............ A Removal of ovary(s) .................................... 18.40 NA 8.75 2.24 NA 29.39 090 

58950 ......... ............ A Resect ovarian malignancy ......................... 16.90 NA 8.50 1.87 NA 27.27 090 

58951 ......... ............ A Resect ovarian malignancy ......................... 22.35 NA 10.55 2.65 NA 35.55 090 

58952 ......... ............ A Resect ovarian malignancy ......................... 24.97 NA 11.85 3.10 NA 39.92 090 

58953 ......... ............ A Tah, rad dissect for debulk .......................... 31.95 NA 14.61 3.98 NA 50.54 090 

58954 ......... ............ A Tah rad debulk/lymph remove ..................... 34.95 NA 15.77 4.29 NA 55.01 090 

58960 ......... ............ A Exploration of abdomen ............................... 14.63 NA 7.45 1.77 NA 23.85 090 

58970 ......... ............ A Retrieval of oocyte ....................................... 3.52 2.32 1.50 0.43 6.27 5.45 000 

58974 ......... ............ C Transfer of embryo ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

58976 ......... ............ A Transfer of embryo ...................................... 3.82 2.64 1.83 0.47 6.93 6.12 000 

58999 ......... ............ C Genital surgery procedure ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59000 ......... ............ A Amniocentesis, diagnostic ........................... 1.30 2.10 0.69 0.28 3.68 2.27 000 

59001 ......... ............ A Amniocentesis, therapeutic .......................... 3.00 NA 1.41 0.28 NA 4.69 000 

59012 ......... ............ A Fetal cord puncture,prenatal ........................ 3.44 NA 1.56 0.75 NA 5.75 000 

59015 ......... ............ A Chorion biopsy ............................................. 2.20 1.57 1.06 0.48 4.25 3.74 000 

59020 ......... ............ A Fetal contract stress test ............................. 0.66 0.79 NA 0.24 1.69 NA 000 

59020 ......... 26 ....... A Fetal contract stress test ............................. 0.66 0.27 0.27 0.14 1.07 1.07 000 

59020 ......... TC ...... A Fetal contract stress test ............................. 0.00 0.52 NA 0.10 0.62 NA 000 

59025 ......... ............ A Fetal non-stress test .................................... 0.53 0.45 NA 0.14 1.12 NA 000 

59025 ......... 26 ....... A Fetal non-stress test .................................... 0.53 0.21 0.21 0.12 0.86 0.86 000 

59025 ......... TC ...... A Fetal non-stress test .................................... 0.00 0.24 NA 0.02 0.26 NA 000 

59030 ......... ............ A Fetal scalp blood sample ............................. 1.99 NA 1.05 0.43 NA 3.47 000 

59050 ......... ............ A Fetal monitor w/report .................................. 0.89 NA 0.36 0.19 NA 1.44 XXX 

59051 ......... ............ A Fetal monitor/interpret only .......................... 0.74 NA 0.30 0.17 NA 1.21 XXX 

59070 ......... ............ A Transabdom amnioinfus w/ us .................... 5.24 5.12 2.41 0.28 10.64 7.93 000 

59072 ......... ............ A Umbilical cord occlud w/ us ......................... 8.99 NA 3.13 0.68 NA 12.80 000 

59074 ......... ............ A Fetal fluid drainage w/ us ............................ 5.24 4.61 2.41 0.28 10.13 7.93 000 

59076 ......... ............ A Fetal shunt placement, w/ us ...................... 8.99 NA 3.13 0.68 NA 12.80 000 

59100 ......... ............ A Remove uterus lesion .................................. 12.33 NA 6.48 2.67 NA 21.48 090 

59120 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.27 2.48 NA 20.22 090 

59121 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.35 2.52 NA 20.52 090 

59130 ......... ............ A Treat ectopic pregnancy .............................. 14.20 NA 4.99 3.06 NA 22.25 090 

59135 ......... ............ A Treat ectopic pregnancy .............................. 13.86 NA 7.25 3.00 NA 24.11 090 

59136 ......... ............ A Treat ectopic pregnancy .............................. 13.16 NA 6.64 2.85 NA 22.65 090 

59140 ......... ............ A Treat ectopic pregnancy .............................. 5.45 5.20 3.59 1.18 11.83 10.22 090 

59150 ......... ............ A Treat ectopic pregnancy .............................. 11.65 NA 6.05 1.48 NA 19.18 090 

59151 ......... ............ A Treat ectopic pregnancy .............................. 11.47 NA 6.09 1.70 NA 19.26 090 

59160 ......... ............ A D & c after delivery ...................................... 2.71 3.27 2.11 0.59 6.57 5.41 010 

59200 ......... ............ A Insert cervical dilator .................................... 0.79 1.20 0.31 0.18 2.17 1.28 000 

59300 ......... ............ A Episiotomy or vaginal repair ........................ 2.41 2.16 0.96 0.52 5.09 3.89 000 

59320 ......... ............ A Revision of cervix ........................................ 2.48 NA 1.26 0.54 NA 4.28 000 

59325 ......... ............ A Revision of cervix ........................................ 4.06 NA 1.92 0.88 NA 6.86 000 

1177

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

59350 ......... ............ A Repair of uterus ........................................... 4.94 NA 1.95 1.06 NA 7.95 000 

59400 ......... ............ A Obstetrical care ............................................ 23.03 NA 15.48 4.99 NA 43.50 MMM 

59409 ......... ............ A Obstetrical care ............................................ 13.48 NA 5.32 2.92 NA 21.72 MMM 

59410 ......... ............ A Obstetrical care ............................................ 14.76 NA 6.33 3.20 NA 24.29 MMM 

59412 ......... ............ A Antepartum manipulation ............................. 1.71 NA 0.81 0.37 NA 2.89 MMM 

59414 ......... ............ A Deliver placenta ........................................... 1.61 NA 0.63 0.35 NA 2.59 MMM 

59425 ......... ............ A Antepartum care only .................................. 4.80 4.26 1.87 1.04 10.10 7.71 MMM 

59426 ......... ............ A Antepartum care only .................................. 8.27 7.65 3.23 1.80 17.72 13.30 MMM 

59430 ......... ............ A Care after delivery ....................................... 2.13 1.24 0.94 0.46 3.83 3.53 MMM 

59510 ......... ............ A Cesarean delivery ........................................ 26.18 NA 17.43 5.67 NA 49.28 MMM 

59514 ......... ............ A Cesarean delivery only ................................ 15.95 NA 6.23 3.45 NA 25.63 MMM 

59515 ......... ............ A Cesarean delivery ........................................ 17.34 NA 7.87 3.76 NA 28.97 MMM 

59525 ......... ............ A Remove uterus after cesarean .................... 8.53 NA 3.32 1.85 NA 13.70 ZZZ 

59610 ......... ............ A Vbac delivery ............................................... 24.58 NA 16.03 5.32 NA 45.93 MMM 

59612 ......... ............ A Vbac delivery only ....................................... 15.04 NA 6.07 3.26 NA 24.37 MMM 

59614 ......... ............ A Vbac care after delivery ............................... 16.32 NA 6.96 3.53 NA 26.81 MMM 

59618 ......... ............ A Attempted vbac delivery .............................. 27.74 NA 18.43 6.01 NA 52.18 MMM 

59620 ......... ............ A Attempted vbac delivery only ...................... 17.50 NA 6.78 3.80 NA 28.08 MMM 

59622 ......... ............ A Attempted vbac after care ........................... 18.90 NA 8.67 4.09 NA 31.66 MMM 

59812 ......... ............ A Treatment of miscarriage ............................. 4.00 NA 2.56 0.70 NA 7.26 090 

59820 ......... ............ A Care of miscarriage ..................................... 4.00 NA 3.52 0.87 NA 8.39 090 

59821 ......... ............ A Treatment of miscarriage ............................. 4.46 NA 3.45 0.96 NA 8.87 090 

59830 ......... ............ A Treat uterus infection ................................... 6.10 NA 4.01 1.33 NA 11.44 090 

59840 ......... ............ R Abortion ........................................................ 3.01 NA 2.13 0.65 NA 5.79 010 

59841 ......... ............ R Abortion ........................................................ 5.23 2.58 2.58 1.13 8.94 8.94 010 

59850 ......... ............ R Abortion ........................................................ 5.90 NA 3.27 1.28 NA 10.45 090 

59851 ......... ............ R Abortion ........................................................ 5.92 NA 3.74 1.28 NA 10.94 090 

59852 ......... ............ R Abortion ........................................................ 8.23 NA 5.06 1.79 NA 15.08 090 

59855 ......... ............ R Abortion ........................................................ 6.11 NA 3.56 1.33 NA 11.00 090 

59856 ......... ............ R Abortion ........................................................ 7.47 NA 4.07 1.62 NA 13.16 090 

59857 ......... ............ R Abortion ........................................................ 9.28 NA 4.59 2.00 NA 15.87 090 

59866 ......... ............ R Abortion (mpr) .............................................. 3.99 NA 1.83 0.87 NA 6.69 000 

59870 ......... ............ A Evacuate mole of uterus .............................. 6.00 NA 4.43 0.93 NA 11.36 090 

59871 ......... ............ A Remove cerclage suture .............................. 2.13 1.76 1.13 0.46 4.35 3.72 000 

59897 ......... ............ C Fetal invas px w/ us ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59898 ......... ............ C Laparo proc, ob care/deliver ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

59899 ......... ............ C Maternity care procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60000 ......... ............ A Drain thyroid/tongue cyst ............................. 1.76 2.16 2.04 0.17 4.09 3.97 010 

60001 ......... ............ A Aspirate/inject thyriod cyst ........................... 0.97 1.49 0.34 0.07 2.53 1.38 000 

60100 ......... ............ A Biopsy of thyroid .......................................... 1.56 1.42 0.53 0.06 3.04 2.15 000 

60200 ......... ............ A Remove thyroid lesion ................................. 9.54 NA 6.14 1.01 NA 16.69 090 

60210 ......... ............ A Partial thyroid excision ................................. 10.86 NA 5.78 1.22 NA 17.86 090 

60212 ......... ............ A Partial thyroid excision ................................. 16.01 NA 7.82 1.82 NA 25.65 090 

60220 ......... ............ A Partial removal of thyroid ............................. 11.88 NA 6.30 1.17 NA 19.35 090 

60225 ......... ............ A Partial removal of thyroid ............................. 14.17 NA 7.55 1.58 NA 23.30 090 

60240 ......... ............ A Removal of thyroid ....................................... 16.04 NA 7.75 1.81 NA 25.60 090 

60252 ......... ............ A Removal of thyroid ....................................... 20.54 NA 10.29 1.97 NA 32.80 090 

60254 ......... ............ A Extensive thyroid surgery ............................ 26.95 NA 14.38 2.36 NA 43.69 090 

60260 ......... ............ A Repeat thyroid surgery ................................ 17.44 NA 8.85 1.68 NA 27.97 090 

60270 ......... ............ A Removal of thyroid ....................................... 20.24 NA 10.66 2.15 NA 33.05 090 

60271 ......... ............ A Removal of thyroid ....................................... 16.80 NA 8.78 1.63 NA 27.21 090 

60280 ......... ............ A Remove thyroid duct lesion ......................... 5.86 NA 4.83 0.54 NA 11.23 090 

60281 ......... ............ A Remove thyroid duct lesion ......................... 8.52 NA 5.99 0.81 NA 15.32 090 

60500 ......... ............ A Explore parathyroid glands .......................... 16.21 NA 7.53 1.94 NA 25.68 090 

60502 ......... ............ A Re-explore parathyroids .............................. 20.32 NA 9.49 2.41 NA 32.22 090 

60505 ......... ............ A Explore parathyroid glands .......................... 21.46 NA 11.12 2.58 NA 35.16 090 

60512 ......... ............ A Autotransplant parathyroid ........................... 4.44 NA 1.63 0.53 NA 6.60 ZZZ 

60520 ......... ............ A Removal of thymus gland ............................ 16.78 NA 8.38 2.22 NA 27.38 090 

60521 ......... ............ A Removal of thymus gland ............................ 18.84 NA 9.63 2.82 NA 31.29 090 

60522 ......... ............ A Removal of thymus gland ............................ 23.06 NA 11.35 3.41 NA 37.82 090 

60540 ......... ............ A Explore adrenal gland .................................. 17.00 NA 7.65 1.71 NA 26.36 090 

60545 ......... ............ A Explore adrenal gland .................................. 19.85 NA 8.61 2.11 NA 30.57 090 

60600 ......... ............ A Remove carotid body lesion ........................ 17.90 NA 10.90 2.26 NA 31.06 090 

60605 ......... ............ A Remove carotid body lesion ........................ 20.21 NA 12.79 2.75 NA 35.75 090 

60650 ......... ............ A Laparoscopy adrenalectomy ........................ 19.97 NA 7.99 2.39 NA 30.35 090 

60659 ......... ............ C Laparo proc, endocrine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

60699 ......... ............ C Endocrine surgery procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

61000 ......... ............ A Remove cranial cavity fluid .......................... 1.58 NA 0.96 0.16 NA 2.70 000 

61001 ......... ............ A Remove cranial cavity fluid .......................... 1.49 NA 1.06 0.18 NA 2.73 000 

61020 ......... ............ A Remove brain cavity fluid ............................ 1.51 NA 1.35 0.31 NA 3.17 000 

61026 ......... ............ A Injection into brain canal .............................. 1.69 NA 1.41 0.25 NA 3.35 000 

61050 ......... ............ A Remove brain canal fluid ............................. 1.51 NA 1.26 0.16 NA 2.93 000 

61055 ......... ............ A Injection into brain canal .............................. 2.10 NA 1.42 0.16 NA 3.68 000 

61070 ......... ............ A Brain canal shunt procedure ....................... 0.89 NA 1.03 0.11 NA 2.03 000 

61105 ......... ............ A Twist drill hole .............................................. 5.13 NA 3.95 1.27 NA 10.35 090 

1178

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

61107 ......... ............ A Drill skull for implantation ............................ 4.99 NA 3.32 1.23 NA 9.54 000 

61108 ......... ............ A Drill skull for drainage .................................. 10.17 NA 7.14 2.46 NA 19.77 090 

61120 ......... ............ A Burr hole for puncture .................................. 8.75 NA 6.00 2.18 NA 16.93 090 

61140 ......... ............ A Pierce skull for biopsy ................................. 15.88 NA 9.91 3.80 NA 29.59 090 

61150 ......... ............ A Pierce skull for drainage .............................. 17.54 NA 10.41 4.25 NA 32.20 090 

61151 ......... ............ A Pierce skull for drainage .............................. 12.40 NA 7.85 2.95 NA 23.20 090 

61154 ......... ............ A Pierce skull & remove clot ........................... 14.97 NA 9.50 3.68 NA 28.15 090 

61156 ......... ............ A Pierce skull for drainage .............................. 16.30 NA 9.86 4.12 NA 30.28 090 

61210 ......... ............ A Pierce skull, implant device ......................... 5.83 NA 3.71 1.40 NA 10.94 000 

61215 ......... ............ A Insert brain-fluid device ............................... 4.88 NA 4.02 1.19 NA 10.09 090 

61250 ......... ............ A Pierce skull & explore .................................. 10.40 NA 6.87 2.44 NA 19.71 090 

61253 ......... ............ A Pierce skull & explore .................................. 12.34 NA 7.74 2.73 NA 22.81 090 

61304 ......... ............ A Open skull for exploration ............................ 21.93 NA 12.88 5.22 NA 40.03 090 

61305 ......... ............ A Open skull for exploration ............................ 26.57 NA 15.37 6.33 NA 48.27 090 

61312 ......... ............ A Open skull for drainage ............................... 24.53 NA 15.08 6.02 NA 45.63 090 

61313 ......... ............ A Open skull for drainage ............................... 24.89 NA 14.85 6.11 NA 45.85 090 

61314 ......... ............ A Open skull for drainage ............................... 24.19 NA 13.08 4.82 NA 42.09 090 

61315 ......... ............ A Open skull for drainage ............................... 27.64 NA 16.07 6.78 NA 50.49 090 

61316 ......... ............ A Implt cran bone flap to abdo ....................... 1.39 NA 0.57 0.52 NA 2.48 ZZZ 

61320 ......... ............ A Open skull for drainage ............................... 25.58 NA 14.80 6.27 NA 46.65 090 

61321 ......... ............ A Open skull for drainage ............................... 28.46 NA 16.18 6.45 NA 51.09 090 

61322 ......... ............ A Decompressive craniotomy ......................... 29.46 NA 14.45 6.02 NA 49.93 090 

61323 ......... ............ A Decompressive lobectomy ........................... 30.95 NA 14.64 6.02 NA 51.61 090 

61330 ......... ............ A Decompress eye socket .............................. 23.29 NA 13.80 3.11 NA 40.20 090 

61332 ......... ............ A Explore/biopsy eye socket ........................... 27.24 NA 15.66 5.01 NA 47.91 090 

61333 ......... ............ A Explore orbit/remove lesion ......................... 27.91 NA 15.66 2.70 NA 46.27 090 

61334 ......... ............ A Explore orbit/remove object ......................... 18.24 NA 10.70 3.64 NA 32.58 090 

61340 ......... ............ A Subtemporal decompression ....................... 18.63 NA 11.16 4.41 NA 34.20 090 

61343 ......... ............ A Incise skull (press relief) .............................. 29.73 NA 16.88 7.28 NA 53.89 090 

61345 ......... ............ A Relieve cranial pressure .............................. 27.16 NA 15.47 6.31 NA 48.94 090 

61440 ......... ............ A Incise skull for surgery ................................. 26.59 NA 14.28 6.72 NA 47.59 090 

61450 ......... ............ A Incise skull for surgery ................................. 25.91 NA 14.35 6.16 NA 46.42 090 

61458 ......... ............ A Incise skull for brain wound ......................... 27.25 NA 15.58 6.37 NA 49.20 090 

61460 ......... ............ A Incise skull for surgery ................................. 28.35 NA 16.49 6.19 NA 51.03 090 

61470 ......... ............ A Incise skull for surgery ................................. 26.02 NA 13.91 5.61 NA 45.54 090 

61480 ......... ............ A Incise skull for surgery ................................. 26.45 NA 15.34 6.68 NA 48.47 090 

61490 ......... ............ A Incise skull for surgery ................................. 25.62 NA 14.39 6.48 NA 46.49 090 

61500 ......... ............ A Removal of skull lesion ................................ 17.89 NA 10.85 3.93 NA 32.67 090 

61501 ......... ............ A Remove infected skull bone ........................ 14.82 NA 9.25 3.17 NA 27.24 090 

61510 ......... ............ A Removal of brain lesion ............................... 28.41 NA 16.76 6.96 NA 52.13 090 

61512 ......... ............ A Remove brain lining lesion .......................... 35.04 NA 19.76 8.61 NA 63.41 090 

61514 ......... ............ A Removal of brain abscess ........................... 25.22 NA 14.50 6.18 NA 45.90 090 

61516 ......... ............ A Removal of brain lesion ............................... 24.57 NA 14.33 5.96 NA 44.86 090 

61517 ......... ............ A Implt brain chemotx add-on ......................... 1.38 NA 0.57 0.10 NA 2.05 ZZZ 

61518 ......... ............ A Removal of brain lesion ............................... 37.26 NA 21.20 9.08 NA 67.54 090 

61519 ......... ............ A Remove brain lining lesion .......................... 41.33 NA 22.75 9.83 NA 73.91 090 

61520 ......... ............ A Removal of brain lesion ............................... 54.76 NA 30.46 12.18 NA 97.40 090 

61521 ......... ............ A Removal of brain lesion ............................... 44.41 NA 24.33 10.67 NA 79.41 090 

61522 ......... ............ A Removal of brain abscess ........................... 29.41 NA 16.49 6.39 NA 52.29 090 

61524 ......... ............ A Removal of brain lesion ............................... 27.82 NA 15.74 6.04 NA 49.60 090 

61526 ......... ............ A Removal of brain lesion ............................... 52.09 NA 29.62 8.10 NA 89.81 090 

61530 ......... ............ A Removal of brain lesion ............................... 43.79 NA 25.19 7.44 NA 76.42 090 

61531 ......... ............ A Implant brain electrodes .............................. 14.61 NA 9.17 3.43 NA 27.21 090 

61533 ......... ............ A Implant brain electrodes .............................. 19.68 NA 11.59 4.58 NA 35.85 090 

61534 ......... ............ A Removal of brain lesion ............................... 20.94 NA 12.15 5.01 NA 38.10 090 

61535 ......... ............ A Remove brain electrodes ............................. 11.61 NA 7.46 2.76 NA 21.83 090 

61536 ......... ............ A Removal of brain lesion ............................... 35.47 NA 19.87 8.06 NA 63.40 090 

61537 ......... ............ A Removal of brain tissue ............................... 24.96 NA 14.45 6.49 NA 45.90 090 

61538 ......... ............ A Removal of brain tissue ............................... 26.77 NA 15.38 6.49 NA 48.64 090 

61539 ......... ............ A Removal of brain tissue ............................... 32.03 NA 17.85 7.98 NA 57.86 090 

61540 ......... ............ A Removal of brain tissue ............................... 29.96 NA 17.48 7.98 NA 55.42 090 

61541 ......... ............ A Incision of brain tissue ................................. 28.81 NA 16.28 6.63 NA 51.72 090 

61542 ......... ............ A Removal of brain tissue ............................... 30.97 NA 17.91 7.83 NA 56.71 090 

61543 ......... ............ A Removal of brain tissue ............................... 29.18 NA 16.46 7.37 NA 53.01 090 

61544 ......... ............ A Remove & treat brain lesion ........................ 25.46 NA 13.90 5.92 NA 45.28 090 

61545 ......... ............ A Excision of brain tumor ................................ 43.73 NA 24.33 10.71 NA 78.77 090 

61546 ......... ............ A Removal of pituitary gland ........................... 31.25 NA 17.58 7.31 NA 56.14 090 

61548 ......... ............ A Removal of pituitary gland ........................... 21.50 NA 12.85 4.38 NA 38.73 090 

61550 ......... ............ A Release of skull seams ............................... 14.63 NA 7.01 1.37 NA 23.01 090 

61552 ......... ............ A Release of skull seams ............................... 19.53 NA 9.20 1.06 NA 29.79 090 

61556 ......... ............ A Incise skull/sutures ...................................... 22.23 NA 11.42 4.31 NA 37.96 090 

61557 ......... ............ A Incise skull/sutures ...................................... 22.35 NA 13.68 5.64 NA 41.67 090 

61558 ......... ............ A Excision of skull/sutures .............................. 25.54 NA 14.25 3.15 NA 42.94 090 

61559 ......... ............ A Excision of skull/sutures .............................. 32.74 NA 19.39 8.27 NA 60.40 090 

61563 ......... ............ A Excision of skull tumor ................................. 26.79 NA 15.33 5.38 NA 47.50 090 

1179

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

61564 ......... ............ A Excision of skull tumor ................................. 33.78 NA 18.37 8.54 NA 60.69 090 

61566 ......... ............ A Removal of brain tissue ............................... 30.95 NA 17.42 6.49 NA 54.86 090 

61567 ......... ............ A Incision of brain tissue ................................. 35.45 NA 20.73 6.49 NA 62.67 090 

61570 ......... ............ A Remove foreign body, brain ........................ 24.56 NA 13.97 5.55 NA 44.08 090 

61571 ......... ............ A Incise skull for brain wound ......................... 26.35 NA 15.21 6.31 NA 47.87 090 

61575 ......... ............ A Skull base/brainstem surgery ...................... 34.31 NA 19.74 6.05 NA 60.10 090 

61576 ......... ............ A Skull base/brainstem surgery ...................... 52.35 NA 29.68 5.64 NA 87.67 090 

61580 ......... ............ A Craniofacial approach, skull ........................ 30.30 NA 25.49 3.32 NA 59.11 090 

61581 ......... ............ A Craniofacial approach, skull ........................ 34.55 NA 23.05 4.06 NA 61.66 090 

61582 ......... ............ A Craniofacial approach, skull ........................ 31.61 NA 26.99 7.60 NA 66.20 090 

61583 ......... ............ A Craniofacial approach, skull ........................ 36.16 NA 25.01 8.37 NA 69.54 090 

61584 ......... ............ A Orbitocranial approach/skull ........................ 34.60 NA 24.41 7.88 NA 66.89 090 

61585 ......... ............ A Orbitocranial approach/skull ........................ 38.55 NA 26.46 7.47 NA 72.48 090 

61586 ......... ............ A Resect nasopharynx, skull ........................... 25.06 NA 22.35 4.25 NA 51.66 090 

61590 ......... ............ A Infratemporal approach/skull ....................... 41.72 NA 28.81 5.16 NA 75.69 090 

61591 ......... ............ A Infratemporal approach/skull ....................... 43.61 NA 29.71 6.34 NA 79.66 090 

61592 ......... ............ A Orbitocranial approach/skull ........................ 39.58 NA 26.60 9.11 NA 75.29 090 

61595 ......... ............ A Transtemporal approach/skull ..................... 29.53 NA 22.51 3.68 NA 55.72 090 

61596 ......... ............ A Transcochlear approach/skull ...................... 35.58 NA 24.59 5.13 NA 65.30 090 

61597 ......... ............ A Transcondylar approach/skull ...................... 37.90 NA 23.05 8.02 NA 68.97 090 

61598 ......... ............ A Transpetrosal approach/skull ....................... 33.36 NA 23.35 5.55 NA 62.26 090 

61600 ......... ............ A Resect/excise cranial lesion ........................ 25.81 NA 19.88 3.76 NA 49.45 090 

61601 ......... ............ A Resect/excise cranial lesion ........................ 27.85 NA 20.56 6.38 NA 54.79 090 

61605 ......... ............ A Resect/excise cranial lesion ........................ 29.29 NA 22.16 3.03 NA 54.48 090 

61606 ......... ............ A Resect/excise cranial lesion ........................ 38.77 NA 25.23 8.21 NA 72.21 090 

61607 ......... ............ A Resect/excise cranial lesion ........................ 36.22 NA 23.88 6.86 NA 66.96 090 

61608 ......... ............ A Resect/excise cranial lesion ........................ 42.04 NA 26.67 10.02 NA 78.73 090 

61609 ......... ............ A Transect artery, sinus .................................. 9.88 NA 4.87 2.50 NA 17.25 ZZZ 

61610 ......... ............ A Transect artery, sinus .................................. 29.63 NA 13.19 4.25 NA 47.07 ZZZ 

61611 ......... ............ A Transect artery, sinus .................................. 7.41 NA 3.84 1.87 NA 13.12 ZZZ 

61612 ......... ............ A Transect artery, sinus .................................. 27.84 NA 13.36 4.28 NA 45.48 ZZZ 

61613 ......... ............ A Remove aneurysm, sinus ............................ 40.80 NA 26.34 10.03 NA 77.17 090 

61615 ......... ............ A Resect/excise lesion, skull ........................... 32.02 NA 22.82 5.60 NA 60.44 090 

61616 ......... ............ A Resect/excise lesion, skull ........................... 43.27 NA 28.77 8.47 NA 80.51 090 

61618 ......... ............ A Repair dura .................................................. 16.96 NA 10.51 3.52 NA 30.99 090 

61619 ......... ............ A Repair dura .................................................. 20.68 NA 12.31 4.12 NA 37.11 090 

61623 ......... ............ A Endovasc tempory vessel occl .................... 9.95 NA 4.23 0.60 NA 14.78 000 

61624 ......... ............ A Transcath occlusion, cns ............................. 20.12 NA 6.93 1.39 NA 28.44 000 

61626 ......... ............ A Transcath occlusion, non-cns ...................... 16.60 NA 5.54 1.01 NA 23.15 000 

61680 ......... ............ A Intracranial vessel surgery ........................... 30.66 NA 17.52 7.28 NA 55.46 090 

61682 ......... ............ A Intracranial vessel surgery ........................... 61.48 NA 32.37 15.31 NA 109.16 090 

61684 ......... ............ A Intracranial vessel surgery ........................... 39.75 NA 22.10 9.49 NA 71.34 090 

61686 ......... ............ A Intracranial vessel surgery ........................... 64.39 NA 34.88 15.92 NA 115.19 090 

61690 ......... ............ A Intracranial vessel surgery ........................... 29.27 NA 16.80 6.65 NA 52.72 090 

61692 ......... ............ A Intracranial vessel surgery ........................... 51.79 NA 27.61 12.27 NA 91.67 090 

61697 ......... ............ A Brain aneurysm repr, complx ...................... 50.44 NA 28.13 12.43 NA 91.00 090 

61698 ......... ............ A Brain aneurysm repr, complx ...................... 48.34 NA 26.80 12.05 NA 87.19 090 

61700 ......... ............ A Brain aneurysm repr, simple ....................... 50.44 NA 27.93 12.28 NA 90.65 090 

61702 ......... ............ A Inner skull vessel surgery ............................ 48.34 NA 26.15 11.76 NA 86.25 090 

61703 ......... ............ A Clamp neck artery ....................................... 17.44 NA 10.52 4.37 NA 32.33 090 

61705 ......... ............ A Revise circulation to head ........................... 36.15 NA 19.34 8.04 NA 63.53 090 

61708 ......... ............ A Revise circulation to head ........................... 35.25 NA 15.20 2.63 NA 53.08 090 

61710 ......... ............ A Revise circulation to head ........................... 29.63 NA 13.66 2.92 NA 46.21 090 

61711 ......... ............ A Fusion of skull arteries ................................ 36.28 NA 19.90 8.91 NA 65.09 090 

61720 ......... ............ A Incise skull/brain surgery ............................. 16.74 NA 10.03 4.23 NA 31.00 090 

61735 ......... ............ A Incise skull/brain surgery ............................. 20.40 NA 12.22 5.02 NA 37.64 090 

61750 ......... ............ A Incise skull/brain biopsy ............................... 18.17 NA 10.67 4.47 NA 33.31 090 

61751 ......... ............ A Brain biopsy w/ct/mr guide .......................... 17.59 NA 10.86 4.31 NA 32.76 090 

61760 ......... ............ A Implant brain electrodes .............................. 22.24 NA 8.77 5.54 NA 36.55 090 

61770 ......... ............ A Incise skull for treatment ............................. 21.41 NA 12.31 4.93 NA 38.65 090 

61790 ......... ............ A Treat trigeminal nerve .................................. 10.84 NA 5.95 2.20 NA 18.99 090 

61791 ......... ............ A Treat trigeminal tract .................................... 14.59 NA 8.96 3.65 NA 27.20 090 

61793 ......... ............ A Focus radiation beam .................................. 17.21 NA 10.16 4.23 NA 31.60 090 

61795 ......... ............ A Brain surgery using computer ..................... 4.03 NA 2.04 0.98 NA 7.05 ZZZ 

61850 ......... ............ A Implant neuroelectrodes .............................. 12.37 NA 7.71 2.69 NA 22.77 090 

61860 ......... ............ A Implant neuroelectrodes .............................. 20.84 NA 12.13 4.87 NA 37.84 090 

61862 ......... ............ D Implant neurostimul, subcort ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

61863 ......... ............ A Implant neuroelectrode ................................ 18.97 NA 9.21 4.79 NA 32.97 090 

61864 ......... ............ A Implant neuroelectrde, add’l ........................ 4.49 NA 2.29 1.13 NA 7.91 ZZZ 

61867 ......... ............ A Implant neuroelectrode ................................ 31.29 NA 13.81 4.79 NA 49.89 090 

61868 ......... ............ A Implant neuroelectrde, add’l ........................ 7.91 NA 4.03 1.21 NA 13.15 ZZZ 

61870 ......... ............ A Implant neuroelectrodes .............................. 14.92 NA 9.82 2.05 NA 26.79 090 

61875 ......... ............ A Implant neuroelectrodes .............................. 15.04 NA 8.61 2.92 NA 26.57 090 

61880 ......... ............ A Revise/remove neuroelectrode .................... 6.28 NA 4.60 1.58 NA 12.46 090 

61885 ......... ............ A Implant neurostim one array ........................ 5.84 NA 5.32 1.47 NA 12.63 090 

1180

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

61886 ......... ............ A Implant neurostim arrays ............................. 7.99 NA 6.36 1.98 NA 16.33 090 

61888 ......... ............ A Revise/remove neuroreceiver ...................... 5.06 NA 3.88 1.25 NA 10.19 010 

62000 ......... ............ A Treat skull fracture ....................................... 12.51 NA 5.55 1.05 NA 19.11 090 

62005 ......... ............ A Treat skull fracture ....................................... 16.15 NA 8.83 2.81 NA 27.79 090 

62010 ......... ............ A Treatment of head injury ............................. 19.78 NA 11.75 4.88 NA 36.41 090 

62100 ......... ............ A Repair brain fluid leakage ............................ 22.00 NA 12.85 4.91 NA 39.76 090 

62115 ......... ............ A Reduction of skull defect ............................. 21.63 NA 11.69 5.46 NA 38.78 090 

62116 ......... ............ A Reduction of skull defect ............................. 23.55 NA 13.42 5.85 NA 42.82 090 

62117 ......... ............ A Reduction of skull defect ............................. 26.56 NA 15.44 6.71 NA 48.71 090 

62120 ......... ............ A Repair skull cavity lesion ............................. 23.31 NA 14.33 3.70 NA 41.34 090 

62121 ......... ............ A Incise skull repair ......................................... 21.55 NA 12.75 2.98 NA 37.28 090 

62140 ......... ............ A Repair of skull defect ................................... 13.49 NA 8.36 3.14 NA 24.99 090 

62141 ......... ............ A Repair of skull defect ................................... 14.89 NA 9.10 3.44 NA 27.43 090 

62142 ......... ............ A Remove skull plate/flap ............................... 10.77 NA 7.03 2.53 NA 20.33 090 

62143 ......... ............ A Replace skull plate/flap ................................ 13.03 NA 8.08 3.08 NA 24.19 090 

62145 ......... ............ A Repair of skull & brain ................................. 18.79 NA 10.95 4.60 NA 34.34 090 

62146 ......... ............ A Repair of skull with graft .............................. 16.10 NA 9.68 3.55 NA 29.33 090 

62147 ......... ............ A Repair of skull with graft .............................. 19.31 NA 11.38 4.39 NA 35.08 090 

62148 ......... ............ A Retr bone flap to fix skull ............................. 2.00 NA 0.82 0.52 NA 3.34 ZZZ 

62160 ......... ............ A Neuroendoscopy add-on ............................. 3.00 NA 1.14 0.63 NA 4.77 ZZZ 

62161 ......... ............ A Dissect brain w/scope .................................. 19.97 NA 9.56 4.46 NA 33.99 090 

62162 ......... ............ A Remove colloid cyst w/scope ...................... 25.21 NA 11.69 6.96 NA 43.86 090 

62163 ......... ............ A Neuroendoscopy w/fb removal .................... 15.48 NA 7.85 4.46 NA 27.79 090 

62164 ......... ............ A Remove brain tumor w/scope ...................... 27.46 NA 12.90 6.96 NA 47.32 090 

62165 ......... ............ A Remove pituit tumor w/scope ...................... 21.97 NA 10.51 4.38 NA 36.86 090 

62180 ......... ............ A Establish brain cavity shunt ......................... 21.03 NA 12.34 5.21 NA 38.58 090 

62190 ......... ............ A Establish brain cavity shunt ......................... 11.05 NA 7.11 2.63 NA 20.79 090 

62192 ......... ............ A Establish brain cavity shunt ......................... 12.23 NA 7.66 2.97 NA 22.86 090 

62194 ......... ............ A Replace/irrigate catheter .............................. 5.02 NA 2.79 0.60 NA 8.41 010 

62200 ......... ............ A Establish brain cavity shunt ......................... 18.29 NA 10.89 4.46 NA 33.64 090 

62201 ......... ............ A Brain cavity shunt w/scope .......................... 14.84 NA 9.49 3.04 NA 27.37 090 

62220 ......... ............ A Establish brain cavity shunt ......................... 12.98 NA 8.02 3.05 NA 24.05 090 

62223 ......... ............ A Establish brain cavity shunt ......................... 12.85 NA 8.28 3.11 NA 24.24 090 

62225 ......... ............ A Replace/irrigate catheter .............................. 5.40 NA 4.11 1.31 NA 10.82 090 

62230 ......... ............ A Replace/revise brain shunt .......................... 10.52 NA 6.51 2.53 NA 19.56 090 

62252 ......... ............ A Csf shunt reprogram .................................... 0.74 1.48 NA 0.21 2.43 NA XXX 

62252 ......... 26 ....... A Csf shunt reprogram .................................... 0.74 0.37 0.37 0.19 1.30 1.30 XXX 

62252 ......... TC ...... A Csf shunt reprogram .................................... 0.00 1.11 NA 0.02 1.13 NA XXX 

62256 ......... ............ A Remove brain cavity shunt .......................... 6.59 NA 4.72 1.62 NA 12.93 090 

62258 ......... ............ A Replace brain cavity shunt .......................... 14.52 NA 8.74 3.51 NA 26.77 090 

62263 ......... ............ A Epidural lysis mult sessions ........................ 6.13 11.87 2.39 0.51 18.51 9.03 010 

62264 ......... ............ A Epidural lysis on single day ......................... 4.42 7.66 1.40 0.36 12.44 6.18 010 

62268 ......... ............ A Drain spinal cord cyst .................................. 4.73 10.58 2.18 0.35 15.66 7.26 000 

62269 ......... ............ A Needle biopsy, spinal cord .......................... 5.01 12.80 2.01 0.35 18.16 7.37 000 

62270 ......... ............ A Spinal fluid tap, diagnostic ........................... 1.13 3.08 0.49 0.07 4.28 1.69 000 

62272 ......... ............ A Drain cerebro spinal fluid ............................. 1.35 3.68 0.64 0.16 5.19 2.15 000 

62273 ......... ............ A Treat epidural spine lesion .......................... 2.15 2.73 0.57 0.17 5.05 2.89 000 

62280 ......... ............ A Treat spinal cord lesion ............................... 2.63 6.59 0.88 0.21 9.43 3.72 010 

62281 ......... ............ A Treat spinal cord lesion ............................... 2.66 5.76 0.77 0.19 8.61 3.62 010 

62282 ......... ............ A Treat spinal canal lesion .............................. 2.33 8.20 0.79 0.17 10.70 3.29 010 

62284 ......... ............ A Injection for myelogram ............................... 1.54 4.88 0.60 0.12 6.54 2.26 000 

62287 ......... ............ A Percutaneous diskectomy ............................ 8.07 NA 5.52 0.80 NA 14.39 090 

62290 ......... ............ A Inject for spine disk x-ray ............................ 3.00 6.81 1.28 0.24 10.05 4.52 000 

62291 ......... ............ A Inject for spine disk x-ray ............................ 2.91 5.69 1.13 0.21 8.81 4.25 000 

62292 ......... ............ A Injection into disk lesion .............................. 7.85 NA 4.50 0.78 NA 13.13 090 

62294 ......... ............ A Injection into spinal artery ............................ 11.81 NA 5.62 1.03 NA 18.46 090 

62310 ......... ............ A Inject spine c/t .............................................. 1.91 4.83 0.50 0.13 6.87 2.54 000 

62311 ......... ............ A Inject spine l/s (cd) ...................................... 1.54 4.91 0.45 0.11 6.56 2.10 000 

62318 ......... ............ A Inject spine w/cath, c/t ................................. 2.04 5.51 0.51 0.14 7.69 2.69 000 

62319 ......... ............ A Inject spine w/cath l/s (cd) ........................... 1.87 4.82 0.47 0.13 6.82 2.47 000 

62350 ......... ............ A Implant spinal canal cath ............................. 6.86 NA 3.99 0.77 NA 11.62 090 

62351 ......... ............ A Implant spinal canal cath ............................. 9.99 NA 7.10 2.16 NA 19.25 090 

62355 ......... ............ A Remove spinal canal catheter ..................... 5.44 NA 3.20 0.57 NA 9.21 090 

62360 ......... ............ A Insert spine infusion device ......................... 2.62 NA 2.71 0.25 NA 5.58 090 

62361 ......... ............ A Implant spine infusion pump ........................ 5.41 NA 3.91 0.60 NA 9.92 090 

62362 ......... ............ A Implant spine infusion pump ........................ 7.03 NA 4.38 1.04 NA 12.45 090 

62365 ......... ............ A Remove spine infusion device ..................... 5.41 NA 3.60 0.70 NA 9.71 090 

62367 ......... ............ C Analyze spine infusion pump ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

62367 ......... 26 ....... A Analyze spine infusion pump ....................... 0.48 0.13 0.13 0.04 0.65 0.65 XXX 

62367 ......... TC ...... C Analyze spine infusion pump ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

62368 ......... ............ C Analyze spine infusion pump ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

62368 ......... 26 ....... A Analyze spine infusion pump ....................... 0.75 0.19 0.19 0.06 1.00 1.00 XXX 

62368 ......... TC ...... C Analyze spine infusion pump ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

63001 ......... ............ A Removal of spinal lamina ............................ 15.80 NA 9.52 3.65 NA 28.97 090 

63003 ......... ............ A Removal of spinal lamina ............................ 15.93 NA 9.86 3.59 NA 29.38 090 

1181

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

63005 ......... ............ A Removal of spinal lamina ............................ 14.90 NA 9.93 3.16 NA 27.99 090 

63011 ......... ............ A Removal of spinal lamina ............................ 14.50 NA 8.26 1.72 NA 24.48 090 

63012 ......... ............ A Removal of spinal lamina ............................ 15.38 NA 10.09 3.27 NA 28.74 090 

63015 ......... ............ A Removal of spinal lamina ............................ 19.32 NA 11.89 4.63 NA 35.84 090 

63016 ......... ............ A Removal of spinal lamina ............................ 19.17 NA 11.79 4.37 NA 35.33 090 

63017 ......... ............ A Removal of spinal lamina ............................ 15.92 NA 10.36 3.51 NA 29.79 090 

63020 ......... ............ A Neck spine disk surgery .............................. 14.79 NA 9.67 3.49 NA 27.95 090 

63030 ......... ............ A Low back disk surgery ................................. 11.98 NA 8.39 2.67 NA 23.04 090 

63035 ......... ............ A Spinal disk surgery add-on .......................... 3.15 NA 1.59 0.69 NA 5.43 ZZZ 

63040 ......... ............ A Laminotomy, single cervical ........................ 18.78 NA 11.50 4.05 NA 34.33 090 

63042 ......... ............ A Laminotomy, single lumbar .......................... 17.44 NA 11.30 3.75 NA 32.49 090 

63043 ......... ............ C Laminotomy, add’l cervical .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63044 ......... ............ C Laminotomy, add’l lumbar ........................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

63045 ......... ............ A Removal of spinal lamina ............................ 16.48 NA 10.35 3.85 NA 30.68 090 

63046 ......... ............ A Removal of spinal lamina ............................ 15.78 NA 10.16 3.49 NA 29.43 090 

63047 ......... ............ A Removal of spinal lamina ............................ 14.59 NA 9.85 3.15 NA 27.59 090 

63048 ......... ............ A Remove spinal lamina add-on ..................... 3.26 NA 1.67 0.70 NA 5.63 ZZZ 

63055 ......... ............ A Decompress spinal cord .............................. 21.96 NA 13.14 4.93 NA 40.03 090 

63056 ......... ............ A Decompress spinal cord .............................. 20.33 NA 12.54 4.03 NA 36.90 090 

63057 ......... ............ A Decompress spine cord add-on .................. 5.25 NA 2.64 0.98 NA 8.87 ZZZ 

63064 ......... ............ A Decompress spinal cord .............................. 24.57 NA 14.45 5.69 NA 44.71 090 

63066 ......... ............ A Decompress spine cord add-on .................. 3.26 NA 1.67 0.76 NA 5.69 ZZZ 

63075 ......... ............ A Neck spine disk surgery .............................. 19.38 NA 12.08 4.50 NA 35.96 090 

63076 ......... ............ A Neck spine disk surgery .............................. 4.04 NA 2.06 0.94 NA 7.04 ZZZ 

63077 ......... ............ A Spine disk surgery, thorax ........................... 21.41 NA 12.76 4.15 NA 38.32 090 

63078 ......... ............ A Spine disk surgery, thorax ........................... 3.28 NA 1.64 0.60 NA 5.52 ZZZ 

63081 ......... ............ A Removal of vertebral body .......................... 23.69 NA 14.33 5.38 NA 43.40 090 

63082 ......... ............ A Remove vertebral body add-on ................... 4.36 NA 2.23 0.99 NA 7.58 ZZZ 

63085 ......... ............ A Removal of vertebral body .......................... 26.88 NA 15.47 5.67 NA 48.02 090 

63086 ......... ............ A Remove vertebral body add-on ................... 3.19 NA 1.60 0.66 NA 5.45 ZZZ 

63087 ......... ............ A Removal of vertebral body .......................... 35.52 NA 19.45 7.08 NA 62.05 090 

63088 ......... ............ A Remove vertebral body add-on ................... 4.32 NA 2.18 0.93 NA 7.43 ZZZ 

63090 ......... ............ A Removal of vertebral body .......................... 28.12 NA 16.01 5.15 NA 49.28 090 

63091 ......... ............ A Remove vertebral body add-on ................... 3.03 NA 1.46 0.54 NA 5.03 ZZZ 

63101 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.34 5.69 NA 56.98 090 

63102 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.34 5.69 NA 56.98 090 

63103 ......... ............ A Remove vertebral body add-on ................... 3.89 NA 2.01 0.76 NA 6.66 ZZZ 

63170 ......... ............ A Incise spinal cord tract(s) ............................ 19.80 NA 12.06 4.69 NA 36.55 090 

63172 ......... ............ A Drainage of spinal cyst ................................ 17.63 NA 10.85 4.17 NA 32.65 090 

63173 ......... ............ A Drainage of spinal cyst ................................ 21.96 NA 13.03 4.99 NA 39.98 090 

63180 ......... ............ A Revise spinal cord ligaments ....................... 18.24 NA 11.21 4.62 NA 34.07 090 

63182 ......... ............ A Revise spinal cord ligaments ....................... 20.47 NA 11.18 4.20 NA 35.85 090 

63185 ......... ............ A Incise spinal column/nerves ........................ 15.02 NA 8.25 2.51 NA 25.78 090 

63190 ......... ............ A Incise spinal column/nerves ........................ 17.42 NA 10.31 3.47 NA 31.20 090 

63191 ......... ............ A Incise spinal column/nerves ........................ 17.51 NA 10.68 4.22 NA 32.41 090 

63194 ......... ............ A Incise spinal column & cord ........................ 19.16 NA 11.89 4.84 NA 35.89 090 

63195 ......... ............ A Incise spinal column & cord ........................ 18.81 NA 11.24 4.15 NA 34.20 090 

63196 ......... ............ A Incise spinal column & cord ........................ 22.27 NA 13.58 5.62 NA 41.47 090 

63197 ......... ............ A Incise spinal column & cord ........................ 21.08 NA 12.39 5.33 NA 38.80 090 

63198 ......... ............ A Incise spinal column & cord ........................ 25.34 NA 8.63 6.40 NA 40.37 090 

63199 ......... ............ A Incise spinal column & cord ........................ 26.85 NA 15.24 6.78 NA 48.87 090 

63200 ......... ............ A Release of spinal cord ................................. 19.15 NA 11.48 4.35 NA 34.98 090 

63250 ......... ............ A Revise spinal cord vessels .......................... 40.70 NA 20.03 9.23 NA 69.96 090 

63251 ......... ............ A Revise spinal cord vessels .......................... 41.14 NA 22.69 9.62 NA 73.45 090 

63252 ......... ............ A Revise spinal cord vessels .......................... 41.13 NA 22.33 9.35 NA 72.81 090 

63265 ......... ............ A Excise intraspinal lesion .............................. 21.53 NA 12.81 5.17 NA 39.51 090 

63266 ......... ............ A Excise intraspinal lesion .............................. 22.27 NA 13.22 5.39 NA 40.88 090 

63267 ......... ............ A Excise intraspinal lesion .............................. 17.92 NA 11.09 4.22 NA 33.23 090 

63268 ......... ............ A Excise intraspinal lesion .............................. 18.49 NA 10.42 3.84 NA 32.75 090 

63270 ......... ............ A Excise intraspinal lesion .............................. 26.76 NA 15.52 6.53 NA 48.81 090 

63271 ......... ............ A Excise intraspinal lesion .............................. 26.88 NA 15.63 6.71 NA 49.22 090 

63272 ......... ............ A Excise intraspinal lesion .............................. 25.28 NA 14.73 6.11 NA 46.12 090 

63273 ......... ............ A Excise intraspinal lesion .............................. 24.25 NA 14.39 6.13 NA 44.77 090 

63275 ......... ............ A Biopsy/excise spinal tumor .......................... 23.64 NA 13.83 5.64 NA 43.11 090 

63276 ......... ............ A Biopsy/excise spinal tumor .......................... 23.41 NA 13.72 5.58 NA 42.71 090 

63277 ......... ............ A Biopsy/excise spinal tumor .......................... 20.80 NA 12.54 4.86 NA 38.20 090 

63278 ......... ............ A Biopsy/excise spinal tumor .......................... 20.53 NA 12.39 4.85 NA 37.77 090 

63280 ......... ............ A Biopsy/excise spinal tumor .......................... 28.31 NA 16.37 7.00 NA 51.68 090 

63281 ......... ............ A Biopsy/excise spinal tumor .......................... 28.01 NA 16.22 6.84 NA 51.07 090 

63282 ......... ............ A Biopsy/excise spinal tumor .......................... 26.35 NA 15.38 6.43 NA 48.16 090 

63283 ......... ............ A Biopsy/excise spinal tumor .......................... 24.96 NA 14.71 6.18 NA 45.85 090 

63285 ......... ............ A Biopsy/excise spinal tumor .......................... 35.95 NA 20.01 8.82 NA 64.78 090 

63286 ......... ............ A Biopsy/excise spinal tumor .......................... 35.58 NA 19.97 8.53 NA 64.08 090 

63287 ......... ............ A Biopsy/excise spinal tumor .......................... 36.64 NA 20.53 9.02 NA 66.19 090 

63290 ......... ............ A Biopsy/excise spinal tumor .......................... 37.32 NA 20.66 9.23 NA 67.21 090 

1182

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

63300 ......... ............ A Removal of vertebral body .......................... 24.39 NA 14.34 5.77 NA 44.50 090 

63301 ......... ............ A Removal of vertebral body .......................... 27.56 NA 15.58 6.07 NA 49.21 090 

63302 ......... ............ A Removal of vertebral body .......................... 27.77 NA 15.88 6.33 NA 49.98 090 

63303 ......... ............ A Removal of vertebral body .......................... 30.45 NA 16.92 6.28 NA 53.65 090 

63304 ......... ............ A Removal of vertebral body .......................... 30.28 NA 17.34 5.69 NA 53.31 090 

63305 ......... ............ A Removal of vertebral body .......................... 31.98 NA 18.06 6.50 NA 56.54 090 

63306 ......... ............ A Removal of vertebral body .......................... 32.17 NA 17.84 2.88 NA 52.89 090 

63307 ......... ............ A Removal of vertebral body .......................... 31.58 NA 16.82 5.10 NA 53.50 090 

63308 ......... ............ A Remove vertebral body add-on ................... 5.24 NA 2.62 1.22 NA 9.08 ZZZ 

63600 ......... ............ A Remove spinal cord lesion .......................... 14.00 NA 5.44 1.47 NA 20.91 090 

63610 ......... ............ A Stimulation of spinal cord ............................ 8.72 55.66 2.30 0.52 64.90 11.54 000 

63615 ......... ............ A Remove lesion of spinal cord ...................... 16.26 NA 9.41 3.44 NA 29.11 090 

63650 ......... ............ A Implant neuroelectrodes .............................. 6.73 NA 3.22 0.58 NA 10.53 090 

63655 ......... ............ A Implant neuroelectrodes .............................. 10.27 NA 6.90 2.23 NA 19.40 090 

63660 ......... ............ A Revise/remove neuroelectrode .................... 6.15 NA 3.63 0.78 NA 10.56 090 

63685 ......... ............ A Implant neuroreceiver .................................. 7.03 NA 4.16 1.16 NA 12.35 090 

63688 ......... ............ A Revise/remove neuroreceiver ...................... 5.38 NA 3.57 0.84 NA 9.79 090 

63700 ......... ............ A Repair of spinal herniation ........................... 16.51 NA 10.27 3.24 NA 30.02 090 

63702 ......... ............ A Repair of spinal herniation ........................... 18.45 NA 10.84 1.64 NA 30.93 090 

63704 ......... ............ A Repair of spinal herniation ........................... 21.15 NA 12.89 4.63 NA 38.67 090 

63706 ......... ............ A Repair of spinal herniation ........................... 24.07 NA 13.61 5.70 NA 43.38 090 

63707 ......... ............ A Repair spinal fluid leakage .......................... 11.24 NA 7.68 2.36 NA 21.28 090 

63709 ......... ............ A Repair spinal fluid leakage .......................... 14.30 NA 9.36 3.00 NA 26.66 090 

63710 ......... ............ A Graft repair of spine defect .......................... 14.05 NA 9.05 3.15 NA 26.25 090 

63740 ......... ............ A Install spinal shunt ....................................... 11.34 NA 7.38 2.59 NA 21.31 090 

63741 ......... ............ A Install spinal shunt ....................................... 8.24 NA 4.78 1.27 NA 14.29 090 

63744 ......... ............ A Revision of spinal shunt .............................. 8.09 NA 5.28 1.82 NA 15.19 090 

63746 ......... ............ A Removal of spinal shunt .............................. 6.42 NA 3.80 1.39 NA 11.61 090 

64400 ......... ............ A N block inj, trigeminal .................................. 1.11 2.01 0.37 0.07 3.19 1.55 000 

64402 ......... ............ A N block inj, facial ......................................... 1.25 1.74 0.53 0.08 3.07 1.86 000 

64405 ......... ............ A N block inj, occipital ..................................... 1.32 1.52 0.39 0.10 2.94 1.81 000 

64408 ......... ............ A N block inj, vagus ........................................ 1.41 1.58 0.66 0.11 3.10 2.18 000 

64410 ......... ............ A N block inj, phrenic ...................................... 1.43 2.56 0.39 0.10 4.09 1.92 000 

64412 ......... ............ A N block inj, spinal accessor ......................... 1.18 2.71 0.37 0.10 3.99 1.65 000 

64413 ......... ............ A N block inj, cervical plexus .......................... 1.40 1.88 0.43 0.11 3.39 1.94 000 

64415 ......... ............ A N block inj, brachial plexus .......................... 1.48 2.84 0.39 0.10 4.42 1.97 000 

64416 ......... ............ A N block cont infuse, b plex .......................... 3.49 NA 0.72 0.10 NA 4.31 010 

64417 ......... ............ A N block inj, axillary ....................................... 1.44 3.09 0.42 0.11 4.64 1.97 000 

64418 ......... ............ A N block inj, suprascapular ........................... 1.32 2.65 0.37 0.08 4.05 1.77 000 

64420 ......... ............ A N block inj, intercost, sng ............................ 1.18 3.53 0.36 0.08 4.79 1.62 000 

64421 ......... ............ A N block inj, intercost, mlt ............................. 1.68 5.39 0.45 0.12 7.19 2.25 000 

64425 ......... ............ A N block inj ilio-ing/hypogi ............................. 1.75 1.70 0.47 0.13 3.58 2.35 000 

64430 ......... ............ A N block inj, pudendal ................................... 1.46 2.59 0.49 0.13 4.18 2.08 000 

64435 ......... ............ A N block inj, paracervical .............................. 1.45 2.58 0.63 0.18 4.21 2.26 000 

64445 ......... ............ A N block inj, sciatic, sng ................................ 1.48 2.69 0.37 0.10 4.27 1.95 000 

64446 ......... ............ A N blk inj, sciatic, cont inf .............................. 3.25 NA 1.18 0.10 NA 4.53 010 

64447 ......... ............ A N block inj fem, single ................................. 1.50 NA 0.51 0.10 NA 2.11 000 

64448 ......... ............ A N block inj fem, cont inf ............................... 3.00 NA 1.03 0.10 NA 4.13 010 

64449 ......... ............ A N block inj, lumbar plexus ........................... 3.00 NA 0.97 0.10 NA 4.07 010 

64450 ......... ............ A N block, other peripheral ............................. 1.27 1.26 0.41 0.10 2.63 1.78 000 

64470 ......... ............ A Inj paravertebral c/t ...................................... 1.85 4.86 0.56 0.14 6.85 2.55 000 

64472 ......... ............ A Inj paravertebral c/t add-on ......................... 1.29 1.94 0.31 0.11 3.34 1.71 ZZZ 

64475 ......... ............ A Inj paravertebral l/s ...................................... 1.41 4.56 0.47 0.11 6.08 1.99 000 

64476 ......... ............ A Inj paravertebral l/s add-on .......................... 0.98 1.82 0.25 0.07 2.87 1.30 ZZZ 

64479 ......... ............ A Inj foramen epidural c/t ................................ 2.20 7.05 0.72 0.17 9.42 3.09 000 

64480 ......... ............ A Inj foramen epidural add-on ........................ 1.54 2.41 0.46 0.11 4.06 2.11 ZZZ 

64483 ......... ............ A Inj foramen epidural l/s ................................ 1.90 7.53 0.66 0.14 9.57 2.70 000 

64484 ......... ............ A Inj foramen epidural add-on ........................ 1.33 2.80 0.37 0.10 4.23 1.80 ZZZ 

64505 ......... ............ A N block, spenopalatine gangl ...................... 1.36 1.22 0.47 0.10 2.68 1.93 000 

64508 ......... ............ A N block, carotid sinus s/p ............................ 1.12 2.96 0.51 0.07 4.15 1.70 000 

64510 ......... ............ A N block, stellate ganglion ............................ 1.22 3.20 0.37 0.08 4.50 1.67 000 

64517 ......... ............ A N block inj, hypogas plxs ............................. 2.20 2.70 0.87 0.13 5.03 3.20 000 

64520 ......... ............ A N block, lumbar/thoracic .............................. 1.35 4.56 0.41 0.10 6.01 1.86 000 

64530 ......... ............ A N block inj, celiac pelus ............................... 1.58 3.94 0.47 0.11 5.63 2.16 000 

64550 ......... ............ A Apply neurostimulator .................................. 0.18 0.30 0.05 0.01 0.49 0.24 000 

64553 ......... ............ A Implant neuroelectrodes .............................. 2.31 2.70 1.86 0.21 5.22 4.38 010 

64555 ......... ............ A Implant neuroelectrodes .............................. 2.27 3.09 1.20 0.13 5.49 3.60 010 

64560 ......... ............ A Implant neuroelectrodes .............................. 2.36 2.64 1.30 0.21 5.21 3.87 010 

64561 ......... ............ A Implant neuroelectrodes .............................. 6.73 NA 3.16 0.13 NA 10.02 010 

64565 ......... ............ A Implant neuroelectrodes .............................. 1.76 3.35 1.26 0.10 5.21 3.12 010 

64573 ......... ............ A Implant neuroelectrodes .............................. 7.49 NA 5.23 1.79 NA 14.51 090 

64575 ......... ............ A Implant neuroelectrodes .............................. 4.34 NA 2.70 0.45 NA 7.49 090 

64577 ......... ............ A Implant neuroelectrodes .............................. 4.61 NA 3.32 0.60 NA 8.53 090 

64580 ......... ............ A Implant neuroelectrodes .............................. 4.11 NA 3.55 0.25 NA 7.91 090 

64581 ......... ............ A Implant neuroelectrodes .............................. 13.48 NA 5.41 0.45 NA 19.34 090 

1183

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

64585 ......... ............ A Revise/remove neuroelectrode .................... 2.06 11.57 1.71 0.35 13.98 4.12 010 

64590 ......... ............ A Implant neuroreceiver .................................. 2.40 7.26 1.90 0.48 10.14 4.78 010 

64595 ......... ............ A Revise/remove neuroreceiver ...................... 1.73 10.69 1.49 0.27 12.69 3.49 010 

64600 ......... ............ A Injection treatment of nerve ......................... 3.44 8.45 1.57 0.34 12.23 5.35 010 

64605 ......... ............ A Injection treatment of nerve ......................... 5.60 8.59 2.05 0.64 14.83 8.29 010 

64610 ......... ............ A Injection treatment of nerve ......................... 7.15 7.89 3.58 1.35 16.39 12.08 010 

64612 ......... ............ A Destroy nerve, face muscle ......................... 1.96 2.62 1.08 0.11 4.69 3.15 010 

64613 ......... ............ A Destroy nerve, spine muscle ....................... 1.96 2.97 0.99 0.12 5.05 3.07 010 

64614 ......... ............ A Destroy nerve, extrem musc ....................... 2.20 3.24 1.12 0.11 5.55 3.43 010 

64620 ......... ............ A Injection treatment of nerve ......................... 2.84 4.60 1.18 0.21 7.65 4.23 010 

64622 ......... ............ A Destr paravertebrl nerve l/s ......................... 3.00 7.62 1.23 0.21 10.83 4.44 010 

64623 ......... ............ A Destr paravertebral n add-on ...................... 0.99 2.42 0.23 0.07 3.48 1.29 ZZZ 

64626 ......... ............ A Destr paravertebrl nerve c/t ......................... 3.28 6.67 1.85 0.27 10.22 5.40 010 

64627 ......... ............ A Destr paravertebral n add-on ...................... 1.16 2.61 0.27 0.10 3.87 1.53 ZZZ 

64630 ......... ............ A Injection treatment of nerve ......................... 3.00 2.73 1.28 0.19 5.92 4.47 010 

64640 ......... ............ A Injection treatment of nerve ......................... 2.76 4.24 1.67 0.13 7.13 4.56 010 

64680 ......... ............ A Injection treatment of nerve ......................... 2.62 5.97 1.28 0.18 8.77 4.08 010 

64681 ......... ............ A Injection treatment of nerve ......................... 3.54 8.71 2.10 0.18 12.43 5.82 010 

64702 ......... ............ A Revise finger/toe nerve ................................ 4.22 NA 3.82 0.62 NA 8.66 090 

64704 ......... ............ A Revise hand/foot nerve ................................ 4.56 NA 3.28 0.71 NA 8.55 090 

64708 ......... ............ A Revise arm/leg nerve ................................... 6.11 NA 4.83 0.99 NA 11.93 090 

64712 ......... ............ A Revision of sciatic nerve .............................. 7.74 NA 4.99 0.65 NA 13.38 090 

64713 ......... ............ A Revision of arm nerve(s) ............................. 10.98 NA 5.90 1.22 NA 18.10 090 

64714 ......... ............ A Revise low back nerve(s) ............................ 10.31 NA 4.24 0.77 NA 15.32 090 

64716 ......... ............ A Revision of cranial nerve ............................. 6.30 NA 5.26 0.71 NA 12.27 090 

64718 ......... ............ A Revise ulnar nerve at elbow ........................ 5.98 NA 5.87 1.05 NA 12.90 090 

64719 ......... ............ A Revise ulnar nerve at wrist .......................... 4.84 NA 4.46 0.76 NA 10.06 090 

64721 ......... ............ A Carpal tunnel surgery .................................. 4.28 4.95 4.95 0.71 9.94 9.94 090 

64722 ......... ............ A Relieve pressure on nerve(s) ...................... 4.69 NA 3.06 0.39 NA 8.14 090 

64726 ......... ............ A Release foot/toe nerve ................................ 4.17 NA 2.76 0.69 NA 7.62 090 

64727 ......... ............ A Internal nerve revision ................................. 3.10 NA 1.51 0.48 NA 5.09 ZZZ 

64732 ......... ............ A Incision of brow nerve ................................. 4.40 NA 3.53 0.93 NA 8.86 090 

64734 ......... ............ A Incision of cheek nerve ................................ 4.91 NA 4.06 1.00 NA 9.97 090 

64736 ......... ............ A Incision of chin nerve ................................... 4.59 NA 4.03 0.86 NA 9.48 090 

64738 ......... ............ A Incision of jaw nerve .................................... 5.72 NA 4.62 1.01 NA 11.35 090 

64740 ......... ............ A Incision of tongue nerve .............................. 5.58 NA 4.39 0.52 NA 10.49 090 

64742 ......... ............ A Incision of facial nerve ................................. 6.21 NA 4.74 0.83 NA 11.78 090 

64744 ......... ............ A Incise nerve, back of head .......................... 5.23 NA 3.79 1.18 NA 10.20 090 

64746 ......... ............ A Incise diaphragm nerve ............................... 5.92 NA 4.53 0.90 NA 11.35 090 

64752 ......... ............ A Incision of vagus nerve ................................ 7.05 NA 4.31 1.00 NA 12.36 090 

64755 ......... ............ A Incision of stomach nerves .......................... 13.50 NA 5.68 1.40 NA 20.58 090 

64760 ......... ............ A Incision of vagus nerve ................................ 6.95 NA 3.52 0.62 NA 11.09 090 

64761 ......... ............ A Incision of pelvis nerve ................................ 6.40 NA 3.56 0.31 NA 10.27 090 

64763 ......... ............ A Incise hip/thigh nerve ................................... 6.92 NA 5.24 0.93 NA 13.09 090 

64766 ......... ............ A Incise hip/thigh nerve ................................... 8.66 NA 5.26 1.19 NA 15.11 090 

64771 ......... ............ A Sever cranial nerve ...................................... 7.34 NA 5.58 1.59 NA 14.51 090 

64772 ......... ............ A Incision of spinal nerve ................................ 7.20 NA 4.93 1.45 NA 13.58 090 

64774 ......... ............ A Remove skin nerve lesion ........................... 5.16 NA 3.81 0.72 NA 9.69 090 

64776 ......... ............ A Remove digit nerve lesion ........................... 5.11 NA 3.67 0.76 NA 9.54 090 

64778 ......... ............ A Digit nerve surgery add-on .......................... 3.11 NA 1.50 0.46 NA 5.07 ZZZ 

64782 ......... ............ A Remove limb nerve lesion ........................... 6.22 NA 3.75 0.95 NA 10.92 090 

64783 ......... ............ A Limb nerve surgery add-on ......................... 3.71 NA 1.85 0.58 NA 6.14 ZZZ 

64784 ......... ............ A Remove nerve lesion ................................... 9.81 NA 6.57 1.41 NA 17.79 090 

64786 ......... ............ A Remove sciatic nerve lesion ........................ 15.44 NA 9.84 2.68 NA 27.96 090 

64787 ......... ............ A Implant nerve end ........................................ 4.29 NA 2.13 0.68 NA 7.10 ZZZ 

64788 ......... ............ A Remove skin nerve lesion ........................... 4.60 NA 3.47 0.65 NA 8.72 090 

64790 ......... ............ A Removal of nerve lesion .............................. 11.29 NA 7.19 2.03 NA 20.51 090 

64792 ......... ............ A Removal of nerve lesion .............................. 14.90 NA 8.84 2.27 NA 26.01 090 

64795 ......... ............ A Biopsy of nerve ............................................ 3.01 NA 1.59 0.48 NA 5.08 000 

64802 ......... ............ A Remove sympathetic nerves ....................... 9.14 NA 5.17 1.05 NA 15.36 090 

64804 ......... ............ A Remove sympathetic nerves ....................... 14.62 NA 7.20 2.16 NA 23.98 090 

64809 ......... ............ A Remove sympathetic nerves ....................... 13.65 NA 5.80 1.16 NA 20.61 090 

64818 ......... ............ A Remove sympathetic nerves ....................... 10.28 NA 5.33 1.30 NA 16.91 090 

64820 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 7.11 1.41 NA 18.87 090 

64821 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.35 1.19 NA 17.28 090 

64822 ......... ............ A Remove sympathetic nerves ....................... 8.74 NA 7.27 1.19 NA 17.20 090 

64823 ......... ............ A Remove sympathetic nerves ....................... 10.35 NA 8.18 1.41 NA 19.94 090 

64831 ......... ............ A Repair of digit nerve .................................... 9.43 NA 7.05 1.37 NA 17.85 090 

64832 ......... ............ A Repair nerve add-on .................................... 5.65 NA 2.95 0.82 NA 9.42 ZZZ 

64834 ......... ............ A Repair of hand or foot nerve ....................... 10.17 NA 7.08 1.48 NA 18.73 090 

64835 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.67 1.64 NA 20.23 090 

64836 ......... ............ A Repair of hand or foot nerve ....................... 10.92 NA 7.65 1.59 NA 20.16 090 

64837 ......... ............ A Repair nerve add-on .................................... 6.25 NA 3.25 0.96 NA 10.46 ZZZ 

64840 ......... ............ A Repair of leg nerve ...................................... 13.00 NA 8.28 1.04 NA 22.32 090 

64856 ......... ............ A Repair/transpose nerve ............................... 13.78 NA 9.17 2.06 NA 25.01 090 

1184

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

64857 ......... ............ A Repair arm/leg nerve ................................... 14.47 NA 9.62 2.12 NA 26.21 090 

64858 ......... ............ A Repair sciatic nerve ..................................... 16.47 NA 10.74 3.35 NA 30.56 090 

64859 ......... ............ A Nerve surgery .............................................. 4.25 NA 2.20 0.60 NA 7.05 ZZZ 

64861 ......... ............ A Repair of arm nerves ................................... 19.21 NA 11.83 2.95 NA 33.99 090 

64862 ......... ............ A Repair of low back nerves ........................... 19.41 NA 11.96 2.98 NA 34.35 090 

64864 ......... ............ A Repair of facial nerve .................................. 12.53 NA 8.10 1.36 NA 21.99 090 

64865 ......... ............ A Repair of facial nerve .................................. 15.22 NA 9.87 1.65 NA 26.74 090 

64866 ......... ............ A Fusion of facial/other nerve ......................... 15.72 NA 9.71 1.28 NA 26.71 090 

64868 ......... ............ A Fusion of facial/other nerve ......................... 14.02 NA 8.87 1.69 NA 24.58 090 

64870 ......... ............ A Fusion of facial/other nerve ......................... 15.97 NA 8.75 1.30 NA 26.02 090 

64872 ......... ............ A Subsequent repair of nerve ......................... 1.99 NA 1.09 0.29 NA 3.37 ZZZ 

64874 ......... ............ A Repair & revise nerve add-on ..................... 2.98 NA 1.54 0.41 NA 4.93 ZZZ 

64876 ......... ............ A Repair nerve/shorten bone .......................... 3.37 NA 1.28 0.47 NA 5.12 ZZZ 

64885 ......... ............ A Nerve graft, head or neck ............................ 17.50 NA 10.91 1.82 NA 30.23 090 

64886 ......... ............ A Nerve graft, head or neck ............................ 20.72 NA 12.75 2.09 NA 35.56 090 

64890 ......... ............ A Nerve graft, hand or foot ............................. 15.13 NA 9.99 2.10 NA 27.22 090 

64891 ......... ............ A Nerve graft, hand or foot ............................. 16.12 NA 7.63 1.66 NA 25.41 090 

64892 ......... ............ A Nerve graft, arm or leg ................................ 14.63 NA 8.86 1.99 NA 25.48 090 

64893 ......... ............ A Nerve graft, arm or leg ................................ 15.58 NA 9.89 2.13 NA 27.60 090 

64895 ......... ............ A Nerve graft, hand or foot ............................. 19.22 NA 9.67 2.46 NA 31.35 090 

64896 ......... ............ A Nerve graft, hand or foot ............................. 20.46 NA 11.01 2.23 NA 33.70 090 

64897 ......... ............ A Nerve graft, arm or leg ................................ 18.21 NA 10.72 3.18 NA 32.11 090 

64898 ......... ............ A Nerve graft, arm or leg ................................ 19.47 NA 11.81 3.27 NA 34.55 090 

64901 ......... ............ A Nerve graft add-on ....................................... 10.20 NA 5.29 1.19 NA 16.68 ZZZ 

64902 ......... ............ A Nerve graft add-on ....................................... 11.81 NA 5.99 1.33 NA 19.13 ZZZ 

64905 ......... ............ A Nerve pedicle transfer ................................. 14.00 NA 8.56 1.83 NA 24.39 090 

64907 ......... ............ A Nerve pedicle transfer ................................. 18.80 NA 12.50 2.16 NA 33.46 090 

64999 ......... ............ C Nervous system surgery .............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

65091 ......... ............ A Revise eye ................................................... 6.45 NA 9.73 0.31 NA 16.49 090 

65093 ......... ............ A Revise eye with implant ............................... 6.86 NA 10.09 0.34 NA 17.29 090 

65101 ......... ............ A Removal of eye ............................................ 7.02 NA 10.68 0.34 NA 18.04 090 

65103 ......... ............ A Remove eye/insert implant .......................... 7.56 NA 10.87 0.36 NA 18.79 090 

65105 ......... ............ A Remove eye/attach implant ......................... 8.48 NA 11.52 0.41 NA 20.41 090 

65110 ......... ............ A Removal of eye ............................................ 13.93 NA 14.61 0.82 NA 29.36 090 

65112 ......... ............ A Remove eye/revise socket .......................... 16.36 NA 16.88 1.16 NA 34.40 090 

65114 ......... ............ A Remove eye/revise socket .......................... 17.50 NA 17.10 1.13 NA 35.73 090 

65125 ......... ............ A Revise ocular implant .................................. 3.12 9.23 2.96 0.18 12.53 6.26 090 

65130 ......... ............ A Insert ocular implant .................................... 7.14 NA 10.24 0.34 NA 17.72 090 

65135 ......... ............ A Insert ocular implant .................................... 7.32 NA 10.42 0.35 NA 18.09 090 

65140 ......... ............ A Attach ocular implant ................................... 8.01 NA 10.87 0.37 NA 19.25 090 

65150 ......... ............ A Revise ocular implant .................................. 6.25 NA 9.29 0.30 NA 15.84 090 

65155 ......... ............ A Reinsert ocular implant ................................ 8.65 NA 11.59 0.48 NA 20.72 090 

65175 ......... ............ A Removal of ocular implant ........................... 6.27 NA 9.65 0.31 NA 16.23 090 

65205 ......... ............ A Remove foreign body from eye ................... 0.71 0.60 0.19 0.04 1.35 0.94 000 

65210 ......... ............ A Remove foreign body from eye ................... 0.84 0.74 0.30 0.04 1.62 1.18 000 

65220 ......... ............ A Remove foreign body from eye ................... 0.71 0.60 0.18 0.06 1.37 0.95 000 

65222 ......... ............ A Remove foreign body from eye ................... 0.93 0.76 0.27 0.05 1.74 1.25 000 

65235 ......... ............ A Remove foreign body from eye ................... 7.56 NA 7.26 0.36 NA 15.18 090 

65260 ......... ............ A Remove foreign body from eye ................... 10.94 NA 11.43 0.52 NA 22.89 090 

65265 ......... ............ A Remove foreign body from eye ................... 12.57 NA 12.67 0.60 NA 25.84 090 

65270 ......... ............ A Repair of eye wound ................................... 1.90 3.83 2.24 0.10 5.83 4.24 010 

65272 ......... ............ A Repair of eye wound ................................... 3.81 5.78 5.21 0.19 9.78 9.21 090 

65273 ......... ............ A Repair of eye wound ................................... 4.35 NA 5.63 0.21 NA 10.19 090 

65275 ......... ............ A Repair of eye wound ................................... 5.33 5.66 5.66 0.33 11.32 11.32 090 

65280 ......... ............ A Repair of eye wound ................................... 7.65 NA 8.17 0.36 NA 16.18 090 

65285 ......... ............ A Repair of eye wound ................................... 12.88 NA 12.38 0.62 NA 25.88 090 

65286 ......... ............ A Repair of eye wound ................................... 5.50 8.42 7.52 0.25 14.17 13.27 090 

65290 ......... ............ A Repair of eye socket wound ........................ 5.40 NA 6.47 0.31 NA 12.18 090 

65400 ......... ............ A Removal of eye lesion ................................. 6.05 8.63 7.47 0.29 14.97 13.81 090 

65410 ......... ............ A Biopsy of cornea .......................................... 1.47 1.72 0.65 0.07 3.26 2.19 000 

65420 ......... ............ A Removal of eye lesion ................................. 4.16 7.53 6.74 0.21 11.90 11.11 090 

65426 ......... ............ A Removal of eye lesion ................................. 5.24 7.49 6.54 0.24 12.97 12.02 090 

65430 ......... ............ A Corneal smear ............................................. 1.47 4.95 0.66 0.07 6.49 2.20 000 

65435 ......... ............ A Curette/treat cornea ..................................... 0.92 1.32 0.39 0.05 2.29 1.36 000 

65436 ......... ............ A Curette/treat cornea ..................................... 4.18 5.85 5.22 0.21 10.24 9.61 090 

65450 ......... ............ A Treatment of corneal lesion ......................... 3.27 7.22 6.33 0.16 10.65 9.76 090 

65600 ......... ............ A Revision of cornea ....................................... 3.39 5.63 3.11 0.17 9.19 6.67 090 

65710 ......... ............ A Corneal transplant ....................................... 12.33 NA 12.33 0.59 NA 25.25 090 

65730 ......... ............ A Corneal transplant ....................................... 14.23 NA 11.86 0.68 NA 26.77 090 

65750 ......... ............ A Corneal transplant ....................................... 14.98 NA 13.35 0.71 NA 29.04 090 

65755 ......... ............ A Corneal transplant ....................................... 14.87 NA 13.26 0.70 NA 28.83 090 

65760 ......... ............ N Revision of cornea ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65765 ......... ............ N Revision of cornea ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65767 ......... ............ N Corneal tissue transplant ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65770 ......... ............ A Revise cornea with implant ......................... 17.53 NA 14.31 0.83 NA 32.67 090 

1185

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

65771 ......... ............ N Radial keratotomy ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

65772 ......... ............ A Correction of astigmatism ............................ 4.28 7.15 6.46 0.21 11.64 10.95 090 

65775 ......... ............ A Correction of astigmatism ............................ 5.78 NA 7.35 0.27 NA 13.40 090 

65780 ......... ............ A Ocular reconst, transplant ........................... 10.23 NA 9.94 0.35 NA 20.52 090 

65781 ......... ............ A Ocular reconst, transplant ........................... 17.64 NA 13.31 0.35 NA 31.30 090 

65782 ......... ............ A Ocular reconst, transplant ........................... 14.98 NA 11.66 0.35 NA 26.99 090 

65800 ......... ............ A Drainage of eye ........................................... 1.91 2.27 1.17 0.10 4.28 3.18 000 

65805 ......... ............ A Drainage of eye ........................................... 1.91 2.27 1.18 0.10 4.28 3.19 000 

65810 ......... ............ A Drainage of eye ........................................... 4.86 NA 8.05 0.23 NA 13.14 090 

65815 ......... ............ A Drainage of eye ........................................... 5.04 8.37 7.49 0.24 13.65 12.77 090 

65820 ......... ............ A Relieve inner eye pressure .......................... 8.12 NA 10.65 0.39 NA 19.16 090 

65850 ......... ............ A Incision of eye .............................................. 10.50 NA 9.38 0.49 NA 20.37 090 

65855 ......... ............ A Laser surgery of eye .................................... 3.84 5.20 4.05 0.21 9.25 8.10 010 

65860 ......... ............ A Incise inner eye adhesions .......................... 3.54 3.90 3.26 0.17 7.61 6.97 090 

65865 ......... ............ A Incise inner eye adhesions .......................... 5.59 NA 6.48 0.27 NA 12.34 090 

65870 ......... ............ A Incise inner eye adhesions .......................... 6.26 NA 7.14 0.29 NA 13.69 090 

65875 ......... ............ A Incise inner eye adhesions .......................... 6.53 NA 7.44 0.30 NA 14.27 090 

65880 ......... ............ A Incise inner eye adhesions .......................... 7.08 NA 7.69 0.34 NA 15.11 090 

65900 ......... ............ A Remove eye lesion ...................................... 10.91 NA 11.51 0.55 NA 22.97 090 

65920 ......... ............ A Remove implant of eye ................................ 8.39 NA 8.70 0.40 NA 17.49 090 

65930 ......... ............ A Remove blood clot from eye ....................... 7.43 NA 7.74 0.35 NA 15.52 090 

66020 ......... ............ A Injection treatment of eye ............................ 1.59 2.37 1.58 0.08 4.04 3.25 010 

66030 ......... ............ A Injection treatment of eye ............................ 1.25 2.21 1.42 0.06 3.52 2.73 010 

66130 ......... ............ A Remove eye lesion ...................................... 7.68 7.48 6.92 0.37 15.53 14.97 090 

66150 ......... ............ A Glaucoma surgery ....................................... 8.29 NA 9.86 0.40 NA 18.55 090 

66155 ......... ............ A Glaucoma surgery ....................................... 8.28 NA 9.80 0.39 NA 18.47 090 

66160 ......... ............ A Glaucoma surgery ....................................... 10.15 NA 10.65 0.49 NA 21.29 090 

66165 ......... ............ A Glaucoma surgery ....................................... 8.00 NA 9.69 0.37 NA 18.06 090 

66170 ......... ............ A Glaucoma surgery ....................................... 12.14 NA 12.45 0.58 NA 25.17 090 

66172 ......... ............ A Incision of eye .............................................. 15.02 NA 15.12 0.71 NA 30.85 090 

66180 ......... ............ A Implant eye shunt ........................................ 14.53 NA 11.56 0.69 NA 26.78 090 

66185 ......... ............ A Revise eye shunt ......................................... 8.13 NA 8.19 0.39 NA 16.71 090 

66220 ......... ............ A Repair eye lesion ......................................... 7.76 NA 8.73 0.39 NA 16.88 090 

66225 ......... ............ A Repair/graft eye lesion ................................. 11.03 NA 9.32 0.53 NA 20.88 090 

66250 ......... ............ A Follow-up surgery of eye ............................. 5.97 7.67 6.50 0.28 13.92 12.75 090 

66500 ......... ............ A Incision of iris ............................................... 3.70 NA 5.10 0.18 NA 8.98 090 

66505 ......... ............ A Incision of iris ............................................... 4.07 NA 5.38 0.21 NA 9.66 090 

66600 ......... ............ A Remove iris and lesion ................................ 8.67 NA 8.91 0.41 NA 17.99 090 

66605 ......... ............ A Removal of iris ............................................. 12.77 NA 11.26 0.74 NA 24.77 090 

66625 ......... ............ A Removal of iris ............................................. 5.12 7.02 6.30 0.24 12.38 11.66 090 

66630 ......... ............ A Removal of iris ............................................. 6.15 NA 7.42 0.29 NA 13.86 090 

66635 ......... ............ A Removal of iris ............................................. 6.24 NA 6.64 0.29 NA 13.17 090 

66680 ......... ............ A Repair iris & ciliary body .............................. 5.43 NA 6.04 0.25 NA 11.72 090 

66682 ......... ............ A Repair iris & ciliary body .............................. 6.20 NA 7.43 0.29 NA 13.92 090 

66700 ......... ............ A Destruction, ciliary body .............................. 4.77 5.34 4.05 0.23 10.34 9.05 090 

66710 ......... ............ A Destruction, ciliary body .............................. 4.77 5.22 3.85 0.22 10.21 8.84 090 

66720 ......... ............ A Destruction, ciliary body .............................. 4.77 5.68 4.60 0.23 10.68 9.60 090 

66740 ......... ............ A Destruction, ciliary body .............................. 4.77 5.38 4.21 0.22 10.37 9.20 090 

66761 ......... ............ A Revision of iris ............................................. 4.06 5.55 4.23 0.19 9.80 8.48 090 

66762 ......... ............ A Revision of iris ............................................. 4.57 5.62 4.22 0.22 10.41 9.01 090 

66770 ......... ............ A Removal of inner eye lesion ........................ 5.17 6.05 4.73 0.24 11.46 10.14 090 

66820 ......... ............ A Incision, secondary cataract ........................ 3.88 NA 7.10 0.19 NA 11.17 090 

66821 ......... ............ A After cataract laser surgery ......................... 2.35 3.98 3.88 0.12 6.45 6.35 090 

66825 ......... ............ A Reposition intraocular lens .......................... 8.22 NA 10.08 0.39 NA 18.69 090 

66830 ......... ............ A Removal of lens lesion ................................ 8.19 NA 7.08 0.39 NA 15.66 090 

66840 ......... ............ A Removal of lens material ............................. 7.90 NA 6.99 0.37 NA 15.26 090 

66850 ......... ............ A Removal of lens material ............................. 9.10 NA 7.75 0.43 NA 17.28 090 

66852 ......... ............ A Removal of lens material ............................. 9.96 NA 8.20 0.47 NA 18.63 090 

66920 ......... ............ A Extraction of lens ......................................... 8.85 NA 7.43 0.42 NA 16.70 090 

66930 ......... ............ A Extraction of lens ......................................... 10.16 NA 8.57 0.49 NA 19.22 090 

66940 ......... ............ A Extraction of lens ......................................... 8.92 NA 8.01 0.42 NA 17.35 090 

66982 ......... ............ A Cataract surgery, complex ........................... 13.48 NA 9.92 0.68 NA 24.08 090 

66983 ......... ............ A Cataract surg w/iol, 1 stage ......................... 8.98 NA 6.20 0.45 NA 15.63 090 

66984 ......... ............ A Cataract surg w/iol, 1 stage ......................... 10.21 NA 7.63 0.49 NA 18.33 090 

66985 ......... ............ A Insert lens prosthesis ................................... 8.38 NA 7.47 0.40 NA 16.25 090 

66986 ......... ............ A Exchange lens prosthesis ............................ 12.26 NA 9.22 0.59 NA 22.07 090 

66990 ......... ............ A Ophthalmic endoscope add-on .................... 1.51 NA 0.69 0.07 NA 2.27 ZZZ 

66999 ......... ............ C Eye surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67005 ......... ............ A Partial removal of eye fluid .......................... 5.69 NA 4.38 0.27 NA 10.34 090 

67010 ......... ............ A Partial removal of eye fluid .......................... 6.86 NA 4.93 0.33 NA 12.12 090 

67015 ......... ............ A Release of eye fluid ..................................... 6.91 NA 7.73 0.33 NA 14.97 090 

67025 ......... ............ A Replace eye fluid ......................................... 6.83 14.23 7.51 0.33 21.39 14.67 090 

67027 ......... ............ A Implant eye drug system ............................. 10.83 12.78 8.79 0.55 24.16 20.17 090 

67028 ......... ............ A Injection eye drug ........................................ 2.52 6.50 1.13 0.13 9.15 3.78 000 

67030 ......... ............ A Incise inner eye strands .............................. 4.83 NA 6.81 0.23 NA 11.87 090 

1186

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

67031 ......... ............ A Laser surgery, eye strands .......................... 3.66 4.74 4.09 0.18 8.58 7.93 090 

67036 ......... ............ A Removal of inner eye fluid ........................... 11.87 NA 9.35 0.57 NA 21.79 090 

67038 ......... ............ A Strip retinal membrane ................................ 21.21 NA 15.83 1.01 NA 38.05 090 

67039 ......... ............ A Laser treatment of retina ............................. 14.50 NA 12.54 0.69 NA 27.73 090 

67040 ......... ............ A Laser treatment of retina ............................. 17.20 NA 14.02 0.82 NA 32.04 090 

67101 ......... ............ A Repair detached retina ................................ 7.52 9.85 8.11 0.35 17.72 15.98 090 

67105 ......... ............ A Repair detached retina ................................ 7.40 7.99 6.23 0.35 15.74 13.98 090 

67107 ......... ............ A Repair detached retina ................................ 14.82 NA 12.82 0.70 NA 28.34 090 

67108 ......... ............ A Repair detached retina ................................ 20.79 NA 17.02 0.99 NA 38.80 090 

67110 ......... ............ A Repair detached retina ................................ 8.80 15.37 9.23 0.42 24.59 18.45 090 

67112 ......... ............ A Rerepair detached retina ............................. 16.83 NA 14.59 0.80 NA 32.22 090 

67115 ......... ............ A Release encircling material ......................... 4.98 NA 7.09 0.23 NA 12.30 090 

67120 ......... ............ A Remove eye implant material ...................... 5.97 12.30 6.93 0.28 18.55 13.18 090 

67121 ......... ............ A Remove eye implant material ...................... 10.65 NA 11.17 0.51 NA 22.33 090 

67141 ......... ............ A Treatment of retina ...................................... 5.19 7.24 6.49 0.24 12.67 11.92 090 

67145 ......... ............ A Treatment of retina ...................................... 5.36 5.76 4.94 0.25 11.37 10.55 090 

67208 ......... ............ A Treatment of retinal lesion ........................... 6.69 5.95 5.38 0.31 12.95 12.38 090 

67210 ......... ............ A Treatment of retinal lesion ........................... 8.81 6.25 5.79 0.42 15.48 15.02 090 

67218 ......... ............ A Treatment of retinal lesion ........................... 18.50 NA 14.13 0.64 NA 33.27 090 

67220 ......... ............ A Treatment of choroid lesion ......................... 13.11 9.84 8.83 0.62 23.57 22.56 090 

67221 ......... ............ R Ocular photodynamic ther ........................... 4.00 4.69 1.81 0.19 8.88 6.00 000 

67225 ......... ............ A Eye photodynamic ther add-on ................... 0.47 0.26 0.22 0.01 0.74 0.70 ZZZ 

67227 ......... ............ A Treatment of retinal lesion ........................... 6.57 6.38 5.39 0.31 13.26 12.27 090 

67228 ......... ............ A Treatment of retinal lesion ........................... 12.72 10.83 8.42 0.60 24.15 21.74 090 

67250 ......... ............ A Reinforce eye wall ....................................... 8.65 NA 10.37 0.43 NA 19.45 090 

67255 ......... ............ A Reinforce/graft eye wall ............................... 8.89 NA 10.95 0.42 NA 20.26 090 

67299 ......... ............ C Eye surgery procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67311 ......... ............ A Revise eye muscle ...................................... 6.64 NA 6.42 0.33 NA 13.39 090 

67312 ......... ............ A Revise two eye muscles .............................. 8.53 NA 7.55 0.42 NA 16.50 090 

67314 ......... ............ A Revise eye muscle ...................................... 7.51 NA 7.26 0.36 NA 15.13 090 

67316 ......... ............ A Revise two eye muscles .............................. 9.65 NA 8.22 0.48 NA 18.35 090 

67318 ......... ............ A Revise eye muscle(s) .................................. 7.84 NA 7.64 0.37 NA 15.85 090 

67320 ......... ............ A Revise eye muscle(s) add-on ...................... 4.32 NA 1.96 0.21 NA 6.49 ZZZ 

67331 ......... ............ A Eye surgery follow-up add-on ...................... 4.05 NA 1.91 0.21 NA 6.17 ZZZ 

67332 ......... ............ A Rerevise eye muscles add-on ..................... 4.48 NA 2.03 0.22 NA 6.73 ZZZ 

67334 ......... ............ A Revise eye muscle w/suture ........................ 3.97 NA 1.81 0.19 NA 5.97 ZZZ 

67335 ......... ............ A Eye suture during surgery ........................... 2.49 NA 1.12 0.12 NA 3.73 ZZZ 

67340 ......... ............ A Revise eye muscle add-on .......................... 4.92 NA 2.23 0.23 NA 7.38 ZZZ 

67343 ......... ............ A Release eye tissue ...................................... 7.34 NA 7.34 0.36 NA 15.04 090 

67345 ......... ............ A Destroy nerve of eye muscle ....................... 2.96 4.36 1.37 0.16 7.48 4.49 010 

67350 ......... ............ A Biopsy eye muscle ....................................... 2.87 NA 1.87 0.16 NA 4.90 000 

67399 ......... ............ C Eye muscle surgery procedure .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67400 ......... ............ A Explore/biopsy eye socket ........................... 9.75 NA 12.51 0.52 NA 22.78 090 

67405 ......... ............ A Explore/drain eye socket ............................. 7.92 NA 11.09 0.43 NA 19.44 090 

67412 ......... ............ A Explore/treat eye socket .............................. 9.49 NA 12.99 0.49 NA 22.97 090 

67413 ......... ............ A Explore/treat eye socket .............................. 9.99 NA 12.14 0.52 NA 22.65 090 

67414 ......... ............ A Explr/decompress eye socket ...................... 11.11 NA 14.01 0.58 NA 25.70 090 

67415 ......... ............ A Aspiration, orbital contents .......................... 1.76 NA 0.77 0.11 NA 2.64 000 

67420 ......... ............ A Explore/treat eye socket .............................. 20.03 NA 18.77 1.01 NA 39.81 090 

67430 ......... ............ A Explore/treat eye socket .............................. 13.37 NA 15.83 1.17 NA 30.37 090 

67440 ......... ............ A Explore/drain eye socket ............................. 13.07 NA 15.47 0.70 NA 29.24 090 

67445 ......... ............ A Explr/decompress eye socket ...................... 14.40 NA 15.70 0.76 NA 30.86 090 

67450 ......... ............ A Explore/biopsy eye socket ........................... 13.49 NA 15.82 0.68 NA 29.99 090 

67500 ......... ............ A Inject/treat eye socket .................................. 0.79 0.82 0.19 0.05 1.66 1.03 000 

67505 ......... ............ A Inject/treat eye socket .................................. 0.82 0.92 0.21 0.05 1.79 1.08 000 

67515 ......... ............ A Inject/treat eye socket .................................. 0.61 0.82 0.28 0.02 1.45 0.91 000 

67550 ......... ............ A Insert eye socket implant ............................. 10.17 NA 12.28 0.60 NA 23.05 090 

67560 ......... ............ A Revise eye socket implant ........................... 10.58 NA 12.33 0.57 NA 23.48 090 

67570 ......... ............ A Decompress optic nerve .............................. 13.56 NA 15.33 0.83 NA 29.72 090 

67599 ......... ............ C Orbit surgery procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

67700 ......... ............ A Drainage of eyelid abscess ......................... 1.35 4.84 0.62 0.07 6.26 2.04 010 

67710 ......... ............ A Incision of eyelid .......................................... 1.02 4.99 0.53 0.05 6.06 1.60 010 

67715 ......... ............ A Incision of eyelid fold ................................... 1.22 4.58 0.62 0.06 5.86 1.90 010 

67800 ......... ............ A Remove eyelid lesion .................................. 1.38 2.50 0.69 0.07 3.95 2.14 010 

67801 ......... ............ A Remove eyelid lesions ................................. 1.88 5.34 0.92 0.10 7.32 2.90 010 

67805 ......... ............ A Remove eyelid lesions ................................. 2.22 5.49 1.08 0.11 7.82 3.41 010 

67808 ......... ............ A Remove eyelid lesion(s) .............................. 3.79 NA 5.23 0.21 NA 9.23 090 

67810 ......... ............ A Biopsy of eyelid ........................................... 1.48 3.65 0.68 0.07 5.20 2.23 000 

67820 ......... ............ A Revise eyelashes ......................................... 0.89 1.11 0.37 0.05 2.05 1.31 000 

67825 ......... ............ A Revise eyelashes ......................................... 1.38 1.58 1.08 0.07 3.03 2.53 010 

67830 ......... ............ A Revise eyelashes ......................................... 1.70 7.48 1.95 0.08 9.26 3.73 010 

67835 ......... ............ A Revise eyelashes ......................................... 5.55 NA 5.00 0.27 NA 10.82 090 

67840 ......... ............ A Remove eyelid lesion .................................. 2.04 5.32 1.00 0.10 7.46 3.14 010 

67850 ......... ............ A Treat eyelid lesion ....................................... 1.69 6.06 1.89 0.08 7.83 3.66 010 

67875 ......... ............ A Closure of eyelid by suture .......................... 1.35 7.05 0.62 0.07 8.47 2.04 000 

1187

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

67880 ......... ............ A Revision of eyelid ........................................ 3.79 9.66 4.29 0.19 13.64 8.27 090 

67882 ......... ............ A Revision of eyelid ........................................ 5.06 11.01 5.50 0.25 16.32 10.81 090 

67900 ......... ............ A Repair brow defect ...................................... 6.13 10.53 6.32 0.36 17.02 12.81 090 

67901 ......... ............ A Repair eyelid defect ..................................... 6.96 NA 6.41 0.39 NA 13.76 090 

67902 ......... ............ A Repair eyelid defect ..................................... 7.02 NA 6.47 0.41 NA 13.90 090 

67903 ......... ............ A Repair eyelid defect ..................................... 6.36 11.28 6.70 0.47 18.11 13.53 090 

67904 ......... ............ A Repair eyelid defect ..................................... 6.25 12.49 7.17 0.31 19.05 13.73 090 

67906 ......... ............ A Repair eyelid defect ..................................... 6.78 9.11 6.01 0.51 16.40 13.30 090 

67908 ......... ............ A Repair eyelid defect ..................................... 5.12 8.83 5.68 0.24 14.19 11.04 090 

67909 ......... ............ A Revise eyelid defect .................................... 5.39 9.36 6.09 0.30 15.05 11.78 090 

67911 ......... ............ A Revise eyelid defect .................................... 5.26 NA 6.04 0.28 NA 11.58 090 

67912 ......... ............ A Correction eyelid w/ implant ........................ 5.67 20.38 5.27 0.28 26.33 11.22 090 

67914 ......... ............ A Repair eyelid defect ..................................... 3.67 9.30 3.95 0.19 13.16 7.81 090 

67915 ......... ............ A Repair eyelid defect ..................................... 3.18 7.90 2.58 0.16 11.24 5.92 090 

67916 ......... ............ A Repair eyelid defect ..................................... 5.30 11.78 5.69 0.27 17.35 11.26 090 

67917 ......... ............ A Repair eyelid defect ..................................... 6.01 9.71 6.15 0.30 16.02 12.46 090 

67921 ......... ............ A Repair eyelid defect ..................................... 3.39 9.11 3.75 0.17 12.67 7.31 090 

67922 ......... ............ A Repair eyelid defect ..................................... 3.06 7.86 3.49 0.16 11.08 6.71 090 

67923 ......... ............ A Repair eyelid defect ..................................... 5.87 11.35 5.90 0.29 17.51 12.06 090 

67924 ......... ............ A Repair eyelid defect ..................................... 5.78 9.10 5.65 0.28 15.16 11.71 090 

67930 ......... ............ A Repair eyelid wound .................................... 3.60 8.42 2.95 0.21 12.23 6.76 010 

67935 ......... ............ A Repair eyelid wound .................................... 6.21 11.36 5.95 0.35 17.92 12.51 090 

67938 ......... ............ A Remove eyelid foreign body ........................ 1.33 5.81 0.56 0.07 7.21 1.96 010 

67950 ......... ............ A Revision of eyelid ........................................ 5.81 8.25 6.57 0.36 14.42 12.74 090 

67961 ......... ............ A Revision of eyelid ........................................ 5.68 10.20 5.70 0.31 16.19 11.69 090 

67966 ......... ............ A Revision of eyelid ........................................ 6.56 8.33 5.66 0.40 15.29 12.62 090 

67971 ......... ............ A Reconstruction of eyelid .............................. 9.78 NA 7.27 0.51 NA 17.56 090 

67973 ......... ............ A Reconstruction of eyelid .............................. 12.85 NA 9.24 0.71 NA 22.80 090 

67974 ......... ............ A Reconstruction of eyelid .............................. 12.82 NA 9.16 0.65 NA 22.63 090 

67975 ......... ............ A Reconstruction of eyelid .............................. 9.12 NA 6.95 0.46 NA 16.53 090 

67999 ......... ............ C Revision of eyelid ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68020 ......... ............ A Incise/drain eyelid lining .............................. 1.37 5.69 0.68 0.07 7.13 2.12 010 

68040 ......... ............ A Treatment of eyelid lesions ......................... 0.85 4.82 0.37 0.04 5.71 1.26 000 

68100 ......... ............ A Biopsy of eyelid lining .................................. 1.35 5.01 0.61 0.07 6.43 2.03 000 

68110 ......... ............ A Remove eyelid lining lesion ......................... 1.77 6.06 1.40 0.08 7.91 3.25 010 

68115 ......... ............ A Remove eyelid lining lesion ......................... 2.36 5.56 1.13 0.12 8.04 3.61 010 

68130 ......... ............ A Remove eyelid lining lesion ......................... 4.92 8.14 4.28 0.23 13.29 9.43 090 

68135 ......... ............ A Remove eyelid lining lesion ......................... 1.84 5.32 0.90 0.08 7.24 2.82 010 

68200 ......... ............ A Treat eyelid by injection ............................... 0.49 0.72 0.23 0.02 1.23 0.74 000 

68320 ......... ............ A Revise/graft eyelid lining .............................. 5.36 6.56 5.41 0.25 12.17 11.02 090 

68325 ......... ............ A Revise/graft eyelid lining .............................. 7.35 NA 6.39 0.36 NA 14.10 090 

68326 ......... ............ A Revise/graft eyelid lining .............................. 7.14 NA 6.28 0.36 NA 13.78 090 

68328 ......... ............ A Revise/graft eyelid lining .............................. 8.17 NA 7.03 0.48 NA 15.68 090 

68330 ......... ............ A Revise eyelid lining ...................................... 4.82 7.24 6.05 0.23 12.29 11.10 090 

68335 ......... ............ A Revise/graft eyelid lining .............................. 7.18 NA 6.79 0.35 NA 14.32 090 

68340 ......... ............ A Separate eyelid adhesions .......................... 4.16 10.80 4.77 0.21 15.17 9.14 090 

68360 ......... ............ A Revise eyelid lining ...................................... 4.36 6.60 5.58 0.21 11.17 10.15 090 

68362 ......... ............ A Revise eyelid lining ...................................... 7.33 NA 7.72 0.35 NA 15.40 090 

68371 ......... ............ A Harvest eye tissue, alograft ......................... 4.89 NA 4.62 0.21 NA 9.72 010 

68399 ......... ............ C Eyelid lining surgery .................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

68400 ......... ............ A Incise/drain tear gland ................................. 1.69 7.61 2.04 0.08 9.38 3.81 010 

68420 ......... ............ A Incise/drain tear sac .................................... 2.30 7.92 2.33 0.12 10.34 4.75 010 

68440 ......... ............ A Incise tear duct opening .............................. 0.94 4.93 0.49 0.05 5.92 1.48 010 

68500 ......... ............ A Removal of tear gland ................................. 11.00 NA 10.16 0.72 NA 21.88 090 

68505 ......... ............ A Partial removal, tear gland .......................... 10.92 NA 11.17 0.69 NA 22.78 090 

68510 ......... ............ A Biopsy of tear gland ..................................... 4.60 8.42 2.10 0.23 13.25 6.93 000 

68520 ......... ............ A Removal of tear sac .................................... 7.50 NA 7.78 0.40 NA 15.68 090 

68525 ......... ............ A Biopsy of tear sac ........................................ 4.42 NA 2.02 0.22 NA 6.66 000 

68530 ......... ............ A Clearance of tear duct ................................. 3.65 9.45 2.85 0.19 13.29 6.69 010 

68540 ......... ............ A Remove tear gland lesion ............................ 10.58 NA 9.78 0.55 NA 20.91 090 

68550 ......... ............ A Remove tear gland lesion ............................ 13.24 NA 11.75 0.80 NA 25.79 090 

68700 ......... ............ A Repair tear ducts ......................................... 6.59 NA 7.29 0.33 NA 14.21 090 

68705 ......... ............ A Revise tear duct opening ............................. 2.06 5.45 1.01 0.10 7.61 3.17 010 

68720 ......... ............ A Create tear sac drain ................................... 8.95 NA 8.26 0.46 NA 17.67 090 

68745 ......... ............ A Create tear duct drain .................................. 8.62 NA 8.22 0.46 NA 17.30 090 

68750 ......... ............ A Create tear duct drain .................................. 8.65 NA 8.69 0.45 NA 17.79 090 

68760 ......... ............ A Close tear duct opening .............................. 1.73 3.99 1.23 0.08 5.80 3.04 010 

68761 ......... ............ A Close tear duct opening .............................. 1.36 3.42 0.98 0.07 4.85 2.41 010 

68770 ......... ............ A Close tear system fistula ............................. 7.01 12.75 6.78 0.34 20.10 14.13 090 

68801 ......... ............ A Dilate tear duct opening .............................. 0.94 0.94 0.60 0.05 1.93 1.59 010 

68810 ......... ............ A Probe nasolacrimal duct .............................. 1.90 2.32 0.92 0.10 4.32 2.92 010 

68811 ......... ............ A Probe nasolacrimal duct .............................. 2.35 NA 2.36 0.12 NA 4.83 010 

68815 ......... ............ A Probe nasolacrimal duct .............................. 3.20 8.16 2.68 0.17 11.53 6.05 010 

68840 ......... ............ A Explore/irrigate tear ducts ............................ 1.25 1.64 0.96 0.06 2.95 2.27 010 

68850 ......... ............ A Injection for tear sac x-ray ........................... 0.80 16.32 0.30 0.04 17.16 1.14 000 

1188

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

68899 ......... ............ C Tear duct system surgery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69000 ......... ............ A Drain external ear lesion ............................. 1.45 2.95 1.39 0.12 4.52 2.96 010 

69005 ......... ............ A Drain external ear lesion ............................. 2.11 2.96 1.85 0.19 5.26 4.15 010 

69020 ......... ............ A Drain outer ear canal lesion ........................ 1.48 3.92 2.03 0.13 5.53 3.64 010 

69090 ......... ............ N Pierce earlobes ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

69100 ......... ............ A Biopsy of external ear .................................. 0.81 1.74 0.39 0.05 2.60 1.25 000 

69105 ......... ............ A Biopsy of external ear canal ........................ 0.85 2.31 0.77 0.07 3.23 1.69 000 

69110 ......... ............ A Remove external ear, partial ....................... 3.43 4.07 3.03 0.29 7.79 6.75 090 

69120 ......... ............ A Removal of external ear .............................. 4.04 NA 3.96 0.37 NA 8.37 090 

69140 ......... ............ A Remove ear canal lesion(s) ......................... 7.96 NA 6.69 0.68 NA 15.33 090 

69145 ......... ............ A Remove ear canal lesion(s) ......................... 2.62 3.57 2.60 0.22 6.41 5.44 090 

69150 ......... ............ A Extensive ear canal surgery ........................ 13.41 NA 9.90 1.29 NA 24.60 090 

69155 ......... ............ A Extensive ear/neck surgery ......................... 20.77 NA 14.47 1.82 NA 37.06 090 

69200 ......... ............ A Clear outer ear canal ................................... 0.77 2.33 0.58 0.06 3.16 1.41 000 

69205 ......... ............ A Clear outer ear canal ................................... 1.20 NA 1.35 0.11 NA 2.66 010 

69210 ......... ............ A Remove impacted ear wax .......................... 0.61 0.63 0.24 0.05 1.29 0.90 000 

69220 ......... ............ A Clean out mastoid cavity ............................. 0.83 2.31 0.74 0.07 3.21 1.64 000 

69222 ......... ............ A Clean out mastoid cavity ............................. 1.40 3.78 2.02 0.12 5.30 3.54 010 

69300 ......... ............ R Revise external ear ...................................... 6.35 NA 4.23 0.52 NA 11.10 YYY 

69310 ......... ............ A Rebuild outer ear canal ............................... 10.77 NA 8.37 0.93 NA 20.07 090 

69320 ......... ............ A Rebuild outer ear canal ............................... 16.93 NA 12.09 1.41 NA 30.43 090 

69399 ......... ............ C Outer ear surgery procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69400 ......... ............ A Inflate middle ear canal ............................... 0.83 2.33 0.67 0.07 3.23 1.57 000 

69401 ......... ............ A Inflate middle ear canal ............................... 0.63 1.30 0.65 0.05 1.98 1.33 000 

69405 ......... ............ A Catheterize middle ear canal ....................... 2.63 3.48 2.29 0.22 6.33 5.14 010 

69410 ......... ............ A Inset middle ear (baffle) ............................... 0.33 2.05 0.48 0.02 2.40 0.83 000 

69420 ......... ............ A Incision of eardrum ...................................... 1.33 3.08 1.58 0.12 4.53 3.03 010 

69421 ......... ............ A Incision of eardrum ...................................... 1.73 NA 2.09 0.16 NA 3.98 010 

69424 ......... ............ A Remove ventilating tube .............................. 0.85 2.14 0.68 0.07 3.06 1.60 000 

69433 ......... ............ A Create eardrum opening .............................. 1.52 3.09 1.66 0.13 4.74 3.31 010 

69436 ......... ............ A Create eardrum opening .............................. 1.96 NA 2.22 0.17 NA 4.35 010 

69440 ......... ............ A Exploration of middle ear ............................. 7.56 NA 6.28 0.64 NA 14.48 090 

69450 ......... ............ A Eardrum revision .......................................... 5.56 NA 5.02 0.47 NA 11.05 090 

69501 ......... ............ A Mastoidectomy ............................................. 9.06 NA 7.06 0.78 NA 16.90 090 

69502 ......... ............ A Mastoidectomy ............................................. 12.36 NA 9.26 1.04 NA 22.66 090 

69505 ......... ............ A Remove mastoid structures ......................... 12.97 NA 9.51 1.11 NA 23.59 090 

69511 ......... ............ A Extensive mastoid surgery .......................... 13.50 NA 9.85 1.16 NA 24.51 090 

69530 ......... ............ A Extensive mastoid surgery .......................... 19.16 NA 13.01 1.59 NA 33.76 090 

69535 ......... ............ A Remove part of temporal bone .................... 36.09 NA 22.36 3.12 NA 61.57 090 

69540 ......... ............ A Remove ear lesion ....................................... 1.20 3.68 1.93 0.11 4.99 3.24 010 

69550 ......... ............ A Remove ear lesion ....................................... 10.97 NA 8.31 0.96 NA 20.24 090 

69552 ......... ............ A Remove ear lesion ....................................... 19.43 NA 12.92 1.64 NA 33.99 090 

69554 ......... ............ A Remove ear lesion ....................................... 33.11 NA 20.88 2.80 NA 56.79 090 

69601 ......... ............ A Mastoid surgery revision .............................. 13.22 NA 10.01 1.11 NA 24.34 090 

69602 ......... ............ A Mastoid surgery revision .............................. 13.56 NA 9.95 1.13 NA 24.64 090 

69603 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 10.16 1.21 NA 25.37 090 

69604 ......... ............ A Mastoid surgery revision .............................. 14.00 NA 10.14 1.18 NA 25.32 090 

69605 ......... ............ A Mastoid surgery revision .............................. 18.46 NA 12.80 1.56 NA 32.82 090 

69610 ......... ............ A Repair of eardrum ........................................ 4.42 5.39 3.27 0.37 10.18 8.06 010 

69620 ......... ............ A Repair of eardrum ........................................ 5.88 6.13 4.51 0.48 12.49 10.87 090 

69631 ......... ............ A Repair eardrum structures ........................... 9.85 NA 7.85 0.83 NA 18.53 090 

69632 ......... ............ A Rebuild eardrum structures ......................... 12.73 NA 9.72 1.07 NA 23.52 090 

69633 ......... ............ A Rebuild eardrum structures ......................... 12.08 NA 9.38 1.01 NA 22.47 090 

69635 ......... ............ A Repair eardrum structures ........................... 13.31 NA 9.38 1.05 NA 23.74 090 

69636 ......... ............ A Rebuild eardrum structures ......................... 15.20 NA 11.15 1.29 NA 27.64 090 

69637 ......... ............ A Rebuild eardrum structures ......................... 15.09 NA 11.09 1.28 NA 27.46 090 

69641 ......... ............ A Revise middle ear & mastoid ...................... 12.69 NA 9.47 1.07 NA 23.23 090 

69642 ......... ............ A Revise middle ear & mastoid ...................... 16.81 NA 12.11 1.42 NA 30.34 090 

69643 ......... ............ A Revise middle ear & mastoid ...................... 15.30 NA 11.15 1.30 NA 27.75 090 

69644 ......... ............ A Revise middle ear & mastoid ...................... 16.94 NA 12.06 1.44 NA 30.44 090 

69645 ......... ............ A Revise middle ear & mastoid ...................... 16.36 NA 11.70 1.40 NA 29.46 090 

69646 ......... ............ A Revise middle ear & mastoid ...................... 17.96 NA 12.63 1.52 NA 32.11 090 

69650 ......... ............ A Release middle ear bone ............................ 9.65 NA 7.40 0.82 NA 17.87 090 

69660 ......... ............ A Revise middle ear bone ............................... 11.88 NA 8.60 1.01 NA 21.49 090 

69661 ......... ............ A Revise middle ear bone ............................... 15.72 NA 11.07 1.33 NA 28.12 090 

69662 ......... ............ A Revise middle ear bone ............................... 15.42 NA 10.79 1.30 NA 27.51 090 

69666 ......... ............ A Repair middle ear structures ....................... 9.74 NA 7.48 0.82 NA 18.04 090 

69667 ......... ............ A Repair middle ear structures ....................... 9.75 NA 7.46 0.87 NA 18.08 090 

69670 ......... ............ A Remove mastoid air cells ............................ 11.49 NA 8.63 0.94 NA 21.06 090 

69676 ......... ............ A Remove middle ear nerve ........................... 9.51 NA 7.60 0.83 NA 17.94 090 

69700 ......... ............ A Close mastoid fistula ................................... 8.22 NA 5.87 0.66 NA 14.75 090 

69710 ......... ............ N Implant/replace hearing aid ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

69711 ......... ............ A Remove/repair hearing aid .......................... 10.42 NA 8.06 0.75 NA 19.23 090 

69714 ......... ............ A Implant temple bone w/stimul ...................... 13.98 NA 9.89 1.22 NA 25.09 090 

69715 ......... ............ A Temple bne implnt w/stimulat ...................... 18.22 NA 12.37 1.59 NA 32.18 090 

1189

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

69717 ......... ............ A Temple bone implant revision ..................... 14.96 NA 9.55 1.30 NA 25.81 090 

69718 ......... ............ A Revise temple bone implant ........................ 18.47 NA 12.27 1.62 NA 32.36 090 

69720 ......... ............ A Release facial nerve .................................... 14.36 NA 10.74 1.24 NA 26.34 090 

69725 ......... ............ A Release facial nerve .................................... 25.34 NA 16.83 2.15 NA 44.32 090 

69740 ......... ............ A Repair facial nerve ....................................... 15.94 NA 10.35 1.36 NA 27.65 090 

69745 ......... ............ A Repair facial nerve ....................................... 16.66 NA 11.34 1.21 NA 29.21 090 

69799 ......... ............ C Middle ear surgery procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69801 ......... ............ A Incise inner ear ............................................ 8.55 NA 6.81 0.72 NA 16.08 090 

69802 ......... ............ A Incise inner ear ............................................ 13.08 NA 9.59 1.10 NA 23.77 090 

69805 ......... ............ A Explore inner ear ......................................... 13.80 NA 10.04 1.17 NA 25.01 090 

69806 ......... ............ A Explore inner ear ......................................... 12.33 NA 9.17 1.04 NA 22.54 090 

69820 ......... ............ A Establish inner ear window .......................... 10.32 NA 7.83 0.80 NA 18.95 090 

69840 ......... ............ A Revise inner ear window ............................. 10.24 NA 6.91 0.77 NA 17.92 090 

69905 ......... ............ A Remove inner ear ........................................ 11.08 NA 8.30 0.93 NA 20.31 090 

69910 ......... ............ A Remove inner ear & mastoid ....................... 13.61 NA 9.70 1.13 NA 24.44 090 

69915 ......... ............ A Incise inner ear nerve .................................. 21.20 NA 14.15 1.86 NA 37.21 090 

69930 ......... ............ A Implant cochlear device ............................... 16.78 NA 11.81 1.44 NA 30.03 090 

69949 ......... ............ C Inner ear surgery procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69950 ......... ............ A Incise inner ear nerve .................................. 25.60 NA 16.04 3.50 NA 45.14 090 

69955 ......... ............ A Release facial nerve .................................... 27.00 NA 17.57 2.28 NA 46.85 090 

69960 ......... ............ A Release inner ear canal .............................. 27.00 NA 17.04 2.93 NA 46.97 090 

69970 ......... ............ A Remove inner ear lesion ............................. 29.99 NA 18.32 2.82 NA 51.13 090 

69979 ......... ............ C Temporal bone surgery ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

69990 ......... ............ R Microsurgery add-on .................................... 3.46 NA 1.80 0.68 NA 5.94 ZZZ 

70010 ......... ............ A Contrast x-ray of brain ................................. 1.19 4.73 NA 0.29 6.21 NA XXX 

70010 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.07 1.65 1.65 XXX 

70010 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 4.34 NA 0.22 4.56 NA XXX 

70015 ......... ............ A Contrast x-ray of brain ................................. 1.19 1.75 NA 0.14 3.08 NA XXX 

70015 ......... 26 ....... A Contrast x-ray of brain ................................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 

70015 ......... TC ...... A Contrast x-ray of brain ................................. 0.00 1.36 NA 0.08 1.44 NA XXX 

70030 ......... ............ A X-ray eye for foreign body ........................... 0.17 0.47 NA 0.03 0.67 NA XXX 

70030 ......... 26 ....... A X-ray eye for foreign body ........................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70030 ......... TC ...... A X-ray eye for foreign body ........................... 0.00 0.41 NA 0.02 0.43 NA XXX 

70100 ......... ............ A X-ray exam of jaw ........................................ 0.18 0.58 NA 0.03 0.79 NA XXX 

70100 ......... 26 ....... A X-ray exam of jaw ........................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70100 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX 

70110 ......... ............ A X-ray exam of jaw ........................................ 0.25 0.70 NA 0.05 1.00 NA XXX 

70110 ......... 26 ....... A X-ray exam of jaw ........................................ 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

70110 ......... TC ...... A X-ray exam of jaw ........................................ 0.00 0.62 NA 0.04 0.66 NA XXX 

70120 ......... ............ A X-ray exam of mastoids ............................... 0.18 0.68 NA 0.05 0.91 NA XXX 

70120 ......... 26 ....... A X-ray exam of mastoids ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70120 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70130 ......... ............ A X-ray exam of mastoids ............................... 0.34 0.90 NA 0.06 1.30 NA XXX 

70130 ......... 26 ....... A X-ray exam of mastoids ............................... 0.34 0.11 0.11 0.01 0.46 0.46 XXX 

70130 ......... TC ...... A X-ray exam of mastoids ............................... 0.00 0.79 NA 0.05 0.84 NA XXX 

70134 ......... ............ A X-ray exam of middle ear ............................ 0.34 0.85 NA 0.06 1.25 NA XXX 

70134 ......... 26 ....... A X-ray exam of middle ear ............................ 0.34 0.11 0.11 0.01 0.46 0.46 XXX 

70134 ......... TC ...... A X-ray exam of middle ear ............................ 0.00 0.74 NA 0.05 0.79 NA XXX 

70140 ......... ............ A X-ray exam of facial bones .......................... 0.19 0.68 NA 0.05 0.92 NA XXX 

70140 ......... 26 ....... A X-ray exam of facial bones .......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70140 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70150 ......... ............ A X-ray exam of facial bones .......................... 0.26 0.88 NA 0.06 1.20 NA XXX 

70150 ......... 26 ....... A X-ray exam of facial bones .......................... 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

70150 ......... TC ...... A X-ray exam of facial bones .......................... 0.00 0.79 NA 0.05 0.84 NA XXX 

70160 ......... ............ A X-ray exam of nasal bones ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 

70160 ......... 26 ....... A X-ray exam of nasal bones ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70160 ......... TC ...... A X-ray exam of nasal bones ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

70170 ......... ............ A X-ray exam of tear duct ............................... 0.30 1.05 NA 0.07 1.42 NA XXX 

70170 ......... 26 ....... A X-ray exam of tear duct ............................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 

70170 ......... TC ...... A X-ray exam of tear duct ............................... 0.00 0.95 NA 0.06 1.01 NA XXX 

70190 ......... ............ A X-ray exam of eye sockets .......................... 0.21 0.69 NA 0.05 0.95 NA XXX 

70190 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

70190 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70200 ......... ............ A X-ray exam of eye sockets .......................... 0.28 0.88 NA 0.06 1.22 NA XXX 

70200 ......... 26 ....... A X-ray exam of eye sockets .......................... 0.28 0.09 0.09 0.01 0.38 0.38 XXX 

70200 ......... TC ...... A X-ray exam of eye sockets .......................... 0.00 0.79 NA 0.05 0.84 NA XXX 

70210 ......... ............ A X-ray exam of sinuses ................................. 0.17 0.68 NA 0.05 0.90 NA XXX 

70210 ......... 26 ....... A X-ray exam of sinuses ................................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70210 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.62 NA 0.04 0.66 NA XXX 

70220 ......... ............ A X-ray exam of sinuses ................................. 0.25 0.87 NA 0.06 1.18 NA XXX 

70220 ......... 26 ....... A X-ray exam of sinuses ................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

70220 ......... TC ...... A X-ray exam of sinuses ................................. 0.00 0.79 NA 0.05 0.84 NA XXX 

70240 ......... ............ A X-ray exam, pituitary saddle ........................ 0.19 0.47 NA 0.03 0.69 NA XXX 

70240 ......... 26 ....... A X-ray exam, pituitary saddle ........................ 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

70240 ......... TC ...... A X-ray exam, pituitary saddle ........................ 0.00 0.41 NA 0.02 0.43 NA XXX 

1190

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

70250 ......... ............ A X-ray exam of skull ...................................... 0.24 0.70 NA 0.05 0.99 NA XXX 

70250 ......... 26 ....... A X-ray exam of skull ...................................... 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70250 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.62 NA 0.04 0.66 NA XXX 

70260 ......... ............ A X-ray exam of skull ...................................... 0.34 1.00 NA 0.07 1.41 NA XXX 

70260 ......... 26 ....... A X-ray exam of skull ...................................... 0.34 0.11 0.11 0.01 0.46 0.46 XXX 

70260 ......... TC ...... A X-ray exam of skull ...................................... 0.00 0.89 NA 0.06 0.95 NA XXX 

70300 ......... ............ A X-ray exam of teeth ..................................... 0.10 0.32 NA 0.03 0.45 NA XXX 

70300 ......... 26 ....... A X-ray exam of teeth ..................................... 0.10 0.05 0.05 0.01 0.16 0.16 XXX 

70300 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.27 NA 0.02 0.29 NA XXX 

70310 ......... ............ A X-ray exam of teeth ..................................... 0.16 0.49 NA 0.03 0.68 NA XXX 

70310 ......... 26 ....... A X-ray exam of teeth ..................................... 0.16 0.08 0.08 0.01 0.25 0.25 XXX 

70310 ......... TC ...... A X-ray exam of teeth ..................................... 0.00 0.41 NA 0.02 0.43 NA XXX 

70320 ......... ............ A Full mouth x-ray of teeth ............................. 0.22 0.87 NA 0.06 1.15 NA XXX 

70320 ......... 26 ....... A Full mouth x-ray of teeth ............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

70320 ......... TC ...... A Full mouth x-ray of teeth ............................. 0.00 0.79 NA 0.05 0.84 NA XXX 

70328 ......... ............ A X-ray exam of jaw joint ................................ 0.18 0.55 NA 0.03 0.76 NA XXX 

70328 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

70328 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 0.49 NA 0.02 0.51 NA XXX 

70330 ......... ............ A X-ray exam of jaw joints .............................. 0.24 0.93 NA 0.06 1.23 NA XXX 

70330 ......... 26 ....... A X-ray exam of jaw joints .............................. 0.24 0.08 0.08 0.01 0.33 0.33 XXX 

70330 ......... TC ...... A X-ray exam of jaw joints .............................. 0.00 0.85 NA 0.05 0.90 NA XXX 

70332 ......... ............ A X-ray exam of jaw joint ................................ 0.54 2.30 NA 0.14 2.98 NA XXX 

70332 ......... 26 ....... A X-ray exam of jaw joint ................................ 0.54 0.20 0.20 0.02 0.76 0.76 XXX 

70332 ......... TC ...... A X-ray exam of jaw joint ................................ 0.00 2.10 NA 0.12 2.22 NA XXX 

70336 ......... ............ A Magnetic image, jaw joint ............................ 1.48 11.72 NA 0.67 13.87 NA XXX 

70336 ......... 26 ....... A Magnetic image, jaw joint ............................ 1.48 0.48 0.48 0.08 2.04 2.04 XXX 

70336 ......... TC ...... A Magnetic image, jaw joint ............................ 0.00 11.24 NA 0.59 11.83 NA XXX 

70350 ......... ............ A X-ray head for orthodontia ........................... 0.17 0.44 NA 0.03 0.64 NA XXX 

70350 ......... 26 ....... A X-ray head for orthodontia ........................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

70350 ......... TC ...... A X-ray head for orthodontia ........................... 0.00 0.37 NA 0.02 0.39 NA XXX 

70355 ......... ............ A Panoramic x-ray of jaws .............................. 0.20 0.65 NA 0.05 0.90 NA XXX 

70355 ......... 26 ....... A Panoramic x-ray of jaws .............................. 0.20 0.08 0.08 0.01 0.29 0.29 XXX 

70355 ......... TC ...... A Panoramic x-ray of jaws .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 

70360 ......... ............ A X-ray exam of neck ..................................... 0.17 0.47 NA 0.03 0.67 NA XXX 

70360 ......... 26 ....... A X-ray exam of neck ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70360 ......... TC ...... A X-ray exam of neck ..................................... 0.00 0.41 NA 0.02 0.43 NA XXX 

70370 ......... ............ A Throat x-ray & fluoroscopy .......................... 0.32 1.42 NA 0.08 1.82 NA XXX 

70370 ......... 26 ....... A Throat x-ray & fluoroscopy .......................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

70370 ......... TC ...... A Throat x-ray & fluoroscopy .......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

70371 ......... ............ A Speech evaluation, complex ........................ 0.84 2.38 NA 0.17 3.39 NA XXX 

70371 ......... 26 ....... A Speech evaluation, complex ........................ 0.84 0.28 0.28 0.05 1.17 1.17 XXX 

70371 ......... TC ...... A Speech evaluation, complex ........................ 0.00 2.10 NA 0.12 2.22 NA XXX 

70373 ......... ............ A Contrast x-ray of larynx ............................... 0.44 1.94 NA 0.13 2.51 NA XXX 

70373 ......... 26 ....... A Contrast x-ray of larynx ............................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

70373 ......... TC ...... A Contrast x-ray of larynx ............................... 0.00 1.79 NA 0.11 1.90 NA XXX 

70380 ......... ............ A X-ray exam of salivary gland ....................... 0.17 0.73 NA 0.05 0.95 NA XXX 

70380 ......... 26 ....... A X-ray exam of salivary gland ....................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

70380 ......... TC ...... A X-ray exam of salivary gland ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 

70390 ......... ............ A X-ray exam of salivary duct ......................... 0.38 1.92 NA 0.13 2.43 NA XXX 

70390 ......... 26 ....... A X-ray exam of salivary duct ......................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

70390 ......... TC ...... A X-ray exam of salivary duct ......................... 0.00 1.79 NA 0.11 1.90 NA XXX 

70450 ......... ............ A Ct head/brain w/o dye ................................. 0.85 5.02 NA 0.30 6.17 NA XXX 

70450 ......... 26 ....... A Ct head/brain w/o dye ................................. 0.85 0.28 0.28 0.05 1.18 1.18 XXX 

70450 ......... TC ...... A Ct head/brain w/o dye ................................. 0.00 4.74 NA 0.25 4.99 NA XXX 

70460 ......... ............ A Ct head/brain w/dye ..................................... 1.13 6.04 NA 0.36 7.53 NA XXX 

70460 ......... 26 ....... A Ct head/brain w/dye ..................................... 1.13 0.37 0.37 0.06 1.56 1.56 XXX 

70460 ......... TC ...... A Ct head/brain w/dye ..................................... 0.00 5.67 NA 0.30 5.97 NA XXX 

70470 ......... ............ A Ct head/brain w/o & w/ dye ......................... 1.27 7.51 NA 0.44 9.22 NA XXX 

70470 ......... 26 ....... A Ct head/brain w/o & w/ dye ......................... 1.27 0.41 0.41 0.07 1.75 1.75 XXX 

70470 ......... TC ...... A Ct head/brain w/o & w/ dye ......................... 0.00 7.10 NA 0.37 7.47 NA XXX 

70480 ......... ............ A Ct orbit/ear/fossa w/o dye ............................ 1.28 5.16 NA 0.32 6.76 NA XXX 

70480 ......... 26 ....... A Ct orbit/ear/fossa w/o dye ............................ 1.28 0.42 0.42 0.07 1.77 1.77 XXX 

70480 ......... TC ...... A Ct orbit/ear/fossa w/o dye ............................ 0.00 4.74 NA 0.25 4.99 NA XXX 

70481 ......... ............ A Ct orbit/ear/fossa w/dye ............................... 1.38 6.12 NA 0.37 7.87 NA XXX 

70481 ......... 26 ....... A Ct orbit/ear/fossa w/dye ............................... 1.38 0.45 0.45 0.07 1.90 1.90 XXX 

70481 ......... TC ...... A Ct orbit/ear/fossa w/dye ............................... 0.00 5.67 NA 0.30 5.97 NA XXX 

70482 ......... ............ A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 7.57 NA 0.44 9.46 NA XXX 

70482 ......... 26 ....... A Ct orbit/ear/fossa w/o&w dye ....................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 

70482 ......... TC ...... A Ct orbit/ear/fossa w/o&w dye ....................... 0.00 7.10 NA 0.37 7.47 NA XXX 

70486 ......... ............ A Ct maxillofacial w/o dye ............................... 1.14 5.11 NA 0.31 6.56 NA XXX 

70486 ......... 26 ....... A Ct maxillofacial w/o dye ............................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

70486 ......... TC ...... A Ct maxillofacial w/o dye ............................... 0.00 4.74 NA 0.25 4.99 NA XXX 

70487 ......... ............ A Ct maxillofacial w/dye .................................. 1.30 6.09 NA 0.37 7.76 NA XXX 

70487 ......... 26 ....... A Ct maxillofacial w/dye .................................. 1.30 0.42 0.42 0.07 1.79 1.79 XXX 

70487 ......... TC ...... A Ct maxillofacial w/dye .................................. 0.00 5.67 NA 0.30 5.97 NA XXX 

1191

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

70488 ......... ............ A Ct maxillofacial w/o & w dye ....................... 1.42 7.56 NA 0.44 9.42 NA XXX 

70488 ......... 26 ....... A Ct maxillofacial w/o & w dye ....................... 1.42 0.46 0.46 0.07 1.95 1.95 XXX 

70488 ......... TC ...... A Ct maxillofacial w/o & w dye ....................... 0.00 7.10 NA 0.37 7.47 NA XXX 

70490 ......... ............ A Ct soft tissue neck w/o dye ......................... 1.28 5.16 NA 0.32 6.76 NA XXX 

70490 ......... 26 ....... A Ct soft tissue neck w/o dye ......................... 1.28 0.42 0.42 0.07 1.77 1.77 XXX 

70490 ......... TC ...... A Ct soft tissue neck w/o dye ......................... 0.00 4.74 NA 0.25 4.99 NA XXX 

70491 ......... ............ A Ct soft tissue neck w/dye ............................ 1.38 6.12 NA 0.37 7.87 NA XXX 

70491 ......... 26 ....... A Ct soft tissue neck w/dye ............................ 1.38 0.45 0.45 0.07 1.90 1.90 XXX 

70491 ......... TC ...... A Ct soft tissue neck w/dye ............................ 0.00 5.67 NA 0.30 5.97 NA XXX 

70492 ......... ............ A Ct sft tsue nck w/o & w/dye ......................... 1.45 7.57 NA 0.44 9.46 NA XXX 

70492 ......... 26 ....... A Ct sft tsue nck w/o & w/dye ......................... 1.45 0.47 0.47 0.07 1.99 1.99 XXX 

70492 ......... TC ...... A Ct sft tsue nck w/o & w/dye ......................... 0.00 7.10 NA 0.37 7.47 NA XXX 

70496 ......... ............ A Ct angiography, head .................................. 1.75 11.22 NA 0.68 13.65 NA XXX 

70496 ......... 26 ....... A Ct angiography, head .................................. 1.75 0.57 0.57 0.10 2.42 2.42 XXX 

70496 ......... TC ...... A Ct angiography, head .................................. 0.00 10.65 NA 0.58 11.23 NA XXX 

70498 ......... ............ A Ct angiography, neck ................................... 1.75 11.22 NA 0.68 13.65 NA XXX 

70498 ......... 26 ....... A Ct angiography, neck ................................... 1.75 0.57 0.57 0.10 2.42 2.42 XXX 

70498 ......... TC ...... A Ct angiography, neck ................................... 0.00 10.65 NA 0.58 11.23 NA XXX 

70540 ......... ............ A Mri orbit/face/neck w/o dye .......................... 1.35 11.68 NA 0.44 13.47 NA XXX 

70540 ......... 26 ....... A Mri orbit/face/neck w/o dye .......................... 1.35 0.44 0.44 0.05 1.84 1.84 XXX 

70540 ......... TC ...... A Mri orbit/face/neck w/o dye .......................... 0.00 11.24 NA 0.39 11.63 NA XXX 

70542 ......... ............ A Mri orbit/face/neck w/dye ............................. 1.62 14.02 NA 0.53 16.17 NA XXX 

70542 ......... 26 ....... A Mri orbit/face/neck w/dye ............................. 1.62 0.53 0.53 0.06 2.21 2.21 XXX 

70542 ......... TC ...... A Mri orbit/face/neck w/dye ............................. 0.00 13.49 NA 0.47 13.96 NA XXX 

70543 ......... ............ A Mri orbt/fac/nck w/o & w dye ....................... 2.15 25.69 NA 0.92 28.76 NA XXX 

70543 ......... 26 ....... A Mri orbt/fac/nck w/o & w dye ....................... 2.15 0.71 0.71 0.08 2.94 2.94 XXX 

70543 ......... TC ...... A Mri orbt/fac/nck w/o & w dye ....................... 0.00 24.98 NA 0.84 25.82 NA XXX 

70544 ......... ............ A Mr angiography head w/o dye ..................... 1.20 11.63 NA 0.65 13.48 NA XXX 

70544 ......... 26 ....... A Mr angiography head w/o dye ..................... 1.20 0.39 0.39 0.06 1.65 1.65 XXX 

70544 ......... TC ...... A Mr angiography head w/o dye ..................... 0.00 11.24 NA 0.59 11.83 NA XXX 

70545 ......... ............ A Mr angiography head w/dye ........................ 1.20 11.63 NA 0.65 13.48 NA XXX 

70545 ......... 26 ....... A Mr angiography head w/dye ........................ 1.20 0.39 0.39 0.06 1.65 1.65 XXX 

70545 ......... TC ...... A Mr angiography head w/dye ........................ 0.00 11.24 NA 0.59 11.83 NA XXX 

70546 ......... ............ A Mr angiograph head w/o&w dye .................. 1.80 23.08 NA 0.69 25.57 NA XXX 

70546 ......... 26 ....... A Mr angiograph head w/o&w dye .................. 1.80 0.59 0.59 0.10 2.49 2.49 XXX 

70546 ......... TC ...... A Mr angiograph head w/o&w dye .................. 0.00 22.49 NA 0.59 23.08 NA XXX 

70547 ......... ............ A Mr angiography neck w/o dye ..................... 1.20 11.63 NA 0.65 13.48 NA XXX 

70547 ......... 26 ....... A Mr angiography neck w/o dye ..................... 1.20 0.39 0.39 0.06 1.65 1.65 XXX 

70547 ......... TC ...... A Mr angiography neck w/o dye ..................... 0.00 11.24 NA 0.59 11.83 NA XXX 

70548 ......... ............ A Mr angiography neck w/dye ........................ 1.20 11.63 NA 0.65 13.48 NA XXX 

70548 ......... 26 ....... A Mr angiography neck w/dye ........................ 1.20 0.39 0.39 0.06 1.65 1.65 XXX 

70548 ......... TC ...... A Mr angiography neck w/dye ........................ 0.00 11.24 NA 0.59 11.83 NA XXX 

70549 ......... ............ A Mr angiograph neck w/o&w dye .................. 1.80 23.08 NA 0.69 25.57 NA XXX 

70549 ......... 26 ....... A Mr angiograph neck w/o&w dye .................. 1.80 0.59 0.59 0.10 2.49 2.49 XXX 

70549 ......... TC ...... A Mr angiograph neck w/o&w dye .................. 0.00 22.49 NA 0.59 23.08 NA XXX 

70551 ......... ............ A Mri brain w/o dye ......................................... 1.48 11.73 NA 0.67 13.88 NA XXX 

70551 ......... 26 ....... A Mri brain w/o dye ......................................... 1.48 0.49 0.49 0.08 2.05 2.05 XXX 

70551 ......... TC ...... A Mri brain w/o dye ......................................... 0.00 11.24 NA 0.59 11.83 NA XXX 

70552 ......... ............ A Mri brain w/ dye ........................................... 1.78 14.08 NA 0.80 16.66 NA XXX 

70552 ......... 26 ....... A Mri brain w/ dye ........................................... 1.78 0.59 0.59 0.10 2.47 2.47 XXX 

70552 ......... TC ...... A Mri brain w/ dye ........................................... 0.00 13.49 NA 0.70 14.19 NA XXX 

70553 ......... ............ A Mri brain w/o & w/ dye ................................. 2.36 25.76 NA 1.43 29.55 NA XXX 

70553 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 2.36 0.78 0.78 0.12 3.26 3.26 XXX 

70553 ......... TC ...... A Mri brain w/o & w/ dye ................................. 0.00 24.98 NA 1.31 26.29 NA XXX 

70557 ......... ............ C Mri brain w/o dye ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70557 ......... 26 ....... A Mri brain w/o dye ......................................... 2.90 0.98 0.98 0.08 3.96 3.96 XXX 

70557 ......... TC ...... C Mri brain w/o dye ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70558 ......... ............ C Mri brain w/ dye ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70558 ......... 26 ....... A Mri brain w/ dye ........................................... 3.20 1.08 1.08 0.10 4.38 4.38 XXX 

70558 ......... TC ...... C Mri brain w/ dye ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70559 ......... ............ C Mri brain w/o & w/ dye ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

70559 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 3.20 1.08 1.08 0.12 4.40 4.40 XXX 

70559 ......... TC ...... C Mri brain w/o & w/ dye ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

71010 ......... ............ A Chest x-ray .................................................. 0.18 0.53 NA 0.03 0.74 NA XXX 

71010 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71010 ......... TC ...... A Chest x-ray .................................................. 0.00 0.47 NA 0.02 0.49 NA XXX 

71015 ......... ............ A Chest x-ray .................................................. 0.21 0.59 NA 0.03 0.83 NA XXX 

71015 ......... 26 ....... A Chest x-ray .................................................. 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

71015 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

71020 ......... ............ A Chest x-ray .................................................. 0.22 0.69 NA 0.05 0.96 NA XXX 

71020 ......... 26 ....... A Chest x-ray .................................................. 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71020 ......... TC ...... A Chest x-ray .................................................. 0.00 0.62 NA 0.04 0.66 NA XXX 

71021 ......... ............ A Chest x-ray .................................................. 0.27 0.83 NA 0.06 1.16 NA XXX 

71021 ......... 26 ....... A Chest x-ray .................................................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71021 ......... TC ...... A Chest x-ray .................................................. 0.00 0.74 NA 0.05 0.79 NA XXX 

1192

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

71022 ......... ............ A Chest x-ray .................................................. 0.31 0.84 NA 0.07 1.22 NA XXX 

71022 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.02 0.43 0.43 XXX 

71022 ......... TC ...... A Chest x-ray .................................................. 0.00 0.74 NA 0.05 0.79 NA XXX 

71023 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.38 0.92 NA 0.07 1.37 NA XXX 

71023 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

71023 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 0.79 NA 0.05 0.84 NA XXX 

71030 ......... ............ A Chest x-ray .................................................. 0.31 0.89 NA 0.06 1.26 NA XXX 

71030 ......... 26 ....... A Chest x-ray .................................................. 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

71030 ......... TC ...... A Chest x-ray .................................................. 0.00 0.79 NA 0.05 0.84 NA XXX 

71034 ......... ............ A Chest x-ray and fluoroscopy ........................ 0.46 1.60 NA 0.10 2.16 NA XXX 

71034 ......... 26 ....... A Chest x-ray and fluoroscopy ........................ 0.46 0.16 0.16 0.02 0.64 0.64 XXX 

71034 ......... TC ...... A Chest x-ray and fluoroscopy ........................ 0.00 1.44 NA 0.08 1.52 NA XXX 

71035 ......... ............ A Chest x-ray .................................................. 0.18 0.58 NA 0.03 0.79 NA XXX 

71035 ......... 26 ....... A Chest x-ray .................................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

71035 ......... TC ...... A Chest x-ray .................................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

71040 ......... ............ A Contrast x-ray of bronchi ............................. 0.58 1.65 NA 0.12 2.35 NA XXX 

71040 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.58 0.19 0.19 0.04 0.81 0.81 XXX 

71040 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

71060 ......... ............ A Contrast x-ray of bronchi ............................. 0.74 2.46 NA 0.17 3.37 NA XXX 

71060 ......... 26 ....... A Contrast x-ray of bronchi ............................. 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

71060 ......... TC ...... A Contrast x-ray of bronchi ............................. 0.00 2.21 NA 0.13 2.34 NA XXX 

71090 ......... ............ A X-ray & pacemaker insertion ....................... 0.54 1.90 NA 0.13 2.57 NA XXX 

71090 ......... 26 ....... A X-ray & pacemaker insertion ....................... 0.54 0.21 0.21 0.02 0.77 0.77 XXX 

71090 ......... TC ...... A X-ray & pacemaker insertion ....................... 0.00 1.69 NA 0.11 1.80 NA XXX 

71100 ......... ............ A X-ray exam of ribs ....................................... 0.22 0.64 NA 0.05 0.91 NA XXX 

71100 ......... 26 ....... A X-ray exam of ribs ....................................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71100 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

71101 ......... ............ A X-ray exam of ribs/chest .............................. 0.27 0.76 NA 0.05 1.08 NA XXX 

71101 ......... 26 ....... A X-ray exam of ribs/chest .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71101 ......... TC ...... A X-ray exam of ribs/chest .............................. 0.00 0.67 NA 0.04 0.71 NA XXX 

71110 ......... ............ A X-ray exam of ribs ....................................... 0.27 0.88 NA 0.06 1.21 NA XXX 

71110 ......... 26 ....... A X-ray exam of ribs ....................................... 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

71110 ......... TC ...... A X-ray exam of ribs ....................................... 0.00 0.79 NA 0.05 0.84 NA XXX 

71111 ......... ............ A X-ray exam of ribs/ chest ............................ 0.32 1.00 NA 0.07 1.39 NA XXX 

71111 ......... 26 ....... A X-ray exam of ribs/ chest ............................ 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

71111 ......... TC ...... A X-ray exam of ribs/ chest ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 

71120 ......... ............ A X-ray exam of breastbone ........................... 0.20 0.72 NA 0.05 0.97 NA XXX 

71120 ......... 26 ....... A X-ray exam of breastbone ........................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

71120 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.65 NA 0.04 0.69 NA XXX 

71130 ......... ............ A X-ray exam of breastbone ........................... 0.22 0.78 NA 0.05 1.05 NA XXX 

71130 ......... 26 ....... A X-ray exam of breastbone ........................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

71130 ......... TC ...... A X-ray exam of breastbone ........................... 0.00 0.71 NA 0.04 0.75 NA XXX 

71250 ......... ............ A Ct thorax w/o dye ........................................ 1.16 6.31 NA 0.37 7.84 NA XXX 

71250 ......... 26 ....... A Ct thorax w/o dye ........................................ 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

71250 ......... TC ...... A Ct thorax w/o dye ........................................ 0.00 5.93 NA 0.31 6.24 NA XXX 

71260 ......... ............ A Ct thorax w/dye ............................................ 1.24 7.50 NA 0.43 9.17 NA XXX 

71260 ......... 26 ....... A Ct thorax w/dye ............................................ 1.24 0.40 0.40 0.06 1.70 1.70 XXX 

71260 ......... TC ...... A Ct thorax w/dye ............................................ 0.00 7.10 NA 0.37 7.47 NA XXX 

71270 ......... ............ A Ct thorax w/o & w/ dye ................................ 1.38 9.33 NA 0.53 11.24 NA XXX 

71270 ......... 26 ....... A Ct thorax w/o & w/ dye ................................ 1.38 0.45 0.45 0.07 1.90 1.90 XXX 

71270 ......... TC ...... A Ct thorax w/o & w/ dye ................................ 0.00 8.88 NA 0.46 9.34 NA XXX 

71275 ......... ............ A Ct angiography, chest .................................. 1.92 13.05 NA 0.46 15.43 NA XXX 

71275 ......... 26 ....... A Ct angiography, chest .................................. 1.92 0.63 0.63 0.07 2.62 2.62 XXX 

71275 ......... TC ...... A Ct angiography, chest .................................. 0.00 12.42 NA 0.39 12.81 NA XXX 

71550 ......... ............ A Mri chest w/o dye ........................................ 1.46 11.72 NA 0.50 13.68 NA XXX 

71550 ......... 26 ....... A Mri chest w/o dye ........................................ 1.46 0.48 0.48 0.05 1.99 1.99 XXX 

71550 ......... TC ...... A Mri chest w/o dye ........................................ 0.00 11.24 NA 0.45 11.69 NA XXX 

71551 ......... ............ A Mri chest w/dye ............................................ 1.73 14.06 NA 0.59 16.38 NA XXX 

71551 ......... 26 ....... A Mri chest w/dye ............................................ 1.73 0.57 0.57 0.07 2.37 2.37 XXX 

71551 ......... TC ...... A Mri chest w/dye ............................................ 0.00 13.49 NA 0.52 14.01 NA XXX 

71552 ......... ............ A Mri chest w/o & w/dye ................................. 2.26 25.72 NA 0.78 28.76 NA XXX 

71552 ......... 26 ....... A Mri chest w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

71552 ......... TC ...... A Mri chest w/o & w/dye ................................. 0.00 24.98 NA 0.68 25.66 NA XXX 

71555 ......... ............ R Mri angio chest w or w/o dye ...................... 1.81 11.84 NA 0.69 14.34 NA XXX 

71555 ......... 26 ....... R Mri angio chest w or w/o dye ...................... 1.81 0.60 0.60 0.10 2.51 2.51 XXX 

71555 ......... TC ...... R Mri angio chest w or w/o dye ...................... 0.00 11.24 NA 0.59 11.83 NA XXX 

72010 ......... ............ A X-ray exam of spine .................................... 0.45 1.18 NA 0.10 1.73 NA XXX 

72010 ......... 26 ....... A X-ray exam of spine .................................... 0.45 0.15 0.15 0.04 0.64 0.64 XXX 

72010 ......... TC ...... A X-ray exam of spine .................................... 0.00 1.03 NA 0.06 1.09 NA XXX 

72020 ......... ............ A X-ray exam of spine .................................... 0.15 0.46 NA 0.03 0.64 NA XXX 

72020 ......... 26 ....... A X-ray exam of spine .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

72020 ......... TC ...... A X-ray exam of spine .................................... 0.00 0.41 NA 0.02 0.43 NA XXX 

72040 ......... ............ A X-ray exam of neck spine ............................ 0.22 0.67 NA 0.05 0.94 NA XXX 

72040 ......... 26 ....... A X-ray exam of neck spine ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72040 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.60 NA 0.04 0.64 NA XXX 

1193

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

72050 ......... ............ A X-ray exam of neck spine ............................ 0.31 0.99 NA 0.08 1.38 NA XXX 

72050 ......... 26 ....... A X-ray exam of neck spine ............................ 0.31 0.10 0.10 0.02 0.43 0.43 XXX 

72050 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 0.89 NA 0.06 0.95 NA XXX 

72052 ......... ............ A X-ray exam of neck spine ............................ 0.36 1.25 NA 0.08 1.69 NA XXX 

72052 ......... 26 ....... A X-ray exam of neck spine ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

72052 ......... TC ...... A X-ray exam of neck spine ............................ 0.00 1.13 NA 0.06 1.19 NA XXX 

72069 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.57 NA 0.04 0.83 NA XXX 

72069 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.08 0.08 0.02 0.32 0.32 XXX 

72069 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.49 NA 0.02 0.51 NA XXX 

72070 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.72 NA 0.05 0.99 NA XXX 

72070 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72070 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.65 NA 0.04 0.69 NA XXX 

72072 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.81 NA 0.06 1.09 NA XXX 

72072 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72072 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.74 NA 0.05 0.79 NA XXX 

72074 ......... ............ A X-ray exam of thoracic spine ....................... 0.22 0.98 NA 0.07 1.27 NA XXX 

72074 ......... 26 ....... A X-ray exam of thoracic spine ....................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

72074 ......... TC ...... A X-ray exam of thoracic spine ....................... 0.00 0.91 NA 0.06 0.97 NA XXX 

72080 ......... ............ A X-ray exam of trunk spine ........................... 0.22 0.74 NA 0.06 1.02 NA XXX 

72080 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX 

72080 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72090 ......... ............ A X-ray exam of trunk spine ........................... 0.28 0.76 NA 0.06 1.10 NA XXX 

72090 ......... 26 ....... A X-ray exam of trunk spine ........................... 0.28 0.09 0.09 0.02 0.39 0.39 XXX 

72090 ......... TC ...... A X-ray exam of trunk spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72100 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.74 NA 0.06 1.02 NA XXX 

72100 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX 

72100 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72110 ......... ............ A X-ray exam of lower spine ........................... 0.31 1.01 NA 0.08 1.40 NA XXX 

72110 ......... 26 ....... A X-ray exam of lower spine ........................... 0.31 0.10 0.10 0.02 0.43 0.43 XXX 

72110 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.91 NA 0.06 0.97 NA XXX 

72114 ......... ............ A X-ray exam of lower spine ........................... 0.36 1.31 NA 0.10 1.77 NA XXX 

72114 ......... 26 ....... A X-ray exam of lower spine ........................... 0.36 0.12 0.12 0.04 0.52 0.52 XXX 

72114 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 1.19 NA 0.06 1.25 NA XXX 

72120 ......... ............ A X-ray exam of lower spine ........................... 0.22 0.96 NA 0.08 1.26 NA XXX 

72120 ......... 26 ....... A X-ray exam of lower spine ........................... 0.22 0.07 0.07 0.02 0.31 0.31 XXX 

72120 ......... TC ...... A X-ray exam of lower spine ........................... 0.00 0.89 NA 0.06 0.95 NA XXX 

72125 ......... ............ A Ct neck spine w/o dye ................................. 1.16 6.31 NA 0.37 7.84 NA XXX 

72125 ......... 26 ....... A Ct neck spine w/o dye ................................. 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

72125 ......... TC ...... A Ct neck spine w/o dye ................................. 0.00 5.93 NA 0.31 6.24 NA XXX 

72126 ......... ............ A Ct neck spine w/dye .................................... 1.22 7.49 NA 0.43 9.14 NA XXX 

72126 ......... 26 ....... A Ct neck spine w/dye .................................... 1.22 0.39 0.39 0.06 1.67 1.67 XXX 

72126 ......... TC ...... A Ct neck spine w/dye .................................... 0.00 7.10 NA 0.37 7.47 NA XXX 

72127 ......... ............ A Ct neck spine w/o & w/dye .......................... 1.27 9.29 NA 0.53 11.09 NA XXX 

72127 ......... 26 ....... A Ct neck spine w/o & w/dye .......................... 1.27 0.41 0.41 0.07 1.75 1.75 XXX 

72127 ......... TC ...... A Ct neck spine w/o & w/dye .......................... 0.00 8.88 NA 0.46 9.34 NA XXX 

72128 ......... ............ A Ct chest spine w/o dye ................................ 1.16 6.31 NA 0.37 7.84 NA XXX 

72128 ......... 26 ....... A Ct chest spine w/o dye ................................ 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

72128 ......... TC ...... A Ct chest spine w/o dye ................................ 0.00 5.93 NA 0.31 6.24 NA XXX 

72129 ......... ............ A Ct chest spine w/dye ................................... 1.22 7.49 NA 0.43 9.14 NA XXX 

72129 ......... 26 ....... A Ct chest spine w/dye ................................... 1.22 0.39 0.39 0.06 1.67 1.67 XXX 

72129 ......... TC ...... A Ct chest spine w/dye ................................... 0.00 7.10 NA 0.37 7.47 NA XXX 

72130 ......... ............ A Ct chest spine w/o & w/dye ......................... 1.27 9.29 NA 0.53 11.09 NA XXX 

72130 ......... 26 ....... A Ct chest spine w/o & w/dye ......................... 1.27 0.41 0.41 0.07 1.75 1.75 XXX 

72130 ......... TC ...... A Ct chest spine w/o & w/dye ......................... 0.00 8.88 NA 0.46 9.34 NA XXX 

72131 ......... ............ A Ct lumbar spine w/o dye .............................. 1.16 6.31 NA 0.37 7.84 NA XXX 

72131 ......... 26 ....... A Ct lumbar spine w/o dye .............................. 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

72131 ......... TC ...... A Ct lumbar spine w/o dye .............................. 0.00 5.93 NA 0.31 6.24 NA XXX 

72132 ......... ............ A Ct lumbar spine w/dye ................................. 1.22 7.50 NA 0.44 9.16 NA XXX 

72132 ......... 26 ....... A Ct lumbar spine w/dye ................................. 1.22 0.40 0.40 0.07 1.69 1.69 XXX 

72132 ......... TC ...... A Ct lumbar spine w/dye ................................. 0.00 7.10 NA 0.37 7.47 NA XXX 

72133 ......... ............ A Ct lumbar spine w/o & w/dye ...................... 1.27 9.30 NA 0.53 11.10 NA XXX 

72133 ......... 26 ....... A Ct lumbar spine w/o & w/dye ...................... 1.27 0.42 0.42 0.07 1.76 1.76 XXX 

72133 ......... TC ...... A Ct lumbar spine w/o & w/dye ...................... 0.00 8.88 NA 0.46 9.34 NA XXX 

72141 ......... ............ A Mri neck spine w/o dye ................................ 1.60 11.77 NA 0.67 14.04 NA XXX 

72141 ......... 26 ....... A Mri neck spine w/o dye ................................ 1.60 0.53 0.53 0.08 2.21 2.21 XXX 

72141 ......... TC ...... A Mri neck spine w/o dye ................................ 0.00 11.24 NA 0.59 11.83 NA XXX 

72142 ......... ............ A Mri neck spine w/dye ................................... 1.92 14.14 NA 0.81 16.87 NA XXX 

72142 ......... 26 ....... A Mri neck spine w/dye ................................... 1.92 0.65 0.65 0.11 2.68 2.68 XXX 

72142 ......... TC ...... A Mri neck spine w/dye ................................... 0.00 13.49 NA 0.70 14.19 NA XXX 

72146 ......... ............ A Mri chest spine w/o dye ............................... 1.60 13.00 NA 0.72 15.32 NA XXX 

72146 ......... 26 ....... A Mri chest spine w/o dye ............................... 1.60 0.52 0.52 0.08 2.20 2.20 XXX 

72146 ......... TC ...... A Mri chest spine w/o dye ............................... 0.00 12.48 NA 0.64 13.12 NA XXX 

72147 ......... ............ A Mri chest spine w/dye .................................. 1.92 14.13 NA 0.81 16.86 NA XXX 

72147 ......... 26 ....... A Mri chest spine w/dye .................................. 1.92 0.64 0.64 0.11 2.67 2.67 XXX 

72147 ......... TC ...... A Mri chest spine w/dye .................................. 0.00 13.49 NA 0.70 14.19 NA XXX 

1194

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

72148 ......... ............ A Mri lumbar spine w/o dye ............................ 1.48 12.97 NA 0.72 15.17 NA XXX 

72148 ......... 26 ....... A Mri lumbar spine w/o dye ............................ 1.48 0.49 0.49 0.08 2.05 2.05 XXX 

72148 ......... TC ...... A Mri lumbar spine w/o dye ............................ 0.00 12.48 NA 0.64 13.12 NA XXX 

72149 ......... ............ A Mri lumbar spine w/dye ............................... 1.78 14.09 NA 0.81 16.68 NA XXX 

72149 ......... 26 ....... A Mri lumbar spine w/dye ............................... 1.78 0.60 0.60 0.11 2.49 2.49 XXX 

72149 ......... TC ...... A Mri lumbar spine w/dye ............................... 0.00 13.49 NA 0.70 14.19 NA XXX 

72156 ......... ............ A Mri neck spine w/o & w/dye ........................ 2.57 25.83 NA 1.44 29.84 NA XXX 

72156 ......... 26 ....... A Mri neck spine w/o & w/dye ........................ 2.57 0.85 0.85 0.13 3.55 3.55 XXX 

72156 ......... TC ...... A Mri neck spine w/o & w/dye ........................ 0.00 24.98 NA 1.31 26.29 NA XXX 

72157 ......... ............ A Mri chest spine w/o & w/dye ....................... 2.57 25.83 NA 1.44 29.84 NA XXX 

72157 ......... 26 ....... A Mri chest spine w/o & w/dye ....................... 2.57 0.85 0.85 0.13 3.55 3.55 XXX 

72157 ......... TC ...... A Mri chest spine w/o & w/dye ....................... 0.00 24.98 NA 1.31 26.29 NA XXX 

72158 ......... ............ A Mri lumbar spine w/o & w/dye ..................... 2.36 25.76 NA 1.44 29.56 NA XXX 

72158 ......... 26 ....... A Mri lumbar spine w/o & w/dye ..................... 2.36 0.78 0.78 0.13 3.27 3.27 XXX 

72158 ......... TC ...... A Mri lumbar spine w/o & w/dye ..................... 0.00 24.98 NA 1.31 26.29 NA XXX 

72159 ......... ............ N Mr angio spine w/o&w/dye .......................... +1.80 12.92 12.92 0.74 15.46 15.46 XXX 

72159 ......... 26 ....... N Mr angio spine w/o&w/dye .......................... +1.80 0.69 0.69 0.10 2.59 2.59 XXX 

72159 ......... TC ...... N Mr angio spine w/o&w/dye .......................... +0.00 12.23 12.23 0.64 12.87 12.87 XXX 

72170 ......... ............ A X-ray exam of pelvis .................................... 0.17 0.58 NA 0.03 0.78 NA XXX 

72170 ......... 26 ....... A X-ray exam of pelvis .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72170 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

72190 ......... ............ A X-ray exam of pelvis .................................... 0.21 0.74 NA 0.05 1.00 NA XXX 

72190 ......... 26 ....... A X-ray exam of pelvis .................................... 0.21 0.07 0.07 0.01 0.29 0.29 XXX 

72190 ......... TC ...... A X-ray exam of pelvis .................................... 0.00 0.67 NA 0.04 0.71 NA XXX 

72191 ......... ............ A Ct angiograph pelv w/o&w/dye .................... 1.81 12.67 NA 0.46 14.94 NA XXX 

72191 ......... 26 ....... A Ct angiograph pelv w/o&w/dye .................... 1.81 0.60 0.60 0.07 2.48 2.48 XXX 

72191 ......... TC ...... A Ct angiograph pelv w/o&w/dye .................... 0.00 12.07 NA 0.39 12.46 NA XXX 

72192 ......... ............ A Ct pelvis w/o dye ......................................... 1.09 6.29 NA 0.37 7.75 NA XXX 

72192 ......... 26 ....... A Ct pelvis w/o dye ......................................... 1.09 0.36 0.36 0.06 1.51 1.51 XXX 

72192 ......... TC ...... A Ct pelvis w/o dye ......................................... 0.00 5.93 NA 0.31 6.24 NA XXX 

72193 ......... ............ A Ct pelvis w/dye ............................................ 1.16 7.25 NA 0.42 8.83 NA XXX 

72193 ......... 26 ....... A Ct pelvis w/dye ............................................ 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

72193 ......... TC ...... A Ct pelvis w/dye ............................................ 0.00 6.87 NA 0.36 7.23 NA XXX 

72194 ......... ............ A Ct pelvis w/o & w/dye .................................. 1.22 8.92 NA 0.49 10.63 NA XXX 

72194 ......... 26 ....... A Ct pelvis w/o & w/dye .................................. 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

72194 ......... TC ...... A Ct pelvis w/o & w/dye .................................. 0.00 8.52 NA 0.43 8.95 NA XXX 

72195 ......... ............ A Mri pelvis w/o dye ........................................ 1.46 11.72 NA 0.51 13.69 NA XXX 

72195 ......... 26 ....... A Mri pelvis w/o dye ........................................ 1.46 0.48 0.48 0.06 2.00 2.00 XXX 

72195 ......... TC ...... A Mri pelvis w/o dye ........................................ 0.00 11.24 NA 0.45 11.69 NA XXX 

72196 ......... ............ A Mri pelvis w/dye ........................................... 1.73 14.06 NA 0.58 16.37 NA XXX 

72196 ......... 26 ....... A Mri pelvis w/dye ........................................... 1.73 0.57 0.57 0.06 2.36 2.36 XXX 

72196 ......... TC ...... A Mri pelvis w/dye ........................................... 0.00 13.49 NA 0.52 14.01 NA XXX 

72197 ......... ............ A Mri pelvis w/o & w/dye ................................. 2.26 25.72 NA 1.02 29.00 NA XXX 

72197 ......... 26 ....... A Mri pelvis w/o & w/dye ................................. 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

72197 ......... TC ...... A Mri pelvis w/o & w/dye ................................. 0.00 24.98 NA 0.92 25.90 NA XXX 

72198 ......... ............ A Mr angio pelvis w/o & w/dye ....................... 1.80 11.92 NA 0.69 14.41 NA XXX 

72198 ......... 26 ....... A Mr angio pelvis w/o & w/dye ....................... 1.80 0.68 0.68 0.10 2.58 2.58 XXX 

72198 ......... TC ...... A Mr angio pelvis w/o & w/dye ....................... 0.00 11.24 NA 0.59 11.83 NA XXX 

72200 ......... ............ A X-ray exam sacroiliac joints ......................... 0.17 0.58 NA 0.03 0.78 NA XXX 

72200 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72200 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

72202 ......... ............ A X-ray exam sacroiliac joints ......................... 0.19 0.68 NA 0.05 0.92 NA XXX 

72202 ......... 26 ....... A X-ray exam sacroiliac joints ......................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

72202 ......... TC ...... A X-ray exam sacroiliac joints ......................... 0.00 0.62 NA 0.04 0.66 NA XXX 

72220 ......... ............ A X-ray exam of tailbone ................................ 0.17 0.63 NA 0.05 0.85 NA XXX 

72220 ......... 26 ....... A X-ray exam of tailbone ................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

72220 ......... TC ...... A X-ray exam of tailbone ................................ 0.00 0.57 NA 0.04 0.61 NA XXX 

72240 ......... ............ A Contrast x-ray of neck spine ....................... 0.91 5.06 NA 0.30 6.27 NA XXX 

72240 ......... 26 ....... A Contrast x-ray of neck spine ....................... 0.91 0.29 0.29 0.05 1.25 1.25 XXX 

72240 ......... TC ...... A Contrast x-ray of neck spine ....................... 0.00 4.77 NA 0.25 5.02 NA XXX 

72255 ......... ............ A Contrast x-ray, thorax spine ........................ 0.91 4.62 NA 0.27 5.80 NA XXX 

72255 ......... 26 ....... A Contrast x-ray, thorax spine ........................ 0.91 0.28 0.28 0.05 1.24 1.24 XXX 

72255 ......... TC ...... A Contrast x-ray, thorax spine ........................ 0.00 4.34 NA 0.22 4.56 NA XXX 

72265 ......... ............ A Contrast x-ray, lower spine .......................... 0.83 4.35 NA 0.27 5.45 NA XXX 

72265 ......... 26 ....... A Contrast x-ray, lower spine .......................... 0.83 0.26 0.26 0.05 1.14 1.14 XXX 

72265 ......... TC ...... A Contrast x-ray, lower spine .......................... 0.00 4.09 NA 0.22 4.31 NA XXX 

72270 ......... ............ A Contrast x-ray, spine ................................... 1.33 6.53 NA 0.41 8.27 NA XXX 

72270 ......... 26 ....... A Contrast x-ray, spine ................................... 1.33 0.41 0.41 0.08 1.82 1.82 XXX 

72270 ......... TC ...... A Contrast x-ray, spine ................................... 0.00 6.12 NA 0.33 6.45 NA XXX 

72275 ......... ............ A Epidurography .............................................. 0.76 2.30 NA 0.26 3.32 NA XXX 

72275 ......... 26 ....... A Epidurography .............................................. 0.76 0.20 0.20 0.04 1.00 1.00 XXX 

72275 ......... TC ...... A Epidurography .............................................. 0.00 2.10 NA 0.22 2.32 NA XXX 

72285 ......... ............ A X-ray c/t spine disk ...................................... 1.16 8.77 NA 0.50 10.43 NA XXX 

72285 ......... 26 ....... A X-ray c/t spine disk ...................................... 1.16 0.36 0.36 0.07 1.59 1.59 XXX 

72285 ......... TC ...... A X-ray c/t spine disk ...................................... 0.00 8.41 NA 0.43 8.84 NA XXX 

1195

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

72295 ......... ............ A X-ray of lower spine disk ............................. 0.83 8.15 NA 0.45 9.43 NA XXX 

72295 ......... 26 ....... A X-ray of lower spine disk ............................. 0.83 0.27 0.27 0.05 1.15 1.15 XXX 

72295 ......... TC ...... A X-ray of lower spine disk ............................. 0.00 7.88 NA 0.40 8.28 NA XXX 

73000 ......... ............ A X-ray exam of collar bone ........................... 0.16 0.57 NA 0.03 0.76 NA XXX 

73000 ......... 26 ....... A X-ray exam of collar bone ........................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73000 ......... TC ...... A X-ray exam of collar bone ........................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73010 ......... ............ A X-ray exam of shoulder blade ..................... 0.17 0.58 NA 0.03 0.78 NA XXX 

73010 ......... 26 ....... A X-ray exam of shoulder blade ..................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73010 ......... TC ...... A X-ray exam of shoulder blade ..................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73020 ......... ............ A X-ray exam of shoulder ............................... 0.15 0.52 NA 0.03 0.70 NA XXX 

73020 ......... 26 ....... A X-ray exam of shoulder ............................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73020 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73030 ......... ............ A X-ray exam of shoulder ............................... 0.18 0.63 NA 0.05 0.86 NA XXX 

73030 ......... 26 ....... A X-ray exam of shoulder ............................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

73030 ......... TC ...... A X-ray exam of shoulder ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73040 ......... ............ A Contrast x-ray of shoulder ........................... 0.54 2.28 NA 0.16 2.98 NA XXX 

73040 ......... 26 ....... A Contrast x-ray of shoulder ........................... 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

73040 ......... TC ...... A Contrast x-ray of shoulder ........................... 0.00 2.10 NA 0.12 2.22 NA XXX 

73050 ......... ............ A X-ray exam of shoulders ............................. 0.20 0.74 NA 0.06 1.00 NA XXX 

73050 ......... 26 ....... A X-ray exam of shoulders ............................. 0.20 0.07 0.07 0.02 0.29 0.29 XXX 

73050 ......... TC ...... A X-ray exam of shoulders ............................. 0.00 0.67 NA 0.04 0.71 NA XXX 

73060 ......... ............ A X-ray exam of humerus ............................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73060 ......... 26 ....... A X-ray exam of humerus ............................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73060 ......... TC ...... A X-ray exam of humerus ............................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73070 ......... ............ A X-ray exam of elbow .................................... 0.15 0.57 NA 0.03 0.75 NA XXX 

73070 ......... 26 ....... A X-ray exam of elbow .................................... 0.15 0.05 0.05 0.01 0.21 0.21 XXX 

73070 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73080 ......... ............ A X-ray exam of elbow .................................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73080 ......... 26 ....... A X-ray exam of elbow .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73080 ......... TC ...... A X-ray exam of elbow .................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73085 ......... ............ A Contrast x-ray of elbow ............................... 0.54 2.29 NA 0.16 2.99 NA XXX 

73085 ......... 26 ....... A Contrast x-ray of elbow ............................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX 

73085 ......... TC ...... A Contrast x-ray of elbow ............................... 0.00 2.10 NA 0.12 2.22 NA XXX 

73090 ......... ............ A X-ray exam of forearm ................................. 0.16 0.57 NA 0.03 0.76 NA XXX 

73090 ......... 26 ....... A X-ray exam of forearm ................................. 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73090 ......... TC ...... A X-ray exam of forearm ................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

73092 ......... ............ A X-ray exam of arm, infant ............................ 0.16 0.54 NA 0.03 0.73 NA XXX 

73092 ......... 26 ....... A X-ray exam of arm, infant ............................ 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73092 ......... TC ...... A X-ray exam of arm, infant ............................ 0.00 0.49 NA 0.02 0.51 NA XXX 

73100 ......... ............ A X-ray exam of wrist ...................................... 0.16 0.55 NA 0.04 0.75 NA XXX 

73100 ......... 26 ....... A X-ray exam of wrist ...................................... 0.16 0.06 0.06 0.02 0.24 0.24 XXX 

73100 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73110 ......... ............ A X-ray exam of wrist ...................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73110 ......... 26 ....... A X-ray exam of wrist ...................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73110 ......... TC ...... A X-ray exam of wrist ...................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73115 ......... ............ A Contrast x-ray of wrist ................................. 0.54 1.77 NA 0.14 2.45 NA XXX 

73115 ......... 26 ....... A Contrast x-ray of wrist ................................. 0.54 0.19 0.19 0.04 0.77 0.77 XXX 

73115 ......... TC ...... A Contrast x-ray of wrist ................................. 0.00 1.58 NA 0.10 1.68 NA XXX 

73120 ......... ............ A X-ray exam of hand ..................................... 0.16 0.54 NA 0.03 0.73 NA XXX 

73120 ......... 26 ....... A X-ray exam of hand ..................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73120 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73130 ......... ............ A X-ray exam of hand ..................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73130 ......... 26 ....... A X-ray exam of hand ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73130 ......... TC ...... A X-ray exam of hand ..................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73140 ......... ............ A X-ray exam of finger(s) ................................ 0.13 0.45 NA 0.03 0.61 NA XXX 

73140 ......... 26 ....... A X-ray exam of finger(s) ................................ 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73140 ......... TC ...... A X-ray exam of finger(s) ................................ 0.00 0.41 NA 0.02 0.43 NA XXX 

73200 ......... ............ A Ct upper extremity w/o dye ......................... 1.09 5.33 NA 0.31 6.73 NA XXX 

73200 ......... 26 ....... A Ct upper extremity w/o dye ......................... 1.09 0.36 0.36 0.06 1.51 1.51 XXX 

73200 ......... TC ...... A Ct upper extremity w/o dye ......................... 0.00 4.97 NA 0.25 5.22 NA XXX 

73201 ......... ............ A Ct upper extremity w/dye ............................. 1.16 6.31 NA 0.37 7.84 NA XXX 

73201 ......... 26 ....... A Ct upper extremity w/dye ............................. 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

73201 ......... TC ...... A Ct upper extremity w/dye ............................. 0.00 5.93 NA 0.31 6.24 NA XXX 

73202 ......... ............ A Ct uppr extremity w/o&w/dye ....................... 1.22 7.85 NA 0.46 9.53 NA XXX 

73202 ......... 26 ....... A Ct uppr extremity w/o&w/dye ....................... 1.22 0.40 0.40 0.07 1.69 1.69 XXX 

73202 ......... TC ...... A Ct uppr extremity w/o&w/dye ....................... 0.00 7.45 NA 0.39 7.84 NA XXX 

73206 ......... ............ A Ct angio upr extrm w/o&w/dye .................... 1.81 11.59 NA 0.46 13.86 NA XXX 

73206 ......... 26 ....... A Ct angio upr extrm w/o&w/dye .................... 1.81 0.59 0.59 0.07 2.47 2.47 XXX 

73206 ......... TC ...... A Ct angio upr extrm w/o&w/dye .................... 0.00 11.00 NA 0.39 11.39 NA XXX 

73218 ......... ............ A Mri upper extremity w/o dye ........................ 1.35 11.68 NA 0.44 13.47 NA XXX 

73218 ......... 26 ....... A Mri upper extremity w/o dye ........................ 1.35 0.44 0.44 0.05 1.84 1.84 XXX 

73218 ......... TC ...... A Mri upper extremity w/o dye ........................ 0.00 11.24 NA 0.39 11.63 NA XXX 

73219 ......... ............ A Mri upper extremity w/dye ........................... 1.62 14.02 NA 0.53 16.17 NA XXX 

73219 ......... 26 ....... A Mri upper extremity w/dye ........................... 1.62 0.53 0.53 0.06 2.21 2.21 XXX 

73219 ......... TC ...... A Mri upper extremity w/dye ........................... 0.00 13.49 NA 0.47 13.96 NA XXX 

1196

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

73220 ......... ............ A Mri uppr extremity w/o&w/dye ..................... 2.15 25.69 NA 0.94 28.78 NA XXX 

73220 ......... 26 ....... A Mri uppr extremity w/o&w/dye ..................... 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

73220 ......... TC ...... A Mri uppr extremity w/o&w/dye ..................... 0.00 24.98 NA 0.84 25.82 NA XXX 

73221 ......... ............ A Mri joint upr extrem w/o dye ........................ 1.35 11.68 NA 0.44 13.47 NA XXX 

73221 ......... 26 ....... A Mri joint upr extrem w/o dye ........................ 1.35 0.44 0.44 0.05 1.84 1.84 XXX 

73221 ......... TC ...... A Mri joint upr extrem w/o dye ........................ 0.00 11.24 NA 0.39 11.63 NA XXX 

73222 ......... ............ A Mri joint upr extrem w/dye ........................... 1.62 14.02 NA 0.53 16.17 NA XXX 

73222 ......... 26 ....... A Mri joint upr extrem w/dye ........................... 1.62 0.53 0.53 0.06 2.21 2.21 XXX 

73222 ......... TC ...... A Mri joint upr extrem w/dye ........................... 0.00 13.49 NA 0.47 13.96 NA XXX 

73223 ......... ............ A Mri joint upr extr w/o&w/dye ........................ 2.15 25.69 NA 0.92 28.76 NA XXX 

73223 ......... 26 ....... A Mri joint upr extr w/o&w/dye ........................ 2.15 0.71 0.71 0.08 2.94 2.94 XXX 

73223 ......... TC ...... A Mri joint upr extr w/o&w/dye ........................ 0.00 24.98 NA 0.84 25.82 NA XXX 

73225 ......... ............ N Mr angio upr extr w/o&w/dye ....................... +1.73 11.68 11.68 0.69 14.10 14.10 XXX 

73225 ......... 26 ....... N Mr angio upr extr w/o&w/dye ....................... +1.73 0.67 0.67 0.10 2.50 2.50 XXX 

73225 ......... TC ...... N Mr angio upr extr w/o&w/dye ....................... +0.00 11.01 11.01 0.59 11.60 11.60 XXX 

73500 ......... ............ A X-ray exam of hip ........................................ 0.17 0.53 NA 0.03 0.73 NA XXX 

73500 ......... 26 ....... A X-ray exam of hip ........................................ 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73500 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.47 NA 0.02 0.49 NA XXX 

73510 ......... ............ A X-ray exam of hip ........................................ 0.21 0.64 NA 0.06 0.91 NA XXX 

73510 ......... 26 ....... A X-ray exam of hip ........................................ 0.21 0.07 0.07 0.02 0.30 0.30 XXX 

73510 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.57 NA 0.04 0.61 NA XXX 

73520 ......... ............ A X-ray exam of hips ...................................... 0.26 0.76 NA 0.06 1.08 NA XXX 

73520 ......... 26 ....... A X-ray exam of hips ...................................... 0.26 0.09 0.09 0.02 0.37 0.37 XXX 

73520 ......... TC ...... A X-ray exam of hips ...................................... 0.00 0.67 NA 0.04 0.71 NA XXX 

73525 ......... ............ A Contrast x-ray of hip .................................... 0.54 2.28 NA 0.16 2.98 NA XXX 

73525 ......... 26 ....... A Contrast x-ray of hip .................................... 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

73525 ......... TC ...... A Contrast x-ray of hip .................................... 0.00 2.10 NA 0.12 2.22 NA XXX 

73530 ......... ............ A X-ray exam of hip ........................................ 0.29 0.62 NA 0.03 0.94 NA XXX 

73530 ......... 26 ....... A X-ray exam of hip ........................................ 0.29 0.10 0.10 0.01 0.40 0.40 XXX 

73530 ......... TC ...... A X-ray exam of hip ........................................ 0.00 0.52 NA 0.02 0.54 NA XXX 

73540 ......... ............ A X-ray exam of pelvis & hips ........................ 0.20 0.64 NA 0.06 0.90 NA XXX 

73540 ......... 26 ....... A X-ray exam of pelvis & hips ........................ 0.20 0.07 0.07 0.02 0.29 0.29 XXX 

73540 ......... TC ...... A X-ray exam of pelvis & hips ........................ 0.00 0.57 NA 0.04 0.61 NA XXX 

73542 ......... ............ A X-ray exam, sacroiliac joint ......................... 0.59 2.26 NA 0.16 3.01 NA XXX 

73542 ......... 26 ....... A X-ray exam, sacroiliac joint ......................... 0.59 0.16 0.16 0.04 0.79 0.79 XXX 

73542 ......... TC ...... A X-ray exam, sacroiliac joint ......................... 0.00 2.10 NA 0.12 2.22 NA XXX 

73550 ......... ............ A X-ray exam of thigh ..................................... 0.17 0.63 NA 0.05 0.85 NA XXX 

73550 ......... 26 ....... A X-ray exam of thigh ..................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73550 ......... TC ...... A X-ray exam of thigh ..................................... 0.00 0.57 NA 0.04 0.61 NA XXX 

73560 ......... ............ A X-ray exam of knee, 1 or 2 ......................... 0.17 0.58 NA 0.04 0.79 NA XXX 

73560 ......... 26 ....... A X-ray exam of knee, 1 or 2 ......................... 0.17 0.06 0.06 0.02 0.25 0.25 XXX 

73560 ......... TC ...... A X-ray exam of knee, 1 or 2 ......................... 0.00 0.52 NA 0.02 0.54 NA XXX 

73562 ......... ............ A X-ray exam of knee, 3 ................................. 0.18 0.63 NA 0.06 0.87 NA XXX 

73562 ......... 26 ....... A X-ray exam of knee, 3 ................................. 0.18 0.06 0.06 0.02 0.26 0.26 XXX 

73562 ......... TC ...... A X-ray exam of knee, 3 ................................. 0.00 0.57 NA 0.04 0.61 NA XXX 

73564 ......... ............ A X-ray exam, knee, 4 or more ...................... 0.22 0.70 NA 0.06 0.98 NA XXX 

73564 ......... 26 ....... A X-ray exam, knee, 4 or more ...................... 0.22 0.08 0.08 0.02 0.32 0.32 XXX 

73564 ......... TC ...... A X-ray exam, knee, 4 or more ...................... 0.00 0.62 NA 0.04 0.66 NA XXX 

73565 ......... ............ A X-ray exam of knees ................................... 0.17 0.55 NA 0.04 0.76 NA XXX 

73565 ......... 26 ....... A X-ray exam of knees ................................... 0.17 0.06 0.06 0.02 0.25 0.25 XXX 

73565 ......... TC ...... A X-ray exam of knees ................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73580 ......... ............ A Contrast x-ray of knee joint ......................... 0.54 2.80 NA 0.18 3.52 NA XXX 

73580 ......... 26 ....... A Contrast x-ray of knee joint ......................... 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

73580 ......... TC ...... A Contrast x-ray of knee joint ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

73590 ......... ............ A X-ray exam of lower leg .............................. 0.17 0.58 NA 0.03 0.78 NA XXX 

73590 ......... 26 ....... A X-ray exam of lower leg .............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73590 ......... TC ...... A X-ray exam of lower leg .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 

73592 ......... ............ A X-ray exam of leg, infant ............................. 0.16 0.55 NA 0.03 0.74 NA XXX 

73592 ......... 26 ....... A X-ray exam of leg, infant ............................. 0.16 0.06 0.06 0.01 0.23 0.23 XXX 

73592 ......... TC ...... A X-ray exam of leg, infant ............................. 0.00 0.49 NA 0.02 0.51 NA XXX 

73600 ......... ............ A X-ray exam of ankle .................................... 0.16 0.54 NA 0.03 0.73 NA XXX 

73600 ......... 26 ....... A X-ray exam of ankle .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73600 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73610 ......... ............ A X-ray exam of ankle .................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73610 ......... 26 ....... A X-ray exam of ankle .................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73610 ......... TC ...... A X-ray exam of ankle .................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

73615 ......... ............ A Contrast x-ray of ankle ................................ 0.54 2.29 NA 0.16 2.99 NA XXX 

73615 ......... 26 ....... A Contrast x-ray of ankle ................................ 0.54 0.19 0.19 0.04 0.77 0.77 XXX 

73615 ......... TC ...... A Contrast x-ray of ankle ................................ 0.00 2.10 NA 0.12 2.22 NA XXX 

73620 ......... ............ A X-ray exam of foot ....................................... 0.16 0.54 NA 0.03 0.73 NA XXX 

73620 ......... 26 ....... A X-ray exam of foot ....................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73620 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.49 NA 0.02 0.51 NA XXX 

73630 ......... ............ A X-ray exam of foot ....................................... 0.17 0.59 NA 0.03 0.79 NA XXX 

73630 ......... 26 ....... A X-ray exam of foot ....................................... 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

73630 ......... TC ...... A X-ray exam of foot ....................................... 0.00 0.53 NA 0.02 0.55 NA XXX 

1197

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

73650 ......... ............ A X-ray exam of heel ...................................... 0.16 0.52 NA 0.03 0.71 NA XXX 

73650 ......... 26 ....... A X-ray exam of heel ...................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

73650 ......... TC ...... A X-ray exam of heel ...................................... 0.00 0.47 NA 0.02 0.49 NA XXX 

73660 ......... ............ A X-ray exam of toe(s) .................................... 0.13 0.45 NA 0.03 0.61 NA XXX 

73660 ......... 26 ....... A X-ray exam of toe(s) .................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

73660 ......... TC ...... A X-ray exam of toe(s) .................................... 0.00 0.41 NA 0.02 0.43 NA XXX 

73700 ......... ............ A Ct lower extremity w/o dye .......................... 1.09 5.33 NA 0.31 6.73 NA XXX 

73700 ......... 26 ....... A Ct lower extremity w/o dye .......................... 1.09 0.36 0.36 0.06 1.51 1.51 XXX 

73700 ......... TC ...... A Ct lower extremity w/o dye .......................... 0.00 4.97 NA 0.25 5.22 NA XXX 

73701 ......... ............ A Ct lower extremity w/dye ............................. 1.16 6.31 NA 0.37 7.84 NA XXX 

73701 ......... 26 ....... A Ct lower extremity w/dye ............................. 1.16 0.38 0.38 0.06 1.60 1.60 XXX 

73701 ......... TC ...... A Ct lower extremity w/dye ............................. 0.00 5.93 NA 0.31 6.24 NA XXX 

73702 ......... ............ A Ct lwr extremity w/o&w/dye ......................... 1.22 7.85 NA 0.45 9.52 NA XXX 

73702 ......... 26 ....... A Ct lwr extremity w/o&w/dye ......................... 1.22 0.40 0.40 0.06 1.68 1.68 XXX 

73702 ......... TC ...... A Ct lwr extremity w/o&w/dye ......................... 0.00 7.45 NA 0.39 7.84 NA XXX 

73706 ......... ............ A Ct angio lwr extr w/o&w/dye ........................ 1.90 11.62 NA 0.46 13.98 NA XXX 

73706 ......... 26 ....... A Ct angio lwr extr w/o&w/dye ........................ 1.90 0.62 0.62 0.07 2.59 2.59 XXX 

73706 ......... TC ...... A Ct angio lwr extr w/o&w/dye ........................ 0.00 11.00 NA 0.39 11.39 NA XXX 

73718 ......... ............ A Mri lower extremity w/o dye ......................... 1.35 11.68 NA 0.44 13.47 NA XXX 

73718 ......... 26 ....... A Mri lower extremity w/o dye ......................... 1.35 0.44 0.44 0.05 1.84 1.84 XXX 

73718 ......... TC ...... A Mri lower extremity w/o dye ......................... 0.00 11.24 NA 0.39 11.63 NA XXX 

73719 ......... ............ A Mri lower extremity w/dye ............................ 1.62 14.02 NA 0.53 16.17 NA XXX 

73719 ......... 26 ....... A Mri lower extremity w/dye ............................ 1.62 0.53 0.53 0.06 2.21 2.21 XXX 

73719 ......... TC ...... A Mri lower extremity w/dye ............................ 0.00 13.49 NA 0.47 13.96 NA XXX 

73720 ......... ............ A Mri lwr extremity w/o&w/dye ........................ 2.15 25.69 NA 0.94 28.78 NA XXX 

73720 ......... 26 ....... A Mri lwr extremity w/o&w/dye ........................ 2.15 0.71 0.71 0.10 2.96 2.96 XXX 

73720 ......... TC ...... A Mri lwr extremity w/o&w/dye ........................ 0.00 24.98 NA 0.84 25.82 NA XXX 

73721 ......... ............ A Mri jnt of lwr extre w/o dye .......................... 1.35 11.68 NA 0.44 13.47 NA XXX 

73721 ......... 26 ....... A Mri jnt of lwr extre w/o dye .......................... 1.35 0.44 0.44 0.05 1.84 1.84 XXX 

73721 ......... TC ...... A Mri jnt of lwr extre w/o dye .......................... 0.00 11.24 NA 0.39 11.63 NA XXX 

73722 ......... ............ A Mri joint of lwr extr w/dye ............................ 1.62 14.02 NA 0.54 16.18 NA XXX 

73722 ......... 26 ....... A Mri joint of lwr extr w/dye ............................ 1.62 0.53 0.53 0.07 2.22 2.22 XXX 

73722 ......... TC ...... A Mri joint of lwr extr w/dye ............................ 0.00 13.49 NA 0.47 13.96 NA XXX 

73723 ......... ............ A Mri joint lwr extr w/o&w/dye ......................... 2.15 25.69 NA 0.92 28.76 NA XXX 

73723 ......... 26 ....... A Mri joint lwr extr w/o&w/dye ......................... 2.15 0.71 0.71 0.08 2.94 2.94 XXX 

73723 ......... TC ...... A Mri joint lwr extr w/o&w/dye ......................... 0.00 24.98 NA 0.84 25.82 NA XXX 

73725 ......... ............ R Mr ang lwr ext w or w/o dye ........................ 1.82 11.84 NA 0.69 14.35 NA XXX 

73725 ......... 26 ....... R Mr ang lwr ext w or w/o dye ........................ 1.82 0.60 0.60 0.10 2.52 2.52 XXX 

73725 ......... TC ...... R Mr ang lwr ext w or w/o dye ........................ 0.00 11.24 NA 0.59 11.83 NA XXX 

74000 ......... ............ A X-ray exam of abdomen .............................. 0.18 0.58 NA 0.03 0.79 NA XXX 

74000 ......... 26 ....... A X-ray exam of abdomen .............................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

74000 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.52 NA 0.02 0.54 NA XXX 

74010 ......... ............ A X-ray exam of abdomen .............................. 0.23 0.65 NA 0.05 0.93 NA XXX 

74010 ......... 26 ....... A X-ray exam of abdomen .............................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 

74010 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.57 NA 0.04 0.61 NA XXX 

74020 ......... ............ A X-ray exam of abdomen .............................. 0.27 0.71 NA 0.05 1.03 NA XXX 

74020 ......... 26 ....... A X-ray exam of abdomen .............................. 0.27 0.09 0.09 0.01 0.37 0.37 XXX 

74020 ......... TC ...... A X-ray exam of abdomen .............................. 0.00 0.62 NA 0.04 0.66 NA XXX 

74022 ......... ............ A X-ray exam series, abdomen ...................... 0.32 0.85 NA 0.06 1.23 NA XXX 

74022 ......... 26 ....... A X-ray exam series, abdomen ...................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

74022 ......... TC ...... A X-ray exam series, abdomen ...................... 0.00 0.74 NA 0.05 0.79 NA XXX 

74150 ......... ............ A Ct abdomen w/o dye ................................... 1.19 6.06 NA 0.36 7.61 NA XXX 

74150 ......... 26 ....... A Ct abdomen w/o dye ................................... 1.19 0.39 0.39 0.06 1.64 1.64 XXX 

74150 ......... TC ...... A Ct abdomen w/o dye ................................... 0.00 5.67 NA 0.30 5.97 NA XXX 

74160 ......... ............ A Ct abdomen w/dye ....................................... 1.27 7.28 NA 0.43 8.98 NA XXX 

74160 ......... 26 ....... A Ct abdomen w/dye ....................................... 1.27 0.41 0.41 0.07 1.75 1.75 XXX 

74160 ......... TC ...... A Ct abdomen w/dye ....................................... 0.00 6.87 NA 0.36 7.23 NA XXX 

74170 ......... ............ A Ct abdomen w/o &w /dye ............................ 1.40 8.97 NA 0.50 10.87 NA XXX 

74170 ......... 26 ....... A Ct abdomen w/o &w /dye ............................ 1.40 0.45 0.45 0.07 1.92 1.92 XXX 

74170 ......... TC ...... A Ct abdomen w/o &w /dye ............................ 0.00 8.52 NA 0.43 8.95 NA XXX 

74175 ......... ............ A Ct angio abdom w/o & w/dye ...................... 1.90 12.69 NA 0.46 15.05 NA XXX 

74175 ......... 26 ....... A Ct angio abdom w/o & w/dye ...................... 1.90 0.62 0.62 0.07 2.59 2.59 XXX 

74175 ......... TC ...... A Ct angio abdom w/o & w/dye ...................... 0.00 12.07 NA 0.39 12.46 NA XXX 

74181 ......... ............ A Mri abdomen w/o dye .................................. 1.46 11.72 NA 0.52 13.70 NA XXX 

74181 ......... 26 ....... A Mri abdomen w/o dye .................................. 1.46 0.48 0.48 0.07 2.01 2.01 XXX 

74181 ......... TC ...... A Mri abdomen w/o dye .................................. 0.00 11.24 NA 0.45 11.69 NA XXX 

74182 ......... ............ A Mri abdomen w/dye ..................................... 1.73 14.05 NA 0.59 16.37 NA XXX 

74182 ......... 26 ....... A Mri abdomen w/dye ..................................... 1.73 0.56 0.56 0.07 2.36 2.36 XXX 

74182 ......... TC ...... A Mri abdomen w/dye ..................................... 0.00 13.49 NA 0.52 14.01 NA XXX 

74183 ......... ............ A Mri abdomen w/o & w/dye ........................... 2.26 25.72 NA 1.02 29.00 NA XXX 

74183 ......... 26 ....... A Mri abdomen w/o & w/dye ........................... 2.26 0.74 0.74 0.10 3.10 3.10 XXX 

74183 ......... TC ...... A Mri abdomen w/o & w/dye ........................... 0.00 24.98 NA 0.92 25.90 NA XXX 

74185 ......... ............ R Mri angio, abdom w orw/o dye .................... 1.80 11.83 NA 0.69 14.32 NA XXX 

74185 ......... 26 ....... R Mri angio, abdom w orw/o dye .................... 1.80 0.59 0.59 0.10 2.49 2.49 XXX 

74185 ......... TC ...... R Mri angio, abdom w orw/o dye .................... 0.00 11.24 NA 0.59 11.83 NA XXX 

1198

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

74190 ......... ............ A X-ray exam of peritoneum ........................... 0.48 1.47 NA 0.09 2.04 NA XXX 

74190 ......... 26 ....... A X-ray exam of peritoneum ........................... 0.48 0.16 0.16 0.02 0.66 0.66 XXX 

74190 ......... TC ...... A X-ray exam of peritoneum ........................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74210 ......... ............ A Contrst x-ray exam of throat ........................ 0.36 1.31 NA 0.08 1.75 NA XXX 

74210 ......... 26 ....... A Contrst x-ray exam of throat ........................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74210 ......... TC ...... A Contrst x-ray exam of throat ........................ 0.00 1.19 NA 0.06 1.25 NA XXX 

74220 ......... ............ A Contrast x-ray, esophagus .......................... 0.46 1.34 NA 0.08 1.88 NA XXX 

74220 ......... 26 ....... A Contrast x-ray, esophagus .......................... 0.46 0.15 0.15 0.02 0.63 0.63 XXX 

74220 ......... TC ...... A Contrast x-ray, esophagus .......................... 0.00 1.19 NA 0.06 1.25 NA XXX 

74230 ......... ............ A Cine/vid x-ray, throat/esoph ......................... 0.53 1.49 NA 0.09 2.11 NA XXX 

74230 ......... 26 ....... A Cine/vid x-ray, throat/esoph ......................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

74230 ......... TC ...... A Cine/vid x-ray, throat/esoph ......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74235 ......... ............ A Remove esophagus obstruction .................. 1.19 3.01 NA 0.20 4.40 NA XXX 

74235 ......... 26 ....... A Remove esophagus obstruction .................. 1.19 0.39 0.39 0.06 1.64 1.64 XXX 

74235 ......... TC ...... A Remove esophagus obstruction .................. 0.00 2.62 NA 0.14 2.76 NA XXX 

74240 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.69 NA 0.12 2.50 NA XXX 

74240 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74240 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.46 NA 0.08 1.54 NA XXX 

74241 ......... ............ A X-ray exam, upper gi tract ........................... 0.69 1.72 NA 0.12 2.53 NA XXX 

74241 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74241 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 1.49 NA 0.08 1.57 NA XXX 

74245 ......... ............ A X-ray exam, upper gi tract ........................... 0.91 2.69 NA 0.18 3.78 NA XXX 

74245 ......... 26 ....... A X-ray exam, upper gi tract ........................... 0.91 0.30 0.30 0.05 1.26 1.26 XXX 

74245 ......... TC ...... A X-ray exam, upper gi tract ........................... 0.00 2.39 NA 0.13 2.52 NA XXX 

74246 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.88 NA 0.14 2.71 NA XXX 

74246 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74246 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.65 NA 0.10 1.75 NA XXX 

74247 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.69 1.92 NA 0.15 2.76 NA XXX 

74247 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74247 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 1.69 NA 0.11 1.80 NA XXX 

74249 ......... ............ A Contrst x-ray uppr gi tract ............................ 0.91 2.89 NA 0.19 3.99 NA XXX 

74249 ......... 26 ....... A Contrst x-ray uppr gi tract ............................ 0.91 0.30 0.30 0.05 1.26 1.26 XXX 

74249 ......... TC ...... A Contrst x-ray uppr gi tract ............................ 0.00 2.59 NA 0.14 2.73 NA XXX 

74250 ......... ............ A X-ray exam of small bowel .......................... 0.47 1.47 NA 0.09 2.03 NA XXX 

74250 ......... 26 ....... A X-ray exam of small bowel .......................... 0.47 0.16 0.16 0.02 0.65 0.65 XXX 

74250 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74251 ......... ............ A X-ray exam of small bowel .......................... 0.69 1.54 NA 0.11 2.34 NA XXX 

74251 ......... 26 ....... A X-ray exam of small bowel .......................... 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74251 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74260 ......... ............ A X-ray exam of small bowel .......................... 0.50 1.66 NA 0.10 2.26 NA XXX 

74260 ......... 26 ....... A X-ray exam of small bowel .......................... 0.50 0.17 0.17 0.02 0.69 0.69 XXX 

74260 ......... TC ...... A X-ray exam of small bowel .......................... 0.00 1.49 NA 0.08 1.57 NA XXX 

74270 ......... ............ A Contrast x-ray exam of colon ...................... 0.69 1.94 NA 0.15 2.78 NA XXX 

74270 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

74270 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 1.71 NA 0.11 1.82 NA XXX 

74280 ......... ............ A Contrast x-ray exam of colon ...................... 0.99 2.57 NA 0.18 3.74 NA XXX 

74280 ......... 26 ....... A Contrast x-ray exam of colon ...................... 0.99 0.33 0.33 0.05 1.37 1.37 XXX 

74280 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.24 NA 0.13 2.37 NA XXX 

74283 ......... ............ A Contrast x-ray exam of colon ...................... 2.02 3.24 NA 0.25 5.51 NA XXX 

74283 ......... 26 ....... A Contrast x-ray exam of colon ...................... 2.02 0.66 0.66 0.11 2.79 2.79 XXX 

74283 ......... TC ...... A Contrast x-ray exam of colon ...................... 0.00 2.58 NA 0.14 2.72 NA XXX 

74290 ......... ............ A Contrast x-ray, gallbladder .......................... 0.32 0.85 NA 0.06 1.23 NA XXX 

74290 ......... 26 ....... A Contrast x-ray, gallbladder .......................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

74290 ......... TC ...... A Contrast x-ray, gallbladder .......................... 0.00 0.74 NA 0.05 0.79 NA XXX 

74291 ......... ............ A Contrast x-rays, gallbladder ......................... 0.20 0.48 NA 0.03 0.71 NA XXX 

74291 ......... 26 ....... A Contrast x-rays, gallbladder ......................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

74291 ......... TC ...... A Contrast x-rays, gallbladder ......................... 0.00 0.41 NA 0.02 0.43 NA XXX 

74300 ......... ............ C X-ray bile ducts/pancreas ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74300 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74300 ......... TC ...... C X-ray bile ducts/pancreas ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

74301 ......... ............ C X-rays at surgery add-on ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

74301 ......... 26 ....... A X-rays at surgery add-on ............................. 0.21 0.07 0.07 0.01 0.29 0.29 ZZZ 

74301 ......... TC ...... C X-rays at surgery add-on ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

74305 ......... ............ A X-ray bile ducts/pancreas ............................ 0.42 0.93 NA 0.07 1.42 NA XXX 

74305 ......... 26 ....... A X-ray bile ducts/pancreas ............................ 0.42 0.14 0.14 0.02 0.58 0.58 XXX 

74305 ......... TC ...... A X-ray bile ducts/pancreas ............................ 0.00 0.79 NA 0.05 0.84 NA XXX 

74320 ......... ............ A Contrast x-ray of bile ducts ......................... 0.54 3.35 NA 0.19 4.08 NA XXX 

74320 ......... 26 ....... A Contrast x-ray of bile ducts ......................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74320 ......... TC ...... A Contrast x-ray of bile ducts ......................... 0.00 3.17 NA 0.17 3.34 NA XXX 

74327 ......... ............ A X-ray bile stone removal .............................. 0.70 2.00 NA 0.15 2.85 NA XXX 

74327 ......... 26 ....... A X-ray bile stone removal .............................. 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

74327 ......... TC ...... A X-ray bile stone removal .............................. 0.00 1.77 NA 0.11 1.88 NA XXX 

74328 ......... ............ A X-ray bile duct endoscopy ........................... 0.70 3.40 NA 0.21 4.31 NA XXX 

74328 ......... 26 ....... A X-ray bile duct endoscopy ........................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

74328 ......... TC ...... A X-ray bile duct endoscopy ........................... 0.00 3.17 NA 0.17 3.34 NA XXX 

1199

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

74329 ......... ............ A X-ray for pancreas endoscopy .................... 0.70 3.40 NA 0.21 4.31 NA XXX 

74329 ......... 26 ....... A X-ray for pancreas endoscopy .................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

74329 ......... TC ...... A X-ray for pancreas endoscopy .................... 0.00 3.17 NA 0.17 3.34 NA XXX 

74330 ......... ............ A X-ray bile/panc endoscopy .......................... 0.90 3.47 NA 0.22 4.59 NA XXX 

74330 ......... 26 ....... A X-ray bile/panc endoscopy .......................... 0.90 0.30 0.30 0.05 1.25 1.25 XXX 

74330 ......... TC ...... A X-ray bile/panc endoscopy .......................... 0.00 3.17 NA 0.17 3.34 NA XXX 

74340 ......... ............ A X-ray guide for GI tube ................................ 0.54 2.80 NA 0.16 3.50 NA XXX 

74340 ......... 26 ....... A X-ray guide for GI tube ................................ 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74340 ......... TC ...... A X-ray guide for GI tube ................................ 0.00 2.62 NA 0.14 2.76 NA XXX 

74350 ......... ............ A X-ray guide, stomach tube .......................... 0.76 3.42 NA 0.21 4.39 NA XXX 

74350 ......... 26 ....... A X-ray guide, stomach tube .......................... 0.76 0.25 0.25 0.04 1.05 1.05 XXX 

74350 ......... TC ...... A X-ray guide, stomach tube .......................... 0.00 3.17 NA 0.17 3.34 NA XXX 

74355 ......... ............ A X-ray guide, intestinal tube .......................... 0.76 2.87 NA 0.18 3.81 NA XXX 

74355 ......... 26 ....... A X-ray guide, intestinal tube .......................... 0.76 0.25 0.25 0.04 1.05 1.05 XXX 

74355 ......... TC ...... A X-ray guide, intestinal tube .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

74360 ......... ............ A X-ray guide, GI dilation ................................ 0.54 3.36 NA 0.19 4.09 NA XXX 

74360 ......... 26 ....... A X-ray guide, GI dilation ................................ 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

74360 ......... TC ...... A X-ray guide, GI dilation ................................ 0.00 3.17 NA 0.17 3.34 NA XXX 

74363 ......... ............ A X-ray, bile duct dilation ................................ 0.88 6.41 NA 0.38 7.67 NA XXX 

74363 ......... 26 ....... A X-ray, bile duct dilation ................................ 0.88 0.29 0.29 0.05 1.22 1.22 XXX 

74363 ......... TC ...... A X-ray, bile duct dilation ................................ 0.00 6.12 NA 0.33 6.45 NA XXX 

74400 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 1.85 NA 0.13 2.47 NA XXX 

74400 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74400 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.69 NA 0.11 1.80 NA XXX 

74410 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.12 NA 0.13 2.74 NA XXX 

74410 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74410 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.96 NA 0.11 2.07 NA XXX 

74415 ......... ............ A Contrst x-ray, urinary tract ........................... 0.49 2.28 NA 0.14 2.91 NA XXX 

74415 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

74415 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.12 NA 0.12 2.24 NA XXX 

74420 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 2.74 NA 0.16 3.26 NA XXX 

74420 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74420 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 2.62 NA 0.14 2.76 NA XXX 

74425 ......... ............ A Contrst x-ray, urinary tract ........................... 0.36 1.43 NA 0.09 1.88 NA XXX 

74425 ......... 26 ....... A Contrst x-ray, urinary tract ........................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

74425 ......... TC ...... A Contrst x-ray, urinary tract ........................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74430 ......... ............ A Contrast x-ray, bladder ................................ 0.32 1.17 NA 0.08 1.57 NA XXX 

74430 ......... 26 ....... A Contrast x-ray, bladder ................................ 0.32 0.11 0.11 0.02 0.45 0.45 XXX 

74430 ......... TC ...... A Contrast x-ray, bladder ................................ 0.00 1.06 NA 0.06 1.12 NA XXX 

74440 ......... ............ A X-ray, male genital tract .............................. 0.38 1.25 NA 0.08 1.71 NA XXX 

74440 ......... 26 ....... A X-ray, male genital tract .............................. 0.38 0.12 0.12 0.02 0.52 0.52 XXX 

74440 ......... TC ...... A X-ray, male genital tract .............................. 0.00 1.13 NA 0.06 1.19 NA XXX 

74445 ......... ............ A X-ray exam of penis .................................... 1.14 1.50 NA 0.12 2.76 NA XXX 

74445 ......... 26 ....... A X-ray exam of penis .................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

74445 ......... TC ...... A X-ray exam of penis .................................... 0.00 1.13 NA 0.06 1.19 NA XXX 

74450 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.57 NA 0.10 2.00 NA XXX 

74450 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 

74450 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.46 NA 0.08 1.54 NA XXX 

74455 ......... ............ A X-ray, urethra/bladder .................................. 0.33 1.69 NA 0.12 2.14 NA XXX 

74455 ......... 26 ....... A X-ray, urethra/bladder .................................. 0.33 0.11 0.11 0.02 0.46 0.46 XXX 

74455 ......... TC ...... A X-ray, urethra/bladder .................................. 0.00 1.58 NA 0.10 1.68 NA XXX 

74470 ......... ............ A X-ray exam of kidney lesion ........................ 0.54 1.43 NA 0.09 2.06 NA XXX 

74470 ......... 26 ....... A X-ray exam of kidney lesion ........................ 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74470 ......... TC ...... A X-ray exam of kidney lesion ........................ 0.00 1.25 NA 0.07 1.32 NA XXX 

74475 ......... ............ A X-ray control, cath insert ............................. 0.54 4.27 NA 0.24 5.05 NA XXX 

74475 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74475 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.09 NA 0.22 4.31 NA XXX 

74480 ......... ............ A X-ray control, cath insert ............................. 0.54 4.27 NA 0.24 5.05 NA XXX 

74480 ......... 26 ....... A X-ray control, cath insert ............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

74480 ......... TC ...... A X-ray control, cath insert ............................. 0.00 4.09 NA 0.22 4.31 NA XXX 

74485 ......... ............ A X-ray guide, GU dilation .............................. 0.54 3.35 NA 0.21 4.10 NA XXX 

74485 ......... 26 ....... A X-ray guide, GU dilation .............................. 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

74485 ......... TC ...... A X-ray guide, GU dilation .............................. 0.00 3.17 NA 0.17 3.34 NA XXX 

74710 ......... ............ A X-ray measurement of pelvis ....................... 0.34 1.17 NA 0.08 1.59 NA XXX 

74710 ......... 26 ....... A X-ray measurement of pelvis ....................... 0.34 0.11 0.11 0.02 0.47 0.47 XXX 

74710 ......... TC ...... A X-ray measurement of pelvis ....................... 0.00 1.06 NA 0.06 1.12 NA XXX 

74740 ......... ............ A X-ray, female genital tract ........................... 0.38 1.44 NA 0.09 1.91 NA XXX 

74740 ......... 26 ....... A X-ray, female genital tract ........................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

74740 ......... TC ...... A X-ray, female genital tract ........................... 0.00 1.31 NA 0.07 1.38 NA XXX 

74742 ......... ............ A X-ray, fallopian tube ..................................... 0.61 3.37 NA 0.19 4.17 NA XXX 

74742 ......... 26 ....... A X-ray, fallopian tube ..................................... 0.61 0.20 0.20 0.02 0.83 0.83 XXX 

74742 ......... TC ...... A X-ray, fallopian tube ..................................... 0.00 3.17 NA 0.17 3.34 NA XXX 

74775 ......... ............ A X-ray exam of perineum .............................. 0.62 1.67 NA 0.12 2.41 NA XXX 

74775 ......... 26 ....... A X-ray exam of perineum .............................. 0.62 0.21 0.21 0.04 0.87 0.87 XXX 

74775 ......... TC ...... A X-ray exam of perineum .............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

1200

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75552 ......... ............ A Heart mri for morph w/o dye ....................... 1.60 11.77 NA 0.67 14.04 NA XXX 

75552 ......... 26 ....... A Heart mri for morph w/o dye ....................... 1.60 0.53 0.53 0.08 2.21 2.21 XXX 

75552 ......... TC ...... A Heart mri for morph w/o dye ....................... 0.00 11.24 NA 0.59 11.83 NA XXX 

75553 ......... ............ A Heart mri for morph w/dye ........................... 2.00 11.89 NA 0.70 14.59 NA XXX 

75553 ......... 26 ....... A Heart mri for morph w/dye ........................... 2.00 0.65 0.65 0.11 2.76 2.76 XXX 

75553 ......... TC ...... A Heart mri for morph w/dye ........................... 0.00 11.24 NA 0.59 11.83 NA XXX 

75554 ......... ............ A Cardiac MRI/function ................................... 1.83 11.88 NA 0.67 14.38 NA XXX 

75554 ......... 26 ....... A Cardiac MRI/function ................................... 1.83 0.64 0.64 0.08 2.55 2.55 XXX 

75554 ......... TC ...... A Cardiac MRI/function ................................... 0.00 11.24 NA 0.59 11.83 NA XXX 

75555 ......... ............ A Cardiac MRI/limited study ............................ 1.74 11.88 NA 0.67 14.29 NA XXX 

75555 ......... 26 ....... A Cardiac MRI/limited study ............................ 1.74 0.64 0.64 0.08 2.46 2.46 XXX 

75555 ......... TC ...... A Cardiac MRI/limited study ............................ 0.00 11.24 NA 0.59 11.83 NA XXX 

75556 ......... ............ N Cardiac MRI/flow mapping .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75600 ......... ............ A Contrast x-ray exam of aorta ....................... 0.49 12.83 NA 0.67 13.99 NA XXX 

75600 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 0.49 0.19 0.19 0.02 0.70 0.70 XXX 

75600 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75605 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 13.03 NA 0.71 14.88 NA XXX 

75605 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.39 0.39 0.06 1.59 1.59 XXX 

75605 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75625 ......... ............ A Contrast x-ray exam of aorta ....................... 1.14 13.02 NA 0.71 14.87 NA XXX 

75625 ......... 26 ....... A Contrast x-ray exam of aorta ....................... 1.14 0.38 0.38 0.06 1.58 1.58 XXX 

75625 ......... TC ...... A Contrast x-ray exam of aorta ....................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75630 ......... ............ A X-ray aorta, leg arteries ............................... 1.79 13.78 NA 0.79 16.36 NA XXX 

75630 ......... 26 ....... A X-ray aorta, leg arteries ............................... 1.79 0.61 0.61 0.10 2.50 2.50 XXX 

75630 ......... TC ...... A X-ray aorta, leg arteries ............................... 0.00 13.17 NA 0.69 13.86 NA XXX 

75635 ......... ............ A Ct angio abdominal arteries ........................ 2.40 16.77 NA 0.50 19.67 NA XXX 

75635 ......... 26 ....... A Ct angio abdominal arteries ........................ 2.40 0.80 0.80 0.11 3.31 3.31 XXX 

75635 ......... TC ...... A Ct angio abdominal arteries ........................ 0.00 15.97 NA 0.39 16.36 NA XXX 

75650 ......... ............ A Artery x-rays, head & neck .......................... 1.49 13.13 NA 0.73 15.35 NA XXX 

75650 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.49 0.49 0.49 0.08 2.06 2.06 XXX 

75650 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75658 ......... ............ A Artery x-rays, arm ........................................ 1.31 13.11 NA 0.72 15.14 NA XXX 

75658 ......... 26 ....... A Artery x-rays, arm ........................................ 1.31 0.47 0.47 0.07 1.85 1.85 XXX 

75658 ......... TC ...... A Artery x-rays, arm ........................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75660 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.08 NA 0.72 15.11 NA XXX 

75660 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.44 0.44 0.07 1.82 1.82 XXX 

75660 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75662 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.23 NA 0.75 15.64 NA XXX 

75662 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.59 0.59 0.10 2.35 2.35 XXX 

75662 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75665 ......... ............ A Artery x-rays, head & neck .......................... 1.31 13.07 NA 0.73 15.11 NA XXX 

75665 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.31 0.43 0.43 0.08 1.82 1.82 XXX 

75665 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75671 ......... ............ A Artery x-rays, head & neck .......................... 1.66 13.19 NA 0.75 15.60 NA XXX 

75671 ......... 26 ....... A Artery x-rays, head & neck .......................... 1.66 0.55 0.55 0.10 2.31 2.31 XXX 

75671 ......... TC ...... A Artery x-rays, head & neck .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75676 ......... ............ A Artery x-rays, neck ....................................... 1.31 13.08 NA 0.73 15.12 NA XXX 

75676 ......... 26 ....... A Artery x-rays, neck ....................................... 1.31 0.44 0.44 0.08 1.83 1.83 XXX 

75676 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75680 ......... ............ A Artery x-rays, neck ....................................... 1.66 13.19 NA 0.75 15.60 NA XXX 

75680 ......... 26 ....... A Artery x-rays, neck ....................................... 1.66 0.55 0.55 0.10 2.31 2.31 XXX 

75680 ......... TC ...... A Artery x-rays, neck ....................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75685 ......... ............ A Artery x-rays, spine ...................................... 1.31 13.07 NA 0.72 15.10 NA XXX 

75685 ......... 26 ....... A Artery x-rays, spine ...................................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75685 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75705 ......... ............ A Artery x-rays, spine ...................................... 2.18 13.37 NA 0.78 16.33 NA XXX 

75705 ......... 26 ....... A Artery x-rays, spine ...................................... 2.18 0.73 0.73 0.13 3.04 3.04 XXX 

75705 ......... TC ...... A Artery x-rays, spine ...................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75710 ......... ............ A Artery x-rays, arm/leg .................................. 1.14 13.02 NA 0.72 14.88 NA XXX 

75710 ......... 26 ....... A Artery x-rays, arm/leg .................................. 1.14 0.38 0.38 0.07 1.59 1.59 XXX 

75710 ......... TC ...... A Artery x-rays, arm/leg .................................. 0.00 12.64 NA 0.65 13.29 NA XXX 

75716 ......... ............ A Artery x-rays, arms/legs ............................... 1.31 13.07 NA 0.72 15.10 NA XXX 

75716 ......... 26 ....... A Artery x-rays, arms/legs ............................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75716 ......... TC ...... A Artery x-rays, arms/legs ............................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75722 ......... ............ A Artery x-rays, kidney .................................... 1.14 13.04 NA 0.71 14.89 NA XXX 

75722 ......... 26 ....... A Artery x-rays, kidney .................................... 1.14 0.40 0.40 0.06 1.60 1.60 XXX 

75722 ......... TC ...... A Artery x-rays, kidney .................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75724 ......... ............ A Artery x-rays, kidneys .................................. 1.49 13.20 NA 0.71 15.40 NA XXX 

75724 ......... 26 ....... A Artery x-rays, kidneys .................................. 1.49 0.56 0.56 0.06 2.11 2.11 XXX 

75724 ......... TC ...... A Artery x-rays, kidneys .................................. 0.00 12.64 NA 0.65 13.29 NA XXX 

75726 ......... ............ A Artery x-rays, abdomen ............................... 1.14 13.01 NA 0.71 14.86 NA XXX 

75726 ......... 26 ....... A Artery x-rays, abdomen ............................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75726 ......... TC ...... A Artery x-rays, abdomen ............................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75731 ......... ............ A Artery x-rays, adrenal gland ........................ 1.14 13.01 NA 0.71 14.86 NA XXX 

75731 ......... 26 ....... A Artery x-rays, adrenal gland ........................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

1201

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75731 ......... TC ...... A Artery x-rays, adrenal gland ........................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75733 ......... ............ A Artery x-rays, adrenals ................................ 1.31 13.07 NA 0.72 15.10 NA XXX 

75733 ......... 26 ....... A Artery x-rays, adrenals ................................ 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75733 ......... TC ...... A Artery x-rays, adrenals ................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75736 ......... ............ A Artery x-rays, pelvis ..................................... 1.14 13.01 NA 0.71 14.86 NA XXX 

75736 ......... 26 ....... A Artery x-rays, pelvis ..................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75736 ......... TC ...... A Artery x-rays, pelvis ..................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75741 ......... ............ A Artery x-rays, lung ....................................... 1.31 13.07 NA 0.72 15.10 NA XXX 

75741 ......... 26 ....... A Artery x-rays, lung ....................................... 1.31 0.43 0.43 0.07 1.81 1.81 XXX 

75741 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75743 ......... ............ A Artery x-rays, lungs ...................................... 1.66 13.18 NA 0.73 15.57 NA XXX 

75743 ......... 26 ....... A Artery x-rays, lungs ...................................... 1.66 0.54 0.54 0.08 2.28 2.28 XXX 

75743 ......... TC ...... A Artery x-rays, lungs ...................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75746 ......... ............ A Artery x-rays, lung ....................................... 1.14 13.01 NA 0.71 14.86 NA XXX 

75746 ......... 26 ....... A Artery x-rays, lung ....................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75746 ......... TC ...... A Artery x-rays, lung ....................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75756 ......... ............ A Artery x-rays, chest ...................................... 1.14 13.08 NA 0.70 14.92 NA XXX 

75756 ......... 26 ....... A Artery x-rays, chest ...................................... 1.14 0.44 0.44 0.05 1.63 1.63 XXX 

75756 ......... TC ...... A Artery x-rays, chest ...................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75774 ......... ............ A Artery x-ray, each vessel ............................. 0.36 12.77 NA 0.67 13.80 NA ZZZ 

75774 ......... 26 ....... A Artery x-ray, each vessel ............................. 0.36 0.13 0.13 0.02 0.51 0.51 ZZZ 

75774 ......... TC ...... A Artery x-ray, each vessel ............................. 0.00 12.64 NA 0.65 13.29 NA ZZZ 

75790 ......... ............ A Visualize A-V shunt ..................................... 1.84 1.96 NA 0.19 3.99 NA XXX 

75790 ......... 26 ....... A Visualize A-V shunt ..................................... 1.84 0.60 0.60 0.11 2.55 2.55 XXX 

75790 ......... TC ...... A Visualize A-V shunt ..................................... 0.00 1.36 NA 0.08 1.44 NA XXX 

75801 ......... ............ A Lymph vessel x-ray, arm/leg ....................... 0.81 5.71 NA 0.35 6.87 NA XXX 

75801 ......... 26 ....... A Lymph vessel x-ray, arm/leg ....................... 0.81 0.27 0.27 0.06 1.14 1.14 XXX 

75801 ......... TC ...... A Lymph vessel x-ray, arm/leg ....................... 0.00 5.44 NA 0.29 5.73 NA XXX 

75803 ......... ............ A Lymph vessel x-ray,arms/legs ..................... 1.17 5.82 NA 0.35 7.34 NA XXX 

75803 ......... 26 ....... A Lymph vessel x-ray,arms/legs ..................... 1.17 0.38 0.38 0.06 1.61 1.61 XXX 

75803 ......... TC ...... A Lymph vessel x-ray,arms/legs ..................... 0.00 5.44 NA 0.29 5.73 NA XXX 

75805 ......... ............ A Lymph vessel x-ray, trunk ........................... 0.81 6.39 NA 0.38 7.58 NA XXX 

75805 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 0.81 0.27 0.27 0.05 1.13 1.13 XXX 

75805 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.12 NA 0.33 6.45 NA XXX 

75807 ......... ............ A Lymph vessel x-ray, trunk ........................... 1.17 6.50 NA 0.39 8.06 NA XXX 

75807 ......... 26 ....... A Lymph vessel x-ray, trunk ........................... 1.17 0.38 0.38 0.06 1.61 1.61 XXX 

75807 ......... TC ...... A Lymph vessel x-ray, trunk ........................... 0.00 6.12 NA 0.33 6.45 NA XXX 

75809 ......... ............ A Nonvascular shunt, x-ray ............................. 0.47 0.95 NA 0.07 1.49 NA XXX 

75809 ......... 26 ....... A Nonvascular shunt, x-ray ............................. 0.47 0.16 0.16 0.02 0.65 0.65 XXX 

75809 ......... TC ...... A Nonvascular shunt, x-ray ............................. 0.00 0.79 NA 0.05 0.84 NA XXX 

75810 ......... ............ A Vein x-ray, spleen/liver ................................ 1.14 13.01 NA 0.72 14.87 NA XXX 

75810 ......... 26 ....... A Vein x-ray, spleen/liver ................................ 1.14 0.37 0.37 0.07 1.58 1.58 XXX 

75810 ......... TC ...... A Vein x-ray, spleen/liver ................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75820 ......... ............ A Vein x-ray, arm/leg ...................................... 0.70 1.18 NA 0.10 1.98 NA XXX 

75820 ......... 26 ....... A Vein x-ray, arm/leg ...................................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

75820 ......... TC ...... A Vein x-ray, arm/leg ...................................... 0.00 0.95 NA 0.06 1.01 NA XXX 

75822 ......... ............ A Vein x-ray, arms/legs ................................... 1.06 1.83 NA 0.14 3.03 NA XXX 

75822 ......... 26 ....... A Vein x-ray, arms/legs ................................... 1.06 0.35 0.35 0.06 1.47 1.47 XXX 

75822 ......... TC ...... A Vein x-ray, arms/legs ................................... 0.00 1.48 NA 0.08 1.56 NA XXX 

75825 ......... ............ A Vein x-ray, trunk .......................................... 1.14 13.01 NA 0.72 14.87 NA XXX 

75825 ......... 26 ....... A Vein x-ray, trunk .......................................... 1.14 0.37 0.37 0.07 1.58 1.58 XXX 

75825 ......... TC ...... A Vein x-ray, trunk .......................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75827 ......... ............ A Vein x-ray, chest .......................................... 1.14 13.01 NA 0.71 14.86 NA XXX 

75827 ......... 26 ....... A Vein x-ray, chest .......................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75827 ......... TC ...... A Vein x-ray, chest .......................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75831 ......... ............ A Vein x-ray, kidney ........................................ 1.14 13.01 NA 0.71 14.86 NA XXX 

75831 ......... 26 ....... A Vein x-ray, kidney ........................................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75831 ......... TC ...... A Vein x-ray, kidney ........................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75833 ......... ............ A Vein x-ray, kidneys ...................................... 1.49 13.13 NA 0.73 15.35 NA XXX 

75833 ......... 26 ....... A Vein x-ray, kidneys ...................................... 1.49 0.49 0.49 0.08 2.06 2.06 XXX 

75833 ......... TC ...... A Vein x-ray, kidneys ...................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75840 ......... ............ A Vein x-ray, adrenal gland ............................ 1.14 13.01 NA 0.73 14.88 NA XXX 

75840 ......... 26 ....... A Vein x-ray, adrenal gland ............................ 1.14 0.37 0.37 0.08 1.59 1.59 XXX 

75840 ......... TC ...... A Vein x-ray, adrenal gland ............................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75842 ......... ............ A Vein x-ray, adrenal glands ........................... 1.49 13.12 NA 0.73 15.34 NA XXX 

75842 ......... 26 ....... A Vein x-ray, adrenal glands ........................... 1.49 0.48 0.48 0.08 2.05 2.05 XXX 

75842 ......... TC ...... A Vein x-ray, adrenal glands ........................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75860 ......... ............ A Vein x-ray, neck ........................................... 1.14 13.03 NA 0.72 14.89 NA XXX 

75860 ......... 26 ....... A Vein x-ray, neck ........................................... 1.14 0.39 0.39 0.07 1.60 1.60 XXX 

75860 ......... TC ...... A Vein x-ray, neck ........................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75870 ......... ............ A Vein x-ray, skull ........................................... 1.14 13.03 NA 0.72 14.89 NA XXX 

75870 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.39 0.39 0.07 1.60 1.60 XXX 

75870 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75872 ......... ............ A Vein x-ray, skull ........................................... 1.14 13.01 NA 0.71 14.86 NA XXX 

75872 ......... 26 ....... A Vein x-ray, skull ........................................... 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

1202

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75872 ......... TC ...... A Vein x-ray, skull ........................................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75880 ......... ............ A Vein x-ray, eye socket ................................. 0.70 1.18 NA 0.10 1.98 NA XXX 

75880 ......... 26 ....... A Vein x-ray, eye socket ................................. 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

75880 ......... TC ...... A Vein x-ray, eye socket ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 

75885 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.11 NA 0.72 15.27 NA XXX 

75885 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75885 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75887 ......... ............ A Vein x-ray, liver ............................................ 1.44 13.11 NA 0.72 15.27 NA XXX 

75887 ......... 26 ....... A Vein x-ray, liver ............................................ 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75887 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75889 ......... ............ A Vein x-ray, liver ............................................ 1.14 13.01 NA 0.71 14.86 NA XXX 

75889 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75889 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75891 ......... ............ A Vein x-ray, liver ............................................ 1.14 13.01 NA 0.71 14.86 NA XXX 

75891 ......... 26 ....... A Vein x-ray, liver ............................................ 1.14 0.37 0.37 0.06 1.57 1.57 XXX 

75891 ......... TC ...... A Vein x-ray, liver ............................................ 0.00 12.64 NA 0.65 13.29 NA XXX 

75893 ......... ............ A Venous sampling by catheter ...................... 0.54 12.82 NA 0.67 14.03 NA XXX 

75893 ......... 26 ....... A Venous sampling by catheter ...................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

75893 ......... TC ...... A Venous sampling by catheter ...................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75894 ......... ............ A X-rays, transcath therapy ............................ 1.31 24.65 NA 1.35 27.31 NA XXX 

75894 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.43 0.43 0.08 1.82 1.82 XXX 

75894 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 24.22 NA 1.27 25.49 NA XXX 

75896 ......... ............ A X-rays, transcath therapy ............................ 1.31 21.51 NA 1.17 23.99 NA XXX 

75896 ......... 26 ....... A X-rays, transcath therapy ............................ 1.31 0.45 0.45 0.07 1.83 1.83 XXX 

75896 ......... TC ...... A X-rays, transcath therapy ............................ 0.00 21.06 NA 1.10 22.16 NA XXX 

75898 ......... ............ A Follow-up angiography ................................ 1.65 1.61 NA 0.14 3.40 NA XXX 

75898 ......... 26 ....... A Follow-up angiography ................................ 1.65 0.55 0.55 0.08 2.28 2.28 XXX 

75898 ......... TC ...... A Follow-up angiography ................................ 0.00 1.06 NA 0.06 1.12 NA XXX 

75900 ......... ............ A Arterial catheter exchange ........................... 0.49 21.20 NA 1.13 22.82 NA XXX 

75900 ......... 26 ....... A Arterial catheter exchange ........................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

75900 ......... TC ...... A Arterial catheter exchange ........................... 0.00 21.04 NA 1.11 22.15 NA XXX 

75901 ......... ............ A Remove cva device obstruct ....................... 0.49 1.47 NA 0.85 2.81 NA XXX 

75901 ......... 26 ....... A Remove cva device obstruct ....................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

75901 ......... TC ...... A Remove cva device obstruct ....................... 0.00 1.31 NA 0.83 2.14 NA XXX 

75902 ......... ............ A Remove cva lumen obstruct ........................ 0.39 1.44 NA 0.85 2.68 NA XXX 

75902 ......... 26 ....... A Remove cva lumen obstruct ........................ 0.39 0.13 0.13 0.02 0.54 0.54 XXX 

75902 ......... TC ...... A Remove cva lumen obstruct ........................ 0.00 1.31 NA 0.83 2.14 NA XXX 

75940 ......... ............ A X-ray placement, vein filter .......................... 0.54 12.82 NA 0.69 14.05 NA XXX 

75940 ......... 26 ....... A X-ray placement, vein filter .......................... 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

75940 ......... TC ...... A X-ray placement, vein filter .......................... 0.00 12.64 NA 0.65 13.29 NA XXX 

75945 ......... ............ A Intravascular us ........................................... 0.40 4.72 NA 0.28 5.40 NA XXX 

75945 ......... 26 ....... A Intravascular us ........................................... 0.40 0.14 0.14 0.04 0.58 0.58 XXX 

75945 ......... TC ...... A Intravascular us ........................................... 0.00 4.58 NA 0.24 4.82 NA XXX 

75946 ......... ............ A Intravascular us add-on ............................... 0.40 2.44 NA 0.17 3.01 NA ZZZ 

75946 ......... 26 ....... A Intravascular us add-on ............................... 0.40 0.14 0.14 0.04 0.58 0.58 ZZZ 

75946 ......... TC ...... A Intravascular us add-on ............................... 0.00 2.30 NA 0.13 2.43 NA ZZZ 

75952 ......... ............ C Endovasc repair abdom aorta ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75952 ......... 26 ....... A Endovasc repair abdom aorta ..................... 4.49 1.50 1.50 0.82 6.81 6.81 XXX 

75952 ......... TC ...... C Endovasc repair abdom aorta ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75953 ......... ............ C Abdom aneurysm endovas rpr .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75953 ......... 26 ....... A Abdom aneurysm endovas rpr .................... 1.36 0.45 0.45 0.82 2.63 2.63 XXX 

75953 ......... TC ...... C Abdom aneurysm endovas rpr .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75954 ......... ............ C Iliac aneurysm endovas rpr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75954 ......... 26 ....... A Iliac aneurysm endovas rpr ......................... 2.25 0.47 0.47 0.82 3.54 3.54 XXX 

75954 ......... TC ...... C Iliac aneurysm endovas rpr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

75960 ......... ............ A Transcatheter intro, stent ............................. 0.82 15.24 NA 0.82 16.88 NA XXX 

75960 ......... 26 ....... A Transcatheter intro, stent ............................. 0.82 0.29 0.29 0.05 1.16 1.16 XXX 

75960 ......... TC ...... A Transcatheter intro, stent ............................. 0.00 14.95 NA 0.77 15.72 NA XXX 

75961 ......... ............ A Retrieval, broken catheter ........................... 4.24 11.94 NA 0.77 16.95 NA XXX 

75961 ......... 26 ....... A Retrieval, broken catheter ........................... 4.24 1.40 1.40 0.22 5.86 5.86 XXX 

75961 ......... TC ...... A Retrieval, broken catheter ........................... 0.00 10.54 NA 0.55 11.09 NA XXX 

75962 ......... ............ A Repair arterial blockage ............................... 0.54 15.99 NA 0.87 17.40 NA XXX 

75962 ......... 26 ....... A Repair arterial blockage ............................... 0.54 0.19 0.19 0.04 0.77 0.77 XXX 

75962 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.80 NA 0.83 16.63 NA XXX 

75964 ......... ............ A Repair artery blockage, each ...................... 0.36 8.54 NA 0.45 9.35 NA ZZZ 

75964 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.12 0.12 0.02 0.50 0.50 ZZZ 

75964 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.42 NA 0.43 8.85 NA ZZZ 

75966 ......... ............ A Repair arterial blockage ............................... 1.31 16.26 NA 0.90 18.47 NA XXX 

75966 ......... 26 ....... A Repair arterial blockage ............................... 1.31 0.46 0.46 0.07 1.84 1.84 XXX 

75966 ......... TC ...... A Repair arterial blockage ............................... 0.00 15.80 NA 0.83 16.63 NA XXX 

75968 ......... ............ A Repair artery blockage, each ...................... 0.36 8.55 NA 0.44 9.35 NA ZZZ 

75968 ......... 26 ....... A Repair artery blockage, each ...................... 0.36 0.13 0.13 0.01 0.50 0.50 ZZZ 

75968 ......... TC ...... A Repair artery blockage, each ...................... 0.00 8.42 NA 0.43 8.85 NA ZZZ 

75970 ......... ............ A Vascular biopsy ........................................... 0.83 11.88 NA 0.65 13.36 NA XXX 

75970 ......... 26 ....... A Vascular biopsy ........................................... 0.83 0.29 0.29 0.05 1.17 1.17 XXX 

1203

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

75970 ......... TC ...... A Vascular biopsy ........................................... 0.00 11.59 NA 0.60 12.19 NA XXX 

75978 ......... ............ A Repair venous blockage .............................. 0.54 15.98 NA 0.85 17.37 NA XXX 

75978 ......... 26 ....... A Repair venous blockage .............................. 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

75978 ......... TC ...... A Repair venous blockage .............................. 0.00 15.80 NA 0.83 16.63 NA XXX 

75980 ......... ............ A Contrast xray exam bile duct ....................... 1.44 5.91 NA 0.36 7.71 NA XXX 

75980 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.47 0.47 0.07 1.98 1.98 XXX 

75980 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 5.44 NA 0.29 5.73 NA XXX 

75982 ......... ............ A Contrast xray exam bile duct ....................... 1.44 6.58 NA 0.40 8.42 NA XXX 

75982 ......... 26 ....... A Contrast xray exam bile duct ....................... 1.44 0.46 0.46 0.07 1.97 1.97 XXX 

75982 ......... TC ...... A Contrast xray exam bile duct ....................... 0.00 6.12 NA 0.33 6.45 NA XXX 

75984 ......... ............ A Xray control catheter change ...................... 0.72 2.20 NA 0.15 3.07 NA XXX 

75984 ......... 26 ....... A Xray control catheter change ...................... 0.72 0.24 0.24 0.04 1.00 1.00 XXX 

75984 ......... TC ...... A Xray control catheter change ...................... 0.00 1.96 NA 0.11 2.07 NA XXX 

75989 ......... ............ A Abscess drainage under x-ray ..................... 1.19 3.55 NA 0.23 4.97 NA XXX 

75989 ......... 26 ....... A Abscess drainage under x-ray ..................... 1.19 0.38 0.38 0.06 1.63 1.63 XXX 

75989 ......... TC ...... A Abscess drainage under x-ray ..................... 0.00 3.17 NA 0.17 3.34 NA XXX 

75992 ......... ............ A Atherectomy, x-ray exam ............................. 0.54 15.99 NA 0.85 17.38 NA XXX 

75992 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.54 0.19 0.19 0.02 0.75 0.75 XXX 

75992 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.80 NA 0.83 16.63 NA XXX 

75993 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.56 NA 0.44 9.36 NA ZZZ 

75993 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.14 0.14 0.01 0.51 0.51 ZZZ 

75993 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.42 NA 0.43 8.85 NA ZZZ 

75994 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.26 NA 0.90 18.47 NA XXX 

75994 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.46 0.46 0.07 1.84 1.84 XXX 

75994 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.80 NA 0.83 16.63 NA XXX 

75995 ......... ............ A Atherectomy, x-ray exam ............................. 1.31 16.27 NA 0.90 18.48 NA XXX 

75995 ......... 26 ....... A Atherectomy, x-ray exam ............................. 1.31 0.47 0.47 0.07 1.85 1.85 XXX 

75995 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 15.80 NA 0.83 16.63 NA XXX 

75996 ......... ............ A Atherectomy, x-ray exam ............................. 0.36 8.54 NA 0.44 9.34 NA ZZZ 

75996 ......... 26 ....... A Atherectomy, x-ray exam ............................. 0.36 0.12 0.12 0.01 0.49 0.49 ZZZ 

75996 ......... TC ...... A Atherectomy, x-ray exam ............................. 0.00 8.42 NA 0.43 8.85 NA ZZZ 

75998 ......... ............ A Fluoroguide for vein device ......................... 0.38 1.44 NA 0.15 1.97 NA ZZZ 

75998 ......... 26 ....... A Fluoroguide for vein device ......................... 0.38 0.13 0.13 0.05 0.56 0.56 ZZZ 

75998 ......... TC ...... A Fluoroguide for vein device ......................... 0.00 1.31 NA 0.10 1.41 NA ZZZ 

76000 ......... ............ A Fluoroscope examination ............................. 0.17 1.36 NA 0.08 1.61 NA XXX 

76000 ......... 26 ....... A Fluoroscope examination ............................. 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

76000 ......... TC ...... A Fluoroscope examination ............................. 0.00 1.31 NA 0.07 1.38 NA XXX 

76001 ......... ............ A Fluoroscope exam, extensive ...................... 0.67 2.84 NA 0.18 3.69 NA XXX 

76001 ......... 26 ....... A Fluoroscope exam, extensive ...................... 0.67 0.22 0.22 0.04 0.93 0.93 XXX 

76001 ......... TC ...... A Fluoroscope exam, extensive ...................... 0.00 2.62 NA 0.14 2.76 NA XXX 

76003 ......... ............ A Needle localization by x-ray ........................ 0.54 1.48 NA 0.11 2.13 NA XXX 

76003 ......... 26 ....... A Needle localization by x-ray ........................ 0.54 0.17 0.17 0.04 0.75 0.75 XXX 

76003 ......... TC ...... A Needle localization by x-ray ........................ 0.00 1.31 NA 0.07 1.38 NA XXX 

76005 ......... ............ A Fluoroguide for spine inject ......................... 0.60 1.47 NA 0.11 2.18 NA XXX 

76005 ......... 26 ....... A Fluoroguide for spine inject ......................... 0.60 0.16 0.16 0.04 0.80 0.80 XXX 

76005 ......... TC ...... A Fluoroguide for spine inject ......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

76006 ......... ............ A X-ray stress view ......................................... 0.41 0.19 0.19 0.05 0.65 0.65 XXX 

76010 ......... ............ A X-ray, nose to rectum .................................. 0.18 0.58 NA 0.03 0.79 NA XXX 

76010 ......... 26 ....... A X-ray, nose to rectum .................................. 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

76010 ......... TC ...... A X-ray, nose to rectum .................................. 0.00 0.52 NA 0.02 0.54 NA XXX 

76012 ......... ............ C Percut vertebroplasty fluor ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76012 ......... 26 ....... A Percut vertebroplasty fluor ........................... 1.31 0.46 0.46 0.28 2.05 2.05 XXX 

76012 ......... TC ...... C Percut vertebroplasty fluor ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76013 ......... ............ C Percut vertebroplasty, ct .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76013 ......... 26 ....... A Percut vertebroplasty, ct .............................. 1.38 0.47 0.47 0.58 2.43 2.43 XXX 

76013 ......... TC ...... C Percut vertebroplasty, ct .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76020 ......... ............ A X-rays for bone age ..................................... 0.19 0.58 NA 0.03 0.80 NA XXX 

76020 ......... 26 ....... A X-rays for bone age ..................................... 0.19 0.06 0.06 0.01 0.26 0.26 XXX 

76020 ......... TC ...... A X-rays for bone age ..................................... 0.00 0.52 NA 0.02 0.54 NA XXX 

76040 ......... ............ A X-rays, bone evaluation ............................... 0.27 0.88 NA 0.09 1.24 NA XXX 

76040 ......... 26 ....... A X-rays, bone evaluation ............................... 0.27 0.09 0.09 0.04 0.40 0.40 XXX 

76040 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.79 NA 0.05 0.84 NA XXX 

76061 ......... ............ A X-rays, bone survey ..................................... 0.45 1.15 NA 0.08 1.68 NA XXX 

76061 ......... 26 ....... A X-rays, bone survey ..................................... 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

76061 ......... TC ...... A X-rays, bone survey ..................................... 0.00 1.00 NA 0.06 1.06 NA XXX 

76062 ......... ............ A X-rays, bone survey ..................................... 0.54 1.62 NA 0.10 2.26 NA XXX 

76062 ......... 26 ....... A X-rays, bone survey ..................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76062 ......... TC ...... A X-rays, bone survey ..................................... 0.00 1.44 NA 0.08 1.52 NA XXX 

76065 ......... ............ A X-rays, bone evaluation ............................... 0.70 0.98 NA 0.06 1.74 NA XXX 

76065 ......... 26 ....... A X-rays, bone evaluation ............................... 0.70 0.24 0.24 0.01 0.95 0.95 XXX 

76065 ......... TC ...... A X-rays, bone evaluation ............................... 0.00 0.74 NA 0.05 0.79 NA XXX 

76066 ......... ............ A Joint survey, single view .............................. 0.31 1.23 NA 0.08 1.62 NA XXX 

76066 ......... 26 ....... A Joint survey, single view .............................. 0.31 0.11 0.11 0.02 0.44 0.44 XXX 

76066 ......... TC ...... A Joint survey, single view .............................. 0.00 1.12 NA 0.06 1.18 NA XXX 

76070 ......... ............ A Ct bone density, axial .................................. 0.25 3.04 NA 0.17 3.46 NA XXX 

1204

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76070 ......... 26 ....... A Ct bone density, axial .................................. 0.25 0.08 0.08 0.01 0.34 0.34 XXX 

76070 ......... TC ...... A Ct bone density, axial .................................. 0.00 2.96 NA 0.16 3.12 NA XXX 

76071 ......... ............ A Ct bone density, peripheral ......................... 0.22 3.03 NA 0.06 3.31 NA XXX 

76071 ......... 26 ....... A Ct bone density, peripheral ......................... 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

76071 ......... TC ...... A Ct bone density, peripheral ......................... 0.00 2.96 NA 0.05 3.01 NA XXX 

76075 ......... ............ A Dexa, axial skeleton study ........................... 0.30 3.21 NA 0.18 3.69 NA XXX 

76075 ......... 26 ....... A Dexa, axial skeleton study ........................... 0.30 0.10 0.10 0.01 0.41 0.41 XXX 

76075 ......... TC ...... A Dexa, axial skeleton study ........................... 0.00 3.11 NA 0.17 3.28 NA XXX 

76076 ......... ............ A Dexa, peripheral study ................................. 0.22 0.84 NA 0.06 1.12 NA XXX 

76076 ......... 26 ....... A Dexa, peripheral study ................................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

76076 ......... TC ...... A Dexa, peripheral study ................................. 0.00 0.76 NA 0.05 0.81 NA XXX 

76078 ......... ............ A Radiographic absorptiometry ....................... 0.20 0.83 NA 0.06 1.09 NA XXX 

76078 ......... 26 ....... A Radiographic absorptiometry ....................... 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

76078 ......... TC ...... A Radiographic absorptiometry ....................... 0.00 0.76 NA 0.05 0.81 NA XXX 

76080 ......... ............ A X-ray exam of fistula .................................... 0.54 1.24 NA 0.08 1.86 NA XXX 

76080 ......... 26 ....... A X-ray exam of fistula .................................... 0.54 0.18 0.18 0.02 0.74 0.74 XXX 

76080 ......... TC ...... A X-ray exam of fistula .................................... 0.00 1.06 NA 0.06 1.12 NA XXX 

76082 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.02 0.51 NA ZZZ 

76082 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76082 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.41 NA 0.01 0.42 NA ZZZ 

76083 ......... ............ A Computer mammogram add-on .................. 0.06 0.43 NA 0.02 0.51 NA ZZZ 

76083 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76083 ......... TC ...... A Computer mammogram add-on .................. 0.00 0.41 NA 0.01 0.42 NA ZZZ 

76085 ......... ............ F Computer mammogram add-on .................. +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

76085 ......... 26 ....... F Computer mammogram add-on .................. +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

76085 ......... TC ...... F Computer mammogram add-on .................. +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

76086 ......... ............ A X-ray of mammary duct ............................... 0.36 2.74 NA 0.16 3.26 NA XXX 

76086 ......... 26 ....... A X-ray of mammary duct ............................... 0.36 0.12 0.12 0.02 0.50 0.50 XXX 

76086 ......... TC ...... A X-ray of mammary duct ............................... 0.00 2.62 NA 0.14 2.76 NA XXX 

76088 ......... ............ A X-ray of mammary ducts ............................. 0.45 3.83 NA 0.21 4.49 NA XXX 

76088 ......... 26 ....... A X-ray of mammary ducts ............................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

76088 ......... TC ...... A X-ray of mammary ducts ............................. 0.00 3.68 NA 0.19 3.87 NA XXX 

76090 ......... ............ A Mammogram, one breast ............................ 0.70 1.29 NA 0.10 2.09 NA XXX 

76090 ......... 26 ....... A Mammogram, one breast ............................ 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

76090 ......... TC ...... A Mammogram, one breast ............................ 0.00 1.06 NA 0.06 1.12 NA XXX 

76091 ......... ............ A Mammogram, both breasts .......................... 0.87 1.60 NA 0.11 2.58 NA XXX 

76091 ......... 26 ....... A Mammogram, both breasts .......................... 0.87 0.29 0.29 0.04 1.20 1.20 XXX 

76091 ......... TC ...... A Mammogram, both breasts .......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

76092 ......... ............ A Mammogram, screening .............................. 0.70 1.46 NA 0.11 2.27 NA XXX 

76092 ......... 26 ....... A Mammogram, screening .............................. 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

76092 ......... TC ...... A Mammogram, screening .............................. 0.00 1.23 NA 0.07 1.30 NA XXX 

76093 ......... ............ A Magnetic image, breast ............................... 1.63 18.21 NA 1.00 20.84 NA XXX 

76093 ......... 26 ....... A Magnetic image, breast ............................... 1.63 0.53 0.53 0.08 2.24 2.24 XXX 

76093 ......... TC ...... A Magnetic image, breast ............................... 0.00 17.68 NA 0.92 18.60 NA XXX 

76094 ......... ............ A Magnetic image, both breasts ..................... 1.63 24.52 NA 1.32 27.47 NA XXX 

76094 ......... 26 ....... A Magnetic image, both breasts ..................... 1.63 0.53 0.53 0.08 2.24 2.24 XXX 

76094 ......... TC ...... A Magnetic image, both breasts ..................... 0.00 23.99 NA 1.24 25.23 NA XXX 

76095 ......... ............ A Stereotactic breast biopsy ........................... 1.59 7.71 NA 0.48 9.78 NA XXX 

76095 ......... 26 ....... A Stereotactic breast biopsy ........................... 1.59 0.52 0.52 0.11 2.22 2.22 XXX 

76095 ......... TC ...... A Stereotactic breast biopsy ........................... 0.00 7.19 NA 0.37 7.56 NA XXX 

76096 ......... ............ A X-ray of needle wire, breast ........................ 0.56 1.50 NA 0.11 2.17 NA XXX 

76096 ......... 26 ....... A X-ray of needle wire, breast ........................ 0.56 0.19 0.19 0.04 0.79 0.79 XXX 

76096 ......... TC ...... A X-ray of needle wire, breast ........................ 0.00 1.31 NA 0.07 1.38 NA XXX 

76098 ......... ............ A X-ray exam, breast specimen ...................... 0.16 0.46 NA 0.03 0.65 NA XXX 

76098 ......... 26 ....... A X-ray exam, breast specimen ...................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76098 ......... TC ...... A X-ray exam, breast specimen ...................... 0.00 0.41 NA 0.02 0.43 NA XXX 

76100 ......... ............ A X-ray exam of body section ......................... 0.58 1.44 NA 0.11 2.13 NA XXX 

76100 ......... 26 ....... A X-ray exam of body section ......................... 0.58 0.19 0.19 0.04 0.81 0.81 XXX 

76100 ......... TC ...... A X-ray exam of body section ......................... 0.00 1.25 NA 0.07 1.32 NA XXX 

76101 ......... ............ A Complex body section x-ray ........................ 0.58 1.62 NA 0.12 2.32 NA XXX 

76101 ......... 26 ....... A Complex body section x-ray ........................ 0.58 0.19 0.19 0.04 0.81 0.81 XXX 

76101 ......... TC ...... A Complex body section x-ray ........................ 0.00 1.43 NA 0.08 1.51 NA XXX 

76102 ......... ............ A Complex body section x-rays ...................... 0.58 1.94 NA 0.15 2.67 NA XXX 

76102 ......... 26 ....... A Complex body section x-rays ...................... 0.58 0.20 0.20 0.04 0.82 0.82 XXX 

76102 ......... TC ...... A Complex body section x-rays ...................... 0.00 1.74 NA 0.11 1.85 NA XXX 

76120 ......... ............ A Cine/video x-rays ......................................... 0.38 1.19 NA 0.08 1.65 NA XXX 

76120 ......... 26 ....... A Cine/video x-rays ......................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76120 ......... TC ...... A Cine/video x-rays ......................................... 0.00 1.06 NA 0.06 1.12 NA XXX 

76125 ......... ............ A Cine/video x-rays add-on ............................. 0.27 0.88 NA 0.06 1.21 NA ZZZ 

76125 ......... 26 ....... A Cine/video x-rays add-on ............................. 0.27 0.09 0.09 0.01 0.37 0.37 ZZZ 

76125 ......... TC ...... A Cine/video x-rays add-on ............................. 0.00 0.79 NA 0.05 0.84 NA ZZZ 

76140 ......... ............ I X-ray consultation ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76150 ......... ............ A X-ray exam, dry process ............................. 0.00 0.41 NA 0.02 0.43 NA XXX 

76350 ......... ............ C Special x-ray contrast study ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76355 ......... ............ A Ct scan for localization ................................ 1.21 8.69 NA 0.49 10.39 NA XXX 

1205

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76355 ......... 26 ....... A Ct scan for localization ................................ 1.21 0.40 0.40 0.07 1.68 1.68 XXX 

76355 ......... TC ...... A Ct scan for localization ................................ 0.00 8.29 NA 0.42 8.71 NA XXX 

76360 ......... ............ A Ct scan for needle biopsy ............................ 1.16 8.66 NA 0.48 10.30 NA XXX 

76360 ......... 26 ....... A Ct scan for needle biopsy ............................ 1.16 0.37 0.37 0.06 1.59 1.59 XXX 

76360 ......... TC ...... A Ct scan for needle biopsy ............................ 0.00 8.29 NA 0.42 8.71 NA XXX 

76362 ......... ............ A Ct guide for tissue ablation .......................... 3.99 9.59 NA 1.68 15.26 NA XXX 

76362 ......... 26 ....... A Ct guide for tissue ablation .......................... 3.99 1.30 1.30 0.22 5.51 5.51 XXX 

76362 ......... TC ...... A Ct guide for tissue ablation .......................... 0.00 8.29 NA 1.46 9.75 NA XXX 

76370 ......... ............ A Ct scan for therapy guide ............................ 0.85 3.24 NA 0.21 4.30 NA XXX 

76370 ......... 26 ....... A Ct scan for therapy guide ............................ 0.85 0.28 0.28 0.05 1.18 1.18 XXX 

76370 ......... TC ...... A Ct scan for therapy guide ............................ 0.00 2.96 NA 0.16 3.12 NA XXX 

76375 ......... ............ A 3d/holograph reconstr add-on ..................... 0.16 3.60 NA 0.19 3.95 NA XXX 

76375 ......... 26 ....... A 3d/holograph reconstr add-on ..................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

76375 ......... TC ...... A 3d/holograph reconstr add-on ..................... 0.00 3.55 NA 0.18 3.73 NA XXX 

76380 ......... ............ A CAT scan follow-up study ............................ 0.98 3.84 NA 0.23 5.05 NA XXX 

76380 ......... 26 ....... A CAT scan follow-up study ............................ 0.98 0.33 0.33 0.05 1.36 1.36 XXX 

76380 ......... TC ...... A CAT scan follow-up study ............................ 0.00 3.51 NA 0.18 3.69 NA XXX 

76390 ......... ............ N Mr spectroscopy .......................................... +1.40 11.48 11.48 0.66 13.54 13.54 XXX 

76390 ......... 26 ....... N Mr spectroscopy .......................................... +1.40 0.47 0.47 0.07 1.94 1.94 XXX 

76390 ......... TC ...... N Mr spectroscopy .......................................... +0.00 11.01 11.01 0.59 11.60 11.60 XXX 

76393 ......... ............ A Mr guidance for needle place ...................... 1.50 11.74 NA 0.63 13.87 NA XXX 

76393 ......... 26 ....... A Mr guidance for needle place ...................... 1.50 0.50 0.50 0.08 2.08 2.08 XXX 

76393 ......... TC ...... A Mr guidance for needle place ...................... 0.00 11.24 NA 0.55 11.79 NA XXX 

76394 ......... ............ A Mri for tissue ablation .................................. 4.24 12.63 NA 1.79 18.66 NA XXX 

76394 ......... 26 ....... A Mri for tissue ablation .................................. 4.24 1.39 1.39 0.23 5.86 5.86 XXX 

76394 ......... TC ...... A Mri for tissue ablation .................................. 0.00 11.24 NA 1.56 12.80 NA XXX 

76400 ......... ............ A Magnetic image, bone marrow .................... 1.60 11.76 NA 0.67 14.03 NA XXX 

76400 ......... 26 ....... A Magnetic image, bone marrow .................... 1.60 0.52 0.52 0.08 2.20 2.20 XXX 

76400 ......... TC ...... A Magnetic image, bone marrow .................... 0.00 11.24 NA 0.59 11.83 NA XXX 

76490 ......... ............ D Us for tissue ablation ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76490 ......... 26 ....... D Us for tissue ablation ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76490 ......... TC ...... D Us for tissue ablation ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 ......... ............ C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 ......... 26 ....... C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76496 ......... TC ...... C Fluoroscopic procedure ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 ......... ............ C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 ......... 26 ....... C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76497 ......... TC ...... C Ct procedure ................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 ......... ............ C Mri procedure ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 ......... 26 ....... C Mri procedure ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76498 ......... TC ...... C Mri procedure ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 ......... ............ C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 ......... 26 ....... C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76499 ......... TC ...... C Radiographic procedure .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76506 ......... ............ A Echo exam of head ..................................... 0.63 1.68 NA 0.12 2.43 NA XXX 

76506 ......... 26 ....... A Echo exam of head ..................................... 0.63 0.25 0.25 0.04 0.92 0.92 XXX 

76506 ......... TC ...... A Echo exam of head ..................................... 0.00 1.43 NA 0.08 1.51 NA XXX 

76511 ......... ............ A Echo exam of eye ........................................ 0.94 1.09 NA 0.09 2.12 NA XXX 

76511 ......... 26 ....... A Echo exam of eye ........................................ 0.94 0.40 0.40 0.02 1.36 1.36 XXX 

76511 ......... TC ...... A Echo exam of eye ........................................ 0.00 0.69 NA 0.07 0.76 NA XXX 

76512 ......... ............ A Echo exam of eye ........................................ 0.66 1.02 NA 0.11 1.79 NA XXX 

76512 ......... 26 ....... A Echo exam of eye ........................................ 0.66 0.30 0.30 0.01 0.97 0.97 XXX 

76512 ......... TC ...... A Echo exam of eye ........................................ 0.00 0.72 NA 0.10 0.82 NA XXX 

76513 ......... ............ A Echo exam of eye, water bath .................... 0.66 1.10 NA 0.11 1.87 NA XXX 

76513 ......... 26 ....... A Echo exam of eye, water bath .................... 0.66 0.30 0.30 0.01 0.97 0.97 XXX 

76513 ......... TC ...... A Echo exam of eye, water bath .................... 0.00 0.80 NA 0.10 0.90 NA XXX 

76514 ......... ............ A Echo exam of eye, thickness ...................... 0.17 0.14 NA 0.02 0.33 NA XXX 

76514 ......... 26 ....... A Echo exam of eye, thickness ...................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX 

76514 ......... TC ...... A Echo exam of eye, thickness ...................... 0.00 0.06 NA 0.01 0.07 NA XXX 

76516 ......... ............ A Echo exam of eye ........................................ 0.54 0.73 NA 0.08 1.35 NA XXX 

76516 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.25 0.25 0.01 0.80 0.80 XXX 

76516 ......... TC ...... A Echo exam of eye ........................................ 0.00 0.48 NA 0.07 0.55 NA XXX 

76519 ......... ............ A Echo exam of eye ........................................ 0.54 0.81 NA 0.08 1.43 NA XXX 

76519 ......... 26 ....... A Echo exam of eye ........................................ 0.54 0.25 0.25 0.01 0.80 0.80 XXX 

76519 ......... TC ...... A Echo exam of eye ........................................ 0.00 0.56 NA 0.07 0.63 NA XXX 

76529 ......... ............ A Echo exam of eye ........................................ 0.57 0.77 NA 0.09 1.43 NA XXX 

76529 ......... 26 ....... A Echo exam of eye ........................................ 0.57 0.25 0.25 0.01 0.83 0.83 XXX 

76529 ......... TC ...... A Echo exam of eye ........................................ 0.00 0.52 NA 0.08 0.60 NA XXX 

76536 ......... ............ A Us exam of head and neck ......................... 0.56 1.62 NA 0.10 2.28 NA XXX 

76536 ......... 26 ....... A Us exam of head and neck ......................... 0.56 0.19 0.19 0.02 0.77 0.77 XXX 

76536 ......... TC ...... A Us exam of head and neck ......................... 0.00 1.43 NA 0.08 1.51 NA XXX 

76604 ......... ............ A Us exam, chest, b-scan ............................... 0.55 1.49 NA 0.09 2.13 NA XXX 

76604 ......... 26 ....... A Us exam, chest, b-scan ............................... 0.55 0.18 0.18 0.02 0.75 0.75 XXX 

76604 ......... TC ...... A Us exam, chest, b-scan ............................... 0.00 1.31 NA 0.07 1.38 NA XXX 

76645 ......... ............ A Us exam, breast(s) ...................................... 0.54 1.24 NA 0.10 1.88 NA XXX 

1206

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76645 ......... 26 ....... A Us exam, breast(s) ...................................... 0.54 0.18 0.18 0.04 0.76 0.76 XXX 

76645 ......... TC ...... A Us exam, breast(s) ...................................... 0.00 1.06 NA 0.06 1.12 NA XXX 

76700 ......... ............ A Us exam, abdom, complete ......................... 0.81 2.25 NA 0.16 3.22 NA XXX 

76700 ......... 26 ....... A Us exam, abdom, complete ......................... 0.81 0.27 0.27 0.05 1.13 1.13 XXX 

76700 ......... TC ...... A Us exam, abdom, complete ......................... 0.00 1.98 NA 0.11 2.09 NA XXX 

76705 ......... ............ A Echo exam of abdomen .............................. 0.59 1.63 NA 0.12 2.34 NA XXX 

76705 ......... 26 ....... A Echo exam of abdomen .............................. 0.59 0.20 0.20 0.04 0.83 0.83 XXX 

76705 ......... TC ...... A Echo exam of abdomen .............................. 0.00 1.43 NA 0.08 1.51 NA XXX 

76770 ......... ............ A Us exam abdo back wall, comp .................. 0.74 2.23 NA 0.15 3.12 NA XXX 

76770 ......... 26 ....... A Us exam abdo back wall, comp .................. 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

76770 ......... TC ...... A Us exam abdo back wall, comp .................. 0.00 1.98 NA 0.11 2.09 NA XXX 

76775 ......... ............ A Us exam abdo back wall, lim ...................... 0.58 1.62 NA 0.12 2.32 NA XXX 

76775 ......... 26 ....... A Us exam abdo back wall, lim ...................... 0.58 0.19 0.19 0.04 0.81 0.81 XXX 

76775 ......... TC ...... A Us exam abdo back wall, lim ...................... 0.00 1.43 NA 0.08 1.51 NA XXX 

76778 ......... ............ A Us exam kidney transplant .......................... 0.74 2.23 NA 0.15 3.12 NA XXX 

76778 ......... 26 ....... A Us exam kidney transplant .......................... 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

76778 ......... TC ...... A Us exam kidney transplant .......................... 0.00 1.98 NA 0.11 2.09 NA XXX 

76800 ......... ............ A Us exam, spinal canal ................................. 1.13 1.78 NA 0.13 3.04 NA XXX 

76800 ......... 26 ....... A Us exam, spinal canal ................................. 1.13 0.35 0.35 0.05 1.53 1.53 XXX 

76800 ......... TC ...... A Us exam, spinal canal ................................. 0.00 1.43 NA 0.08 1.51 NA XXX 

76801 ......... ............ A Ob us < 14 wks, single fetus ....................... 0.99 2.45 NA 0.17 3.61 NA XXX 

76801 ......... 26 ....... A Ob us < 14 wks, single fetus ....................... 0.99 0.35 0.35 0.05 1.39 1.39 XXX 

76801 ......... TC ...... A Ob us < 14 wks, single fetus ....................... 0.00 2.10 NA 0.12 2.22 NA XXX 

76802 ......... ............ A Ob us < 14 wks, add’l fetus ........................ 0.83 1.35 NA 0.17 2.35 NA ZZZ 

76802 ......... 26 ....... A Ob us < 14 wks, add’l fetus ........................ 0.83 0.29 0.29 0.05 1.17 1.17 ZZZ 

76802 ......... TC ...... A Ob us < 14 wks, add’l fetus ........................ 0.00 1.06 NA 0.12 1.18 NA ZZZ 

76805 ......... ............ A Ob us >/= 14 wks, sngl fetus ...................... 0.99 2.45 NA 0.17 3.61 NA XXX 

76805 ......... 26 ....... A Ob us >/= 14 wks, sngl fetus ...................... 0.99 0.35 0.35 0.05 1.39 1.39 XXX 

76805 ......... TC ...... A Ob us >/= 14 wks, sngl fetus ...................... 0.00 2.10 NA 0.12 2.22 NA XXX 

76810 ......... ............ A Ob us >/= 14 wks, addl fetus ...................... 0.98 1.41 NA 0.30 2.69 NA ZZZ 

76810 ......... 26 ....... A Ob us >/= 14 wks, addl fetus ...................... 0.98 0.35 0.35 0.08 1.41 1.41 ZZZ 

76810 ......... TC ...... A Ob us >/= 14 wks, addl fetus ...................... 0.00 1.06 NA 0.22 1.28 NA ZZZ 

76811 ......... ............ A Ob us, detailed, sngl fetus ........................... 1.90 4.20 NA 0.61 6.71 NA XXX 

76811 ......... 26 ....... A Ob us, detailed, sngl fetus ........................... 1.90 0.66 0.66 0.18 2.74 2.74 XXX 

76811 ......... TC ...... A Ob us, detailed, sngl fetus ........................... 0.00 3.54 NA 0.43 3.97 NA XXX 

76812 ......... ............ A Ob us, detailed, addl fetus .......................... 1.78 1.69 NA 0.55 4.02 NA ZZZ 

76812 ......... 26 ....... A Ob us, detailed, addl fetus .......................... 1.78 0.63 0.63 0.14 2.55 2.55 ZZZ 

76812 ......... TC ...... A Ob us, detailed, addl fetus .......................... 0.00 1.06 NA 0.41 1.47 NA ZZZ 

76815 ......... ............ A Ob us, limited, fetus(s) ................................ 0.65 1.66 NA 0.10 2.41 NA XXX 

76815 ......... 26 ....... A Ob us, limited, fetus(s) ................................ 0.65 0.23 0.23 0.02 0.90 0.90 XXX 

76815 ......... TC ...... A Ob us, limited, fetus(s) ................................ 0.00 1.43 NA 0.08 1.51 NA XXX 

76816 ......... ............ A Ob us, follow-up, per fetus .......................... 0.85 1.44 NA 0.08 2.37 NA XXX 

76816 ......... 26 ....... A Ob us, follow-up, per fetus .......................... 0.85 0.32 0.32 0.02 1.19 1.19 XXX 

76816 ......... TC ...... A Ob us, follow-up, per fetus .......................... 0.00 1.12 NA 0.06 1.18 NA XXX 

76817 ......... ............ A Transvaginal us, obstetric ............................ 0.75 1.80 NA 0.08 2.63 NA XXX 

76817 ......... 26 ....... A Transvaginal us, obstetric ............................ 0.75 0.28 0.28 0.02 1.05 1.05 XXX 

76817 ......... TC ...... A Transvaginal us, obstetric ............................ 0.00 1.52 NA 0.06 1.58 NA XXX 

76818 ......... ............ A Fetal biophys profile w/nst ........................... 1.05 2.00 NA 0.15 3.20 NA XXX 

76818 ......... 26 ....... A Fetal biophys profile w/nst ........................... 1.05 0.38 0.38 0.05 1.48 1.48 XXX 

76818 ......... TC ...... A Fetal biophys profile w/nst ........................... 0.00 1.62 NA 0.10 1.72 NA XXX 

76819 ......... ............ A Fetal biophys profil w/o nst .......................... 0.77 1.90 NA 0.12 2.79 NA XXX 

76819 ......... 26 ....... A Fetal biophys profil w/o nst .......................... 0.77 0.28 0.28 0.02 1.07 1.07 XXX 

76819 ......... TC ...... A Fetal biophys profil w/o nst .......................... 0.00 1.62 NA 0.10 1.72 NA XXX 

76825 ......... ............ A Echo exam of fetal heart ............................. 1.67 2.58 NA 0.18 4.43 NA XXX 

76825 ......... 26 ....... A Echo exam of fetal heart ............................. 1.67 0.60 0.60 0.07 2.34 2.34 XXX 

76825 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.98 NA 0.11 2.09 NA XXX 

76826 ......... ............ A Echo exam of fetal heart ............................. 0.83 1.00 NA 0.09 1.92 NA XXX 

76826 ......... 26 ....... A Echo exam of fetal heart ............................. 0.83 0.29 0.29 0.04 1.16 1.16 XXX 

76826 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 0.71 NA 0.05 0.76 NA XXX 

76827 ......... ............ A Echo exam of fetal heart ............................. 0.58 1.95 NA 0.14 2.67 NA XXX 

76827 ......... 26 ....... A Echo exam of fetal heart ............................. 0.58 0.22 0.22 0.02 0.82 0.82 XXX 

76827 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.73 NA 0.12 1.85 NA XXX 

76828 ......... ............ A Echo exam of fetal heart ............................. 0.56 1.34 NA 0.10 2.00 NA XXX 

76828 ......... 26 ....... A Echo exam of fetal heart ............................. 0.56 0.22 0.22 0.02 0.80 0.80 XXX 

76828 ......... TC ...... A Echo exam of fetal heart ............................. 0.00 1.12 NA 0.08 1.20 NA XXX 

76830 ......... ............ A Transvaginal us, non-ob .............................. 0.69 1.75 NA 0.14 2.58 NA XXX 

76830 ......... 26 ....... A Transvaginal us, non-ob .............................. 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

76830 ......... TC ...... A Transvaginal us, non-ob .............................. 0.00 1.52 NA 0.10 1.62 NA XXX 

76831 ......... ............ A Echo exam, uterus ....................................... 0.72 1.78 NA 0.12 2.62 NA XXX 

76831 ......... 26 ....... A Echo exam, uterus ....................................... 0.72 0.26 0.26 0.02 1.00 1.00 XXX 

76831 ......... TC ...... A Echo exam, uterus ....................................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76856 ......... ............ A Us exam, pelvic, complete .......................... 0.69 1.75 NA 0.14 2.58 NA XXX 

76856 ......... 26 ....... A Us exam, pelvic, complete .......................... 0.69 0.23 0.23 0.04 0.96 0.96 XXX 

76856 ......... TC ...... A Us exam, pelvic, complete .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76857 ......... ............ A Us exam, pelvic, limited ............................... 0.38 1.70 NA 0.08 2.16 NA XXX 

1207

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

76857 ......... 26 ....... A Us exam, pelvic, limited ............................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76857 ......... TC ...... A Us exam, pelvic, limited ............................... 0.00 1.57 NA 0.06 1.63 NA XXX 

76870 ......... ............ A Us exam, scrotum ........................................ 0.64 1.73 NA 0.14 2.51 NA XXX 

76870 ......... 26 ....... A Us exam, scrotum ........................................ 0.64 0.21 0.21 0.04 0.89 0.89 XXX 

76870 ......... TC ...... A Us exam, scrotum ........................................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76872 ......... ............ A Us, transrectal .............................................. 0.69 2.09 NA 0.15 2.93 NA XXX 

76872 ......... 26 ....... A Us, transrectal .............................................. 0.69 0.23 0.23 0.05 0.97 0.97 XXX 

76872 ......... TC ...... A Us, transrectal .............................................. 0.00 1.86 NA 0.10 1.96 NA XXX 

76873 ......... ............ A Echograp trans r, pros study ....................... 1.55 2.59 NA 0.26 4.40 NA XXX 

76873 ......... 26 ....... A Echograp trans r, pros study ....................... 1.55 0.49 0.49 0.10 2.14 2.14 XXX 

76873 ......... TC ...... A Echograp trans r, pros study ....................... 0.00 2.10 NA 0.16 2.26 NA XXX 

76880 ......... ............ A Us exam, extremity ...................................... 0.59 1.63 NA 0.12 2.34 NA XXX 

76880 ......... 26 ....... A Us exam, extremity ...................................... 0.59 0.20 0.20 0.04 0.83 0.83 XXX 

76880 ......... TC ...... A Us exam, extremity ...................................... 0.00 1.43 NA 0.08 1.51 NA XXX 

76885 ......... ............ A Us exam infant hips, dynamic ..................... 0.74 1.77 NA 0.14 2.65 NA XXX 

76885 ......... 26 ....... A Us exam infant hips, dynamic ..................... 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

76885 ......... TC ...... A Us exam infant hips, dynamic ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76886 ......... ............ A Us exam infant hips, static .......................... 0.62 1.64 NA 0.12 2.38 NA XXX 

76886 ......... 26 ....... A Us exam infant hips, static .......................... 0.62 0.21 0.21 0.04 0.87 0.87 XXX 

76886 ......... TC ...... A Us exam infant hips, static .......................... 0.00 1.43 NA 0.08 1.51 NA XXX 

76930 ......... ............ A Echo guide, cardiocentesis .......................... 0.67 1.78 NA 0.12 2.57 NA XXX 

76930 ......... 26 ....... A Echo guide, cardiocentesis .......................... 0.67 0.26 0.26 0.02 0.95 0.95 XXX 

76930 ......... TC ...... A Echo guide, cardiocentesis .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76932 ......... ............ A Echo guide for heart biopsy ........................ 0.67 1.78 NA 0.12 2.57 NA XXX 

76932 ......... 26 ....... A Echo guide for heart biopsy ........................ 0.67 0.26 0.26 0.02 0.95 0.95 XXX 

76932 ......... TC ...... A Echo guide for heart biopsy ........................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76936 ......... ............ A Echo guide for artery repair ......................... 1.99 6.98 NA 0.47 9.44 NA XXX 

76936 ......... 26 ....... A Echo guide for artery repair ......................... 1.99 0.66 0.66 0.13 2.78 2.78 XXX 

76936 ......... TC ...... A Echo guide for artery repair ......................... 0.00 6.32 NA 0.34 6.66 NA XXX 

76937 ......... ............ A Us guide, vascular access ........................... 0.30 0.47 NA 0.15 0.92 NA ZZZ 

76937 ......... 26 ....... A Us guide, vascular access ........................... 0.30 0.10 0.10 0.05 0.45 0.45 ZZZ 

76937 ......... TC ...... A Us guide, vascular access ........................... 0.00 0.37 NA 0.10 0.47 NA ZZZ 

76940 ......... ............ A Us guide, tissue ablation ............................. 2.00 2.17 NA 0.42 4.59 NA XXX 

76940 ......... 26 ....... A Us guide, tissue ablation ............................. 2.00 0.65 0.65 0.13 2.78 2.78 XXX 

76940 ......... TC ...... A Us guide, tissue ablation ............................. 0.00 1.52 NA 0.29 1.81 NA XXX 

76941 ......... ............ A Echo guide for transfusion ........................... 1.34 2.00 NA 0.15 3.49 NA XXX 

76941 ......... 26 ....... A Echo guide for transfusion ........................... 1.34 0.47 0.47 0.07 1.88 1.88 XXX 

76941 ......... TC ...... A Echo guide for transfusion ........................... 0.00 1.53 NA 0.08 1.61 NA XXX 

76942 ......... ............ A Echo guide for biopsy .................................. 0.67 2.76 NA 0.15 3.58 NA XXX 

76942 ......... 26 ....... A Echo guide for biopsy .................................. 0.67 0.22 0.22 0.05 0.94 0.94 XXX 

76942 ......... TC ...... A Echo guide for biopsy .................................. 0.00 2.54 NA 0.10 2.64 NA XXX 

76945 ......... ............ A Echo guide, villus sampling ......................... 0.67 1.76 NA 0.12 2.55 NA XXX 

76945 ......... 26 ....... A Echo guide, villus sampling ......................... 0.67 0.23 0.23 0.04 0.94 0.94 XXX 

76945 ......... TC ...... A Echo guide, villus sampling ......................... 0.00 1.53 NA 0.08 1.61 NA XXX 

76946 ......... ............ A Echo guide for amniocentesis ..................... 0.38 1.66 NA 0.11 2.15 NA XXX 

76946 ......... 26 ....... A Echo guide for amniocentesis ..................... 0.38 0.14 0.14 0.01 0.53 0.53 XXX 

76946 ......... TC ...... A Echo guide for amniocentesis ..................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76948 ......... ............ A Echo guide, ova aspiration .......................... 0.38 1.65 NA 0.12 2.15 NA XXX 

76948 ......... 26 ....... A Echo guide, ova aspiration .......................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

76948 ......... TC ...... A Echo guide, ova aspiration .......................... 0.00 1.52 NA 0.10 1.62 NA XXX 

76950 ......... ............ A Echo guidance radiotherapy ........................ 0.58 1.50 NA 0.11 2.19 NA XXX 

76950 ......... 26 ....... A Echo guidance radiotherapy ........................ 0.58 0.19 0.19 0.04 0.81 0.81 XXX 

76950 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 1.31 NA 0.07 1.38 NA XXX 

76965 ......... ............ A Echo guidance radiotherapy ........................ 1.34 6.01 NA 0.37 7.72 NA XXX 

76965 ......... 26 ....... A Echo guidance radiotherapy ........................ 1.34 0.42 0.42 0.08 1.84 1.84 XXX 

76965 ......... TC ...... A Echo guidance radiotherapy ........................ 0.00 5.59 NA 0.29 5.88 NA XXX 

76970 ......... ............ A Ultrasound exam follow-up .......................... 0.40 1.19 NA 0.08 1.67 NA XXX 

76970 ......... 26 ....... A Ultrasound exam follow-up .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 

76970 ......... TC ...... A Ultrasound exam follow-up .......................... 0.00 1.06 NA 0.06 1.12 NA XXX 

76975 ......... ............ A GI endoscopic ultrasound ............................ 0.81 1.80 NA 0.14 2.75 NA XXX 

76975 ......... 26 ....... A GI endoscopic ultrasound ............................ 0.81 0.28 0.28 0.04 1.13 1.13 XXX 

76975 ......... TC ...... A GI endoscopic ultrasound ............................ 0.00 1.52 NA 0.10 1.62 NA XXX 

76977 ......... ............ A Us bone density measure ............................ 0.05 0.85 NA 0.06 0.96 NA XXX 

76977 ......... 26 ....... A Us bone density measure ............................ 0.05 0.02 0.02 0.01 0.08 0.08 XXX 

76977 ......... TC ...... A Us bone density measure ............................ 0.00 0.83 NA 0.05 0.88 NA XXX 

76986 ......... ............ A Ultrasound guide intraoper .......................... 1.20 3.02 NA 0.22 4.44 NA XXX 

76986 ......... 26 ....... A Ultrasound guide intraoper .......................... 1.20 0.40 0.40 0.08 1.68 1.68 XXX 

76986 ......... TC ...... A Ultrasound guide intraoper .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

76999 ......... ............ C Echo examination procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76999 ......... 26 ....... C Echo examination procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

76999 ......... TC ...... C Echo examination procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77261 ......... ............ A Radiation therapy planning .......................... 1.39 0.51 0.51 0.07 1.97 1.97 XXX 

77262 ......... ............ A Radiation therapy planning .......................... 2.11 0.75 0.75 0.11 2.97 2.97 XXX 

77263 ......... ............ A Radiation therapy planning .......................... 3.14 1.12 1.12 0.16 4.42 4.42 XXX 

77280 ......... ............ A Set radiation therapy field ............................ 0.70 3.70 NA 0.22 4.62 NA XXX 

1208

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

77280 ......... 26 ....... A Set radiation therapy field ............................ 0.70 0.22 0.22 0.04 0.96 0.96 XXX 

77280 ......... TC ...... A Set radiation therapy field ............................ 0.00 3.48 NA 0.18 3.66 NA XXX 

77285 ......... ............ A Set radiation therapy field ............................ 1.05 5.93 NA 0.35 7.33 NA XXX 

77285 ......... 26 ....... A Set radiation therapy field ............................ 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77285 ......... TC ...... A Set radiation therapy field ............................ 0.00 5.59 NA 0.30 5.89 NA XXX 

77290 ......... ............ A Set radiation therapy field ............................ 1.56 7.02 NA 0.42 9.00 NA XXX 

77290 ......... 26 ....... A Set radiation therapy field ............................ 1.56 0.49 0.49 0.07 2.12 2.12 XXX 

77290 ......... TC ...... A Set radiation therapy field ............................ 0.00 6.53 NA 0.35 6.88 NA XXX 

77295 ......... ............ A Set radiation therapy field ............................ 4.56 29.48 NA 1.70 35.74 NA XXX 

77295 ......... 26 ....... A Set radiation therapy field ............................ 4.56 1.45 1.45 0.22 6.23 6.23 XXX 

77295 ......... TC ...... A Set radiation therapy field ............................ 0.00 28.03 NA 1.48 29.51 NA XXX 

77299 ......... ............ C Radiation therapy planning .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 ......... 26 ....... C Radiation therapy planning .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77299 ......... TC ...... C Radiation therapy planning .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77300 ......... ............ A Radiation therapy dose plan ........................ 0.62 1.55 NA 0.11 2.28 NA XXX 

77300 ......... 26 ....... A Radiation therapy dose plan ........................ 0.62 0.20 0.20 0.04 0.86 0.86 XXX 

77300 ......... TC ...... A Radiation therapy dose plan ........................ 0.00 1.35 NA 0.07 1.42 NA XXX 

77301 ......... ............ A Radiotherapy dose plan, imrt ...................... 7.99 30.57 NA 1.70 40.26 NA XXX 

77301 ......... 26 ....... A Radiotherapy dose plan, imrt ...................... 7.99 2.54 2.54 0.22 10.75 10.75 XXX 

77301 ......... TC ...... A Radiotherapy dose plan, imrt ...................... 0.00 28.03 NA 1.48 29.51 NA XXX 

77305 ......... ............ A Teletx isodose plan simple .......................... 0.70 2.10 NA 0.15 2.95 NA XXX 

77305 ......... 26 ....... A Teletx isodose plan simple .......................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

77305 ......... TC ...... A Teletx isodose plan simple .......................... 0.00 1.87 NA 0.11 1.98 NA XXX 

77310 ......... ............ A Teletx isodose plan intermed ...................... 1.05 2.68 NA 0.18 3.91 NA XXX 

77310 ......... 26 ....... A Teletx isodose plan intermed ...................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77310 ......... TC ...... A Teletx isodose plan intermed ...................... 0.00 2.34 NA 0.13 2.47 NA XXX 

77315 ......... ............ A Teletx isodose plan complex ....................... 1.56 3.15 NA 0.21 4.92 NA XXX 

77315 ......... 26 ....... A Teletx isodose plan complex ....................... 1.56 0.49 0.49 0.07 2.12 2.12 XXX 

77315 ......... TC ...... A Teletx isodose plan complex ....................... 0.00 2.66 NA 0.14 2.80 NA XXX 

77321 ......... ............ A Special teletx port plan ................................ 0.95 4.37 NA 0.26 5.58 NA XXX 

77321 ......... 26 ....... A Special teletx port plan ................................ 0.95 0.31 0.31 0.05 1.31 1.31 XXX 

77321 ......... TC ...... A Special teletx port plan ................................ 0.00 4.06 NA 0.21 4.27 NA XXX 

77326 ......... ............ A Brachytx isodose calc simp ......................... 0.93 2.67 NA 0.18 3.78 NA XXX 

77326 ......... 26 ....... A Brachytx isodose calc simp ......................... 0.93 0.30 0.30 0.05 1.28 1.28 XXX 

77326 ......... TC ...... A Brachytx isodose calc simp ......................... 0.00 2.37 NA 0.13 2.50 NA XXX 

77327 ......... ............ A Brachytx isodose calc interm ....................... 1.39 3.92 NA 0.25 5.56 NA XXX 

77327 ......... 26 ....... A Brachytx isodose calc interm ....................... 1.39 0.44 0.44 0.07 1.90 1.90 XXX 

77327 ......... TC ...... A Brachytx isodose calc interm ....................... 0.00 3.48 NA 0.18 3.66 NA XXX 

77328 ......... ............ A Brachytx isodose plan compl ....................... 2.09 5.63 NA 0.36 8.08 NA XXX 

77328 ......... 26 ....... A Brachytx isodose plan compl ....................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 

77328 ......... TC ...... A Brachytx isodose plan compl ....................... 0.00 4.97 NA 0.25 5.22 NA XXX 

77331 ......... ............ A Special radiation dosimetry ......................... 0.87 0.78 NA 0.07 1.72 NA XXX 

77331 ......... 26 ....... A Special radiation dosimetry ......................... 0.87 0.28 0.28 0.05 1.20 1.20 XXX 

77331 ......... TC ...... A Special radiation dosimetry ......................... 0.00 0.50 NA 0.02 0.52 NA XXX 

77332 ......... ............ A Radiation treatment aid(s) ........................... 0.54 1.52 NA 0.09 2.15 NA XXX 

77332 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.54 0.17 0.17 0.02 0.73 0.73 XXX 

77332 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.35 NA 0.07 1.42 NA XXX 

77333 ......... ............ A Radiation treatment aid(s) ........................... 0.84 2.17 NA 0.16 3.17 NA XXX 

77333 ......... 26 ....... A Radiation treatment aid(s) ........................... 0.84 0.27 0.27 0.05 1.16 1.16 XXX 

77333 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 1.90 NA 0.11 2.01 NA XXX 

77334 ......... ............ A Radiation treatment aid(s) ........................... 1.24 3.65 NA 0.23 5.12 NA XXX 

77334 ......... 26 ....... A Radiation treatment aid(s) ........................... 1.24 0.39 0.39 0.06 1.69 1.69 XXX 

77334 ......... TC ...... A Radiation treatment aid(s) ........................... 0.00 3.26 NA 0.17 3.43 NA XXX 

77336 ......... ............ A Radiation physics consult ............................ 0.00 2.99 NA 0.16 3.15 NA XXX 

77370 ......... ............ A Radiation physics consult ............................ 0.00 3.50 NA 0.18 3.68 NA XXX 

77399 ......... ............ C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 ......... 26 ....... C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77399 ......... TC ...... C External radiation dosimetry ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77401 ......... ............ A Radiation treatment delivery ........................ 0.00 1.78 NA 0.11 1.89 NA XXX 

77402 ......... ............ A Radiation treatment delivery ........................ 0.00 1.78 NA 0.11 1.89 NA XXX 

77403 ......... ............ A Radiation treatment delivery ........................ 0.00 1.78 NA 0.11 1.89 NA XXX 

77404 ......... ............ A Radiation treatment delivery ........................ 0.00 1.78 NA 0.11 1.89 NA XXX 

77406 ......... ............ A Radiation treatment delivery ........................ 0.00 1.78 NA 0.11 1.89 NA XXX 

77407 ......... ............ A Radiation treatment delivery ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 

77408 ......... ............ A Radiation treatment delivery ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 

77409 ......... ............ A Radiation treatment delivery ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 

77411 ......... ............ A Radiation treatment delivery ........................ 0.00 2.09 NA 0.12 2.21 NA XXX 

77412 ......... ............ A Radiation treatment delivery ........................ 0.00 2.34 NA 0.13 2.47 NA XXX 

77413 ......... ............ A Radiation treatment delivery ........................ 0.00 2.34 NA 0.13 2.47 NA XXX 

77414 ......... ............ A Radiation treatment delivery ........................ 0.00 2.34 NA 0.13 2.47 NA XXX 

77416 ......... ............ A Radiation treatment delivery ........................ 0.00 2.34 NA 0.13 2.47 NA XXX 

77417 ......... ............ A Radiology port film(s) ................................... 0.00 0.59 NA 0.04 0.63 NA XXX 

77418 ......... ............ A Radiation tx delivery, imrt ............................ 0.00 18.05 NA 0.13 18.18 NA XXX 

77427 ......... ............ A Radiation tx management, x5 ...................... 3.31 1.05 1.05 0.17 4.53 4.53 XXX 

77431 ......... ............ A Radiation therapy management .................. 1.81 0.68 0.68 0.08 2.57 2.57 XXX 

1209

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

77432 ......... ............ A Stereotactic radiation trmt ............................ 7.92 2.91 2.91 0.40 11.23 11.23 XXX 

77470 ......... ............ A Special radiation treatment .......................... 2.09 11.85 NA 0.70 14.64 NA XXX 

77470 ......... 26 ....... A Special radiation treatment .......................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 

77470 ......... TC ...... A Special radiation treatment .......................... 0.00 11.19 NA 0.59 11.78 NA XXX 

77499 ......... ............ C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 ......... 26 ....... C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77499 ......... TC ...... C Radiation therapy management .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77520 ......... ............ C Proton trmt, simple w/o comp ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77522 ......... ............ C Proton trmt, simple w/comp ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77523 ......... ............ C Proton trmt, intermediate ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77525 ......... ............ C Proton treatment, complex .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77600 ......... ............ R Hyperthermia treatment ............................... 1.56 3.55 NA 0.26 5.37 NA XXX 

77600 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.49 0.49 0.10 2.15 2.15 XXX 

77600 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.06 NA 0.16 3.22 NA XXX 

77605 ......... ............ R Hyperthermia treatment ............................... 2.09 4.74 NA 0.38 7.21 NA XXX 

77605 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.16 2.91 2.91 XXX 

77605 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.08 NA 0.22 4.30 NA XXX 

77610 ......... ............ R Hyperthermia treatment ............................... 1.56 3.56 NA 0.24 5.36 NA XXX 

77610 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.50 0.50 0.08 2.14 2.14 XXX 

77610 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.06 NA 0.16 3.22 NA XXX 

77615 ......... ............ R Hyperthermia treatment ............................... 2.09 4.74 NA 0.33 7.16 NA XXX 

77615 ......... 26 ....... R Hyperthermia treatment ............................... 2.09 0.66 0.66 0.11 2.86 2.86 XXX 

77615 ......... TC ...... R Hyperthermia treatment ............................... 0.00 4.08 NA 0.22 4.30 NA XXX 

77620 ......... ............ R Hyperthermia treatment ............................... 1.56 3.57 NA 0.23 5.36 NA XXX 

77620 ......... 26 ....... R Hyperthermia treatment ............................... 1.56 0.51 0.51 0.07 2.14 2.14 XXX 

77620 ......... TC ...... R Hyperthermia treatment ............................... 0.00 3.06 NA 0.16 3.22 NA XXX 

77750 ......... ............ A Infuse radioactive materials ......................... 4.90 2.91 NA 0.28 8.09 NA 090 

77750 ......... 26 ....... A Infuse radioactive materials ......................... 4.90 1.57 1.57 0.21 6.68 6.68 090 

77750 ......... TC ...... A Infuse radioactive materials ......................... 0.00 1.34 NA 0.07 1.41 NA 090 

77761 ......... ............ A Apply intrcav radiat simple .......................... 3.80 3.62 NA 0.33 7.75 NA 090 

77761 ......... 26 ....... A Apply intrcav radiat simple .......................... 3.80 1.10 1.10 0.19 5.09 5.09 090 

77761 ......... TC ...... A Apply intrcav radiat simple .......................... 0.00 2.52 NA 0.14 2.66 NA 090 

77762 ......... ............ A Apply intrcav radiat interm ........................... 5.71 5.45 NA 0.46 11.62 NA 090 

77762 ......... 26 ....... A Apply intrcav radiat interm ........................... 5.71 1.83 1.83 0.27 7.81 7.81 090 

77762 ......... TC ...... A Apply intrcav radiat interm ........................... 0.00 3.62 NA 0.19 3.81 NA 090 

77763 ......... ............ A Apply intrcav radiat compl ........................... 8.56 7.22 NA 0.64 16.42 NA 090 

77763 ......... 26 ....... A Apply intrcav radiat compl ........................... 8.56 2.72 2.72 0.41 11.69 11.69 090 

77763 ......... TC ...... A Apply intrcav radiat compl ........................... 0.00 4.50 NA 0.23 4.73 NA 090 

77776 ......... ............ A Apply interstit radiat simpl ........................... 4.65 3.14 NA 0.42 8.21 NA 090 

77776 ......... 26 ....... A Apply interstit radiat simpl ........................... 4.65 0.96 0.96 0.29 5.90 5.90 090 

77776 ......... TC ...... A Apply interstit radiat simpl ........................... 0.00 2.18 NA 0.13 2.31 NA 090 

77777 ......... ............ A Apply interstit radiat inter ............................. 7.47 6.61 NA 0.61 14.69 NA 090 

77777 ......... 26 ....... A Apply interstit radiat inter ............................. 7.47 2.36 2.36 0.39 10.22 10.22 090 

77777 ......... TC ...... A Apply interstit radiat inter ............................. 0.00 4.25 NA 0.22 4.47 NA 090 

77778 ......... ............ A Apply interstit radiat compl .......................... 11.17 8.69 NA 0.84 20.70 NA 090 

77778 ......... 26 ....... A Apply interstit radiat compl .......................... 11.17 3.54 3.54 0.57 15.28 15.28 090 

77778 ......... TC ...... A Apply interstit radiat compl .......................... 0.00 5.15 NA 0.27 5.42 NA 090 

77781 ......... ............ A High intensity brachytherapy ....................... 1.66 20.91 NA 1.14 23.71 NA 090 

77781 ......... 26 ....... A High intensity brachytherapy ....................... 1.66 0.53 0.53 0.08 2.27 2.27 090 

77781 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.38 NA 1.06 21.44 NA 090 

77782 ......... ............ A High intensity brachytherapy ....................... 2.49 21.18 NA 1.18 24.85 NA 090 

77782 ......... 26 ....... A High intensity brachytherapy ....................... 2.49 0.80 0.80 0.12 3.41 3.41 090 

77782 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.38 NA 1.06 21.44 NA 090 

77783 ......... ............ A High intensity brachytherapy ....................... 3.72 21.56 NA 1.24 26.52 NA 090 

77783 ......... 26 ....... A High intensity brachytherapy ....................... 3.72 1.18 1.18 0.18 5.08 5.08 090 

77783 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.38 NA 1.06 21.44 NA 090 

77784 ......... ............ A High intensity brachytherapy ....................... 5.60 22.16 NA 1.33 29.09 NA 090 

77784 ......... 26 ....... A High intensity brachytherapy ....................... 5.60 1.78 1.78 0.27 7.65 7.65 090 

77784 ......... TC ...... A High intensity brachytherapy ....................... 0.00 20.38 NA 1.06 21.44 NA 090 

77789 ......... ............ A Apply surface radiation ................................ 1.12 0.82 NA 0.06 2.00 NA 000 

77789 ......... 26 ....... A Apply surface radiation ................................ 1.12 0.37 0.37 0.04 1.53 1.53 000 

77789 ......... TC ...... A Apply surface radiation ................................ 0.00 0.45 NA 0.02 0.47 NA 000 

77790 ......... ............ A Radiation handling ....................................... 1.05 0.84 NA 0.07 1.96 NA XXX 

77790 ......... 26 ....... A Radiation handling ....................................... 1.05 0.34 0.34 0.05 1.44 1.44 XXX 

77790 ......... TC ...... A Radiation handling ....................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

77799 ......... ............ C Radium/radioisotope therapy ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77799 ......... 26 ....... C Radium/radioisotope therapy ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

77799 ......... TC ...... C Radium/radioisotope therapy ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78000 ......... ............ A Thyroid, single uptake ................................. 0.19 1.04 NA 0.07 1.30 NA XXX 

78000 ......... 26 ....... A Thyroid, single uptake ................................. 0.19 0.07 0.07 0.01 0.27 0.27 XXX 

78000 ......... TC ...... A Thyroid, single uptake ................................. 0.00 0.97 NA 0.06 1.03 NA XXX 

78001 ......... ............ A Thyroid, multiple uptakes ............................. 0.26 1.40 NA 0.08 1.74 NA XXX 

78001 ......... 26 ....... A Thyroid, multiple uptakes ............................. 0.26 0.09 0.09 0.01 0.36 0.36 XXX 

78001 ......... TC ...... A Thyroid, multiple uptakes ............................. 0.00 1.31 NA 0.07 1.38 NA XXX 

78003 ......... ............ A Thyroid suppress/stimul ............................... 0.33 1.08 NA 0.07 1.48 NA XXX 

1210

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78003 ......... 26 ....... A Thyroid suppress/stimul ............................... 0.33 0.11 0.11 0.01 0.45 0.45 XXX 

78003 ......... TC ...... A Thyroid suppress/stimul ............................... 0.00 0.97 NA 0.06 1.03 NA XXX 

78006 ......... ............ A Thyroid imaging with uptake ........................ 0.49 2.56 NA 0.15 3.20 NA XXX 

78006 ......... 26 ....... A Thyroid imaging with uptake ........................ 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78006 ......... TC ...... A Thyroid imaging with uptake ........................ 0.00 2.39 NA 0.13 2.52 NA XXX 

78007 ......... ............ A Thyroid image, mult uptakes ....................... 0.50 2.76 NA 0.16 3.42 NA XXX 

78007 ......... 26 ....... A Thyroid image, mult uptakes ....................... 0.50 0.17 0.17 0.02 0.69 0.69 XXX 

78007 ......... TC ...... A Thyroid image, mult uptakes ....................... 0.00 2.59 NA 0.14 2.73 NA XXX 

78010 ......... ............ A Thyroid imaging ........................................... 0.39 1.96 NA 0.13 2.48 NA XXX 

78010 ......... 26 ....... A Thyroid imaging ........................................... 0.39 0.13 0.13 0.02 0.54 0.54 XXX 

78010 ......... TC ...... A Thyroid imaging ........................................... 0.00 1.83 NA 0.11 1.94 NA XXX 

78011 ......... ............ A Thyroid imaging with flow ............................ 0.45 2.57 NA 0.15 3.17 NA XXX 

78011 ......... 26 ....... A Thyroid imaging with flow ............................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78011 ......... TC ...... A Thyroid imaging with flow ............................ 0.00 2.42 NA 0.13 2.55 NA XXX 

78015 ......... ............ A Thyroid met imaging .................................... 0.67 2.82 NA 0.18 3.67 NA XXX 

78015 ......... 26 ....... A Thyroid met imaging .................................... 0.67 0.23 0.23 0.04 0.94 0.94 XXX 

78015 ......... TC ...... A Thyroid met imaging .................................... 0.00 2.59 NA 0.14 2.73 NA XXX 

78016 ......... ............ A Thyroid met imaging/studies ........................ 0.82 3.78 NA 0.22 4.82 NA XXX 

78016 ......... 26 ....... A Thyroid met imaging/studies ........................ 0.82 0.29 0.29 0.04 1.15 1.15 XXX 

78016 ......... TC ...... A Thyroid met imaging/studies ........................ 0.00 3.49 NA 0.18 3.67 NA XXX 

78018 ......... ............ A Thyroid met imaging, body .......................... 0.86 5.75 NA 0.33 6.94 NA XXX 

78018 ......... 26 ....... A Thyroid met imaging, body .......................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78018 ......... TC ...... A Thyroid met imaging, body .......................... 0.00 5.45 NA 0.29 5.74 NA XXX 

78020 ......... ............ A Thyroid met uptake ...................................... 0.60 1.52 NA 0.16 2.28 NA ZZZ 

78020 ......... 26 ....... A Thyroid met uptake ...................................... 0.60 0.21 0.21 0.02 0.83 0.83 ZZZ 

78020 ......... TC ...... A Thyroid met uptake ...................................... 0.00 1.31 NA 0.14 1.45 NA ZZZ 

78070 ......... ............ A Parathyroid nuclear imaging ........................ 0.82 2.11 NA 0.15 3.08 NA XXX 

78070 ......... 26 ....... A Parathyroid nuclear imaging ........................ 0.82 0.28 0.28 0.04 1.14 1.14 XXX 

78070 ......... TC ...... A Parathyroid nuclear imaging ........................ 0.00 1.83 NA 0.11 1.94 NA XXX 

78075 ......... ............ A Adrenal nuclear imaging .............................. 0.74 5.72 NA 0.33 6.79 NA XXX 

78075 ......... 26 ....... A Adrenal nuclear imaging .............................. 0.74 0.27 0.27 0.04 1.05 1.05 XXX 

78075 ......... TC ...... A Adrenal nuclear imaging .............................. 0.00 5.45 NA 0.29 5.74 NA XXX 

78099 ......... ............ C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 ......... 26 ....... C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78099 ......... TC ...... C Endocrine nuclear procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78102 ......... ............ A Bone marrow imaging, ltd ............................ 0.55 2.24 NA 0.14 2.93 NA XXX 

78102 ......... 26 ....... A Bone marrow imaging, ltd ............................ 0.55 0.20 0.20 0.02 0.77 0.77 XXX 

78102 ......... TC ...... A Bone marrow imaging, ltd ............................ 0.00 2.04 NA 0.12 2.16 NA XXX 

78103 ......... ............ A Bone marrow imaging, mult ......................... 0.75 3.44 NA 0.21 4.40 NA XXX 

78103 ......... 26 ....... A Bone marrow imaging, mult ......................... 0.75 0.26 0.26 0.04 1.05 1.05 XXX 

78103 ......... TC ...... A Bone marrow imaging, mult ......................... 0.00 3.18 NA 0.17 3.35 NA XXX 

78104 ......... ............ A Bone marrow imaging, body ........................ 0.80 4.36 NA 0.26 5.42 NA XXX 

78104 ......... 26 ....... A Bone marrow imaging, body ........................ 0.80 0.27 0.27 0.04 1.11 1.11 XXX 

78104 ......... TC ...... A Bone marrow imaging, body ........................ 0.00 4.09 NA 0.22 4.31 NA XXX 

78110 ......... ............ A Plasma volume, single ................................. 0.19 1.02 NA 0.07 1.28 NA XXX 

78110 ......... 26 ....... A Plasma volume, single ................................. 0.19 0.07 0.07 0.01 0.27 0.27 XXX 

78110 ......... TC ...... A Plasma volume, single ................................. 0.00 0.95 NA 0.06 1.01 NA XXX 

78111 ......... ............ A Plasma volume, multiple .............................. 0.22 2.67 NA 0.15 3.04 NA XXX 

78111 ......... 26 ....... A Plasma volume, multiple .............................. 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

78111 ......... TC ...... A Plasma volume, multiple .............................. 0.00 2.59 NA 0.14 2.73 NA XXX 

78120 ......... ............ A Red cell mass, single .................................. 0.23 1.82 NA 0.12 2.17 NA XXX 

78120 ......... 26 ....... A Red cell mass, single .................................. 0.23 0.08 0.08 0.01 0.32 0.32 XXX 

78120 ......... TC ...... A Red cell mass, single .................................. 0.00 1.74 NA 0.11 1.85 NA XXX 

78121 ......... ............ A Red cell mass, multiple ............................... 0.32 3.03 NA 0.15 3.50 NA XXX 

78121 ......... 26 ....... A Red cell mass, multiple ............................... 0.32 0.11 0.11 0.01 0.44 0.44 XXX 

78121 ......... TC ...... A Red cell mass, multiple ............................... 0.00 2.92 NA 0.14 3.06 NA XXX 

78122 ......... ............ A Blood volume ............................................... 0.45 4.78 NA 0.26 5.49 NA XXX 

78122 ......... 26 ....... A Blood volume ............................................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78122 ......... TC ...... A Blood volume ............................................... 0.00 4.62 NA 0.24 4.86 NA XXX 

78130 ......... ............ A Red cell survival study ................................. 0.61 3.07 NA 0.18 3.86 NA XXX 

78130 ......... 26 ....... A Red cell survival study ................................. 0.61 0.21 0.21 0.04 0.86 0.86 XXX 

78130 ......... TC ...... A Red cell survival study ................................. 0.00 2.86 NA 0.14 3.00 NA XXX 

78135 ......... ............ A Red cell survival kinetics ............................. 0.64 5.11 NA 0.29 6.04 NA XXX 

78135 ......... 26 ....... A Red cell survival kinetics ............................. 0.64 0.22 0.22 0.04 0.90 0.90 XXX 

78135 ......... TC ...... A Red cell survival kinetics ............................. 0.00 4.89 NA 0.25 5.14 NA XXX 

78140 ......... ............ A Red cell sequestration ................................. 0.61 4.15 NA 0.25 5.01 NA XXX 

78140 ......... 26 ....... A Red cell sequestration ................................. 0.61 0.20 0.20 0.04 0.85 0.85 XXX 

78140 ......... TC ...... A Red cell sequestration ................................. 0.00 3.95 NA 0.21 4.16 NA XXX 

78160 ......... ............ A Plasma iron turnover ................................... 0.33 3.80 NA 0.23 4.36 NA XXX 

78160 ......... 26 ....... A Plasma iron turnover ................................... 0.33 0.12 0.12 0.04 0.49 0.49 XXX 

78160 ......... TC ...... A Plasma iron turnover ................................... 0.00 3.68 NA 0.19 3.87 NA XXX 

78162 ......... ............ A Radioiron absorption exam .......................... 0.45 3.40 NA 0.18 4.03 NA XXX 

78162 ......... 26 ....... A Radioiron absorption exam .......................... 0.45 0.19 0.19 0.01 0.65 0.65 XXX 

78162 ......... TC ...... A Radioiron absorption exam .......................... 0.00 3.21 NA 0.17 3.38 NA XXX 

78170 ......... ............ A Red cell iron utilization ................................ 0.41 5.47 NA 0.33 6.21 NA XXX 

1211

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78170 ......... 26 ....... A Red cell iron utilization ................................ 0.41 0.14 0.14 0.05 0.60 0.60 XXX 

78170 ......... TC ...... A Red cell iron utilization ................................ 0.00 5.33 NA 0.28 5.61 NA XXX 

78172 ......... ............ C Total body iron estimation ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78172 ......... 26 ....... A Total body iron estimation ........................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78172 ......... TC ...... C Total body iron estimation ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78185 ......... ............ A Spleen imaging ............................................ 0.40 2.51 NA 0.15 3.06 NA XXX 

78185 ......... 26 ....... A Spleen imaging ............................................ 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

78185 ......... TC ...... A Spleen imaging ............................................ 0.00 2.37 NA 0.13 2.50 NA XXX 

78190 ......... ............ A Platelet survival, kinetics ............................. 1.09 6.12 NA 0.37 7.58 NA XXX 

78190 ......... 26 ....... A Platelet survival, kinetics ............................. 1.09 0.39 0.39 0.07 1.55 1.55 XXX 

78190 ......... TC ...... A Platelet survival, kinetics ............................. 0.00 5.73 NA 0.30 6.03 NA XXX 

78191 ......... ............ A Platelet survival ............................................ 0.61 7.56 NA 0.41 8.58 NA XXX 

78191 ......... 26 ....... A Platelet survival ............................................ 0.61 0.20 0.20 0.04 0.85 0.85 XXX 

78191 ......... TC ...... A Platelet survival ............................................ 0.00 7.36 NA 0.37 7.73 NA XXX 

78195 ......... ............ A Lymph system imaging ................................ 1.20 4.50 NA 0.28 5.98 NA XXX 

78195 ......... 26 ....... A Lymph system imaging ................................ 1.20 0.41 0.41 0.06 1.67 1.67 XXX 

78195 ......... TC ...... A Lymph system imaging ................................ 0.00 4.09 NA 0.22 4.31 NA XXX 

78199 ......... ............ C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 ......... 26 ....... C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78199 ......... TC ...... C Blood/lymph nuclear exam .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78201 ......... ............ A Liver imaging ............................................... 0.44 2.52 NA 0.15 3.11 NA XXX 

78201 ......... 26 ....... A Liver imaging ............................................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

78201 ......... TC ...... A Liver imaging ............................................... 0.00 2.37 NA 0.13 2.50 NA XXX 

78202 ......... ............ A Liver imaging with flow ................................ 0.51 3.07 NA 0.16 3.74 NA XXX 

78202 ......... 26 ....... A Liver imaging with flow ................................ 0.51 0.18 0.18 0.02 0.71 0.71 XXX 

78202 ......... TC ...... A Liver imaging with flow ................................ 0.00 2.89 NA 0.14 3.03 NA XXX 

78205 ......... ............ A Liver imaging (3D) ....................................... 0.71 6.18 NA 0.35 7.24 NA XXX 

78205 ......... 26 ....... A Liver imaging (3D) ....................................... 0.71 0.25 0.25 0.04 1.00 1.00 XXX 

78205 ......... TC ...... A Liver imaging (3D) ....................................... 0.00 5.93 NA 0.31 6.24 NA XXX 

78206 ......... ............ A Liver image (3d) with flow ........................... 0.96 6.27 NA 0.16 7.39 NA XXX 

78206 ......... 26 ....... A Liver image (3d) with flow ........................... 0.96 0.34 0.34 0.05 1.35 1.35 XXX 

78206 ......... TC ...... A Liver image (3d) with flow ........................... 0.00 5.93 NA 0.11 6.04 NA XXX 

78215 ......... ............ A Liver and spleen imaging ............................ 0.49 3.12 NA 0.16 3.77 NA XXX 

78215 ......... 26 ....... A Liver and spleen imaging ............................ 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78215 ......... TC ...... A Liver and spleen imaging ............................ 0.00 2.95 NA 0.14 3.09 NA XXX 

78216 ......... ............ A Liver & spleen image/flow ........................... 0.57 3.69 NA 0.20 4.46 NA XXX 

78216 ......... 26 ....... A Liver & spleen image/flow ........................... 0.57 0.20 0.20 0.02 0.79 0.79 XXX 

78216 ......... TC ...... A Liver & spleen image/flow ........................... 0.00 3.49 NA 0.18 3.67 NA XXX 

78220 ......... ............ A Liver function study ...................................... 0.49 3.91 NA 0.21 4.61 NA XXX 

78220 ......... 26 ....... A Liver function study ...................................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78220 ......... TC ...... A Liver function study ...................................... 0.00 3.74 NA 0.19 3.93 NA XXX 

78223 ......... ............ A Hepatobiliary imaging .................................. 0.84 3.96 NA 0.24 5.04 NA XXX 

78223 ......... 26 ....... A Hepatobiliary imaging .................................. 0.84 0.28 0.28 0.05 1.17 1.17 XXX 

78223 ......... TC ...... A Hepatobiliary imaging .................................. 0.00 3.68 NA 0.19 3.87 NA XXX 

78230 ......... ............ A Salivary gland imaging ................................ 0.45 2.33 NA 0.15 2.93 NA XXX 

78230 ......... 26 ....... A Salivary gland imaging ................................ 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78230 ......... TC ...... A Salivary gland imaging ................................ 0.00 2.18 NA 0.13 2.31 NA XXX 

78231 ......... ............ A Serial salivary imaging ................................. 0.52 3.37 NA 0.19 4.08 NA XXX 

78231 ......... 26 ....... A Serial salivary imaging ................................. 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

78231 ......... TC ...... A Serial salivary imaging ................................. 0.00 3.18 NA 0.17 3.35 NA XXX 

78232 ......... ............ A Salivary gland function exam ...................... 0.47 3.72 NA 0.19 4.38 NA XXX 

78232 ......... 26 ....... A Salivary gland function exam ...................... 0.47 0.17 0.17 0.01 0.65 0.65 XXX 

78232 ......... TC ...... A Salivary gland function exam ...................... 0.00 3.55 NA 0.18 3.73 NA XXX 

78258 ......... ............ A Esophageal motility study ............................ 0.74 3.14 NA 0.18 4.06 NA XXX 

78258 ......... 26 ....... A Esophageal motility study ............................ 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

78258 ......... TC ...... A Esophageal motility study ............................ 0.00 2.89 NA 0.14 3.03 NA XXX 

78261 ......... ............ A Gastric mucosa imaging .............................. 0.69 4.36 NA 0.26 5.31 NA XXX 

78261 ......... 26 ....... A Gastric mucosa imaging .............................. 0.69 0.25 0.25 0.04 0.98 0.98 XXX 

78261 ......... TC ...... A Gastric mucosa imaging .............................. 0.00 4.11 NA 0.22 4.33 NA XXX 

78262 ......... ............ A Gastroesophageal reflux exam .................... 0.68 4.51 NA 0.26 5.45 NA XXX 

78262 ......... 26 ....... A Gastroesophageal reflux exam .................... 0.68 0.24 0.24 0.04 0.96 0.96 XXX 

78262 ......... TC ...... A Gastroesophageal reflux exam .................... 0.00 4.27 NA 0.22 4.49 NA XXX 

78264 ......... ............ A Gastric emptying study ................................ 0.78 4.41 NA 0.26 5.45 NA XXX 

78264 ......... 26 ....... A Gastric emptying study ................................ 0.78 0.27 0.27 0.04 1.09 1.09 XXX 

78264 ......... TC ...... A Gastric emptying study ................................ 0.00 4.14 NA 0.22 4.36 NA XXX 

78267 ......... ............ X Breath tst attain/anal c-14 ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78268 ......... ............ X Breath test analysis, c-14 ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78270 ......... ............ A Vit B-12 absorption exam ............................ 0.20 1.62 NA 0.11 1.93 NA XXX 

78270 ......... 26 ....... A Vit B-12 absorption exam ............................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78270 ......... TC ...... A Vit B-12 absorption exam ............................ 0.00 1.55 NA 0.10 1.65 NA XXX 

78271 ......... ............ A Vit b-12 absrp exam, int fac ........................ 0.20 1.72 NA 0.11 2.03 NA XXX 

78271 ......... 26 ....... A Vit b-12 absrp exam, int fac ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

78271 ......... TC ...... A Vit b-12 absrp exam, int fac ........................ 0.00 1.65 NA 0.10 1.75 NA XXX 

78272 ......... ............ A Vit B-12 absorp, combined .......................... 0.27 2.43 NA 0.14 2.84 NA XXX 

78272 ......... 26 ....... A Vit B-12 absorp, combined .......................... 0.27 0.10 0.10 0.01 0.38 0.38 XXX 

1212

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78272 ......... TC ...... A Vit B-12 absorp, combined .......................... 0.00 2.33 NA 0.13 2.46 NA XXX 

78278 ......... ............ A Acute GI blood loss imaging ....................... 0.99 5.23 NA 0.30 6.52 NA XXX 

78278 ......... 26 ....... A Acute GI blood loss imaging ....................... 0.99 0.34 0.34 0.05 1.38 1.38 XXX 

78278 ......... TC ...... A Acute GI blood loss imaging ....................... 0.00 4.89 NA 0.25 5.14 NA XXX 

78282 ......... ............ C GI protein loss exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78282 ......... 26 ....... A GI protein loss exam ................................... 0.38 0.13 0.13 0.02 0.53 0.53 XXX 

78282 ......... TC ...... C GI protein loss exam ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78290 ......... ............ A Meckel’s divert exam ................................... 0.68 3.29 NA 0.20 4.17 NA XXX 

78290 ......... 26 ....... A Meckel’s divert exam ................................... 0.68 0.23 0.23 0.04 0.95 0.95 XXX 

78290 ......... TC ...... A Meckel’s divert exam ................................... 0.00 3.06 NA 0.16 3.22 NA XXX 

78291 ......... ............ A Leveen/shunt patency exam ........................ 0.88 3.38 NA 0.21 4.47 NA XXX 

78291 ......... 26 ....... A Leveen/shunt patency exam ........................ 0.88 0.30 0.30 0.05 1.23 1.23 XXX 

78291 ......... TC ...... A Leveen/shunt patency exam ........................ 0.00 3.08 NA 0.16 3.24 NA XXX 

78299 ......... ............ C GI nuclear procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 ......... 26 ....... C GI nuclear procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78299 ......... TC ...... C GI nuclear procedure ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78300 ......... ............ A Bone imaging, limited area .......................... 0.62 2.71 NA 0.18 3.51 NA XXX 

78300 ......... 26 ....... A Bone imaging, limited area .......................... 0.62 0.21 0.21 0.04 0.87 0.87 XXX 

78300 ......... TC ...... A Bone imaging, limited area .......................... 0.00 2.50 NA 0.14 2.64 NA XXX 

78305 ......... ............ A Bone imaging, multiple areas ...................... 0.83 3.96 NA 0.23 5.02 NA XXX 

78305 ......... 26 ....... A Bone imaging, multiple areas ...................... 0.83 0.28 0.28 0.04 1.15 1.15 XXX 

78305 ......... TC ...... A Bone imaging, multiple areas ...................... 0.00 3.68 NA 0.19 3.87 NA XXX 

78306 ......... ............ A Bone imaging, whole body .......................... 0.86 4.58 NA 0.27 5.71 NA XXX 

78306 ......... 26 ....... A Bone imaging, whole body .......................... 0.86 0.29 0.29 0.05 1.20 1.20 XXX 

78306 ......... TC ...... A Bone imaging, whole body .......................... 0.00 4.29 NA 0.22 4.51 NA XXX 

78315 ......... ............ A Bone imaging, 3 phase ................................ 1.02 5.15 NA 0.30 6.47 NA XXX 

78315 ......... 26 ....... A Bone imaging, 3 phase ................................ 1.02 0.35 0.35 0.05 1.42 1.42 XXX 

78315 ......... TC ...... A Bone imaging, 3 phase ................................ 0.00 4.80 NA 0.25 5.05 NA XXX 

78320 ......... ............ A Bone imaging (3D) ....................................... 1.04 6.30 NA 0.36 7.70 NA XXX 

78320 ......... 26 ....... A Bone imaging (3D) ....................................... 1.04 0.37 0.37 0.05 1.46 1.46 XXX 

78320 ......... TC ...... A Bone imaging (3D) ....................................... 0.00 5.93 NA 0.31 6.24 NA XXX 

78350 ......... ............ A Bone mineral, single photon ........................ 0.22 0.83 NA 0.06 1.11 NA XXX 

78350 ......... 26 ....... A Bone mineral, single photon ........................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

78350 ......... TC ...... A Bone mineral, single photon ........................ 0.00 0.76 NA 0.05 0.81 NA XXX 

78351 ......... ............ N Bone mineral, dual photon .......................... +0.30 1.72 0.12 0.01 2.03 0.43 XXX 

78399 ......... ............ C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 ......... 26 ....... C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78399 ......... TC ...... C Musculoskeletal nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78414 ......... ............ C Non-imaging heart function ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78414 ......... 26 ....... A Non-imaging heart function ......................... 0.45 0.16 0.16 0.02 0.63 0.63 XXX 

78414 ......... TC ...... C Non-imaging heart function ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78428 ......... ............ A Cardiac shunt imaging ................................. 0.78 2.56 NA 0.17 3.51 NA XXX 

78428 ......... 26 ....... A Cardiac shunt imaging ................................. 0.78 0.30 0.30 0.04 1.12 1.12 XXX 

78428 ......... TC ...... A Cardiac shunt imaging ................................. 0.00 2.26 NA 0.13 2.39 NA XXX 

78445 ......... ............ A Vascular flow imaging .................................. 0.49 2.04 NA 0.13 2.66 NA XXX 

78445 ......... 26 ....... A Vascular flow imaging .................................. 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78445 ......... TC ...... A Vascular flow imaging .................................. 0.00 1.87 NA 0.11 1.98 NA XXX 

78455 ......... ............ A Venous thrombosis study ............................ 0.73 4.25 NA 0.25 5.23 NA XXX 

78455 ......... 26 ....... A Venous thrombosis study ............................ 0.73 0.25 0.25 0.04 1.02 1.02 XXX 

78455 ......... TC ...... A Venous thrombosis study ............................ 0.00 4.00 NA 0.21 4.21 NA XXX 

78456 ......... ............ A Acute venous thrombus image .................... 1.00 4.35 NA 0.34 5.69 NA XXX 

78456 ......... 26 ....... A Acute venous thrombus image .................... 1.00 0.35 0.35 0.05 1.40 1.40 XXX 

78456 ......... TC ...... A Acute venous thrombus image .................... 0.00 4.00 NA 0.29 4.29 NA XXX 

78457 ......... ............ A Venous thrombosis imaging ........................ 0.77 2.92 NA 0.18 3.87 NA XXX 

78457 ......... 26 ....... A Venous thrombosis imaging ........................ 0.77 0.26 0.26 0.04 1.07 1.07 XXX 

78457 ......... TC ...... A Venous thrombosis imaging ........................ 0.00 2.66 NA 0.14 2.80 NA XXX 

78458 ......... ............ A Ven thrombosis images, bilat ...................... 0.90 4.37 NA 0.25 5.52 NA XXX 

78458 ......... 26 ....... A Ven thrombosis images, bilat ...................... 0.90 0.33 0.33 0.04 1.27 1.27 XXX 

78458 ......... TC ...... A Ven thrombosis images, bilat ...................... 0.00 4.04 NA 0.21 4.25 NA XXX 

78459 ......... ............ C Heart muscle imaging (PET) ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78459 ......... 26 ....... R Heart muscle imaging (PET) ....................... 1.50 0.57 0.57 0.05 2.12 2.12 XXX 

78459 ......... TC ...... C Heart muscle imaging (PET) ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78460 ......... ............ A Heart muscle blood, single .......................... 0.86 2.67 NA 0.17 3.70 NA XXX 

78460 ......... 26 ....... A Heart muscle blood, single .......................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78460 ......... TC ...... A Heart muscle blood, single .......................... 0.00 2.37 NA 0.13 2.50 NA XXX 

78461 ......... ............ A Heart muscle blood, multiple ....................... 1.23 5.17 NA 0.31 6.71 NA XXX 

78461 ......... 26 ....... A Heart muscle blood, multiple ....................... 1.23 0.43 0.43 0.06 1.72 1.72 XXX 

78461 ......... TC ...... A Heart muscle blood, multiple ....................... 0.00 4.74 NA 0.25 4.99 NA XXX 

78464 ......... ............ A Heart image (3d), single .............................. 1.09 7.48 NA 0.42 8.99 NA XXX 

78464 ......... 26 ....... A Heart image (3d), single .............................. 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78464 ......... TC ...... A Heart image (3d), single .............................. 0.00 7.10 NA 0.37 7.47 NA XXX 

78465 ......... ............ A Heart image (3d), multiple ........................... 1.46 12.35 NA 0.68 14.49 NA XXX 

78465 ......... 26 ....... A Heart image (3d), multiple ........................... 1.46 0.52 0.52 0.06 2.04 2.04 XXX 

78465 ......... TC ...... A Heart image (3d), multiple ........................... 0.00 11.83 NA 0.62 12.45 NA XXX 

78466 ......... ............ A Heart infarct image ...................................... 0.69 2.87 NA 0.18 3.74 NA XXX 

1213

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78466 ......... 26 ....... A Heart infarct image ...................................... 0.69 0.25 0.25 0.04 0.98 0.98 XXX 

78466 ......... TC ...... A Heart infarct image ...................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

78468 ......... ............ A Heart infarct image (ef) ................................ 0.80 3.96 NA 0.23 4.99 NA XXX 

78468 ......... 26 ....... A Heart infarct image (ef) ................................ 0.80 0.28 0.28 0.04 1.12 1.12 XXX 

78468 ......... TC ...... A Heart infarct image (ef) ................................ 0.00 3.68 NA 0.19 3.87 NA XXX 

78469 ......... ............ A Heart infarct image (3D) .............................. 0.92 5.56 NA 0.32 6.80 NA XXX 

78469 ......... 26 ....... A Heart infarct image (3D) .............................. 0.92 0.32 0.32 0.04 1.28 1.28 XXX 

78469 ......... TC ...... A Heart infarct image (3D) .............................. 0.00 5.24 NA 0.28 5.52 NA XXX 

78472 ......... ............ A Gated heart, planar, single .......................... 0.98 5.88 NA 0.35 7.21 NA XXX 

78472 ......... 26 ....... A Gated heart, planar, single .......................... 0.98 0.35 0.35 0.05 1.38 1.38 XXX 

78472 ......... TC ...... A Gated heart, planar, single .......................... 0.00 5.53 NA 0.30 5.83 NA XXX 

78473 ......... ............ A Gated heart, multiple ................................... 1.47 8.80 NA 0.48 10.75 NA XXX 

78473 ......... 26 ....... A Gated heart, multiple ................................... 1.47 0.51 0.51 0.06 2.04 2.04 XXX 

78473 ......... TC ...... A Gated heart, multiple ................................... 0.00 8.29 NA 0.42 8.71 NA XXX 

78478 ......... ............ A Heart wall motion add-on ............................ 0.62 1.79 NA 0.12 2.53 NA XXX 

78478 ......... 26 ....... A Heart wall motion add-on ............................ 0.62 0.23 0.23 0.02 0.87 0.87 XXX 

78478 ......... TC ...... A Heart wall motion add-on ............................ 0.00 1.56 NA 0.10 1.66 NA XXX 

78480 ......... ............ A Heart function add-on .................................. 0.62 1.79 NA 0.12 2.53 NA XXX 

78480 ......... 26 ....... A Heart function add-on .................................. 0.62 0.23 0.23 0.02 0.87 0.87 XXX 

78480 ......... TC ...... A Heart function add-on .................................. 0.00 1.56 NA 0.10 1.66 NA XXX 

78481 ......... ............ A Heart first pass, single ................................. 0.98 5.61 NA 0.32 6.91 NA XXX 

78481 ......... 26 ....... A Heart first pass, single ................................. 0.98 0.37 0.37 0.04 1.39 1.39 XXX 

78481 ......... TC ...... A Heart first pass, single ................................. 0.00 5.24 NA 0.28 5.52 NA XXX 

78483 ......... ............ A Heart first pass, multiple .............................. 1.47 8.43 NA 0.47 10.37 NA XXX 

78483 ......... 26 ....... A Heart first pass, multiple .............................. 1.47 0.54 0.54 0.06 2.07 2.07 XXX 

78483 ......... TC ...... A Heart first pass, multiple .............................. 0.00 7.89 NA 0.41 8.30 NA XXX 

78491 ......... ............ I Heart image (pet), single ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78491 ......... 26 ....... I Heart image (pet), single ............................. +1.50 0.59 0.59 0.06 2.15 2.15 XXX 

78491 ......... TC ...... I Heart image (pet), single ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78492 ......... ............ I Heart image (pet), multiple .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78492 ......... 26 ....... I Heart image (pet), multiple .......................... +1.87 0.74 0.74 0.07 2.68 2.68 XXX 

78492 ......... TC ...... I Heart image (pet), multiple .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78494 ......... ............ A Heart image, spect ...................................... 1.19 7.51 NA 0.35 9.05 NA XXX 

78494 ......... 26 ....... A Heart image, spect ...................................... 1.19 0.41 0.41 0.05 1.65 1.65 XXX 

78494 ......... TC ...... A Heart image, spect ...................................... 0.00 7.10 NA 0.30 7.40 NA XXX 

78496 ......... ............ A Heart first pass add-on ................................ 0.50 7.28 NA 0.32 8.10 NA ZZZ 

78496 ......... 26 ....... A Heart first pass add-on ................................ 0.50 0.18 0.18 0.02 0.70 0.70 ZZZ 

78496 ......... TC ...... A Heart first pass add-on ................................ 0.00 7.10 NA 0.30 7.40 NA ZZZ 

78499 ......... ............ C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 ......... 26 ....... C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78499 ......... TC ...... C Cardiovascular nuclear exam ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78580 ......... ............ A Lung perfusion imaging ............................... 0.74 3.69 NA 0.22 4.65 NA XXX 

78580 ......... 26 ....... A Lung perfusion imaging ............................... 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

78580 ......... TC ...... A Lung perfusion imaging ............................... 0.00 3.44 NA 0.18 3.62 NA XXX 

78584 ......... ............ A Lung V/Q image single breath ..................... 0.99 3.54 NA 0.22 4.75 NA XXX 

78584 ......... 26 ....... A Lung V/Q image single breath ..................... 0.99 0.33 0.33 0.05 1.37 1.37 XXX 

78584 ......... TC ...... A Lung V/Q image single breath ..................... 0.00 3.21 NA 0.17 3.38 NA XXX 

78585 ......... ............ A Lung V/Q imaging ........................................ 1.09 6.02 NA 0.36 7.47 NA XXX 

78585 ......... 26 ....... A Lung V/Q imaging ........................................ 1.09 0.37 0.37 0.06 1.52 1.52 XXX 

78585 ......... TC ...... A Lung V/Q imaging ........................................ 0.00 5.65 NA 0.30 5.95 NA XXX 

78586 ......... ............ A Aerosol lung image, single .......................... 0.40 2.73 NA 0.16 3.29 NA XXX 

78586 ......... 26 ....... A Aerosol lung image, single .......................... 0.40 0.13 0.13 0.02 0.55 0.55 XXX 

78586 ......... TC ...... A Aerosol lung image, single .......................... 0.00 2.60 NA 0.14 2.74 NA XXX 

78587 ......... ............ A Aerosol lung image, multiple ....................... 0.49 2.98 NA 0.16 3.63 NA XXX 

78587 ......... 26 ....... A Aerosol lung image, multiple ....................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78587 ......... TC ...... A Aerosol lung image, multiple ....................... 0.00 2.81 NA 0.14 2.95 NA XXX 

78588 ......... ............ A Perfusion lung image ................................... 1.09 3.58 NA 0.24 4.91 NA XXX 

78588 ......... 26 ....... A Perfusion lung image ................................... 1.09 0.37 0.37 0.06 1.52 1.52 XXX 

78588 ......... TC ...... A Perfusion lung image ................................... 0.00 3.21 NA 0.18 3.39 NA XXX 

78591 ......... ............ A Vent image, 1 breath, 1 proj ........................ 0.40 3.00 NA 0.16 3.56 NA XXX 

78591 ......... 26 ....... A Vent image, 1 breath, 1 proj ........................ 0.40 0.14 0.14 0.02 0.56 0.56 XXX 

78591 ......... TC ...... A Vent image, 1 breath, 1 proj ........................ 0.00 2.86 NA 0.14 3.00 NA XXX 

78593 ......... ............ A Vent image, 1 proj, gas ............................... 0.49 3.63 NA 0.20 4.32 NA XXX 

78593 ......... 26 ....... A Vent image, 1 proj, gas ............................... 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78593 ......... TC ...... A Vent image, 1 proj, gas ............................... 0.00 3.46 NA 0.18 3.64 NA XXX 

78594 ......... ............ A Vent image, mult proj, gas .......................... 0.53 5.17 NA 0.27 5.97 NA XXX 

78594 ......... 26 ....... A Vent image, mult proj, gas .......................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78594 ......... TC ...... A Vent image, mult proj, gas .......................... 0.00 4.99 NA 0.25 5.24 NA XXX 

78596 ......... ............ A Lung differential function ............................. 1.27 7.52 NA 0.43 9.22 NA XXX 

78596 ......... 26 ....... A Lung differential function ............................. 1.27 0.42 0.42 0.06 1.75 1.75 XXX 

78596 ......... TC ...... A Lung differential function ............................. 0.00 7.10 NA 0.37 7.47 NA XXX 

78599 ......... ............ C Respiratory nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 ......... 26 ....... C Respiratory nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78599 ......... TC ...... C Respiratory nuclear exam ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78600 ......... ............ A Brain imaging, ltd static ............................... 0.44 3.04 NA 0.16 3.64 NA XXX 

1214

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78600 ......... 26 ....... A Brain imaging, ltd static ............................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

78600 ......... TC ...... A Brain imaging, ltd static ............................... 0.00 2.89 NA 0.14 3.03 NA XXX 

78601 ......... ............ A Brain imaging, ltd w/flow .............................. 0.51 3.58 NA 0.20 4.29 NA XXX 

78601 ......... 26 ....... A Brain imaging, ltd w/flow .............................. 0.51 0.17 0.17 0.02 0.70 0.70 XXX 

78601 ......... TC ...... A Brain imaging, ltd w/flow .............................. 0.00 3.41 NA 0.18 3.59 NA XXX 

78605 ......... ............ A Brain imaging, complete .............................. 0.53 3.60 NA 0.20 4.33 NA XXX 

78605 ......... 26 ....... A Brain imaging, complete .............................. 0.53 0.19 0.19 0.02 0.74 0.74 XXX 

78605 ......... TC ...... A Brain imaging, complete .............................. 0.00 3.41 NA 0.18 3.59 NA XXX 

78606 ......... ............ A Brain imaging, compl w/flow ........................ 0.64 4.10 NA 0.25 4.99 NA XXX 

78606 ......... 26 ....... A Brain imaging, compl w/flow ........................ 0.64 0.22 0.22 0.04 0.90 0.90 XXX 

78606 ......... TC ...... A Brain imaging, compl w/flow ........................ 0.00 3.88 NA 0.21 4.09 NA XXX 

78607 ......... ............ A Brain imaging (3D) ....................................... 1.23 7.01 NA 0.41 8.65 NA XXX 

78607 ......... 26 ....... A Brain imaging (3D) ....................................... 1.23 0.43 0.43 0.06 1.72 1.72 XXX 

78607 ......... TC ...... A Brain imaging (3D) ....................................... 0.00 6.58 NA 0.35 6.93 NA XXX 

78608 ......... ............ N Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78609 ......... ............ N Brain imaging (PET) .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78610 ......... ............ A Brain flow imaging only ............................... 0.30 1.69 NA 0.11 2.10 NA XXX 

78610 ......... 26 ....... A Brain flow imaging only ............................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78610 ......... TC ...... A Brain flow imaging only ............................... 0.00 1.58 NA 0.10 1.68 NA XXX 

78615 ......... ............ A Cerebral vascular flow image ...................... 0.42 4.02 NA 0.23 4.67 NA XXX 

78615 ......... 26 ....... A Cerebral vascular flow image ...................... 0.42 0.16 0.16 0.02 0.60 0.60 XXX 

78615 ......... TC ...... A Cerebral vascular flow image ...................... 0.00 3.86 NA 0.21 4.07 NA XXX 

78630 ......... ............ A Cerebrospinal fluid scan .............................. 0.68 5.28 NA 0.31 6.27 NA XXX 

78630 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.68 0.23 0.23 0.04 0.95 0.95 XXX 

78630 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.05 NA 0.27 5.32 NA XXX 

78635 ......... ............ A CSF ventriculography .................................. 0.61 2.80 NA 0.16 3.57 NA XXX 

78635 ......... 26 ....... A CSF ventriculography .................................. 0.61 0.24 0.24 0.02 0.87 0.87 XXX 

78635 ......... TC ...... A CSF ventriculography .................................. 0.00 2.56 NA 0.14 2.70 NA XXX 

78645 ......... ............ A CSF shunt evaluation .................................. 0.57 3.64 NA 0.20 4.41 NA XXX 

78645 ......... 26 ....... A CSF shunt evaluation .................................. 0.57 0.20 0.20 0.02 0.79 0.79 XXX 

78645 ......... TC ...... A CSF shunt evaluation .................................. 0.00 3.44 NA 0.18 3.62 NA XXX 

78647 ......... ............ A Cerebrospinal fluid scan .............................. 0.90 6.25 NA 0.35 7.50 NA XXX 

78647 ......... 26 ....... A Cerebrospinal fluid scan .............................. 0.90 0.32 0.32 0.04 1.26 1.26 XXX 

78647 ......... TC ...... A Cerebrospinal fluid scan .............................. 0.00 5.93 NA 0.31 6.24 NA XXX 

78650 ......... ............ A CSF leakage imaging .................................. 0.61 4.87 NA 0.26 5.74 NA XXX 

78650 ......... 26 ....... A CSF leakage imaging .................................. 0.61 0.21 0.21 0.02 0.84 0.84 XXX 

78650 ......... TC ...... A CSF leakage imaging .................................. 0.00 4.66 NA 0.24 4.90 NA XXX 

78660 ......... ............ A Nuclear exam of tear flow ........................... 0.53 2.30 NA 0.14 2.97 NA XXX 

78660 ......... 26 ....... A Nuclear exam of tear flow ........................... 0.53 0.18 0.18 0.02 0.73 0.73 XXX 

78660 ......... TC ...... A Nuclear exam of tear flow ........................... 0.00 2.12 NA 0.12 2.24 NA XXX 

78699 ......... ............ C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 ......... 26 ....... C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78699 ......... TC ...... C Nervous system nuclear exam .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78700 ......... ............ A Kidney imaging, static .................................. 0.45 3.21 NA 0.18 3.84 NA XXX 

78700 ......... 26 ....... A Kidney imaging, static .................................. 0.45 0.15 0.15 0.02 0.62 0.62 XXX 

78700 ......... TC ...... A Kidney imaging, static .................................. 0.00 3.06 NA 0.16 3.22 NA XXX 

78701 ......... ............ A Kidney imaging with flow ............................. 0.49 3.74 NA 0.20 4.43 NA XXX 

78701 ......... 26 ....... A Kidney imaging with flow ............................. 0.49 0.17 0.17 0.02 0.68 0.68 XXX 

78701 ......... TC ...... A Kidney imaging with flow ............................. 0.00 3.57 NA 0.18 3.75 NA XXX 

78704 ......... ............ A Imaging renogram ........................................ 0.74 4.22 NA 0.25 5.21 NA XXX 

78704 ......... 26 ....... A Imaging renogram ........................................ 0.74 0.25 0.25 0.04 1.03 1.03 XXX 

78704 ......... TC ...... A Imaging renogram ........................................ 0.00 3.97 NA 0.21 4.18 NA XXX 

78707 ......... ............ A Kidney flow/function image .......................... 0.96 4.81 NA 0.28 6.05 NA XXX 

78707 ......... 26 ....... A Kidney flow/function image .......................... 0.96 0.33 0.33 0.05 1.34 1.34 XXX 

78707 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.48 NA 0.23 4.71 NA XXX 

78708 ......... ............ A Kidney flow/function image .......................... 1.21 4.89 NA 0.29 6.39 NA XXX 

78708 ......... 26 ....... A Kidney flow/function image .......................... 1.21 0.41 0.41 0.06 1.68 1.68 XXX 

78708 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.48 NA 0.23 4.71 NA XXX 

78709 ......... ............ A Kidney flow/function image .......................... 1.41 4.95 NA 0.30 6.66 NA XXX 

78709 ......... 26 ....... A Kidney flow/function image .......................... 1.41 0.47 0.47 0.07 1.95 1.95 XXX 

78709 ......... TC ...... A Kidney flow/function image .......................... 0.00 4.48 NA 0.23 4.71 NA XXX 

78710 ......... ............ A Kidney imaging (3D) .................................... 0.66 6.15 NA 0.35 7.16 NA XXX 

78710 ......... 26 ....... A Kidney imaging (3D) .................................... 0.66 0.22 0.22 0.04 0.92 0.92 XXX 

78710 ......... TC ...... A Kidney imaging (3D) .................................... 0.00 5.93 NA 0.31 6.24 NA XXX 

78715 ......... ............ A Renal vascular flow exam ........................... 0.30 1.69 NA 0.11 2.10 NA XXX 

78715 ......... 26 ....... A Renal vascular flow exam ........................... 0.30 0.11 0.11 0.01 0.42 0.42 XXX 

78715 ......... TC ...... A Renal vascular flow exam ........................... 0.00 1.58 NA 0.10 1.68 NA XXX 

78725 ......... ............ A Kidney function study .................................. 0.38 1.92 NA 0.12 2.42 NA XXX 

78725 ......... 26 ....... A Kidney function study .................................. 0.38 0.13 0.13 0.01 0.52 0.52 XXX 

78725 ......... TC ...... A Kidney function study .................................. 0.00 1.79 NA 0.11 1.90 NA XXX 

78730 ......... ............ A Urinary bladder retention ............................. 0.36 1.59 NA 0.10 2.05 NA XXX 

78730 ......... 26 ....... A Urinary bladder retention ............................. 0.36 0.13 0.13 0.02 0.51 0.51 XXX 

78730 ......... TC ...... A Urinary bladder retention ............................. 0.00 1.46 NA 0.08 1.54 NA XXX 

78740 ......... ............ A Ureteral reflux study .................................... 0.57 2.31 NA 0.14 3.02 NA XXX 

78740 ......... 26 ....... A Ureteral reflux study .................................... 0.57 0.19 0.19 0.02 0.78 0.78 XXX 

1215

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

78740 ......... TC ...... A Ureteral reflux study .................................... 0.00 2.12 NA 0.12 2.24 NA XXX 

78760 ......... ............ A Testicular imaging ........................................ 0.66 2.90 NA 0.18 3.74 NA XXX 

78760 ......... 26 ....... A Testicular imaging ........................................ 0.66 0.22 0.22 0.04 0.92 0.92 XXX 

78760 ......... TC ...... A Testicular imaging ........................................ 0.00 2.68 NA 0.14 2.82 NA XXX 

78761 ......... ............ A Testicular imaging/flow ................................ 0.71 3.45 NA 0.21 4.37 NA XXX 

78761 ......... 26 ....... A Testicular imaging/flow ................................ 0.71 0.24 0.24 0.04 0.99 0.99 XXX 

78761 ......... TC ...... A Testicular imaging/flow ................................ 0.00 3.21 NA 0.17 3.38 NA XXX 

78799 ......... ............ C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 ......... 26 ....... C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78799 ......... TC ...... C Genitourinary nuclear exam ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78800 ......... ............ A Tumor imaging, limited area ........................ 0.66 3.63 NA 0.22 4.51 NA XXX 

78800 ......... 26 ....... A Tumor imaging, limited area ........................ 0.66 0.22 0.22 0.04 0.92 0.92 XXX 

78800 ......... TC ...... A Tumor imaging, limited area ........................ 0.00 3.41 NA 0.18 3.59 NA XXX 

78801 ......... ............ A Tumor imaging, mult areas .......................... 0.79 4.51 NA 0.26 5.56 NA XXX 

78801 ......... 26 ....... A Tumor imaging, mult areas .......................... 0.79 0.27 0.27 0.04 1.10 1.10 XXX 

78801 ......... TC ...... A Tumor imaging, mult areas .......................... 0.00 4.24 NA 0.22 4.46 NA XXX 

78802 ......... ............ A Tumor imaging, whole body ........................ 0.86 5.85 NA 0.34 7.05 NA XXX 

78802 ......... 26 ....... A Tumor imaging, whole body ........................ 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78802 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 5.55 NA 0.30 5.85 NA XXX 

78803 ......... ............ A Tumor imaging (3D) ..................................... 1.09 6.96 NA 0.40 8.45 NA XXX 

78803 ......... 26 ....... A Tumor imaging (3D) ..................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78803 ......... TC ...... A Tumor imaging (3D) ..................................... 0.00 6.58 NA 0.35 6.93 NA XXX 

78804 ......... ............ A Tumor imaging, whole body ........................ 1.07 4.66 NA 0.34 6.07 NA XXX 

78804 ......... 26 ....... A Tumor imaging, whole body ........................ 1.07 0.37 0.37 0.04 1.48 1.48 XXX 

78804 ......... TC ...... A Tumor imaging, whole body ........................ 0.00 4.29 NA 0.30 4.59 NA XXX 

78805 ......... ............ A Abscess imaging, ltd area ........................... 0.73 3.66 NA 0.22 4.61 NA XXX 

78805 ......... 26 ....... A Abscess imaging, ltd area ........................... 0.73 0.25 0.25 0.04 1.02 1.02 XXX 

78805 ......... TC ...... A Abscess imaging, ltd area ........................... 0.00 3.41 NA 0.18 3.59 NA XXX 

78806 ......... ............ A Abscess imaging, whole body ..................... 0.86 6.75 NA 0.39 8.00 NA XXX 

78806 ......... 26 ....... A Abscess imaging, whole body ..................... 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78806 ......... TC ...... A Abscess imaging, whole body ..................... 0.00 6.45 NA 0.35 6.80 NA XXX 

78807 ......... ............ A Nuclear localization/abscess ....................... 1.09 6.97 NA 0.40 8.46 NA XXX 

78807 ......... 26 ....... A Nuclear localization/abscess ....................... 1.09 0.39 0.39 0.05 1.53 1.53 XXX 

78807 ......... TC ...... A Nuclear localization/abscess ....................... 0.00 6.58 NA 0.35 6.93 NA XXX 

78810 ......... ............ N Tumor imaging (PET) .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78810 ......... 26 ....... N Tumor imaging (PET) .................................. +1.93 0.74 0.74 0.11 2.78 2.78 XXX 

78810 ......... TC ...... N Tumor imaging (PET) .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78890 ......... ............ B Nuclear medicine data proc ......................... +0.05 1.33 NA 0.07 1.45 NA XXX 

78890 ......... 26 ....... B Nuclear medicine data proc ......................... +0.05 0.02 0.02 0.01 0.08 0.08 XXX 

78890 ......... TC ...... B Nuclear medicine data proc ......................... +0.00 1.31 NA 0.06 1.37 NA XXX 

78891 ......... ............ B Nuclear med data proc ................................ +0.10 2.66 NA 0.14 2.90 NA XXX 

78891 ......... 26 ....... B Nuclear med data proc ................................ +0.10 0.04 0.04 0.01 0.15 0.15 XXX 

78891 ......... TC ...... B Nuclear med data proc ................................ +0.00 2.62 NA 0.13 2.75 NA XXX 

78990 ......... ............ I Provide diag radionuclide(s) ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 ......... ............ C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 ......... 26 ....... C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

78999 ......... TC ...... C Nuclear diagnostic exam ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79000 ......... ............ A Init hyperthyroid therapy .............................. 1.80 3.22 NA 0.22 5.24 NA XXX 

79000 ......... 26 ....... A Init hyperthyroid therapy .............................. 1.80 0.60 0.60 0.08 2.48 2.48 XXX 

79000 ......... TC ...... A Init hyperthyroid therapy .............................. 0.00 2.62 NA 0.14 2.76 NA XXX 

79001 ......... ............ A Repeat hyperthyroid therapy ....................... 1.05 1.67 NA 0.12 2.84 NA XXX 

79001 ......... 26 ....... A Repeat hyperthyroid therapy ....................... 1.05 0.36 0.36 0.05 1.46 1.46 XXX 

79001 ......... TC ...... A Repeat hyperthyroid therapy ....................... 0.00 1.31 NA 0.07 1.38 NA XXX 

79020 ......... ............ A Thyroid ablation ........................................... 1.81 3.22 NA 0.22 5.25 NA XXX 

79020 ......... 26 ....... A Thyroid ablation ........................................... 1.81 0.60 0.60 0.08 2.49 2.49 XXX 

79020 ......... TC ...... A Thyroid ablation ........................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79030 ......... ............ A Thyroid ablation, carcinoma ........................ 2.10 3.33 NA 0.24 5.67 NA XXX 

79030 ......... 26 ....... A Thyroid ablation, carcinoma ........................ 2.10 0.71 0.71 0.10 2.91 2.91 XXX 

79030 ......... TC ...... A Thyroid ablation, carcinoma ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 

79035 ......... ............ A Thyroid metastatic therapy .......................... 2.52 3.50 NA 0.25 6.27 NA XXX 

79035 ......... 26 ....... A Thyroid metastatic therapy .......................... 2.52 0.88 0.88 0.11 3.51 3.51 XXX 

79035 ......... TC ...... A Thyroid metastatic therapy .......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79100 ......... ............ A Hematopoetic nuclear therapy ..................... 1.32 3.08 NA 0.20 4.60 NA XXX 

79100 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 1.32 0.46 0.46 0.06 1.84 1.84 XXX 

79100 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79200 ......... ............ A Intracavitary nuclear trmt ............................. 1.99 3.31 NA 0.22 5.52 NA XXX 

79200 ......... 26 ....... A Intracavitary nuclear trmt ............................. 1.99 0.69 0.69 0.08 2.76 2.76 XXX 

79200 ......... TC ...... A Intracavitary nuclear trmt ............................. 0.00 2.62 NA 0.14 2.76 NA XXX 

79300 ......... ............ C Interstitial nuclear therapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79300 ......... 26 ....... A Interstitial nuclear therapy ........................... 1.60 0.56 0.56 0.08 2.24 2.24 XXX 

79300 ......... TC ...... C Interstitial nuclear therapy ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79400 ......... ............ A Nonhemato nuclear therapy ........................ 1.96 3.29 NA 0.24 5.49 NA XXX 

79400 ......... 26 ....... A Nonhemato nuclear therapy ........................ 1.96 0.67 0.67 0.10 2.73 2.73 XXX 

79400 ......... TC ...... A Nonhemato nuclear therapy ........................ 0.00 2.62 NA 0.14 2.76 NA XXX 

79403 ......... ............ A Hematopoetic nuclear therapy ..................... 2.25 5.19 NA 0.24 7.68 NA XXX 

1216

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

79403 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 2.25 0.90 0.90 0.10 3.25 3.25 XXX 

79403 ......... TC ...... A Hematopoetic nuclear therapy ..................... 0.00 4.29 NA 0.14 4.43 NA XXX 

79420 ......... ............ C Intravascular nuclear ther ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79420 ......... 26 ....... A Intravascular nuclear ther ............................ 1.51 0.49 0.49 0.07 2.07 2.07 XXX 

79420 ......... TC ...... C Intravascular nuclear ther ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79440 ......... ............ A Nuclear joint therapy .................................... 1.99 3.34 NA 0.24 5.57 NA XXX 

79440 ......... 26 ....... A Nuclear joint therapy .................................... 1.99 0.72 0.72 0.10 2.81 2.81 XXX 

79440 ......... TC ...... A Nuclear joint therapy .................................... 0.00 2.62 NA 0.14 2.76 NA XXX 

79900 ......... ............ C Provide ther radiopharm(s) .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 ......... ............ C Nuclear medicine therapy ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 ......... 26 ....... C Nuclear medicine therapy ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

79999 ......... TC ...... C Nuclear medicine therapy ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

80500 ......... ............ A Lab pathology consultation .......................... 0.37 0.22 0.16 0.01 0.60 0.54 XXX 

80502 ......... ............ A Lab pathology consultation .......................... 1.33 0.62 0.58 0.06 2.01 1.97 XXX 

83020 ......... 26 ....... A Hemoglobin electrophoresis ........................ 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

83912 ......... 26 ....... A Genetic examination .................................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

84165 ......... 26 ....... A Electrophoreisis of proteins ......................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

84181 ......... 26 ....... A Western blot test .......................................... 0.37 0.14 0.14 0.01 0.52 0.52 XXX 

84182 ......... 26 ....... A Protein, western blot test ............................. 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

85060 ......... ............ A Blood smear interpretation .......................... 0.45 0.20 0.20 0.02 0.67 0.67 XXX 

85097 ......... ............ A Bone marrow interpretation ......................... 0.94 1.75 0.41 0.04 2.73 1.39 XXX 

85390 ......... 26 ....... A Fibrinolysins screen ..................................... 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

85396 ......... ............ A Clotting assay, whole blood ......................... 0.37 NA 0.17 0.04 NA 0.58 XXX 

85576 ......... 26 ....... A Blood platelet aggregation ........................... 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

86077 ......... ............ A Physician blood bank service ...................... 0.94 0.46 0.41 0.04 1.44 1.39 XXX 

86078 ......... ............ A Physician blood bank service ...................... 0.94 0.49 0.40 0.04 1.47 1.38 XXX 

86079 ......... ............ A Physician blood bank service ...................... 0.94 0.49 0.41 0.04 1.47 1.39 XXX 

86255 ......... 26 ....... A Fluorescent antibody, screen ...................... 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

86256 ......... 26 ....... A Fluorescent antibody, titer ........................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86320 ......... 26 ....... A Serum immunoelectrophoresis .................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86325 ......... 26 ....... A Other immunoelectrophoresis ...................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86327 ......... 26 ....... A Immunoelectrophoresis assay ..................... 0.42 0.19 0.19 0.01 0.62 0.62 XXX 

86334 ......... 26 ....... A Immunofixation procedure ........................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

86485 ......... ............ C Skin test, candida ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

86490 ......... ............ A Coccidioidomycosis skin test ....................... 0.00 0.29 NA 0.02 0.31 NA XXX 

86510 ......... ............ A Histoplasmosis skin test .............................. 0.00 0.32 NA 0.02 0.34 NA XXX 

86580 ......... ............ A TB intradermal test ...................................... 0.00 0.26 NA 0.02 0.28 NA XXX 

86585 ......... ............ A TB tine test .................................................. 0.00 0.21 NA 0.01 0.22 NA XXX 

86586 ......... ............ C Skin test, unlisted ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

87164 ......... 26 ....... A Dark field examination ................................. 0.37 0.12 0.12 0.01 0.50 0.50 XXX 

87207 ......... 26 ....... A Smear, special stain .................................... 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

88104 ......... ............ A Cytopathology, fluids ................................... 0.56 0.75 NA 0.04 1.35 NA XXX 

88104 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.25 0.25 0.02 0.83 0.83 XXX 

88104 ......... TC ...... A Cytopathology, fluids ................................... 0.00 0.50 NA 0.02 0.52 NA XXX 

88106 ......... ............ A Cytopathology, fluids ................................... 0.56 0.62 NA 0.04 1.22 NA XXX 

88106 ......... 26 ....... A Cytopathology, fluids ................................... 0.56 0.25 0.25 0.02 0.83 0.83 XXX 

88106 ......... TC ...... A Cytopathology, fluids ................................... 0.00 0.37 NA 0.02 0.39 NA XXX 

88107 ......... ............ A Cytopathology, fluids ................................... 0.76 0.98 NA 0.06 1.80 NA XXX 

88107 ......... 26 ....... A Cytopathology, fluids ................................... 0.76 0.34 0.34 0.04 1.14 1.14 XXX 

88107 ......... TC ...... A Cytopathology, fluids ................................... 0.00 0.64 NA 0.02 0.66 NA XXX 

88108 ......... ............ A Cytopath, concentrate tech .......................... 0.56 0.81 NA 0.04 1.41 NA XXX 

88108 ......... 26 ....... A Cytopath, concentrate tech .......................... 0.56 0.25 0.25 0.02 0.83 0.83 XXX 

88108 ......... TC ...... A Cytopath, concentrate tech .......................... 0.00 0.56 NA 0.02 0.58 NA XXX 

88112 ......... ............ A Cytopath, cell enhance tech ........................ 1.18 1.98 NA 0.08 3.24 NA XXX 

88112 ......... 26 ....... A Cytopath, cell enhance tech ........................ 1.18 0.51 0.51 0.06 1.75 1.75 XXX 

88112 ......... TC ...... A Cytopath, cell enhance tech ........................ 0.00 1.47 NA 0.02 1.49 NA XXX 

88125 ......... ............ A Forensic cytopathology ................................ 0.26 0.26 NA 0.02 0.54 NA XXX 

88125 ......... 26 ....... A Forensic cytopathology ................................ 0.26 0.12 0.12 0.01 0.39 0.39 XXX 

88125 ......... TC ...... A Forensic cytopathology ................................ 0.00 0.14 NA 0.01 0.15 NA XXX 

88141 ......... ............ A Cytopath, c/v, interpret ................................ 0.42 0.18 0.18 0.01 0.61 0.61 XXX 

88160 ......... ............ A Cytopath smear, other source ..................... 0.50 0.92 NA 0.04 1.46 NA XXX 

88160 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.22 0.22 0.02 0.74 0.74 XXX 

88160 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.70 NA 0.02 0.72 NA XXX 

88161 ......... ............ A Cytopath smear, other source ..................... 0.50 0.88 NA 0.04 1.42 NA XXX 

88161 ......... 26 ....... A Cytopath smear, other source ..................... 0.50 0.22 0.22 0.02 0.74 0.74 XXX 

88161 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.66 NA 0.02 0.68 NA XXX 

88162 ......... ............ A Cytopath smear, other source ..................... 0.76 0.68 NA 0.06 1.50 NA XXX 

88162 ......... 26 ....... A Cytopath smear, other source ..................... 0.76 0.34 0.34 0.04 1.14 1.14 XXX 

88162 ......... TC ...... A Cytopath smear, other source ..................... 0.00 0.34 NA 0.02 0.36 NA XXX 

88172 ......... ............ A Cytopathology eval of fna ............................ 0.60 0.66 NA 0.04 1.30 NA XXX 

88172 ......... 26 ....... A Cytopathology eval of fna ............................ 0.60 0.27 0.27 0.02 0.89 0.89 XXX 

88172 ......... TC ...... A Cytopathology eval of fna ............................ 0.00 0.39 NA 0.02 0.41 NA XXX 

88173 ......... ............ A Cytopath eval, fna, report ............................ 1.39 1.75 NA 0.08 3.22 NA XXX 

88173 ......... 26 ....... A Cytopath eval, fna, report ............................ 1.39 0.60 0.60 0.06 2.05 2.05 XXX 

88173 ......... TC ...... A Cytopath eval, fna, report ............................ 0.00 1.15 NA 0.02 1.17 NA XXX 

1217

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

88180 ......... ............ A Cell marker study ......................................... 0.36 1.43 NA 0.03 1.82 NA XXX 

88180 ......... 26 ....... A Cell marker study ......................................... 0.36 0.16 0.16 0.01 0.53 0.53 XXX 

88180 ......... TC ...... A Cell marker study ......................................... 0.00 1.27 NA 0.02 1.29 NA XXX 

88182 ......... ............ A Cell marker study ......................................... 0.77 1.59 NA 0.08 2.44 NA XXX 

88182 ......... 26 ....... A Cell marker study ......................................... 0.77 0.34 0.34 0.04 1.15 1.15 XXX 

88182 ......... TC ...... A Cell marker study ......................................... 0.00 1.25 NA 0.04 1.29 NA XXX 

88199 ......... ............ C Cytopathology procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 ......... 26 ....... C Cytopathology procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88199 ......... TC ...... C Cytopathology procedure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88291 ......... ............ A Cyto/molecular report .................................. 0.52 0.28 0.28 0.02 0.82 0.82 XXX 

88299 ......... ............ C Cytogenetic study ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88300 ......... ............ A Surgical path, gross ..................................... 0.08 0.28 NA 0.02 0.38 NA XXX 

88300 ......... 26 ....... A Surgical path, gross ..................................... 0.08 0.04 0.04 0.01 0.13 0.13 XXX 

88300 ......... TC ...... A Surgical path, gross ..................................... 0.00 0.24 NA 0.01 0.25 NA XXX 

88302 ......... ............ A Tissue exam by pathologist ......................... 0.13 0.69 NA 0.03 0.85 NA XXX 

88302 ......... 26 ....... A Tissue exam by pathologist ......................... 0.13 0.06 0.06 0.01 0.20 0.20 XXX 

88302 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 0.63 NA 0.02 0.65 NA XXX 

88304 ......... ............ A Tissue exam by pathologist ......................... 0.22 0.87 NA 0.03 1.12 NA XXX 

88304 ......... 26 ....... A Tissue exam by pathologist ......................... 0.22 0.10 0.10 0.01 0.33 0.33 XXX 

88304 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 0.77 NA 0.02 0.79 NA XXX 

88305 ......... ............ A Tissue exam by pathologist ......................... 0.75 1.74 NA 0.06 2.55 NA XXX 

88305 ......... 26 ....... A Tissue exam by pathologist ......................... 0.75 0.34 0.34 0.02 1.11 1.11 XXX 

88305 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.40 NA 0.04 1.44 NA XXX 

88307 ......... ............ A Tissue exam by pathologist ......................... 1.59 2.65 NA 0.13 4.37 NA XXX 

88307 ......... 26 ....... A Tissue exam by pathologist ......................... 1.59 0.69 0.69 0.07 2.35 2.35 XXX 

88307 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 1.96 NA 0.06 2.02 NA XXX 

88309 ......... ............ A Tissue exam by pathologist ......................... 2.28 3.25 NA 0.16 5.69 NA XXX 

88309 ......... 26 ....... A Tissue exam by pathologist ......................... 2.28 1.00 1.00 0.10 3.38 3.38 XXX 

88309 ......... TC ...... A Tissue exam by pathologist ......................... 0.00 2.25 NA 0.06 2.31 NA XXX 

88311 ......... ............ A Decalcify tissue ............................................ 0.24 0.20 NA 0.02 0.46 NA XXX 

88311 ......... 26 ....... A Decalcify tissue ............................................ 0.24 0.11 0.11 0.01 0.36 0.36 XXX 

88311 ......... TC ...... A Decalcify tissue ............................................ 0.00 0.09 NA 0.01 0.10 NA XXX 

88312 ......... ............ A Special stains ............................................... 0.54 1.35 NA 0.03 1.92 NA XXX 

88312 ......... 26 ....... A Special stains ............................................... 0.54 0.24 0.24 0.02 0.80 0.80 XXX 

88312 ......... TC ...... A Special stains ............................................... 0.00 1.11 NA 0.01 1.12 NA XXX 

88313 ......... ............ A Special stains ............................................... 0.24 1.09 NA 0.02 1.35 NA XXX 

88313 ......... 26 ....... A Special stains ............................................... 0.24 0.11 0.11 0.01 0.36 0.36 XXX 

88313 ......... TC ...... A Special stains ............................................... 0.00 0.98 NA 0.01 0.99 NA XXX 

88314 ......... ............ A Histochemical stain ...................................... 0.45 0.89 NA 0.04 1.38 NA XXX 

88314 ......... 26 ....... A Histochemical stain ...................................... 0.45 0.20 0.20 0.02 0.67 0.67 XXX 

88314 ......... TC ...... A Histochemical stain ...................................... 0.00 0.69 NA 0.02 0.71 NA XXX 

88318 ......... ............ A Chemical histochemistry .............................. 0.42 0.80 NA 0.02 1.24 NA XXX 

88318 ......... 26 ....... A Chemical histochemistry .............................. 0.42 0.19 0.19 0.01 0.62 0.62 XXX 

88318 ......... TC ...... A Chemical histochemistry .............................. 0.00 0.61 NA 0.01 0.62 NA XXX 

88319 ......... ............ A Enzyme histochemistry ................................ 0.53 1.89 NA 0.04 2.46 NA XXX 

88319 ......... 26 ....... A Enzyme histochemistry ................................ 0.53 0.23 0.23 0.02 0.78 0.78 XXX 

88319 ......... TC ...... A Enzyme histochemistry ................................ 0.00 1.66 NA 0.02 1.68 NA XXX 

88321 ......... ............ A Microslide consultation ................................ 1.30 0.82 0.56 0.05 2.17 1.91 XXX 

88323 ......... ............ A Microslide consultation ................................ 1.35 1.44 NA 0.08 2.87 NA XXX 

88323 ......... 26 ....... A Microslide consultation ................................ 1.35 0.59 0.59 0.06 2.00 2.00 XXX 

88323 ......... TC ...... A Microslide consultation ................................ 0.00 0.85 NA 0.02 0.87 NA XXX 

88325 ......... ............ A Comprehensive review of data .................... 2.22 2.90 0.97 0.10 5.22 3.29 XXX 

88329 ......... ............ A Path consult introp ....................................... 0.67 0.63 0.30 0.02 1.32 0.99 XXX 

88331 ......... ............ A Path consult intraop, 1 bloc ......................... 1.19 0.98 NA 0.09 2.26 NA XXX 

88331 ......... 26 ....... A Path consult intraop, 1 bloc ......................... 1.19 0.52 0.52 0.05 1.76 1.76 XXX 

88331 ......... TC ...... A Path consult intraop, 1 bloc ......................... 0.00 0.46 NA 0.04 0.50 NA XXX 

88332 ......... ............ A Path consult intraop, add’l ........................... 0.59 0.50 NA 0.04 1.13 NA XXX 

88332 ......... 26 ....... A Path consult intraop, add’l ........................... 0.59 0.26 0.26 0.02 0.87 0.87 XXX 

88332 ......... TC ...... A Path consult intraop, add’l ........................... 0.00 0.24 NA 0.02 0.26 NA XXX 

88342 ......... ............ A Immunohistochemistry ................................. 0.85 1.35 NA 0.06 2.26 NA XXX 

88342 ......... 26 ....... A Immunohistochemistry ................................. 0.85 0.37 0.37 0.04 1.26 1.26 XXX 

88342 ......... TC ...... A Immunohistochemistry ................................. 0.00 0.98 NA 0.02 1.00 NA XXX 

88346 ......... ............ A Immunofluorescent study ............................. 0.86 1.44 NA 0.06 2.36 NA XXX 

88346 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.37 0.37 0.04 1.27 1.27 XXX 

88346 ......... TC ...... A Immunofluorescent study ............................. 0.00 1.07 NA 0.02 1.09 NA XXX 

88347 ......... ............ A Immunofluorescent study ............................. 0.86 1.76 NA 0.06 2.68 NA XXX 

88347 ......... 26 ....... A Immunofluorescent study ............................. 0.86 0.36 0.36 0.04 1.26 1.26 XXX 

88347 ......... TC ...... A Immunofluorescent study ............................. 0.00 1.40 NA 0.02 1.42 NA XXX 

88348 ......... ............ A Electron microscopy .................................... 1.51 8.47 NA 0.13 10.11 NA XXX 

88348 ......... 26 ....... A Electron microscopy .................................... 1.51 0.65 0.65 0.06 2.22 2.22 XXX 

88348 ......... TC ...... A Electron microscopy .................................... 0.00 7.82 NA 0.07 7.89 NA XXX 

88349 ......... ............ A Scanning electron microscopy ..................... 0.76 9.99 NA 0.10 10.85 NA XXX 

88349 ......... 26 ....... A Scanning electron microscopy ..................... 0.76 0.34 0.34 0.04 1.14 1.14 XXX 

88349 ......... TC ...... A Scanning electron microscopy ..................... 0.00 9.65 NA 0.06 9.71 NA XXX 

88355 ......... ............ A Analysis, skeletal muscle ............................. 1.85 2.60 NA 0.14 4.59 NA XXX 

1218

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

88355 ......... 26 ....... A Analysis, skeletal muscle ............................. 1.85 0.80 0.80 0.08 2.73 2.73 XXX 

88355 ......... TC ...... A Analysis, skeletal muscle ............................. 0.00 1.80 NA 0.06 1.86 NA XXX 

88356 ......... ............ A Analysis, nerve ............................................ 3.02 2.87 NA 0.19 6.08 NA XXX 

88356 ......... 26 ....... A Analysis, nerve ............................................ 3.02 1.27 1.27 0.12 4.41 4.41 XXX 

88356 ......... TC ...... A Analysis, nerve ............................................ 0.00 1.60 NA 0.07 1.67 NA XXX 

88358 ......... ............ A Analysis, tumor ............................................ 0.95 1.38 NA 0.19 2.52 NA XXX 

88358 ......... 26 ....... A Analysis, tumor ............................................ 0.95 1.23 1.23 0.12 2.30 2.30 XXX 

88358 ......... TC ...... A Analysis, tumor ............................................ 0.00 0.15 NA 0.07 0.22 NA XXX 

88361 ......... ............ A Immunohistochemistry, tumor ...................... 0.94 2.59 NA 0.19 3.72 NA XXX 

88361 ......... 26 ....... A Immunohistochemistry, tumor ...................... 0.94 0.41 0.41 0.12 1.47 1.47 XXX 

88361 ......... TC ...... A Immunohistochemistry, tumor ...................... 0.00 2.18 NA 0.07 2.25 NA XXX 

88362 ......... ............ A Nerve teasing preparations ......................... 2.17 4.40 NA 0.14 6.71 NA XXX 

88362 ......... 26 ....... A Nerve teasing preparations ......................... 2.17 0.93 0.93 0.08 3.18 3.18 XXX 

88362 ......... TC ...... A Nerve teasing preparations ......................... 0.00 3.47 NA 0.06 3.53 NA XXX 

88365 ......... ............ A Tissue hybridization ..................................... 0.93 2.21 NA 0.06 3.20 NA XXX 

88365 ......... 26 ....... A Tissue hybridization ..................................... 0.93 0.41 0.41 0.04 1.38 1.38 XXX 

88365 ......... TC ...... A Tissue hybridization ..................................... 0.00 1.80 NA 0.02 1.82 NA XXX 

88371 ......... 26 ....... A Protein, western blot tissue ......................... 0.37 0.13 0.13 0.01 0.51 0.51 XXX 

88372 ......... 26 ....... A Protein analysis w/probe ............................. 0.37 0.17 0.17 0.01 0.55 0.55 XXX 

88380 ......... ............ C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 ......... 26 ....... C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88380 ......... TC ...... C Microdissection ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 ......... ............ C Surgical pathology procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 ......... 26 ....... C Surgical pathology procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

88399 ......... TC ...... C Surgical pathology procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

89060 ......... 26 ....... A Exam,synovial fluid crystals ......................... 0.37 0.17 0.16 0.01 0.55 0.54 XXX 

89100 ......... ............ A Sample intestinal contents ........................... 0.60 1.60 0.22 0.02 2.22 0.84 XXX 

89105 ......... ............ A Sample intestinal contents ........................... 0.50 2.24 0.17 0.02 2.76 0.69 XXX 

89130 ......... ............ A Sample stomach contents ........................... 0.45 1.74 0.13 0.02 2.21 0.60 XXX 

89132 ......... ............ A Sample stomach contents ........................... 0.19 1.48 0.06 0.01 1.68 0.26 XXX 

89135 ......... ............ A Sample stomach contents ........................... 0.79 1.59 0.25 0.04 2.42 1.08 XXX 

89136 ......... ............ A Sample stomach contents ........................... 0.21 1.60 0.09 0.01 1.82 0.31 XXX 

89140 ......... ............ A Sample stomach contents ........................... 0.94 2.06 0.28 0.04 3.04 1.26 XXX 

89141 ......... ............ A Sample stomach contents ........................... 0.85 2.72 0.34 0.04 3.61 1.23 XXX 

90281 ......... ............ I Human ig, im ............................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90283 ......... ............ I Human ig, iv ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90287 ......... ............ I Botulinum antitoxin ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90288 ......... ............ I Botulism ig, iv .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90291 ......... ............ I Cmv ig, iv ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90296 ......... ............ E Diphtheria antitoxin ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90371 ......... ............ E Hep b ig, im ................................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90375 ......... ............ E Rabies ig, im/sc ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90376 ......... ............ E Rabies ig, heat treated ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90378 ......... ............ X Rsv ig, im, 50mg .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90379 ......... ............ I Rsv ig, iv ...................................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90384 ......... ............ I Rh ig, full-dose, im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90385 ......... ............ E Rh ig, minidose, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90386 ......... ............ I Rh ig, iv ........................................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90389 ......... ............ I Tetanus ig, im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90393 ......... ............ E Vaccina ig, im .............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90396 ......... ............ E Varicella-zoster ig, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90399 ......... ............ I Immune globulin .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90471 ......... ............ A Immunization admin ..................................... 0.00 0.21 NA 0.01 0.22 NA XXX 

90472 ......... ............ A Immunization admin, each add ................... 0.00 0.14 NA 0.01 0.15 NA ZZZ 

90473 ......... ............ N Immune admin oral/nasal ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90474 ......... ............ N Immune admin oral/nasal addl .................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

90476 ......... ............ E Adenovirus vaccine, type 4 ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90477 ......... ............ E Adenovirus vaccine, type 7 ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90581 ......... ............ E Anthrax vaccine, sc ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90585 ......... ............ E Bcg vaccine, percut ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90586 ......... ............ E Bcg vaccine, intravesical ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90632 ......... ............ E Hep a vaccine, adult im ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90633 ......... ............ E Hep a vacc, ped/adol, 2 dose ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90634 ......... ............ E Hep a vacc, ped/adol, 3 dose ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90636 ......... ............ E Hep a/hep b vacc, adult im ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90645 ......... ............ E Hib vaccine, hboc, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90646 ......... ............ E Hib vaccine, prp-d, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90647 ......... ............ E Hib vaccine, prp-omp, im ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90648 ......... ............ E Hib vaccine, prp-t, im ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90655 ......... ............ X Flu vaccine, 6-35 mo, im ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90657 ......... ............ X Flu vaccine, 6-35 mo, im ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90658 ......... ............ X Flu vaccine, 3 yrs, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90659 ......... ............ D Flu vaccine, whole, im ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90660 ......... ............ X Flu vaccine, nasal ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90665 ......... ............ E Lyme disease vaccine, im ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1219

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

90669 ......... ............ N Pneumococcal vacc, ped <5 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90675 ......... ............ E Rabies vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90676 ......... ............ E Rabies vaccine, id ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90680 ......... ............ E Rotovirus vaccine, oral ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90690 ......... ............ E Typhoid vaccine, oral ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90691 ......... ............ E Typhoid vaccine, im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90692 ......... ............ E Typhoid vaccine, h-p, sc/id .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90693 ......... ............ E Typhoid vaccine, akd, sc ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90698 ......... ............ E Dtap-hib-ip vaccine, im ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90700 ......... ............ E Dtap vaccine, im .......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90701 ......... ............ E Dtp vaccine, im ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90702 ......... ............ E Dt vaccine < 7, im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90703 ......... ............ E Tetanus vaccine, im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90704 ......... ............ E Mumps vaccine, sc ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90705 ......... ............ E Measles vaccine, sc .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90706 ......... ............ E Rubella vaccine, sc ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90707 ......... ............ E Mmr vaccine, sc ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90708 ......... ............ E Measles-rubella vaccine, sc ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90710 ......... ............ E Mmrv vaccine, sc ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90712 ......... ............ E Oral poliovirus vaccine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90713 ......... ............ E Poliovirus, ipv, sc ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90715 ......... ............ E Tdap vaccine >7 im ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90716 ......... ............ E Chicken pox vaccine, sc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90717 ......... ............ E Yellow fever vaccine, sc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90718 ......... ............ E Td vaccine > 7, im ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90719 ......... ............ E Diphtheria vaccine, im ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90720 ......... ............ E Dtp/hib vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90721 ......... ............ E Dtap/hib vaccine, im .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90723 ......... ............ I Dtap-hep b-ipv vaccine, im .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90725 ......... ............ E Cholera vaccine, injectable .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90727 ......... ............ E Plague vaccine, im ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90732 ......... ............ X Pneumococcal vaccine ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90733 ......... ............ E Meningococcal vaccine, sc .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90734 ......... ............ E Meningococcal vaccine, im .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90735 ......... ............ E Encephalitis vaccine, sc .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90740 ......... ............ X Hepb vacc, ill pat 3 dose im ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90743 ......... ............ X Hep b vacc, adol, 2 dose, im ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90744 ......... ............ X Hepb vacc ped/adol 3 dose im .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90746 ......... ............ X Hep b vaccine, adult, im .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90747 ......... ............ X Hepb vacc, ill pat 4 dose im ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90748 ......... ............ I Hep b/hib vaccine, im .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90749 ......... ............ E Vaccine toxoid ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90780 ......... ............ A IV infusion therapy, 1 hour .......................... 0.17 2.15 NA 0.07 2.39 NA XXX 

90781 ......... ............ A IV infusion, additional hour .......................... 0.17 0.46 NA 0.04 0.67 NA ZZZ 

90782 ......... ............ T Injection, sc/im ............................................. 0.17 0.32 NA 0.01 0.50 NA XXX 

90783 ......... ............ T Injection, ia ................................................... 0.17 0.32 NA 0.02 0.51 NA XXX 

90784 ......... ............ T Injection, iv ................................................... 0.17 0.80 NA 0.04 1.01 NA XXX 

90788 ......... ............ T Injection of antibiotic .................................... 0.17 0.27 NA 0.01 0.45 NA XXX 

90799 ......... ............ C Ther/prophylactic/dx inject ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90801 ......... ............ A Psy dx interview ........................................... 2.80 1.17 0.94 0.07 4.04 3.81 XXX 

90802 ......... ............ A Intac psy dx interview .................................. 3.01 1.20 0.98 0.08 4.29 4.07 XXX 

90804 ......... ............ A Psytx, office, 20-30 min ............................... 1.21 0.49 0.38 0.04 1.74 1.63 XXX 

90805 ......... ............ A Psytx, off, 20-30 min w/e&m ....................... 1.37 0.50 0.42 0.04 1.91 1.83 XXX 

90806 ......... ............ A Psytx, off, 45-50 min .................................... 1.86 0.70 0.60 0.05 2.61 2.51 XXX 

90807 ......... ............ A Psytx, off, 45-50 min w/e&m ....................... 2.02 0.70 0.63 0.06 2.78 2.71 XXX 

90808 ......... ............ A Psytx, office, 75-80 min ............................... 2.79 1.03 0.91 0.08 3.90 3.78 XXX 

90809 ......... ............ A Psytx, off, 75-80, w/e&m ............................. 2.95 1.00 0.92 0.08 4.03 3.95 XXX 

90810 ......... ............ A Intac psytx, off, 20-30 min ........................... 1.32 0.50 0.42 0.04 1.86 1.78 XXX 

90811 ......... ............ A Intac psytx, 20-30, w/e&m ........................... 1.48 0.57 0.46 0.04 2.09 1.98 XXX 

90812 ......... ............ A Intac psytx, off, 45-50 min ........................... 1.97 0.79 0.64 0.06 2.82 2.67 XXX 

90813 ......... ............ A Intac psytx, 45-50 min w/e&m ..................... 2.13 0.77 0.67 0.06 2.96 2.86 XXX 

90814 ......... ............ A Intac psytx, off, 75-80 min ........................... 2.90 1.11 0.99 0.08 4.09 3.97 XXX 

90815 ......... ............ A Intac psytx, 75-80 w/e&m ............................ 3.06 1.05 0.95 0.08 4.19 4.09 XXX 

90816 ......... ............ A Psytx, hosp, 20-30 min ................................ 1.25 NA 0.46 0.04 NA 1.75 XXX 

90817 ......... ............ A Psytx, hosp, 20-30 min w/e&m .................... 1.41 NA 0.45 0.04 NA 1.90 XXX 

90818 ......... ............ A Psytx, hosp, 45-50 min ................................ 1.89 NA 0.69 0.05 NA 2.63 XXX 

90819 ......... ............ A Psytx, hosp, 45-50 min w/e&m .................... 2.05 NA 0.65 0.06 NA 2.76 XXX 

90821 ......... ............ A Psytx, hosp, 75-80 min ................................ 2.83 NA 1.01 0.07 NA 3.91 XXX 

90822 ......... ............ A Psytx, hosp, 75-80 min w/e&m .................... 2.99 NA 0.95 0.08 NA 4.02 XXX 

90823 ......... ............ A Intac psytx, hosp, 20-30 min ....................... 1.36 NA 0.48 0.04 NA 1.88 XXX 

90824 ......... ............ A Intac psytx, hsp 20-30 w/e&m ..................... 1.52 NA 0.49 0.04 NA 2.05 XXX 

90826 ......... ............ A Intac psytx, hosp, 45-50 min ....................... 2.01 NA 0.73 0.05 NA 2.79 XXX 

90827 ......... ............ A Intac psytx, hsp 45-50 w/e&m ..................... 2.16 NA 0.69 0.06 NA 2.91 XXX 

90828 ......... ............ A Intac psytx, hosp, 75-80 min ....................... 2.94 NA 1.07 0.08 NA 4.09 XXX 

90829 ......... ............ A Intac psytx, hsp 75-80 w/e&m ..................... 3.10 NA 0.99 0.08 NA 4.17 XXX 

1220

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

90845 ......... ............ A Psychoanalysis ............................................ 1.79 0.58 0.55 0.05 2.42 2.39 XXX 

90846 ......... ............ R Family psytx w/o patient .............................. 1.83 0.65 0.65 0.05 2.53 2.53 XXX 

90847 ......... ............ R Family psytx w/patient ................................. 2.21 0.82 0.76 0.06 3.09 3.03 XXX 

90849 ......... ............ R Multiple family group psytx .......................... 0.59 0.27 0.24 0.01 0.87 0.84 XXX 

90853 ......... ............ A Group psychotherapy .................................. 0.59 0.25 0.23 0.01 0.85 0.83 XXX 

90857 ......... ............ A Intac group psytx ......................................... 0.63 0.30 0.26 0.02 0.95 0.91 XXX 

90862 ......... ............ A Medication management ............................. 0.95 0.40 0.32 0.02 1.37 1.29 XXX 

90865 ......... ............ A Narcosynthesis ............................................ 2.84 1.59 0.89 0.08 4.51 3.81 XXX 

90870 ......... ............ A Electroconvulsive therapy ............................ 1.88 0.79 0.79 0.05 2.72 2.72 000 

90871 ......... ............ N Electroconvulsive therapy ............................ +2.72 1.07 1.07 0.07 3.86 3.86 000 

90875 ......... ............ N Psychophysiological therapy ....................... +1.20 0.90 0.46 0.04 2.14 1.70 XXX 

90876 ......... ............ N Psychophysiological therapy ....................... +1.90 1.16 0.73 0.05 3.11 2.68 XXX 

90880 ......... ............ A Hypnotherapy ............................................... 2.19 1.04 0.69 0.06 3.29 2.94 XXX 

90882 ......... ............ N Environmental manipulation ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90885 ......... ............ B Psy evaluation of records ............................ +0.97 0.37 0.37 0.02 1.36 1.36 XXX 

90887 ......... ............ B Consultation with family ............................... +1.48 0.82 0.56 0.04 2.34 2.08 XXX 

90889 ......... ............ B Preparation of report .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90899 ......... ............ C Psychiatric service/therapy .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90901 ......... ............ A Biofeedback train, any meth ........................ 0.41 0.66 0.14 0.02 1.09 0.57 000 

90911 ......... ............ A Biofeedback peri/uro/rectal .......................... 0.89 1.61 0.31 0.05 2.55 1.25 000 

90918 ......... ............ I ESRD related services, month .................... +11.16 7.34 7.34 0.36 18.86 18.86 XXX 

90919 ......... ............ I ESRD related services, month .................... +8.53 4.07 4.07 0.29 12.89 12.89 XXX 

90920 ......... ............ I ESRD related services, month .................... +7.26 3.81 3.81 0.23 11.30 11.30 XXX 

90921 ......... ............ I ESRD related services, month .................... +4.46 2.48 2.48 0.14 7.08 7.08 XXX 

90922 ......... ............ I ESRD related services, day ........................ +0.37 0.22 0.22 0.01 0.60 0.60 XXX 

90923 ......... ............ I Esrd related services, day ........................... +0.28 0.13 0.13 0.01 0.42 0.42 XXX 

90924 ......... ............ I Esrd related services, day ........................... +0.24 0.12 0.12 0.01 0.37 0.37 XXX 

90925 ......... ............ I Esrd related services, day ........................... +0.15 0.08 0.08 0.01 0.24 0.24 XXX 

90935 ......... ............ A Hemodialysis, one evaluation ...................... 1.22 NA 0.67 0.04 NA 1.93 000 

90937 ......... ............ A Hemodialysis, repeated eval ....................... 2.11 NA 0.98 0.07 NA 3.16 000 

90939 ......... ............ X Hemodialysis study, transcut ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90940 ......... ............ X Hemodialysis access study ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90945 ......... ............ A Dialysis, one evaluation ............................... 1.28 NA 0.70 0.05 NA 2.03 000 

90947 ......... ............ A Dialysis, repeated eval ................................ 2.16 NA 1.01 0.07 NA 3.24 000 

90989 ......... ............ X Dialysis training, complete ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90993 ......... ............ X Dialysis training, incompl ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

90997 ......... ............ A Hemoperfusion ............................................. 1.84 NA 1.41 0.06 NA 3.31 000 

90999 ......... ............ C Dialysis procedure ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91000 ......... ............ A Esophageal intubation ................................. 0.73 0.33 NA 0.05 1.11 NA 000 

91000 ......... 26 ....... A Esophageal intubation ................................. 0.73 0.25 0.25 0.04 1.02 1.02 000 

91000 ......... TC ...... A Esophageal intubation ................................. 0.00 0.08 NA 0.01 0.09 NA 000 

91010 ......... ............ A Esophagus motility study ............................. 1.25 2.71 NA 0.12 4.08 NA 000 

91010 ......... 26 ....... A Esophagus motility study ............................. 1.25 0.43 0.43 0.06 1.74 1.74 000 

91010 ......... TC ...... A Esophagus motility study ............................. 0.00 2.28 NA 0.06 2.34 NA 000 

91011 ......... ............ A Esophagus motility study ............................. 1.50 3.20 NA 0.12 4.82 NA 000 

91011 ......... 26 ....... A Esophagus motility study ............................. 1.50 0.53 0.53 0.06 2.09 2.09 000 

91011 ......... TC ...... A Esophagus motility study ............................. 0.00 2.67 NA 0.06 2.73 NA 000 

91012 ......... ............ A Esophagus motility study ............................. 1.46 3.34 NA 0.14 4.94 NA 000 

91012 ......... 26 ....... A Esophagus motility study ............................. 1.46 0.51 0.51 0.07 2.04 2.04 000 

91012 ......... TC ...... A Esophagus motility study ............................. 0.00 2.83 NA 0.07 2.90 NA 000 

91020 ......... ............ A Gastric motility ............................................. 1.44 2.93 NA 0.13 4.50 NA 000 

91020 ......... 26 ....... A Gastric motility ............................................. 1.44 0.48 0.48 0.07 1.99 1.99 000 

91020 ......... TC ...... A Gastric motility ............................................. 0.00 2.45 NA 0.06 2.51 NA 000 

91030 ......... ............ A Acid perfusion of esophagus ....................... 0.91 2.40 NA 0.06 3.37 NA 000 

91030 ......... 26 ....... A Acid perfusion of esophagus ....................... 0.91 0.33 0.33 0.04 1.28 1.28 000 

91030 ......... TC ...... A Acid perfusion of esophagus ....................... 0.00 2.07 NA 0.02 2.09 NA 000 

91032 ......... ............ A Esophagus, acid reflux test ......................... 1.21 4.10 NA 0.12 5.43 NA 000 

91032 ......... 26 ....... A Esophagus, acid reflux test ......................... 1.21 0.41 0.41 0.06 1.68 1.68 000 

91032 ......... TC ...... A Esophagus, acid reflux test ......................... 0.00 3.69 NA 0.06 3.75 NA 000 

91033 ......... ............ A Prolonged acid reflux test ............................ 1.30 4.16 NA 0.17 5.63 NA 000 

91033 ......... 26 ....... A Prolonged acid reflux test ............................ 1.30 0.45 0.45 0.06 1.81 1.81 000 

91033 ......... TC ...... A Prolonged acid reflux test ............................ 0.00 3.71 NA 0.11 3.82 NA 000 

91052 ......... ............ A Gastric analysis test .................................... 0.79 2.19 NA 0.06 3.04 NA 000 

91052 ......... 26 ....... A Gastric analysis test .................................... 0.79 0.28 0.28 0.04 1.11 1.11 000 

91052 ......... TC ...... A Gastric analysis test .................................... 0.00 1.91 NA 0.02 1.93 NA 000 

91055 ......... ............ A Gastric intubation for smear ........................ 0.94 2.37 NA 0.07 3.38 NA 000 

91055 ......... 26 ....... A Gastric intubation for smear ........................ 0.94 0.27 0.27 0.05 1.26 1.26 000 

91055 ......... TC ...... A Gastric intubation for smear ........................ 0.00 2.10 NA 0.02 2.12 NA 000 

91060 ......... ............ A Gastric saline load test ................................ 0.45 0.30 NA 0.04 0.79 NA 000 

91060 ......... 26 ....... A Gastric saline load test ................................ 0.45 0.14 0.14 0.02 0.61 0.61 000 

91060 ......... TC ...... A Gastric saline load test ................................ 0.00 0.16 NA 0.02 0.18 NA 000 

91065 ......... ............ A Breath hydrogen test ................................... 0.20 1.96 NA 0.03 2.19 NA 000 

91065 ......... 26 ....... A Breath hydrogen test ................................... 0.20 0.07 0.07 0.01 0.28 0.28 000 

91065 ......... TC ...... A Breath hydrogen test ................................... 0.00 1.89 NA 0.02 1.91 NA 000 

91100 ......... ............ A Pass intestine bleeding tube ....................... 1.08 NA 0.29 0.07 NA 1.44 000 

1221

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

91105 ......... ............ A Gastric intubation treatment ........................ 0.37 NA 0.09 0.02 NA 0.48 000 

91110 ......... ............ A Gi tract capsule endoscopy ......................... 3.64 21.13 NA 0.09 24.86 NA XXX 

91110 ......... 26 ....... A Gi tract capsule endoscopy ......................... 3.64 1.30 1.30 0.02 4.96 4.96 XXX 

91110 ......... TC ...... A Gi tract capsule endoscopy ......................... 0.00 19.83 NA 0.07 19.90 NA XXX 

91122 ......... ............ A Anal pressure record ................................... 1.77 6.06 NA 0.20 8.03 NA 000 

91122 ......... 26 ....... A Anal pressure record ................................... 1.77 0.60 0.60 0.12 2.49 2.49 000 

91122 ......... TC ...... A Anal pressure record ................................... 0.00 5.46 NA 0.08 5.54 NA 000 

91123 ......... ............ B Irrigate fecal impaction ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91132 ......... ............ C Electrogastrography ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91132 ......... 26 ....... A Electrogastrography ..................................... 0.52 0.19 0.19 0.04 0.75 0.75 XXX 

91132 ......... TC ...... C Electrogastrography ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91133 ......... ............ C Electrogastrography w/test .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91133 ......... 26 ....... A Electrogastrography w/test .......................... 0.66 0.24 0.24 0.04 0.94 0.94 XXX 

91133 ......... TC ...... C Electrogastrography w/test .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 ......... ............ C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 ......... 26 ....... C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

91299 ......... TC ...... C Gastroenterology procedure ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92002 ......... ............ A Eye exam, new patient ................................ 0.88 0.96 0.35 0.02 1.86 1.25 XXX 

92004 ......... ............ A Eye exam, new patient ................................ 1.67 1.68 0.68 0.04 3.39 2.39 XXX 

92012 ......... ............ A Eye exam established pat ........................... 0.67 1.02 0.29 0.01 1.70 0.97 XXX 

92014 ......... ............ A Eye exam & treatment ................................. 1.10 1.38 0.46 0.02 2.50 1.58 XXX 

92015 ......... ............ N Refraction ..................................................... +0.38 1.49 0.15 0.01 1.88 0.54 XXX 

92018 ......... ............ A New eye exam & treatment ......................... 2.50 NA 1.08 0.04 NA 3.62 XXX 

92019 ......... ............ A Eye exam & treatment ................................. 1.31 NA 0.56 0.04 NA 1.91 XXX 

92020 ......... ............ A Special eye evaluation ................................. 0.37 0.33 0.16 0.01 0.71 0.54 XXX 

92060 ......... ............ A Special eye evaluation ................................. 0.69 0.72 NA 0.02 1.43 NA XXX 

92060 ......... 26 ....... A Special eye evaluation ................................. 0.69 0.29 0.29 0.01 0.99 0.99 XXX 

92060 ......... TC ...... A Special eye evaluation ................................. 0.00 0.43 NA 0.01 0.44 NA XXX 

92065 ......... ............ A Orthoptic/pleoptic training ............................ 0.37 0.54 NA 0.02 0.93 NA XXX 

92065 ......... 26 ....... A Orthoptic/pleoptic training ............................ 0.37 0.15 0.15 0.01 0.53 0.53 XXX 

92065 ......... TC ...... A Orthoptic/pleoptic training ............................ 0.00 0.39 NA 0.01 0.40 NA XXX 

92070 ......... ............ A Fitting of contact lens .................................. 0.70 1.08 0.32 0.01 1.79 1.03 XXX 

92081 ......... ............ A Visual field examination(s) ........................... 0.36 0.85 NA 0.02 1.23 NA XXX 

92081 ......... 26 ....... A Visual field examination(s) ........................... 0.36 0.15 0.15 0.01 0.52 0.52 XXX 

92081 ......... TC ...... A Visual field examination(s) ........................... 0.00 0.70 NA 0.01 0.71 NA XXX 

92082 ......... ............ A Visual field examination(s) ........................... 0.44 1.15 NA 0.02 1.61 NA XXX 

92082 ......... 26 ....... A Visual field examination(s) ........................... 0.44 0.19 0.19 0.01 0.64 0.64 XXX 

92082 ......... TC ...... A Visual field examination(s) ........................... 0.00 0.96 NA 0.01 0.97 NA XXX 

92083 ......... ............ A Visual field examination(s) ........................... 0.50 1.33 NA 0.02 1.85 NA XXX 

92083 ......... 26 ....... A Visual field examination(s) ........................... 0.50 0.22 0.22 0.01 0.73 0.73 XXX 

92083 ......... TC ...... A Visual field examination(s) ........................... 0.00 1.11 NA 0.01 1.12 NA XXX 

92100 ......... ............ A Serial tonometry exam(s) ............................ 0.92 1.26 0.37 0.02 2.20 1.31 XXX 

92120 ......... ............ A Tonography & eye evaluation ...................... 0.81 1.04 0.32 0.02 1.87 1.15 XXX 

92130 ......... ............ A Water provocation tonography .................... 0.81 1.23 0.37 0.02 2.06 1.20 XXX 

92135 ......... ............ A Opthalmic dx imaging .................................. 0.35 0.78 NA 0.02 1.15 NA XXX 

92135 ......... 26 ....... A Opthalmic dx imaging .................................. 0.35 0.16 0.16 0.01 0.52 0.52 XXX 

92135 ......... TC ...... A Opthalmic dx imaging .................................. 0.00 0.62 NA 0.01 0.63 NA XXX 

92136 ......... ............ A Ophthalmic biometry .................................... 0.54 1.75 NA 0.08 2.37 NA XXX 

92136 ......... 26 ....... A Ophthalmic biometry .................................... 0.54 0.25 0.25 0.01 0.80 0.80 XXX 

92136 ......... TC ...... A Ophthalmic biometry .................................... 0.00 1.50 NA 0.07 1.57 NA XXX 

92140 ......... ............ A Glaucoma provocative tests ........................ 0.50 0.94 0.21 0.01 1.45 0.72 XXX 

92225 ......... ............ A Special eye exam, initial .............................. 0.38 0.22 0.16 0.01 0.61 0.55 XXX 

92226 ......... ............ A Special eye exam, subsequent ................... 0.33 0.21 0.15 0.01 0.55 0.49 XXX 

92230 ......... ............ A Eye exam with photos ................................. 0.60 1.67 0.20 0.02 2.29 0.82 XXX 

92235 ......... ............ A Eye exam with photos ................................. 0.81 2.93 NA 0.08 3.82 NA XXX 

92235 ......... 26 ....... A Eye exam with photos ................................. 0.81 0.37 0.37 0.02 1.20 1.20 XXX 

92235 ......... TC ...... A Eye exam with photos ................................. 0.00 2.56 NA 0.06 2.62 NA XXX 

92240 ......... ............ A Icg angiography ........................................... 1.10 7.03 NA 0.08 8.21 NA XXX 

92240 ......... 26 ....... A Icg angiography ........................................... 1.10 0.49 0.49 0.02 1.61 1.61 XXX 

92240 ......... TC ...... A Icg angiography ........................................... 0.00 6.54 NA 0.06 6.60 NA XXX 

92250 ......... ............ A Eye exam with photos ................................. 0.44 1.73 NA 0.02 2.19 NA XXX 

92250 ......... 26 ....... A Eye exam with photos ................................. 0.44 0.20 0.20 0.01 0.65 0.65 XXX 

92250 ......... TC ...... A Eye exam with photos ................................. 0.00 1.53 NA 0.01 1.54 NA XXX 

92260 ......... ............ A Ophthalmoscopy/dynamometry ................... 0.20 0.29 0.09 0.01 0.50 0.30 XXX 

92265 ......... ............ A Eye muscle evaluation ................................. 0.81 1.88 NA 0.04 2.73 NA XXX 

92265 ......... 26 ....... A Eye muscle evaluation ................................. 0.81 0.28 0.28 0.02 1.11 1.11 XXX 

92265 ......... TC ...... A Eye muscle evaluation ................................. 0.00 1.60 NA 0.02 1.62 NA XXX 

92270 ......... ............ A Electro-oculography ..................................... 0.81 1.56 NA 0.06 2.43 NA XXX 

92270 ......... 26 ....... A Electro-oculography ..................................... 0.81 0.34 0.34 0.04 1.19 1.19 XXX 

92270 ......... TC ...... A Electro-oculography ..................................... 0.00 1.22 NA 0.02 1.24 NA XXX 

92275 ......... ............ A Electroretinography ...................................... 1.01 1.93 NA 0.04 2.98 NA XXX 

92275 ......... 26 ....... A Electroretinography ...................................... 1.01 0.42 0.42 0.02 1.45 1.45 XXX 

92275 ......... TC ...... A Electroretinography ...................................... 0.00 1.51 NA 0.02 1.53 NA XXX 

92283 ......... ............ A Color vision examination ............................. 0.17 0.83 NA 0.02 1.02 NA XXX 

92283 ......... 26 ....... A Color vision examination ............................. 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

1222

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92283 ......... TC ...... A Color vision examination ............................. 0.00 0.76 NA 0.01 0.77 NA XXX 

92284 ......... ............ A Dark adaptation eye exam .......................... 0.24 2.31 NA 0.02 2.57 NA XXX 

92284 ......... 26 ....... A Dark adaptation eye exam .......................... 0.24 0.09 0.09 0.01 0.34 0.34 XXX 

92284 ......... TC ...... A Dark adaptation eye exam .......................... 0.00 2.22 NA 0.01 2.23 NA XXX 

92285 ......... ............ A Eye photography .......................................... 0.20 1.07 NA 0.02 1.29 NA XXX 

92285 ......... 26 ....... A Eye photography .......................................... 0.20 0.09 0.09 0.01 0.30 0.30 XXX 

92285 ......... TC ...... A Eye photography .......................................... 0.00 0.98 NA 0.01 0.99 NA XXX 

92286 ......... ............ A Internal eye photography ............................. 0.66 3.37 NA 0.03 4.06 NA XXX 

92286 ......... 26 ....... A Internal eye photography ............................. 0.66 0.30 0.30 0.01 0.97 0.97 XXX 

92286 ......... TC ...... A Internal eye photography ............................. 0.00 3.07 NA 0.02 3.09 NA XXX 

92287 ......... ............ A Internal eye photography ............................. 0.81 2.69 0.31 0.02 3.52 1.14 XXX 

92310 ......... ............ N Contact lens fitting ....................................... +1.17 1.12 0.45 0.04 2.33 1.66 XXX 

92311 ......... ............ A Contact lens fitting ....................................... 1.08 1.18 0.35 0.04 2.30 1.47 XXX 

92312 ......... ............ A Contact lens fitting ....................................... 1.26 1.16 0.49 0.04 2.46 1.79 XXX 

92313 ......... ............ A Contact lens fitting ....................................... 0.92 1.16 0.29 0.02 2.10 1.23 XXX 

92314 ......... ............ N Prescription of contact lens ......................... +0.69 0.94 0.27 0.01 1.64 0.97 XXX 

92315 ......... ............ A Prescription of contact lens ......................... 0.45 0.95 0.16 0.01 1.41 0.62 XXX 

92316 ......... ............ A Prescription of contact lens ......................... 0.68 1.00 0.30 0.01 1.69 0.99 XXX 

92317 ......... ............ A Prescription of contact lens ......................... 0.45 1.05 0.15 0.01 1.51 0.61 XXX 

92325 ......... ............ A Modification of contact lens ......................... 0.00 0.39 NA 0.01 0.40 NA XXX 

92326 ......... ............ A Replacement of contact lens ....................... 0.00 1.64 NA 0.06 1.70 NA XXX 

92330 ......... ............ A Fitting of artificial eye ................................... 1.08 1.08 0.33 0.05 2.21 1.46 XXX 

92335 ......... ............ A Fitting of artificial eye ................................... 0.45 1.01 0.17 0.01 1.47 0.63 XXX 

92340 ......... ............ N Fitting of spectacles ..................................... +0.37 0.70 0.14 0.01 1.08 0.52 XXX 

92341 ......... ............ N Fitting of spectacles ..................................... +0.47 0.74 0.18 0.01 1.22 0.66 XXX 

92342 ......... ............ N Fitting of spectacles ..................................... +0.53 0.76 0.21 0.01 1.30 0.75 XXX 

92352 ......... ............ B Special spectacles fitting ............................. +0.37 0.73 0.14 0.01 1.11 0.52 XXX 

92353 ......... ............ B Special spectacles fitting ............................. +0.50 0.78 0.19 0.02 1.30 0.71 XXX 

92354 ......... ............ B Special spectacles fitting ............................. +0.00 8.89 NA 0.10 8.99 NA XXX 

92355 ......... ............ B Special spectacles fitting ............................. +0.00 4.34 NA 0.01 4.35 NA XXX 

92358 ......... ............ B Eye prosthesis service ................................. +0.00 0.97 NA 0.05 1.02 NA XXX 

92370 ......... ............ N Repair & adjust spectacles .......................... +0.32 0.55 0.13 0.02 0.89 0.47 XXX 

92371 ......... ............ B Repair & adjust spectacles .......................... +0.00 0.62 NA 0.02 0.64 NA XXX 

92390 ......... ............ N Supply of spectacles .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92391 ......... ............ N Supply of contact lenses ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92392 ......... ............ I Supply of low vision aids ............................. +0.00 3.79 3.79 0.02 3.81 3.81 XXX 

92393 ......... ............ I Supply of artificial eye ................................. +0.00 11.76 11.76 0.57 12.33 12.33 XXX 

92395 ......... ............ I Supply of spectacles .................................... +0.00 1.28 1.28 0.10 1.38 1.38 XXX 

92396 ......... ............ I Supply of contact lenses ............................. +0.00 2.16 2.16 0.07 2.23 2.23 XXX 

92499 ......... ............ C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92499 ......... 26 ....... C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92499 ......... TC ...... C Eye service or procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92502 ......... ............ A Ear and throat examination ......................... 1.51 NA 1.13 0.07 NA 2.71 000 

92504 ......... ............ A Ear microscopy examination ....................... 0.18 0.49 0.09 0.01 0.68 0.28 XXX 

92506 ......... ............ A Speech/hearing evaluation .......................... 0.86 2.61 0.40 0.05 3.52 1.31 XXX 

92507 ......... ............ A Speech/hearing therapy ............................... 0.52 1.13 0.24 0.02 1.67 0.78 XXX 

92508 ......... ............ A Speech/hearing therapy ............................... 0.26 0.52 0.12 0.01 0.79 0.39 XXX 

92510 ......... ............ I Rehab for ear implant .................................. +1.50 2.08 0.82 0.07 3.65 2.39 XXX 

92511 ......... ............ A Nasopharyngoscopy .................................... 0.84 3.14 0.79 0.04 4.02 1.67 000 

92512 ......... ............ A Nasal function studies ................................. 0.55 1.08 0.18 0.02 1.65 0.75 XXX 

92516 ......... ............ A Facial nerve function test ............................ 0.43 0.89 0.22 0.02 1.34 0.67 XXX 

92520 ......... ............ A Laryngeal function studies ........................... 0.76 0.50 0.38 0.04 1.30 1.18 XXX 

92526 ......... ............ A Oral function therapy ................................... 0.55 1.66 0.20 0.02 2.23 0.77 XXX 

92531 ......... ............ B Spontaneous nystagmus study ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92532 ......... ............ B Positional nystagmus test ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92533 ......... ............ B Caloric vestibular test .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92534 ......... ............ B Optokinetic nystagmus test ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92541 ......... ............ A Spontaneous nystagmus test ...................... 0.40 0.97 NA 0.04 1.41 NA XXX 

92541 ......... 26 ....... A Spontaneous nystagmus test ...................... 0.40 0.19 0.19 0.02 0.61 0.61 XXX 

92541 ......... TC ...... A Spontaneous nystagmus test ...................... 0.00 0.78 NA 0.02 0.80 NA XXX 

92542 ......... ............ A Positional nystagmus test ............................ 0.33 1.06 NA 0.03 1.42 NA XXX 

92542 ......... 26 ....... A Positional nystagmus test ............................ 0.33 0.16 0.16 0.01 0.50 0.50 XXX 

92542 ......... TC ...... A Positional nystagmus test ............................ 0.00 0.90 NA 0.02 0.92 NA XXX 

92543 ......... ............ A Caloric vestibular test .................................. 0.10 0.53 NA 0.02 0.65 NA XXX 

92543 ......... 26 ....... A Caloric vestibular test .................................. 0.10 0.05 0.05 0.01 0.16 0.16 XXX 

92543 ......... TC ...... A Caloric vestibular test .................................. 0.00 0.48 NA 0.01 0.49 NA XXX 

92544 ......... ............ A Optokinetic nystagmus test ......................... 0.26 0.84 NA 0.03 1.13 NA XXX 

92544 ......... 26 ....... A Optokinetic nystagmus test ......................... 0.26 0.12 0.12 0.01 0.39 0.39 XXX 

92544 ......... TC ...... A Optokinetic nystagmus test ......................... 0.00 0.72 NA 0.02 0.74 NA XXX 

92545 ......... ............ A Oscillating tracking test ................................ 0.23 0.79 NA 0.03 1.05 NA XXX 

92545 ......... 26 ....... A Oscillating tracking test ................................ 0.23 0.11 0.11 0.01 0.35 0.35 XXX 

92545 ......... TC ...... A Oscillating tracking test ................................ 0.00 0.68 NA 0.02 0.70 NA XXX 

92546 ......... ............ A Sinusoidal rotational test ............................. 0.29 1.80 NA 0.03 2.12 NA XXX 

92546 ......... 26 ....... A Sinusoidal rotational test ............................. 0.29 0.13 0.13 0.01 0.43 0.43 XXX 

92546 ......... TC ...... A Sinusoidal rotational test ............................. 0.00 1.67 NA 0.02 1.69 NA XXX 

1223

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92547 ......... ............ A Supplemental electrical test ......................... 0.00 1.15 NA 0.06 1.21 NA ZZZ 

92548 ......... ............ A Posturography .............................................. 0.50 3.19 NA 0.15 3.84 NA XXX 

92548 ......... 26 ....... A Posturography .............................................. 0.50 0.26 0.26 0.02 0.78 0.78 XXX 

92548 ......... TC ...... A Posturography .............................................. 0.00 2.93 NA 0.13 3.06 NA XXX 

92551 ......... ............ N Pure tone hearing test, air ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92552 ......... ............ A Pure tone audiometry, air ............................ 0.00 0.44 NA 0.04 0.48 NA XXX 

92553 ......... ............ A Audiometry, air & bone ................................ 0.00 0.66 NA 0.06 0.72 NA XXX 

92555 ......... ............ A Speech threshold audiometry ...................... 0.00 0.37 NA 0.04 0.41 NA XXX 

92556 ......... ............ A Speech audiometry, complete ..................... 0.00 0.57 NA 0.06 0.63 NA XXX 

92557 ......... ............ A Comprehensive hearing test ........................ 0.00 1.19 NA 0.12 1.31 NA XXX 

92559 ......... ............ N Group audiometric testing ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92560 ......... ............ N Bekesy audiometry, screen ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92561 ......... ............ A Bekesy audiometry, diagnosis ..................... 0.00 0.72 NA 0.06 0.78 NA XXX 

92562 ......... ............ A Loudness balance test ................................. 0.00 0.40 NA 0.04 0.44 NA XXX 

92563 ......... ............ A Tone decay hearing test .............................. 0.00 0.37 NA 0.04 0.41 NA XXX 

92564 ......... ............ A Sisi hearing test ........................................... 0.00 0.47 NA 0.05 0.52 NA XXX 

92565 ......... ............ A Stenger test, pure tone ................................ 0.00 0.39 NA 0.04 0.43 NA XXX 

92567 ......... ............ A Tympanometry ............................................. 0.00 0.52 NA 0.06 0.58 NA XXX 

92568 ......... ............ A Acoustic reflex testing .................................. 0.00 0.37 NA 0.04 0.41 NA XXX 

92569 ......... ............ A Acoustic reflex decay test ............................ 0.00 0.40 NA 0.04 0.44 NA XXX 

92571 ......... ............ A Filtered speech hearing test ........................ 0.00 0.38 NA 0.04 0.42 NA XXX 

92572 ......... ............ A Staggered spondaic word test ..................... 0.00 0.09 NA 0.01 0.10 NA XXX 

92573 ......... ............ A Lombard test ................................................ 0.00 0.35 NA 0.04 0.39 NA XXX 

92575 ......... ............ A Sensorineural acuity test ............................. 0.00 0.30 NA 0.02 0.32 NA XXX 

92576 ......... ............ A Synthetic sentence test ............................... 0.00 0.44 NA 0.05 0.49 NA XXX 

92577 ......... ............ A Stenger test, speech .................................... 0.00 0.72 NA 0.07 0.79 NA XXX 

92579 ......... ............ A Visual audiometry (vra) ................................ 0.00 0.73 NA 0.06 0.79 NA XXX 

92582 ......... ............ A Conditioning play audiometry ...................... 0.00 0.73 NA 0.06 0.79 NA XXX 

92583 ......... ............ A Select picture audiometry ............................ 0.00 0.89 NA 0.08 0.97 NA XXX 

92584 ......... ............ A Electrocochleography .................................. 0.00 2.49 NA 0.21 2.70 NA XXX 

92585 ......... ............ A Auditor evoke potent, compre ..................... 0.50 2.08 NA 0.16 2.74 NA XXX 

92585 ......... 26 ....... A Auditor evoke potent, compre ..................... 0.50 0.22 0.22 0.02 0.74 0.74 XXX 

92585 ......... TC ...... A Auditor evoke potent, compre ..................... 0.00 1.86 NA 0.14 2.00 NA XXX 

92586 ......... ............ A Auditor evoke potent, limit ........................... 0.00 1.86 NA 0.14 2.00 NA XXX 

92587 ......... ............ A Evoked auditory test .................................... 0.13 1.38 NA 0.12 1.63 NA XXX 

92587 ......... 26 ....... A Evoked auditory test .................................... 0.13 0.07 0.07 0.01 0.21 0.21 XXX 

92587 ......... TC ...... A Evoked auditory test .................................... 0.00 1.31 NA 0.11 1.42 NA XXX 

92588 ......... ............ A Evoked auditory test .................................... 0.36 1.64 NA 0.14 2.14 NA XXX 

92588 ......... 26 ....... A Evoked auditory test .................................... 0.36 0.17 0.17 0.01 0.54 0.54 XXX 

92588 ......... TC ...... A Evoked auditory test .................................... 0.00 1.47 NA 0.13 1.60 NA XXX 

92589 ......... ............ A Auditory function test(s) ............................... 0.00 0.53 NA 0.06 0.59 NA XXX 

92590 ......... ............ N Hearing aid exam, one ear .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92591 ......... ............ N Hearing aid exam, both ears ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92592 ......... ............ N Hearing aid check, one ear ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92593 ......... ............ N Hearing aid check, both ears ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92594 ......... ............ N Electro hearng aid test, one ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92595 ......... ............ N Electro hearng aid tst, both ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92596 ......... ............ A Ear protector evaluation .............................. 0.00 0.59 NA 0.06 0.65 NA XXX 

92597 ......... ............ A Oral speech device eval .............................. 0.86 1.69 0.45 0.05 2.60 1.36 XXX 

92601 ......... ............ A Cochlear implt f/up exam < 7 ...................... 0.00 3.41 NA 0.07 3.48 NA XXX 

92602 ......... ............ A Reprogram cochlear implt < 7 ..................... 0.00 2.36 NA 0.07 2.43 NA XXX 

92603 ......... ............ A Cochlear implt f/up exam 7 > ...................... 0.00 2.23 NA 0.07 2.30 NA XXX 

92604 ......... ............ A Reprogram cochlear implt 7 > ..................... 0.00 1.47 NA 0.07 1.54 NA XXX 

92605 ......... ............ B Eval for nonspeech device rx ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92606 ......... ............ B Non-speech device service ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92607 ......... ............ A Ex for speech device rx, 1hr ....................... 0.00 3.22 NA 0.05 3.27 NA XXX 

92608 ......... ............ A Ex for speech device rx addl ....................... 0.00 0.67 NA 0.05 0.72 NA XXX 

92609 ......... ............ A Use of speech device service ..................... 0.00 1.60 NA 0.04 1.64 NA XXX 

92610 ......... ............ A Evaluate swallowing function ....................... 0.00 3.44 NA 0.08 3.52 NA XXX 

92611 ......... ............ A Motion fluoroscopy/swallow ......................... 0.00 3.44 NA 0.08 3.52 NA XXX 

92612 ......... ............ A Endoscopy swallow tst (fees) ...................... 1.27 2.71 0.67 0.08 4.06 2.02 XXX 

92613 ......... ............ A Endoscopy swallow tst (fees) ...................... 0.71 0.39 0.39 0.05 1.15 1.15 XXX 

92614 ......... ............ A Laryngoscopic sensory test ......................... 1.27 2.41 0.61 0.08 3.76 1.96 XXX 

92615 ......... ............ A Eval laryngoscopy sense tst ........................ 0.63 0.36 0.36 0.05 1.04 1.04 XXX 

92616 ......... ............ A Fees w/laryngeal sense test ........................ 1.88 3.29 0.97 0.08 5.25 2.93 XXX 

92617 ......... ............ A Interprt fees/laryngeal test ........................... 0.79 0.44 0.44 0.05 1.28 1.28 XXX 

92700 ......... ............ C Ent procedure/service .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

92950 ......... ............ A Heart/lung resuscitation cpr ......................... 3.79 NA 0.98 0.25 NA 5.02 000 

92953 ......... ............ A Temporary external pacing .......................... 0.23 NA 0.23 0.01 NA 0.47 000 

92960 ......... ............ A Cardioversion electric, ext ........................... 2.25 6.66 1.17 0.10 9.01 3.52 000 

92961 ......... ............ A Cardioversion, electric, int ........................... 4.59 NA 2.09 0.21 NA 6.89 000 

92970 ......... ............ A Cardioassist, internal ................................... 3.51 NA 1.07 0.21 NA 4.79 000 

92971 ......... ............ A Cardioassist, external .................................. 1.77 NA 0.85 0.07 NA 2.69 000 

92973 ......... ............ A Percut coronary thrombectomy ................... 3.28 NA 1.29 0.14 NA 4.71 ZZZ 

92974 ......... ............ A Cath place, cardio brachytx ......................... 3.00 NA 1.18 0.17 NA 4.35 ZZZ 

1224

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

92975 ......... ............ A Dissolve clot, heart vessel ........................... 7.24 NA 2.81 0.27 NA 10.32 000 

92977 ......... ............ A Dissolve clot, heart vessel ........................... 0.00 8.08 NA 0.46 8.54 NA XXX 

92978 ......... ............ A Intravasc us, heart add-on ........................... 1.80 5.29 NA 0.31 7.40 NA ZZZ 

92978 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.80 0.71 0.71 0.07 2.58 2.58 ZZZ 

92978 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 4.58 NA 0.24 4.82 NA ZZZ 

92979 ......... ............ A Intravasc us, heart add-on ........................... 1.44 2.86 NA 0.18 4.48 NA ZZZ 

92979 ......... 26 ....... A Intravasc us, heart add-on ........................... 1.44 0.56 0.56 0.05 2.05 2.05 ZZZ 

92979 ......... TC ...... A Intravasc us, heart add-on ........................... 0.00 2.30 NA 0.13 2.43 NA ZZZ 

92980 ......... ............ A Insert intracoronary stent ............................. 14.82 NA 6.07 0.86 NA 21.75 000 

92981 ......... ............ A Insert intracoronary stent ............................. 4.16 NA 1.64 0.24 NA 6.04 ZZZ 

92982 ......... ............ A Coronary artery dilation ............................... 10.96 NA 4.55 0.63 NA 16.14 000 

92984 ......... ............ A Coronary artery dilation ............................... 2.97 NA 1.16 0.17 NA 4.30 ZZZ 

92986 ......... ............ A Revision of aortic valve ............................... 21.77 NA 11.62 1.37 NA 34.76 090 

92987 ......... ............ A Revision of mitral valve ............................... 22.67 NA 12.01 1.42 NA 36.10 090 

92990 ......... ............ A Revision of pulmonary valve ....................... 17.31 NA 9.63 1.09 NA 28.03 090 

92992 ......... ............ C Revision of heart chamber .......................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

92993 ......... ............ C Revision of heart chamber .......................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

92995 ......... ............ A Coronary atherectomy ................................. 12.07 NA 4.98 0.70 NA 17.75 000 

92996 ......... ............ A Coronary atherectomy add-on ..................... 3.26 NA 1.28 0.19 NA 4.73 ZZZ 

92997 ......... ............ A Pul art balloon repr, percut .......................... 11.98 NA 4.85 0.76 NA 17.59 000 

92998 ......... ............ A Pul art balloon repr, percut .......................... 5.99 NA 2.21 0.37 NA 8.57 ZZZ 

93000 ......... ............ A Electrocardiogram, complete ....................... 0.17 0.51 NA 0.03 0.71 NA XXX 

93005 ......... ............ A Electrocardiogram, tracing ........................... 0.00 0.45 NA 0.02 0.47 NA XXX 

93010 ......... ............ A Electrocardiogram report ............................. 0.17 0.06 0.06 0.01 0.24 0.24 XXX 

93012 ......... ............ A Transmission of ecg .................................... 0.00 6.04 NA 0.18 6.22 NA XXX 

93014 ......... ............ A Report on transmitted ecg ........................... 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93015 ......... ............ A Cardiovascular stress test ........................... 0.75 1.98 NA 0.13 2.86 NA XXX 

93016 ......... ............ A Cardiovascular stress test ........................... 0.45 0.17 0.17 0.01 0.63 0.63 XXX 

93017 ......... ............ A Cardiovascular stress test ........................... 0.00 1.69 NA 0.11 1.80 NA XXX 

93018 ......... ............ A Cardiovascular stress test ........................... 0.30 0.12 0.12 0.01 0.43 0.43 XXX 

93024 ......... ............ A Cardiac drug stress test .............................. 1.17 1.57 NA 0.13 2.87 NA XXX 

93024 ......... 26 ....... A Cardiac drug stress test .............................. 1.17 0.45 0.45 0.05 1.67 1.67 XXX 

93024 ......... TC ...... A Cardiac drug stress test .............................. 0.00 1.12 NA 0.08 1.20 NA XXX 

93025 ......... ............ A Microvolt t-wave assess .............................. 0.75 8.18 NA 0.13 9.06 NA XXX 

93025 ......... 26 ....... A Microvolt t-wave assess .............................. 0.75 0.29 0.29 0.02 1.06 1.06 XXX 

93025 ......... TC ...... A Microvolt t-wave assess .............................. 0.00 7.89 NA 0.11 8.00 NA XXX 

93040 ......... ............ A Rhythm ECG with report ............................. 0.16 0.20 NA 0.02 0.38 NA XXX 

93041 ......... ............ A Rhythm ECG, tracing ................................... 0.00 0.15 NA 0.01 0.16 NA XXX 

93042 ......... ............ A Rhythm ECG, report .................................... 0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93224 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.63 NA 0.24 4.39 NA XXX 

93225 ......... ............ A ECG monitor/record, 24 hrs ........................ 0.00 1.24 NA 0.08 1.32 NA XXX 

93226 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.19 NA 0.14 2.33 NA XXX 

93227 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

93230 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.52 3.90 NA 0.26 4.68 NA XXX 

93231 ......... ............ A Ecg monitor/record, 24 hrs .......................... 0.00 1.52 NA 0.11 1.63 NA XXX 

93232 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.18 NA 0.13 2.31 NA XXX 

93233 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.52 0.20 0.20 0.02 0.74 0.74 XXX 

93235 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.45 2.79 NA 0.15 3.39 NA XXX 

93236 ......... ............ A ECG monitor/report, 24 hrs ......................... 0.00 2.62 NA 0.14 2.76 NA XXX 

93237 ......... ............ A ECG monitor/review, 24 hrs ........................ 0.45 0.17 0.17 0.01 0.63 0.63 XXX 

93268 ......... ............ A ECG record/review ...................................... 0.52 7.47 NA 0.28 8.27 NA XXX 

93270 ......... ............ A ECG recording ............................................. 0.00 1.24 NA 0.08 1.32 NA XXX 

93271 ......... ............ A Ecg/monitoring and analysis ........................ 0.00 6.04 NA 0.18 6.22 NA XXX 

93272 ......... ............ A Ecg/review, interpret only ............................ 0.52 0.19 0.19 0.02 0.73 0.73 XXX 

93278 ......... ............ A ECG/signal-averaged ................................... 0.25 1.25 NA 0.12 1.62 NA XXX 

93278 ......... 26 ....... A ECG/signal-averaged ................................... 0.25 0.10 0.10 0.01 0.36 0.36 XXX 

93278 ......... TC ...... A ECG/signal-averaged ................................... 0.00 1.15 NA 0.11 1.26 NA XXX 

93303 ......... ............ A Echo transthoracic ....................................... 1.30 4.35 NA 0.28 5.93 NA XXX 

93303 ......... 26 ....... A Echo transthoracic ....................................... 1.30 0.48 0.48 0.05 1.83 1.83 XXX 

93303 ......... TC ...... A Echo transthoracic ....................................... 0.00 3.87 NA 0.23 4.10 NA XXX 

93304 ......... ............ A Echo transthoracic ....................................... 0.75 2.23 NA 0.15 3.13 NA XXX 

93304 ......... 26 ....... A Echo transthoracic ....................................... 0.75 0.28 0.28 0.02 1.05 1.05 XXX 

93304 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.95 NA 0.13 2.08 NA XXX 

93307 ......... ............ A Echo exam of heart ..................................... 0.92 4.23 NA 0.27 5.42 NA XXX 

93307 ......... 26 ....... A Echo exam of heart ..................................... 0.92 0.36 0.36 0.04 1.32 1.32 XXX 

93307 ......... TC ...... A Echo exam of heart ..................................... 0.00 3.87 NA 0.23 4.10 NA XXX 

93308 ......... ............ A Echo exam of heart ..................................... 0.53 2.16 NA 0.15 2.84 NA XXX 

93308 ......... 26 ....... A Echo exam of heart ..................................... 0.53 0.21 0.21 0.02 0.76 0.76 XXX 

93308 ......... TC ...... A Echo exam of heart ..................................... 0.00 1.95 NA 0.13 2.08 NA XXX 

93312 ......... ............ A Echo transesophageal ................................. 2.20 4.58 NA 0.39 7.17 NA XXX 

93312 ......... 26 ....... A Echo transesophageal ................................. 2.20 0.79 0.79 0.10 3.09 3.09 XXX 

93312 ......... TC ...... A Echo transesophageal ................................. 0.00 3.79 NA 0.29 4.08 NA XXX 

93313 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.21 0.06 NA 1.22 XXX 

93314 ......... ............ A Echo transesophageal ................................. 1.25 4.26 NA 0.34 5.85 NA XXX 

93314 ......... 26 ....... A Echo transesophageal ................................. 1.25 0.47 0.47 0.05 1.77 1.77 XXX 

1225

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93314 ......... TC ...... A Echo transesophageal ................................. 0.00 3.79 NA 0.29 4.08 NA XXX 

93315 ......... ............ C Echo transesophageal ................................. 0.00 0.00 NA 0.00 0.00 NA XXX 

93315 ......... 26 ....... A Echo transesophageal ................................. 2.78 1.02 1.02 0.12 3.92 3.92 XXX 

93315 ......... TC ...... C Echo transesophageal ................................. 0.00 0.00 NA 0.00 0.00 NA XXX 

93316 ......... ............ A Echo transesophageal ................................. 0.95 NA 0.24 0.06 NA 1.25 XXX 

93317 ......... ............ C Echo transesophageal ................................. 0.00 0.00 NA 0.00 0.00 NA XXX 

93317 ......... 26 ....... A Echo transesophageal ................................. 1.83 0.67 0.67 0.07 2.57 2.57 XXX 

93317 ......... TC ...... C Echo transesophageal ................................. 0.00 0.00 NA 0.00 0.00 NA XXX 

93318 ......... ............ C Echo transesophageal intraop ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93318 ......... 26 ....... A Echo transesophageal intraop ..................... 2.20 0.47 0.47 0.07 2.74 2.74 XXX 

93318 ......... TC ...... C Echo transesophageal intraop ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93320 ......... ............ A Doppler echo exam, heart ........................... 0.38 1.87 NA 0.13 2.38 NA ZZZ 

93320 ......... 26 ....... A Doppler echo exam, heart ........................... 0.38 0.15 0.15 0.01 0.54 0.54 ZZZ 

93320 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.72 NA 0.12 1.84 NA ZZZ 

93321 ......... ............ A Doppler echo exam, heart ........................... 0.15 1.18 NA 0.09 1.42 NA ZZZ 

93321 ......... 26 ....... A Doppler echo exam, heart ........................... 0.15 0.06 0.06 0.01 0.22 0.22 ZZZ 

93321 ......... TC ...... A Doppler echo exam, heart ........................... 0.00 1.12 NA 0.08 1.20 NA ZZZ 

93325 ......... ............ A Doppler color flow add-on ........................... 0.07 2.94 NA 0.22 3.23 NA ZZZ 

93325 ......... 26 ....... A Doppler color flow add-on ........................... 0.07 0.03 0.03 0.01 0.11 0.11 ZZZ 

93325 ......... TC ...... A Doppler color flow add-on ........................... 0.00 2.91 NA 0.21 3.12 NA ZZZ 

93350 ......... ............ A Echo transthoracic ....................................... 1.48 2.34 NA 0.15 3.97 NA XXX 

93350 ......... 26 ....... A Echo transthoracic ....................................... 1.48 0.57 0.57 0.02 2.07 2.07 XXX 

93350 ......... TC ...... A Echo transthoracic ....................................... 0.00 1.77 NA 0.13 1.90 NA XXX 

93501 ......... ............ A Right heart catheterization ........................... 3.02 18.11 NA 1.24 22.37 NA 000 

93501 ......... 26 ....... A Right heart catheterization ........................... 3.02 1.15 1.15 0.19 4.36 4.36 000 

93501 ......... TC ...... A Right heart catheterization ........................... 0.00 16.96 NA 1.05 18.01 NA 000 

93503 ......... ............ A Insert/place heart catheter ........................... 2.91 NA 0.68 0.19 NA 3.78 000 

93505 ......... ............ A Biopsy of heart lining ................................... 4.37 3.68 NA 0.44 8.49 NA 000 

93505 ......... 26 ....... A Biopsy of heart lining ................................... 4.37 1.69 1.69 0.28 6.34 6.34 000 

93505 ......... TC ...... A Biopsy of heart lining ................................... 0.00 1.99 NA 0.16 2.15 NA 000 

93508 ......... ............ A Cath placement, angiography ...................... 4.09 14.73 NA 0.90 19.72 NA 000 

93508 ......... 26 ....... A Cath placement, angiography ...................... 4.09 2.09 2.09 0.25 6.43 6.43 000 

93508 ......... TC ...... A Cath placement, angiography ...................... 0.00 12.64 NA 0.65 13.29 NA 000 

93510 ......... ............ A Left heart catheterization ............................. 4.32 39.26 NA 2.57 46.15 NA 000 

93510 ......... 26 ....... A Left heart catheterization ............................. 4.32 2.18 2.18 0.27 6.77 6.77 000 

93510 ......... TC ...... A Left heart catheterization ............................. 0.00 37.08 NA 2.30 39.38 NA 000 

93511 ......... ............ A Left heart catheterization ............................. 5.02 38.55 NA 2.54 46.11 NA 000 

93511 ......... 26 ....... A Left heart catheterization ............................. 5.02 2.45 2.45 0.31 7.78 7.78 000 

93511 ......... TC ...... A Left heart catheterization ............................. 0.00 36.10 NA 2.23 38.33 NA 000 

93514 ......... ............ A Left heart catheterization ............................. 7.04 39.24 NA 2.68 48.96 NA 000 

93514 ......... 26 ....... A Left heart catheterization ............................. 7.04 3.14 3.14 0.45 10.63 10.63 000 

93514 ......... TC ...... A Left heart catheterization ............................. 0.00 36.10 NA 2.23 38.33 NA 000 

93524 ......... ............ A Left heart catheterization ............................. 6.94 50.36 NA 3.36 60.66 NA 000 

93524 ......... 26 ....... A Left heart catheterization ............................. 6.94 3.19 3.19 0.43 10.56 10.56 000 

93524 ......... TC ...... A Left heart catheterization ............................. 0.00 47.17 NA 2.93 50.10 NA 000 

93526 ......... ............ A Rt & Lt heart catheters ................................ 5.98 51.28 NA 3.39 60.65 NA 000 

93526 ......... 26 ....... A Rt & Lt heart catheters ................................ 5.98 2.82 2.82 0.37 9.17 9.17 000 

93526 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 48.46 NA 3.02 51.48 NA 000 

93527 ......... ............ A Rt & Lt heart catheters ................................ 7.27 50.50 NA 3.39 61.16 NA 000 

93527 ......... 26 ....... A Rt & Lt heart catheters ................................ 7.27 3.33 3.33 0.46 11.06 11.06 000 

93527 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 47.17 NA 2.93 50.10 NA 000 

93528 ......... ............ A Rt & Lt heart catheters ................................ 8.99 51.22 NA 3.50 63.71 NA 000 

93528 ......... 26 ....... A Rt & Lt heart catheters ................................ 8.99 4.05 4.05 0.57 13.61 13.61 000 

93528 ......... TC ...... A Rt & Lt heart catheters ................................ 0.00 47.17 NA 2.93 50.10 NA 000 

93529 ......... ............ A Rt, lt heart catheterization ........................... 4.79 49.46 NA 3.23 57.48 NA 000 

93529 ......... 26 ....... A Rt, lt heart catheterization ........................... 4.79 2.29 2.29 0.30 7.38 7.38 000 

93529 ......... TC ...... A Rt, lt heart catheterization ........................... 0.00 47.17 NA 2.93 50.10 NA 000 

93530 ......... ............ A Rt heart cath, congenital ............................. 4.22 18.90 NA 1.34 24.46 NA 000 

93530 ......... 26 ....... A Rt heart cath, congenital ............................. 4.22 1.94 1.94 0.29 6.45 6.45 000 

93530 ......... TC ...... A Rt heart cath, congenital ............................. 0.00 16.96 NA 1.05 18.01 NA 000 

93531 ......... ............ A R & l heart cath, congenital ......................... 8.34 52.05 NA 3.57 63.96 NA 000 

93531 ......... 26 ....... A R & l heart cath, congenital ......................... 8.34 3.59 3.59 0.55 12.48 12.48 000 

93531 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 48.46 NA 3.02 51.48 NA 000 

93532 ......... ............ A R & l heart cath, congenital ......................... 9.99 51.44 NA 3.56 64.99 NA 000 

93532 ......... 26 ....... A R & l heart cath, congenital ......................... 9.99 4.27 4.27 0.63 14.89 14.89 000 

93532 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 47.17 NA 2.93 50.10 NA 000 

93533 ......... ............ A R & l heart cath, congenital ......................... 6.69 49.98 NA 3.45 60.12 NA 000 

93533 ......... 26 ....... A R & l heart cath, congenital ......................... 6.69 2.81 2.81 0.52 10.02 10.02 000 

93533 ......... TC ...... A R & l heart cath, congenital ......................... 0.00 47.17 NA 2.93 50.10 NA 000 

93539 ......... ............ A Injection, cardiac cath .................................. 0.40 NA 0.16 0.01 NA 0.57 000 

93540 ......... ............ A Injection, cardiac cath .................................. 0.43 NA 0.17 0.01 NA 0.61 000 

93541 ......... ............ A Injection for lung angiogram ........................ 0.29 NA 0.11 0.01 NA 0.41 000 

93542 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.11 0.01 NA 0.41 000 

93543 ......... ............ A Injection for heart x-rays .............................. 0.29 NA 0.12 0.01 NA 0.42 000 

93544 ......... ............ A Injection for aortography .............................. 0.25 NA 0.10 0.01 NA 0.36 000 

1226

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93545 ......... ............ A Inject for coronary x-rays ............................. 0.40 NA 0.16 0.01 NA 0.57 000 

93555 ......... ............ A Imaging, cardiac cath .................................. 0.81 6.62 NA 0.38 7.81 NA XXX 

93555 ......... 26 ....... A Imaging, cardiac cath .................................. 0.81 0.32 0.32 0.04 1.17 1.17 XXX 

93555 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 6.30 NA 0.34 6.64 NA XXX 

93556 ......... ............ A Imaging, cardiac cath .................................. 0.83 10.26 NA 0.55 11.64 NA XXX 

93556 ......... 26 ....... A Imaging, cardiac cath .................................. 0.83 0.33 0.33 0.04 1.20 1.20 XXX 

93556 ......... TC ...... A Imaging, cardiac cath .................................. 0.00 9.93 NA 0.51 10.44 NA XXX 

93561 ......... ............ A Cardiac output measurement ...................... 0.50 0.68 NA 0.08 1.26 NA 000 

93561 ......... 26 ....... A Cardiac output measurement ...................... 0.50 0.16 0.16 0.02 0.68 0.68 000 

93561 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.52 NA 0.06 0.58 NA 000 

93562 ......... ............ A Cardiac output measurement ...................... 0.16 0.37 NA 0.05 0.58 NA 000 

93562 ......... 26 ....... A Cardiac output measurement ...................... 0.16 0.05 0.05 0.01 0.22 0.22 000 

93562 ......... TC ...... A Cardiac output measurement ...................... 0.00 0.32 NA 0.04 0.36 NA 000 

93571 ......... ............ A Heart flow reserve measure ........................ 1.80 5.26 NA 0.37 7.43 NA ZZZ 

93571 ......... 26 ....... A Heart flow reserve measure ........................ 1.80 0.68 0.68 0.13 2.61 2.61 ZZZ 

93571 ......... TC ...... A Heart flow reserve measure ........................ 0.00 4.58 NA 0.24 4.82 NA ZZZ 

93572 ......... ............ A Heart flow reserve measure ........................ 1.44 2.80 NA 0.34 4.58 NA ZZZ 

93572 ......... 26 ....... A Heart flow reserve measure ........................ 1.44 0.50 0.50 0.21 2.15 2.15 ZZZ 

93572 ......... TC ...... A Heart flow reserve measure ........................ 0.00 2.30 NA 0.13 2.43 NA ZZZ 

93580 ......... ............ A Transcath closure of asd ............................. 17.97 NA 7.21 1.37 NA 26.55 000 

93581 ......... ............ A Transcath closure of vsd ............................. 24.39 NA 9.66 1.37 NA 35.42 000 

93600 ......... ............ A Bundle of His recording ............................... 2.12 2.79 NA 0.26 5.17 NA 000 

93600 ......... 26 ....... A Bundle of His recording ............................... 2.12 0.83 0.83 0.13 3.08 3.08 000 

93600 ......... TC ...... A Bundle of His recording ............................... 0.00 1.96 NA 0.13 2.09 NA 000 

93602 ......... ............ A Intra-atrial recording ..................................... 2.12 1.95 NA 0.21 4.28 NA 000 

93602 ......... 26 ....... A Intra-atrial recording ..................................... 2.12 0.83 0.83 0.14 3.09 3.09 000 

93602 ......... TC ...... A Intra-atrial recording ..................................... 0.00 1.12 NA 0.07 1.19 NA 000 

93603 ......... ............ A Right ventricular recording ........................... 2.12 2.51 NA 0.24 4.87 NA 000 

93603 ......... 26 ....... A Right ventricular recording ........................... 2.12 0.82 0.82 0.13 3.07 3.07 000 

93603 ......... TC ...... A Right ventricular recording ........................... 0.00 1.69 NA 0.11 1.80 NA 000 

93609 ......... ............ A Map tachycardia, add-on ............................. 4.99 4.67 NA 0.80 10.46 NA ZZZ 

93609 ......... 26 ....... A Map tachycardia, add-on ............................. 4.99 1.95 1.95 0.63 7.57 7.57 ZZZ 

93609 ......... TC ...... A Map tachycardia, add-on ............................. 0.00 2.72 NA 0.17 2.89 NA ZZZ 

93610 ......... ............ A Intra-atrial pacing ......................................... 3.02 2.52 NA 0.31 5.85 NA 000 

93610 ......... 26 ....... A Intra-atrial pacing ......................................... 3.02 1.16 1.16 0.21 4.39 4.39 000 

93610 ......... TC ...... A Intra-atrial pacing ......................................... 0.00 1.36 NA 0.10 1.46 NA 000 

93612 ......... ............ A Intraventricular pacing ................................. 3.02 2.78 NA 0.32 6.12 NA 000 

93612 ......... 26 ....... A Intraventricular pacing ................................. 3.02 1.16 1.16 0.21 4.39 4.39 000 

93612 ......... TC ...... A Intraventricular pacing ................................. 0.00 1.62 NA 0.11 1.73 NA 000 

93613 ......... ............ A Electrophys map 3d, add-on ....................... 6.99 NA 2.76 0.63 NA 10.38 ZZZ 

93615 ......... ............ A Esophageal recording .................................. 0.99 0.59 NA 0.06 1.64 NA 000 

93615 ......... 26 ....... A Esophageal recording .................................. 0.99 0.27 0.27 0.04 1.30 1.30 000 

93615 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 

93616 ......... ............ A Esophageal recording .................................. 1.49 0.74 NA 0.09 2.32 NA 000 

93616 ......... 26 ....... A Esophageal recording .................................. 1.49 0.42 0.42 0.07 1.98 1.98 000 

93616 ......... TC ...... A Esophageal recording .................................. 0.00 0.32 NA 0.02 0.34 NA 000 

93618 ......... ............ A Heart rhythm pacing .................................... 4.25 5.66 NA 0.51 10.42 NA 000 

93618 ......... 26 ....... A Heart rhythm pacing .................................... 4.25 1.68 1.68 0.27 6.20 6.20 000 

93618 ......... TC ...... A Heart rhythm pacing .................................... 0.00 3.98 NA 0.24 4.22 NA 000 

93619 ......... ............ A Electrophysiology evaluation ....................... 7.31 10.94 NA 0.93 19.18 NA 000 

93619 ......... 26 ....... A Electrophysiology evaluation ....................... 7.31 3.20 3.20 0.46 10.97 10.97 000 

93619 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.74 NA 0.47 8.21 NA 000 

93620 ......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 NA 0.00 0.00 NA 000 

93620 ......... 26 ....... A Electrophysiology evaluation ....................... 11.57 4.86 4.86 0.72 17.15 17.15 000 

93620 ......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 NA 0.00 0.00 NA 000 

93621 ......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93621 ......... 26 ....... A Electrophysiology evaluation ....................... 2.10 0.82 0.82 0.18 3.10 3.10 ZZZ 

93621 ......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93622 ......... ............ C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93622 ......... 26 ....... A Electrophysiology evaluation ....................... 3.10 1.21 1.21 0.81 5.12 5.12 ZZZ 

93622 ......... TC ...... C Electrophysiology evaluation ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93623 ......... ............ C Stimulation, pacing heart ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93623 ......... 26 ....... A Stimulation, pacing heart ............................. 2.85 1.12 1.12 0.18 4.15 4.15 ZZZ 

93623 ......... TC ...... C Stimulation, pacing heart ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93624 ......... ............ A Electrophysiologic study .............................. 4.80 4.19 NA 0.43 9.42 NA 000 

93624 ......... 26 ....... A Electrophysiologic study .............................. 4.80 2.20 2.20 0.30 7.30 7.30 000 

93624 ......... TC ...... A Electrophysiologic study .............................. 0.00 1.99 NA 0.13 2.12 NA 000 

93631 ......... ............ A Heart pacing, mapping ................................ 7.59 8.95 NA 1.42 17.96 NA 000 

93631 ......... 26 ....... A Heart pacing, mapping ................................ 7.59 2.78 2.78 0.80 11.17 11.17 000 

93631 ......... TC ...... A Heart pacing, mapping ................................ 0.00 6.17 NA 0.62 6.79 NA 000 

93640 ......... ............ A Evaluation heart device ............................... 3.51 8.56 NA 0.64 12.71 NA 000 

93640 ......... 26 ....... A Evaluation heart device ............................... 3.51 1.36 1.36 0.22 5.09 5.09 000 

93640 ......... TC ...... A Evaluation heart device ............................... 0.00 7.20 NA 0.42 7.62 NA 000 

93641 ......... ............ A Electrophysiology evaluation ....................... 5.92 9.52 NA 0.79 16.23 NA 000 

93641 ......... 26 ....... A Electrophysiology evaluation ....................... 5.92 2.32 2.32 0.37 8.61 8.61 000 

1227

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93641 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.20 NA 0.42 7.62 NA 000 

93642 ......... ............ A Electrophysiology evaluation ....................... 4.88 9.42 NA 0.61 14.91 NA 000 

93642 ......... 26 ....... A Electrophysiology evaluation ....................... 4.88 2.22 2.22 0.19 7.29 7.29 000 

93642 ......... TC ...... A Electrophysiology evaluation ....................... 0.00 7.20 NA 0.42 7.62 NA 000 

93650 ......... ............ A Ablate heart dysrhythm focus ...................... 10.49 NA 4.45 0.66 NA 15.60 000 

93651 ......... ............ A Ablate heart dysrhythm focus ...................... 16.23 NA 6.35 1.03 NA 23.61 000 

93652 ......... ............ A Ablate heart dysrhythm focus ...................... 17.65 NA 6.91 1.11 NA 25.67 000 

93660 ......... ............ A Tilt table evaluation ...................................... 1.89 2.43 NA 0.09 4.41 NA 000 

93660 ......... 26 ....... A Tilt table evaluation ...................................... 1.89 0.74 0.74 0.07 2.70 2.70 000 

93660 ......... TC ...... A Tilt table evaluation ...................................... 0.00 1.69 NA 0.02 1.71 NA 000 

93662 ......... ............ C Intracardiac ecg (ice) ................................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

93662 ......... 26 ....... A Intracardiac ecg (ice) ................................... 2.80 1.11 1.11 0.49 4.40 4.40 ZZZ 

93662 ......... TC ...... C Intracardiac ecg (ice) ................................... 0.00 0.00 NA 0.00 0.00 NA ZZZ 

93668 ......... ............ N Peripheral vascular rehab ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93701 ......... ............ A Bioimpedance, thoracic ............................... 0.17 1.02 NA 0.02 1.21 NA XXX 

93701 ......... 26 ....... A Bioimpedance, thoracic ............................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93701 ......... TC ...... A Bioimpedance, thoracic ............................... 0.00 0.95 NA 0.01 0.96 NA XXX 

93720 ......... ............ A Total body plethysmography ....................... 0.17 0.76 NA 0.07 1.00 NA XXX 

93721 ......... ............ A Plethysmography tracing ............................. 0.00 0.71 NA 0.06 0.77 NA XXX 

93722 ......... ............ A Plethysmography report ............................... 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

93724 ......... ............ A Analyze pacemaker system ......................... 4.88 5.90 NA 0.46 11.24 NA 000 

93724 ......... 26 ....... A Analyze pacemaker system ......................... 4.88 1.92 1.92 0.22 7.02 7.02 000 

93724 ......... TC ...... A Analyze pacemaker system ......................... 0.00 3.98 NA 0.24 4.22 NA 000 

93727 ......... ............ A Analyze ilr system ........................................ 0.52 0.20 0.20 0.06 0.78 0.78 XXX 

93731 ......... ............ A Analyze pacemaker system ......................... 0.45 0.67 NA 0.06 1.18 NA XXX 

93731 ......... 26 ....... A Analyze pacemaker system ......................... 0.45 0.18 0.18 0.02 0.65 0.65 XXX 

93731 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.49 NA 0.04 0.53 NA XXX 

93732 ......... ............ A Analyze pacemaker system ......................... 0.92 0.87 NA 0.08 1.87 NA XXX 

93732 ......... 26 ....... A Analyze pacemaker system ......................... 0.92 0.36 0.36 0.04 1.32 1.32 XXX 

93732 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.51 NA 0.04 0.55 NA XXX 

93733 ......... ............ A Telephone analy, pacemaker ...................... 0.17 0.80 NA 0.07 1.04 NA XXX 

93733 ......... 26 ....... A Telephone analy, pacemaker ...................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

93733 ......... TC ...... A Telephone analy, pacemaker ...................... 0.00 0.73 NA 0.06 0.79 NA XXX 

93734 ......... ............ A Analyze pacemaker system ......................... 0.38 0.50 NA 0.03 0.91 NA XXX 

93734 ......... 26 ....... A Analyze pacemaker system ......................... 0.38 0.15 0.15 0.01 0.54 0.54 XXX 

93734 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.35 NA 0.02 0.37 NA XXX 

93735 ......... ............ A Analyze pacemaker system ......................... 0.74 0.73 NA 0.08 1.55 NA XXX 

93735 ......... 26 ....... A Analyze pacemaker system ......................... 0.74 0.29 0.29 0.04 1.07 1.07 XXX 

93735 ......... TC ...... A Analyze pacemaker system ......................... 0.00 0.44 NA 0.04 0.48 NA XXX 

93736 ......... ............ A Telephonic analy, pacemaker ...................... 0.15 0.69 NA 0.07 0.91 NA XXX 

93736 ......... 26 ....... A Telephonic analy, pacemaker ...................... 0.15 0.06 0.06 0.01 0.22 0.22 XXX 

93736 ......... TC ...... A Telephonic analy, pacemaker ...................... 0.00 0.63 NA 0.06 0.69 NA XXX 

93740 ......... ............ B Temperature gradient studies ...................... +0.16 0.20 NA 0.02 0.38 NA XXX 

93740 ......... 26 ....... B Temperature gradient studies ...................... +0.16 0.04 0.04 0.01 0.21 0.21 XXX 

93740 ......... TC ...... B Temperature gradient studies ...................... +0.00 0.16 NA 0.01 0.17 NA XXX 

93741 ......... ............ A Analyze ht pace device sngl ........................ 0.80 0.99 NA 0.06 1.85 NA XXX 

93741 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.80 0.32 0.32 0.02 1.14 1.14 XXX 

93741 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 

93742 ......... ............ A Analyze ht pace device sngl ........................ 0.91 1.03 NA 0.06 2.00 NA XXX 

93742 ......... 26 ....... A Analyze ht pace device sngl ........................ 0.91 0.36 0.36 0.02 1.29 1.29 XXX 

93742 ......... TC ...... A Analyze ht pace device sngl ........................ 0.00 0.67 NA 0.04 0.71 NA XXX 

93743 ......... ............ A Analyze ht pace device dual ....................... 1.03 1.14 NA 0.08 2.25 NA XXX 

93743 ......... 26 ....... A Analyze ht pace device dual ....................... 1.03 0.40 0.40 0.04 1.47 1.47 XXX 

93743 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.74 NA 0.04 0.78 NA XXX 

93744 ......... ............ A Analyze ht pace device dual ....................... 1.18 1.13 NA 0.08 2.39 NA XXX 

93744 ......... 26 ....... A Analyze ht pace device dual ....................... 1.18 0.46 0.46 0.04 1.68 1.68 XXX 

93744 ......... TC ...... A Analyze ht pace device dual ....................... 0.00 0.67 NA 0.04 0.71 NA XXX 

93760 ......... ............ N Cephalic thermogram .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93762 ......... ............ N Peripheral thermogram ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93770 ......... ............ B Measure venous pressure ........................... +0.16 0.08 NA 0.02 0.26 NA XXX 

93770 ......... 26 ....... B Measure venous pressure ........................... +0.16 0.05 0.05 0.01 0.22 0.22 XXX 

93770 ......... TC ...... B Measure venous pressure ........................... +0.00 0.03 NA 0.01 0.04 NA XXX 

93784 ......... ............ A Ambulatory BP monitoring ........................... 0.38 1.55 NA 0.03 1.96 NA XXX 

93786 ......... ............ A Ambulatory BP recording ............................. 0.00 0.91 NA 0.01 0.92 NA XXX 

93788 ......... ............ A Ambulatory BP analysis ............................... 0.00 0.51 NA 0.01 0.52 NA XXX 

93790 ......... ............ A Review/report BP recording ......................... 0.38 0.13 0.13 0.01 0.52 0.52 XXX 

93797 ......... ............ A Cardiac rehab .............................................. 0.18 0.37 0.07 0.01 0.56 0.26 000 

93798 ......... ............ A Cardiac rehab/monitor ................................. 0.28 0.49 0.11 0.01 0.78 0.40 000 

93799 ......... ............ C Cardiovascular procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 ......... 26 ....... C Cardiovascular procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93799 ......... TC ...... C Cardiovascular procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

93875 ......... ............ A Extracranial study ........................................ 0.22 1.66 NA 0.12 2.00 NA XXX 

93875 ......... 26 ....... A Extracranial study ........................................ 0.22 0.08 0.08 0.01 0.31 0.31 XXX 

93875 ......... TC ...... A Extracranial study ........................................ 0.00 1.58 NA 0.11 1.69 NA XXX 

93880 ......... ............ A Extracranial study ........................................ 0.60 4.18 NA 0.40 5.18 NA XXX 

1228

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

93880 ......... 26 ....... A Extracranial study ........................................ 0.60 0.21 0.21 0.05 0.86 0.86 XXX 

93880 ......... TC ...... A Extracranial study ........................................ 0.00 3.97 NA 0.35 4.32 NA XXX 

93882 ......... ............ A Extracranial study ........................................ 0.40 3.01 NA 0.27 3.68 NA XXX 

93882 ......... 26 ....... A Extracranial study ........................................ 0.40 0.14 0.14 0.05 0.59 0.59 XXX 

93882 ......... TC ...... A Extracranial study ........................................ 0.00 2.87 NA 0.22 3.09 NA XXX 

93886 ......... ............ A Intracranial study ......................................... 0.94 4.47 NA 0.45 5.86 NA XXX 

93886 ......... 26 ....... A Intracranial study ......................................... 0.94 0.37 0.37 0.06 1.37 1.37 XXX 

93886 ......... TC ...... A Intracranial study ......................................... 0.00 4.10 NA 0.39 4.49 NA XXX 

93888 ......... ............ A Intracranial study ......................................... 0.62 3.02 NA 0.32 3.96 NA XXX 

93888 ......... 26 ....... A Intracranial study ......................................... 0.62 0.23 0.23 0.05 0.90 0.90 XXX 

93888 ......... TC ...... A Intracranial study ......................................... 0.00 2.79 NA 0.27 3.06 NA XXX 

93922 ......... ............ A Extremity study ............................................ 0.25 1.93 NA 0.15 2.33 NA XXX 

93922 ......... 26 ....... A Extremity study ............................................ 0.25 0.09 0.09 0.02 0.36 0.36 XXX 

93922 ......... TC ...... A Extremity study ............................................ 0.00 1.84 NA 0.13 1.97 NA XXX 

93923 ......... ............ A Extremity study ............................................ 0.45 3.00 NA 0.27 3.72 NA XXX 

93923 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.05 0.65 0.65 XXX 

93923 ......... TC ...... A Extremity study ............................................ 0.00 2.85 NA 0.22 3.07 NA XXX 

93924 ......... ............ A Extremity study ............................................ 0.50 3.76 NA 0.31 4.57 NA XXX 

93924 ......... 26 ....... A Extremity study ............................................ 0.50 0.17 0.17 0.06 0.73 0.73 XXX 

93924 ......... TC ...... A Extremity study ............................................ 0.00 3.59 NA 0.25 3.84 NA XXX 

93925 ......... ............ A Lower extremity study .................................. 0.58 4.87 NA 0.40 5.85 NA XXX 

93925 ......... 26 ....... A Lower extremity study .................................. 0.58 0.20 0.20 0.05 0.83 0.83 XXX 

93925 ......... TC ...... A Lower extremity study .................................. 0.00 4.67 NA 0.35 5.02 NA XXX 

93926 ......... ............ A Lower extremity study .................................. 0.39 3.49 NA 0.27 4.15 NA XXX 

93926 ......... 26 ....... A Lower extremity study .................................. 0.39 0.13 0.13 0.04 0.56 0.56 XXX 

93926 ......... TC ...... A Lower extremity study .................................. 0.00 3.36 NA 0.23 3.59 NA XXX 

93930 ......... ............ A Upper extremity study .................................. 0.46 3.85 NA 0.41 4.72 NA XXX 

93930 ......... 26 ....... A Upper extremity study .................................. 0.46 0.16 0.16 0.04 0.66 0.66 XXX 

93930 ......... TC ...... A Upper extremity study .................................. 0.00 3.69 NA 0.37 4.06 NA XXX 

93931 ......... ............ A Upper extremity study .................................. 0.31 2.82 NA 0.26 3.39 NA XXX 

93931 ......... 26 ....... A Upper extremity study .................................. 0.31 0.11 0.11 0.02 0.44 0.44 XXX 

93931 ......... TC ...... A Upper extremity study .................................. 0.00 2.71 NA 0.24 2.95 NA XXX 

93965 ......... ............ A Extremity study ............................................ 0.35 1.86 NA 0.14 2.35 NA XXX 

93965 ......... 26 ....... A Extremity study ............................................ 0.35 0.12 0.12 0.02 0.49 0.49 XXX 

93965 ......... TC ...... A Extremity study ............................................ 0.00 1.74 NA 0.12 1.86 NA XXX 

93970 ......... ............ A Extremity study ............................................ 0.68 3.97 NA 0.46 5.11 NA XXX 

93970 ......... 26 ....... A Extremity study ............................................ 0.68 0.23 0.23 0.06 0.97 0.97 XXX 

93970 ......... TC ...... A Extremity study ............................................ 0.00 3.74 NA 0.40 4.14 NA XXX 

93971 ......... ............ A Extremity study ............................................ 0.45 2.86 NA 0.31 3.62 NA XXX 

93971 ......... 26 ....... A Extremity study ............................................ 0.45 0.15 0.15 0.04 0.64 0.64 XXX 

93971 ......... TC ...... A Extremity study ............................................ 0.00 2.71 NA 0.27 2.98 NA XXX 

93975 ......... ............ A Vascular study ............................................. 1.80 5.82 NA 0.56 8.18 NA XXX 

93975 ......... 26 ....... A Vascular study ............................................. 1.80 0.60 0.60 0.13 2.53 2.53 XXX 

93975 ......... TC ...... A Vascular study ............................................. 0.00 5.22 NA 0.43 5.65 NA XXX 

93976 ......... ............ A Vascular study ............................................. 1.21 3.46 NA 0.37 5.04 NA XXX 

93976 ......... 26 ....... A Vascular study ............................................. 1.21 0.40 0.40 0.07 1.68 1.68 XXX 

93976 ......... TC ...... A Vascular study ............................................. 0.00 3.06 NA 0.30 3.36 NA XXX 

93978 ......... ............ A Vascular study ............................................. 0.65 3.58 NA 0.43 4.66 NA XXX 

93978 ......... 26 ....... A Vascular study ............................................. 0.65 0.22 0.22 0.06 0.93 0.93 XXX 

93978 ......... TC ...... A Vascular study ............................................. 0.00 3.36 NA 0.37 3.73 NA XXX 

93979 ......... ............ A Vascular study ............................................. 0.44 2.65 NA 0.29 3.38 NA XXX 

93979 ......... 26 ....... A Vascular study ............................................. 0.44 0.15 0.15 0.05 0.64 0.64 XXX 

93979 ......... TC ...... A Vascular study ............................................. 0.00 2.50 NA 0.24 2.74 NA XXX 

93980 ......... ............ A Penile vascular study ................................... 1.25 4.78 NA 0.42 6.45 NA XXX 

93980 ......... 26 ....... A Penile vascular study ................................... 1.25 0.41 0.41 0.08 1.74 1.74 XXX 

93980 ......... TC ...... A Penile vascular study ................................... 0.00 4.37 NA 0.34 4.71 NA XXX 

93981 ......... ............ A Penile vascular study ................................... 0.44 4.61 NA 0.33 5.38 NA XXX 

93981 ......... 26 ....... A Penile vascular study ................................... 0.44 0.15 0.15 0.02 0.61 0.61 XXX 

93981 ......... TC ...... A Penile vascular study ................................... 0.00 4.46 NA 0.31 4.77 NA XXX 

93990 ......... ............ A Doppler flow testing ..................................... 0.25 3.42 NA 0.25 3.92 NA XXX 

93990 ......... 26 ....... A Doppler flow testing ..................................... 0.25 0.09 0.09 0.02 0.36 0.36 XXX 

93990 ......... TC ...... A Doppler flow testing ..................................... 0.00 3.33 NA 0.23 3.56 NA XXX 

94010 ......... ............ A Breathing capacity test ................................ 0.17 0.67 NA 0.03 0.87 NA XXX 

94010 ......... 26 ....... A Breathing capacity test ................................ 0.17 0.05 0.05 0.01 0.23 0.23 XXX 

94010 ......... TC ...... A Breathing capacity test ................................ 0.00 0.62 NA 0.02 0.64 NA XXX 

94014 ......... ............ A Patient recorded spirometry ........................ 0.52 0.77 NA 0.03 1.32 NA XXX 

94015 ......... ............ A Patient recorded spirometry ........................ 0.00 0.60 NA 0.01 0.61 NA XXX 

94016 ......... ............ A Review patient spirometry ........................... 0.52 0.17 0.17 0.02 0.71 0.71 XXX 

94060 ......... ............ A Evaluation of wheezing ................................ 0.31 1.12 NA 0.07 1.50 NA XXX 

94060 ......... 26 ....... A Evaluation of wheezing ................................ 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

94060 ......... TC ...... A Evaluation of wheezing ................................ 0.00 1.02 NA 0.06 1.08 NA XXX 

94070 ......... ............ A Evaluation of wheezing ................................ 0.60 2.99 NA 0.12 3.71 NA XXX 

94070 ......... 26 ....... A Evaluation of wheezing ................................ 0.60 0.19 0.19 0.02 0.81 0.81 XXX 

94070 ......... TC ...... A Evaluation of wheezing ................................ 0.00 2.80 NA 0.10 2.90 NA XXX 

94150 ......... ............ B Vital capacity test ......................................... +0.07 0.48 NA 0.02 0.57 NA XXX 

1229

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

94150 ......... 26 ....... B Vital capacity test ......................................... +0.07 0.03 0.03 0.01 0.11 0.11 XXX 

94150 ......... TC ...... B Vital capacity test ......................................... +0.00 0.45 NA 0.01 0.46 NA XXX 

94200 ......... ............ A Lung function test (MBC/MVV) .................... 0.11 0.44 NA 0.03 0.58 NA XXX 

94200 ......... 26 ....... A Lung function test (MBC/MVV) .................... 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94200 ......... TC ...... A Lung function test (MBC/MVV) .................... 0.00 0.41 NA 0.02 0.43 NA XXX 

94240 ......... ............ A Residual lung capacity ................................. 0.26 0.65 NA 0.06 0.97 NA XXX 

94240 ......... 26 ....... A Residual lung capacity ................................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94240 ......... TC ...... A Residual lung capacity ................................. 0.00 0.57 NA 0.05 0.62 NA XXX 

94250 ......... ............ A Expired gas collection .................................. 0.11 0.65 NA 0.02 0.78 NA XXX 

94250 ......... 26 ....... A Expired gas collection .................................. 0.11 0.03 0.03 0.01 0.15 0.15 XXX 

94250 ......... TC ...... A Expired gas collection .................................. 0.00 0.62 NA 0.01 0.63 NA XXX 

94260 ......... ............ A Thoracic gas volume ................................... 0.13 0.57 NA 0.05 0.75 NA XXX 

94260 ......... 26 ....... A Thoracic gas volume ................................... 0.13 0.04 0.04 0.01 0.18 0.18 XXX 

94260 ......... TC ...... A Thoracic gas volume ................................... 0.00 0.53 NA 0.04 0.57 NA XXX 

94350 ......... ............ A Lung nitrogen washout curve ...................... 0.26 0.75 NA 0.05 1.06 NA XXX 

94350 ......... 26 ....... A Lung nitrogen washout curve ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94350 ......... TC ...... A Lung nitrogen washout curve ...................... 0.00 0.67 NA 0.04 0.71 NA XXX 

94360 ......... ............ A Measure airflow resistance .......................... 0.26 0.69 NA 0.07 1.02 NA XXX 

94360 ......... 26 ....... A Measure airflow resistance .......................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94360 ......... TC ...... A Measure airflow resistance .......................... 0.00 0.61 NA 0.06 0.67 NA XXX 

94370 ......... ............ A Breath airway closing volume ...................... 0.26 0.72 NA 0.03 1.01 NA XXX 

94370 ......... 26 ....... A Breath airway closing volume ...................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94370 ......... TC ...... A Breath airway closing volume ...................... 0.00 0.64 NA 0.02 0.66 NA XXX 

94375 ......... ............ A Respiratory flow volume loop ...................... 0.31 0.61 NA 0.03 0.95 NA XXX 

94375 ......... 26 ....... A Respiratory flow volume loop ...................... 0.31 0.10 0.10 0.01 0.42 0.42 XXX 

94375 ......... TC ...... A Respiratory flow volume loop ...................... 0.00 0.51 NA 0.02 0.53 NA XXX 

94400 ......... ............ A CO2 breathing response curve ................... 0.40 0.84 NA 0.07 1.31 NA XXX 

94400 ......... 26 ....... A CO2 breathing response curve ................... 0.40 0.12 0.12 0.01 0.53 0.53 XXX 

94400 ......... TC ...... A CO2 breathing response curve ................... 0.00 0.72 NA 0.06 0.78 NA XXX 

94450 ......... ............ A Hypoxia response curve .............................. 0.40 0.68 NA 0.04 1.12 NA XXX 

94450 ......... 26 ....... A Hypoxia response curve .............................. 0.40 0.12 0.12 0.02 0.54 0.54 XXX 

94450 ......... TC ...... A Hypoxia response curve .............................. 0.00 0.56 NA 0.02 0.58 NA XXX 

94620 ......... ............ A Pulmonary stress test/simple ....................... 0.64 2.42 NA 0.12 3.18 NA XXX 

94620 ......... 26 ....... A Pulmonary stress test/simple ....................... 0.64 0.20 0.20 0.02 0.86 0.86 XXX 

94620 ......... TC ...... A Pulmonary stress test/simple ....................... 0.00 2.22 NA 0.10 2.32 NA XXX 

94621 ......... ............ A Pulm stress test/complex ............................. 1.42 2.06 NA 0.16 3.64 NA XXX 

94621 ......... 26 ....... A Pulm stress test/complex ............................. 1.42 0.43 0.43 0.06 1.91 1.91 XXX 

94621 ......... TC ...... A Pulm stress test/complex ............................. 0.00 1.63 NA 0.10 1.73 NA XXX 

94640 ......... ............ A Airway inhalation treatment ......................... 0.00 0.32 NA 0.02 0.34 NA XXX 

94642 ......... ............ C Aerosol inhalation treatment ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94656 ......... ............ A Initial ventilator mgmt ................................... 1.22 1.18 0.32 0.07 2.47 1.61 XXX 

94657 ......... ............ A Continued ventilator mgmt ........................... 0.83 1.00 0.25 0.04 1.87 1.12 XXX 

94660 ......... ............ A Pos airway pressure, CPAP ........................ 0.76 0.66 0.24 0.04 1.46 1.04 XXX 

94662 ......... ............ A Neg press ventilation, cnp ........................... 0.76 NA 0.24 0.02 NA 1.02 XXX 

94664 ......... ............ A Evaluate pt use of inhaler ............................ 0.00 0.32 NA 0.04 0.36 NA XXX 

94667 ......... ............ A Chest wall manipulation ............................... 0.00 0.54 NA 0.05 0.59 NA XXX 

94668 ......... ............ A Chest wall manipulation ............................... 0.00 0.46 NA 0.02 0.48 NA XXX 

94680 ......... ............ A Exhaled air analysis, o2 .............................. 0.26 1.89 NA 0.07 2.22 NA XXX 

94680 ......... 26 ....... A Exhaled air analysis, o2 .............................. 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94680 ......... TC ...... A Exhaled air analysis, o2 .............................. 0.00 1.81 NA 0.06 1.87 NA XXX 

94681 ......... ............ A Exhaled air analysis, o2/co2 ........................ 0.20 2.62 NA 0.13 2.95 NA XXX 

94681 ......... 26 ....... A Exhaled air analysis, o2/co2 ........................ 0.20 0.07 0.07 0.01 0.28 0.28 XXX 

94681 ......... TC ...... A Exhaled air analysis, o2/co2 ........................ 0.00 2.55 NA 0.12 2.67 NA XXX 

94690 ......... ............ A Exhaled air analysis ..................................... 0.07 1.97 NA 0.05 2.09 NA XXX 

94690 ......... 26 ....... A Exhaled air analysis ..................................... 0.07 0.02 0.02 0.01 0.10 0.10 XXX 

94690 ......... TC ...... A Exhaled air analysis ..................................... 0.00 1.95 NA 0.04 1.99 NA XXX 

94720 ......... ............ A Monoxide diffusing capacity ........................ 0.26 1.00 NA 0.07 1.33 NA XXX 

94720 ......... 26 ....... A Monoxide diffusing capacity ........................ 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94720 ......... TC ...... A Monoxide diffusing capacity ........................ 0.00 0.92 NA 0.06 0.98 NA XXX 

94725 ......... ............ A Membrane diffusion capacity ....................... 0.26 2.92 NA 0.13 3.31 NA XXX 

94725 ......... 26 ....... A Membrane diffusion capacity ....................... 0.26 0.08 0.08 0.01 0.35 0.35 XXX 

94725 ......... TC ...... A Membrane diffusion capacity ....................... 0.00 2.84 NA 0.12 2.96 NA XXX 

94750 ......... ............ A Pulmonary compliance study ....................... 0.23 1.35 NA 0.05 1.63 NA XXX 

94750 ......... 26 ....... A Pulmonary compliance study ....................... 0.23 0.07 0.07 0.01 0.31 0.31 XXX 

94750 ......... TC ...... A Pulmonary compliance study ....................... 0.00 1.28 NA 0.04 1.32 NA XXX 

94760 ......... ............ T Measure blood oxygen level ........................ 0.00 0.04 NA 0.02 0.06 NA XXX 

94761 ......... ............ T Measure blood oxygen level ........................ 0.00 0.07 NA 0.06 0.13 NA XXX 

94762 ......... ............ A Measure blood oxygen level ........................ 0.00 0.40 NA 0.10 0.50 NA XXX 

94770 ......... ............ A Exhaled carbon dioxide test ........................ 0.15 1.67 NA 0.08 1.90 NA XXX 

94770 ......... 26 ....... A Exhaled carbon dioxide test ........................ 0.15 0.04 0.04 0.01 0.20 0.20 XXX 

94770 ......... TC ...... A Exhaled carbon dioxide test ........................ 0.00 1.63 NA 0.07 1.70 NA XXX 

94772 ......... ............ C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 ......... 26 ....... C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94772 ......... TC ...... C Breath recording, infant ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 ......... ............ C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1230

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

94799 ......... 26 ....... C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

94799 ......... TC ...... C Pulmonary service/procedure ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95004 ......... ............ A Percut allergy skin tests .............................. 0.00 0.10 NA 0.01 0.11 NA XXX 

95010 ......... ............ A Percut allergy titrate test .............................. 0.15 0.33 0.06 0.01 0.49 0.22 XXX 

95015 ......... ............ A Id allergy titrate-drug/bug ............................. 0.15 0.15 0.06 0.01 0.31 0.22 XXX 

95024 ......... ............ A Id allergy test, drug/bug ............................... 0.00 0.15 NA 0.01 0.16 NA XXX 

95027 ......... ............ A Id allergy titrate-airborne .............................. 0.00 0.15 NA 0.01 0.16 NA XXX 

95028 ......... ............ A Id allergy test-delayed type ......................... 0.00 0.24 NA 0.01 0.25 NA XXX 

95044 ......... ............ A Allergy patch tests ....................................... 0.00 0.21 NA 0.01 0.22 NA XXX 

95052 ......... ............ A Photo patch test ........................................... 0.00 0.26 NA 0.01 0.27 NA XXX 

95056 ......... ............ A Photosensitivity tests ................................... 0.00 0.18 NA 0.01 0.19 NA XXX 

95060 ......... ............ A Eye allergy tests .......................................... 0.00 0.35 NA 0.02 0.37 NA XXX 

95065 ......... ............ A Nose allergy test .......................................... 0.00 0.21 NA 0.01 0.22 NA XXX 

95070 ......... ............ A Bronchial allergy tests ................................. 0.00 2.29 NA 0.02 2.31 NA XXX 

95071 ......... ............ A Bronchial allergy tests ................................. 0.00 2.93 NA 0.02 2.95 NA XXX 

95075 ......... ............ A Ingestion challenge test ............................... 0.95 0.83 0.38 0.04 1.82 1.37 XXX 

95078 ......... ............ A Provocative testing ...................................... 0.00 0.26 NA 0.02 0.28 NA XXX 

95115 ......... ............ A Immunotherapy, one injection ..................... 0.00 0.38 NA 0.02 0.40 NA 000 

95117 ......... ............ A Immunotherapy injections ............................ 0.00 0.50 NA 0.02 0.52 NA 000 

95120 ......... ............ I Immunotherapy, one injection ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95125 ......... ............ I Immunotherapy, many antigens .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95130 ......... ............ I Immunotherapy, insect venom .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95131 ......... ............ I Immunotherapy, insect venoms ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95132 ......... ............ I Immunotherapy, insect venoms ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95133 ......... ............ I Immunotherapy, insect venoms ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95134 ......... ............ I Immunotherapy, insect venoms ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95144 ......... ............ A Antigen therapy services ............................. 0.06 0.15 0.02 0.01 0.22 0.09 000 

95145 ......... ............ A Antigen therapy services ............................. 0.06 0.33 0.02 0.01 0.40 0.09 000 

95146 ......... ............ A Antigen therapy services ............................. 0.06 0.44 0.03 0.01 0.51 0.10 000 

95147 ......... ............ A Antigen therapy services ............................. 0.06 0.42 0.02 0.01 0.49 0.09 000 

95148 ......... ............ A Antigen therapy services ............................. 0.06 0.58 0.03 0.01 0.65 0.10 000 

95149 ......... ............ A Antigen therapy services ............................. 0.06 0.81 0.03 0.01 0.88 0.10 000 

95165 ......... ............ A Antigen therapy services ............................. 0.06 0.20 0.02 0.01 0.27 0.09 000 

95170 ......... ............ A Antigen therapy services ............................. 0.06 0.14 0.02 0.01 0.21 0.09 000 

95180 ......... ............ A Rapid desensitization ................................... 2.01 1.52 0.82 0.05 3.58 2.88 000 

95199 ......... ............ C Allergy immunology services ....................... 0.00 0.00 0.00 0.00 0.00 0.00 000 

95250 ......... ............ A Glucose monitoring, cont ............................. 0.00 3.82 NA 0.01 3.83 NA XXX 

95805 ......... ............ A Multiple sleep latency test ........................... 1.88 16.26 NA 0.41 18.55 NA XXX 

95805 ......... 26 ....... A Multiple sleep latency test ........................... 1.88 0.66 0.66 0.07 2.61 2.61 XXX 

95805 ......... TC ...... A Multiple sleep latency test ........................... 0.00 15.60 NA 0.34 15.94 NA XXX 

95806 ......... ............ A Sleep study, unattended .............................. 1.66 3.81 NA 0.38 5.85 NA XXX 

95806 ......... 26 ....... A Sleep study, unattended .............................. 1.66 0.53 0.53 0.07 2.26 2.26 XXX 

95806 ......... TC ...... A Sleep study, unattended .............................. 0.00 3.28 NA 0.31 3.59 NA XXX 

95807 ......... ............ A Sleep study, attended .................................. 1.66 11.67 NA 0.48 13.81 NA XXX 

95807 ......... 26 ....... A Sleep study, attended .................................. 1.66 0.53 0.53 0.06 2.25 2.25 XXX 

95807 ......... TC ...... A Sleep study, attended .................................. 0.00 11.14 NA 0.42 11.56 NA XXX 

95808 ......... ............ A Polysomnography, 1-3 ................................. 2.65 12.91 NA 0.53 16.09 NA XXX 

95808 ......... 26 ....... A Polysomnography, 1-3 ................................. 2.65 0.93 0.93 0.11 3.69 3.69 XXX 

95808 ......... TC ...... A Polysomnography, 1-3 ................................. 0.00 11.98 NA 0.42 12.40 NA XXX 

95810 ......... ............ A Polysomnography, 4 or more ...................... 3.52 17.02 NA 0.56 21.10 NA XXX 

95810 ......... 26 ....... A Polysomnography, 4 or more ...................... 3.52 1.18 1.18 0.14 4.84 4.84 XXX 

95810 ......... TC ...... A Polysomnography, 4 or more ...................... 0.00 15.84 NA 0.42 16.26 NA XXX 

95811 ......... ............ A Polysomnography w/cpap ............................ 3.79 18.45 NA 0.59 22.83 NA XXX 

95811 ......... 26 ....... A Polysomnography w/cpap ............................ 3.79 1.27 1.27 0.16 5.22 5.22 XXX 

95811 ......... TC ...... A Polysomnography w/cpap ............................ 0.00 17.18 NA 0.43 17.61 NA XXX 

95812 ......... ............ A Eeg, 41-60 minutes ..................................... 1.08 3.91 NA 0.16 5.15 NA XXX 

95812 ......... 26 ....... A Eeg, 41-60 minutes ..................................... 1.08 0.45 0.45 0.05 1.58 1.58 XXX 

95812 ......... TC ...... A Eeg, 41-60 minutes ..................................... 0.00 3.46 NA 0.11 3.57 NA XXX 

95813 ......... ............ A Eeg, over 1 hour .......................................... 1.73 4.93 NA 0.18 6.84 NA XXX 

95813 ......... 26 ....... A Eeg, over 1 hour .......................................... 1.73 0.70 0.70 0.07 2.50 2.50 XXX 

95813 ......... TC ...... A Eeg, over 1 hour .......................................... 0.00 4.23 NA 0.11 4.34 NA XXX 

95816 ......... ............ A Eeg, awake and drowsy .............................. 1.08 3.14 NA 0.15 4.37 NA XXX 

95816 ......... 26 ....... A Eeg, awake and drowsy .............................. 1.08 0.46 0.46 0.05 1.59 1.59 XXX 

95816 ......... TC ...... A Eeg, awake and drowsy .............................. 0.00 2.68 NA 0.10 2.78 NA XXX 

95819 ......... ............ A Eeg, awake and asleep ............................... 1.08 3.69 NA 0.15 4.92 NA XXX 

95819 ......... 26 ....... A Eeg, awake and asleep ............................... 1.08 0.46 0.46 0.05 1.59 1.59 XXX 

95819 ......... TC ...... A Eeg, awake and asleep ............................... 0.00 3.23 NA 0.10 3.33 NA XXX 

95822 ......... ............ A Eeg, coma or sleep only .............................. 1.08 4.35 NA 0.18 5.61 NA XXX 

95822 ......... 26 ....... A Eeg, coma or sleep only .............................. 1.08 0.45 0.45 0.05 1.58 1.58 XXX 

95822 ......... TC ...... A Eeg, coma or sleep only .............................. 0.00 3.90 NA 0.13 4.03 NA XXX 

95824 ......... ............ C Eeg, cerebral death only ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95824 ......... 26 ....... A Eeg, cerebral death only ............................. 0.74 0.32 0.32 0.06 1.12 1.12 XXX 

95824 ......... TC ...... C Eeg, cerebral death only ............................. 0.00 0.00 NA 0.00 0.00 NA XXX 

95827 ......... ............ A Eeg, all night recording ................................ 1.08 2.70 NA 0.18 3.96 NA XXX 

95827 ......... 26 ....... A Eeg, all night recording ................................ 1.08 0.40 0.40 0.04 1.52 1.52 XXX 

1231

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

95827 ......... TC ...... A Eeg, all night recording ................................ 0.00 2.30 NA 0.14 2.44 NA XXX 

95829 ......... ............ A Surgery electrocorticogram .......................... 6.20 31.30 NA 0.39 37.89 NA XXX 

95829 ......... 26 ....... A Surgery electrocorticogram .......................... 6.20 2.33 2.33 0.37 8.90 8.90 XXX 

95829 ......... TC ...... A Surgery electrocorticogram .......................... 0.00 28.97 NA 0.02 28.99 NA XXX 

95830 ......... ............ A Insert electrodes for EEG ............................ 1.70 3.37 0.73 0.08 5.15 2.51 XXX 

95831 ......... ............ A Limb muscle testing, manual ....................... 0.28 0.34 0.13 0.01 0.63 0.42 XXX 

95832 ......... ............ A Hand muscle testing, manual ...................... 0.29 0.25 0.12 0.01 0.55 0.42 XXX 

95833 ......... ............ A Body muscle testing, manual ...................... 0.47 0.45 0.23 0.01 0.93 0.71 XXX 

95834 ......... ............ A Body muscle testing, manual ...................... 0.60 0.50 0.28 0.02 1.12 0.90 XXX 

95851 ......... ............ A Range of motion measurements ................. 0.16 0.37 0.08 0.01 0.54 0.25 XXX 

95852 ......... ............ A Range of motion measurements ................. 0.11 0.26 0.05 0.01 0.38 0.17 XXX 

95857 ......... ............ A Tensilon test ................................................ 0.53 0.61 0.23 0.02 1.16 0.78 XXX 

95858 ......... ............ A Tensilon test & myogram ............................. 1.56 1.06 NA 0.09 2.71 NA XXX 

95858 ......... 26 ....... A Tensilon test & myogram ............................. 1.56 0.67 0.67 0.05 2.28 2.28 XXX 

95858 ......... TC ...... A Tensilon test & myogram ............................. 0.00 0.39 NA 0.04 0.43 NA XXX 

95860 ......... ............ A Muscle test, one limb ................................... 0.96 1.45 NA 0.06 2.47 NA XXX 

95860 ......... 26 ....... A Muscle test, one limb ................................... 0.96 0.42 0.42 0.04 1.42 1.42 XXX 

95860 ......... TC ...... A Muscle test, one limb ................................... 0.00 1.03 NA 0.02 1.05 NA XXX 

95861 ......... ............ A Muscle test, 2 limbs ..................................... 1.54 1.42 NA 0.12 3.08 NA XXX 

95861 ......... 26 ....... A Muscle test, 2 limbs ..................................... 1.54 0.68 0.68 0.06 2.28 2.28 XXX 

95861 ......... TC ...... A Muscle test, 2 limbs ..................................... 0.00 0.74 NA 0.06 0.80 NA XXX 

95863 ......... ............ A Muscle test, 3 limbs ..................................... 1.87 1.75 NA 0.13 3.75 NA XXX 

95863 ......... 26 ....... A Muscle test, 3 limbs ..................................... 1.87 0.81 0.81 0.07 2.75 2.75 XXX 

95863 ......... TC ...... A Muscle test, 3 limbs ..................................... 0.00 0.94 NA 0.06 1.00 NA XXX 

95864 ......... ............ A Muscle test, 4 limbs ..................................... 1.99 2.66 NA 0.19 4.84 NA XXX 

95864 ......... 26 ....... A Muscle test, 4 limbs ..................................... 1.99 0.87 0.87 0.07 2.93 2.93 XXX 

95864 ......... TC ...... A Muscle test, 4 limbs ..................................... 0.00 1.79 NA 0.12 1.91 NA XXX 

95867 ......... ............ A Muscle test cran nerv unilat ........................ 0.79 0.93 NA 0.08 1.80 NA XXX 

95867 ......... 26 ....... A Muscle test cran nerv unilat ........................ 0.79 0.35 0.35 0.04 1.18 1.18 XXX 

95867 ......... TC ...... A Muscle test cran nerv unilat ........................ 0.00 0.58 NA 0.04 0.62 NA XXX 

95868 ......... ............ A Muscle test cran nerve bilat ........................ 1.18 1.21 NA 0.10 2.49 NA XXX 

95868 ......... 26 ....... A Muscle test cran nerve bilat ........................ 1.18 0.51 0.51 0.05 1.74 1.74 XXX 

95868 ......... TC ...... A Muscle test cran nerve bilat ........................ 0.00 0.70 NA 0.05 0.75 NA XXX 

95869 ......... ............ A Muscle test, thor paraspinal ........................ 0.37 0.38 NA 0.03 0.78 NA XXX 

95869 ......... 26 ....... A Muscle test, thor paraspinal ........................ 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

95869 ......... TC ...... A Muscle test, thor paraspinal ........................ 0.00 0.22 NA 0.02 0.24 NA XXX 

95870 ......... ............ A Muscle test, nonparaspinal .......................... 0.37 0.38 NA 0.03 0.78 NA XXX 

95870 ......... 26 ....... A Muscle test, nonparaspinal .......................... 0.37 0.16 0.16 0.01 0.54 0.54 XXX 

95870 ......... TC ...... A Muscle test, nonparaspinal .......................... 0.00 0.22 NA 0.02 0.24 NA XXX 

95872 ......... ............ A Muscle test, one fiber .................................. 1.50 1.23 NA 0.10 2.83 NA XXX 

95872 ......... 26 ....... A Muscle test, one fiber .................................. 1.50 0.63 0.63 0.05 2.18 2.18 XXX 

95872 ......... TC ...... A Muscle test, one fiber .................................. 0.00 0.60 NA 0.05 0.65 NA XXX 

95875 ......... ............ A Limb exercise test ........................................ 1.10 1.46 NA 0.11 2.67 NA XXX 

95875 ......... 26 ....... A Limb exercise test ........................................ 1.10 0.46 0.46 0.05 1.61 1.61 XXX 

95875 ......... TC ...... A Limb exercise test ........................................ 0.00 1.00 NA 0.06 1.06 NA XXX 

95900 ......... ............ A Motor nerve conduction test ........................ 0.42 1.29 NA 0.03 1.74 NA XXX 

95900 ......... 26 ....... A Motor nerve conduction test ........................ 0.42 0.19 0.19 0.01 0.62 0.62 XXX 

95900 ......... TC ...... A Motor nerve conduction test ........................ 0.00 1.10 NA 0.02 1.12 NA XXX 

95903 ......... ............ A Motor nerve conduction test ........................ 0.60 1.21 NA 0.04 1.85 NA XXX 

95903 ......... 26 ....... A Motor nerve conduction test ........................ 0.60 0.26 0.26 0.02 0.88 0.88 XXX 

95903 ......... TC ...... A Motor nerve conduction test ........................ 0.00 0.95 NA 0.02 0.97 NA XXX 

95904 ......... ............ A Sense nerve conduction test ....................... 0.34 1.11 NA 0.03 1.48 NA XXX 

95904 ......... 26 ....... A Sense nerve conduction test ....................... 0.34 0.15 0.15 0.01 0.50 0.50 XXX 

95904 ......... TC ...... A Sense nerve conduction test ....................... 0.00 0.96 NA 0.02 0.98 NA XXX 

95920 ......... ............ A Intraop nerve test add-on ............................ 2.11 2.25 NA 0.24 4.60 NA ZZZ 

95920 ......... 26 ....... A Intraop nerve test add-on ............................ 2.11 0.94 0.94 0.17 3.22 3.22 ZZZ 

95920 ......... TC ...... A Intraop nerve test add-on ............................ 0.00 1.31 NA 0.07 1.38 NA ZZZ 

95921 ......... ............ A Autonomic nerv function test ....................... 0.90 0.70 NA 0.06 1.66 NA XXX 

95921 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.33 0.33 0.04 1.27 1.27 XXX 

95921 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.37 NA 0.02 0.39 NA XXX 

95922 ......... ............ A Autonomic nerv function test ....................... 0.96 0.77 NA 0.06 1.79 NA XXX 

95922 ......... 26 ....... A Autonomic nerv function test ....................... 0.96 0.40 0.40 0.04 1.40 1.40 XXX 

95922 ......... TC ...... A Autonomic nerv function test ....................... 0.00 0.37 NA 0.02 0.39 NA XXX 

95923 ......... ............ A Autonomic nerv function test ....................... 0.90 2.08 NA 0.06 3.04 NA XXX 

95923 ......... 26 ....... A Autonomic nerv function test ....................... 0.90 0.37 0.37 0.04 1.31 1.31 XXX 

95923 ......... TC ...... A Autonomic nerv function test ....................... 0.00 1.71 NA 0.02 1.73 NA XXX 

95925 ......... ............ A Somatosensory testing ................................ 0.54 1.14 NA 0.08 1.76 NA XXX 

95925 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.23 0.23 0.02 0.79 0.79 XXX 

95925 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

95926 ......... ............ A Somatosensory testing ................................ 0.54 1.15 NA 0.08 1.77 NA XXX 

95926 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.24 0.24 0.02 0.80 0.80 XXX 

95926 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

95927 ......... ............ A Somatosensory testing ................................ 0.54 1.16 NA 0.10 1.80 NA XXX 

95927 ......... 26 ....... A Somatosensory testing ................................ 0.54 0.25 0.25 0.04 0.83 0.83 XXX 

95927 ......... TC ...... A Somatosensory testing ................................ 0.00 0.91 NA 0.06 0.97 NA XXX 

1232

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

95930 ......... ............ A Visual evoked potential test ......................... 0.35 1.43 NA 0.02 1.80 NA XXX 

95930 ......... 26 ....... A Visual evoked potential test ......................... 0.35 0.15 0.15 0.01 0.51 0.51 XXX 

95930 ......... TC ...... A Visual evoked potential test ......................... 0.00 1.28 NA 0.01 1.29 NA XXX 

95933 ......... ............ A Blink reflex test ............................................ 0.59 1.03 NA 0.08 1.70 NA XXX 

95933 ......... 26 ....... A Blink reflex test ............................................ 0.59 0.24 0.24 0.02 0.85 0.85 XXX 

95933 ......... TC ...... A Blink reflex test ............................................ 0.00 0.79 NA 0.06 0.85 NA XXX 

95934 ......... ............ A H-reflex test ................................................. 0.51 0.44 NA 0.04 0.99 NA XXX 

95934 ......... 26 ....... A H-reflex test ................................................. 0.51 0.22 0.22 0.02 0.75 0.75 XXX 

95934 ......... TC ...... A H-reflex test ................................................. 0.00 0.22 NA 0.02 0.24 NA XXX 

95936 ......... ............ A H-reflex test ................................................. 0.55 0.46 NA 0.04 1.05 NA XXX 

95936 ......... 26 ....... A H-reflex test ................................................. 0.55 0.24 0.24 0.02 0.81 0.81 XXX 

95936 ......... TC ...... A H-reflex test ................................................. 0.00 0.22 NA 0.02 0.24 NA XXX 

95937 ......... ............ A Neuromuscular junction test ........................ 0.65 0.61 NA 0.04 1.30 NA XXX 

95937 ......... 26 ....... A Neuromuscular junction test ........................ 0.65 0.27 0.27 0.02 0.94 0.94 XXX 

95937 ......... TC ...... A Neuromuscular junction test ........................ 0.00 0.34 NA 0.02 0.36 NA XXX 

95950 ......... ............ A Ambulatory eeg monitoring .......................... 1.51 4.47 NA 0.53 6.51 NA XXX 

95950 ......... 26 ....... A Ambulatory eeg monitoring .......................... 1.51 0.64 0.64 0.10 2.25 2.25 XXX 

95950 ......... TC ...... A Ambulatory eeg monitoring .......................... 0.00 3.83 NA 0.43 4.26 NA XXX 

95951 ......... ............ C EEG monitoring/videorecord ........................ 0.00 0.00 NA 0.00 0.00 NA XXX 

95951 ......... 26 ....... A EEG monitoring/videorecord ........................ 5.99 2.57 2.57 0.24 8.80 8.80 XXX 

95951 ......... TC ...... C EEG monitoring/videorecord ........................ 0.00 0.00 NA 0.00 0.00 NA XXX 

95953 ......... ............ A EEG monitoring/computer ........................... 3.08 7.64 NA 0.55 11.27 NA XXX 

95953 ......... 26 ....... A EEG monitoring/computer ........................... 3.08 1.29 1.29 0.12 4.49 4.49 XXX 

95953 ......... TC ...... A EEG monitoring/computer ........................... 0.00 6.35 NA 0.43 6.78 NA XXX 

95954 ......... ............ A EEG monitoring/giving drugs ....................... 2.45 4.29 NA 0.18 6.92 NA XXX 

95954 ......... 26 ....... A EEG monitoring/giving drugs ....................... 2.45 1.05 1.05 0.12 3.62 3.62 XXX 

95954 ......... TC ...... A EEG monitoring/giving drugs ....................... 0.00 3.24 NA 0.06 3.30 NA XXX 

95955 ......... ............ A EEG during surgery ..................................... 1.01 2.33 NA 0.23 3.57 NA XXX 

95955 ......... 26 ....... A EEG during surgery ..................................... 1.01 0.36 0.36 0.06 1.43 1.43 XXX 

95955 ......... TC ...... A EEG during surgery ..................................... 0.00 1.97 NA 0.17 2.14 NA XXX 

95956 ......... ............ A Eeg monitoring, cable/radio ......................... 3.08 14.14 NA 0.56 17.78 NA XXX 

95956 ......... 26 ....... A Eeg monitoring, cable/radio ......................... 3.08 1.30 1.30 0.13 4.51 4.51 XXX 

95956 ......... TC ...... A Eeg monitoring, cable/radio ......................... 0.00 12.84 NA 0.43 13.27 NA XXX 

95957 ......... ............ A EEG digital analysis ..................................... 1.98 2.56 NA 0.20 4.74 NA XXX 

95957 ......... 26 ....... A EEG digital analysis ..................................... 1.98 0.85 0.85 0.08 2.91 2.91 XXX 

95957 ......... TC ...... A EEG digital analysis ..................................... 0.00 1.71 NA 0.12 1.83 NA XXX 

95958 ......... ............ A EEG monitoring/function test ....................... 4.24 3.50 NA 0.35 8.09 NA XXX 

95958 ......... 26 ....... A EEG monitoring/function test ....................... 4.24 1.75 1.75 0.22 6.21 6.21 XXX 

95958 ......... TC ...... A EEG monitoring/function test ....................... 0.00 1.75 NA 0.13 1.88 NA XXX 

95961 ......... ............ A Electrode stimulation, brain ......................... 2.97 2.63 NA 0.29 5.89 NA XXX 

95961 ......... 26 ....... A Electrode stimulation, brain ......................... 2.97 1.32 1.32 0.22 4.51 4.51 XXX 

95961 ......... TC ...... A Electrode stimulation, brain ......................... 0.00 1.31 NA 0.07 1.38 NA XXX 

95962 ......... ............ A Electrode stim, brain add-on ....................... 3.21 2.70 NA 0.28 6.19 NA ZZZ 

95962 ......... 26 ....... A Electrode stim, brain add-on ....................... 3.21 1.39 1.39 0.21 4.81 4.81 ZZZ 

95962 ......... TC ...... A Electrode stim, brain add-on ....................... 0.00 1.31 NA 0.07 1.38 NA ZZZ 

95965 ......... ............ C Meg, spontaneous ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95965 ......... 26 ....... A Meg, spontaneous ....................................... 7.99 3.42 3.42 0.37 11.78 11.78 XXX 

95965 ......... TC ...... C Meg, spontaneous ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95966 ......... ............ C Meg, evoked, single ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95966 ......... 26 ....... A Meg, evoked, single ..................................... 3.99 1.73 1.73 0.18 5.90 5.90 XXX 

95966 ......... TC ...... C Meg, evoked, single ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

95967 ......... ............ C Meg, evoked, each add’l ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

95967 ......... 26 ....... A Meg, evoked, each add’l ............................. 3.49 1.33 1.33 0.16 4.98 4.98 ZZZ 

95967 ......... TC ...... C Meg, evoked, each add’l ............................. 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

95970 ......... ............ A Analyze neurostim, no prog ......................... 0.45 0.17 0.15 0.04 0.66 0.64 XXX 

95971 ......... ............ A Analyze neurostim, simple ........................... 0.78 0.28 0.23 0.07 1.13 1.08 XXX 

95972 ......... ............ A Analyze neurostim, complex ........................ 1.50 0.59 0.49 0.21 2.30 2.20 XXX 

95973 ......... ............ A Analyze neurostim, complex ........................ 0.92 0.39 0.35 0.08 1.39 1.35 ZZZ 

95974 ......... ............ A Cranial neurostim, complex ......................... 3.00 1.29 1.29 0.18 4.47 4.47 XXX 

95975 ......... ............ A Cranial neurostim, complex ......................... 1.70 0.73 0.73 0.08 2.51 2.51 ZZZ 

95990 ......... ............ A Spin/brain pump refil & main ....................... 0.00 1.50 NA 0.06 1.56 NA XXX 

95991 ......... ............ A Spin/brain pump refil & main ....................... 0.77 1.43 0.19 0.06 2.26 1.02 XXX 

95999 ......... ............ C Neurological procedure ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96000 ......... ............ A Motion analysis, video/3d ............................ 1.80 NA 0.55 0.02 NA 2.37 XXX 

96001 ......... ............ A Motion test w/ft press meas ........................ 2.15 NA 0.66 0.02 NA 2.83 XXX 

96002 ......... ............ A Dynamic surface emg .................................. 0.41 NA 0.15 0.02 NA 0.58 XXX 

96003 ......... ............ A Dynamic fine wire emg ................................ 0.37 NA 0.14 0.04 NA 0.55 XXX 

96004 ......... ............ A Phys review of motion tests ........................ 2.14 0.95 0.95 0.10 3.19 3.19 XXX 

96100 ......... ............ A Psychological testing ................................... 0.00 1.77 NA 0.18 1.95 NA XXX 

96105 ......... ............ A Assessment of aphasia ............................... 0.00 1.77 NA 0.18 1.95 NA XXX 

96110 ......... ............ A Developmental test, lim ............................... 0.00 0.19 NA 0.18 0.37 NA XXX 

96111 ......... ............ A Developmental test, extend ......................... 2.60 1.07 NA 0.18 3.85 NA XXX 

96115 ......... ............ A Neurobehavior status exam ......................... 0.00 1.77 NA 0.18 1.95 NA XXX 

96117 ......... ............ A Neuropsych test battery ............................... 0.00 1.77 NA 0.18 1.95 NA XXX 

96150 ......... ............ A Assess lth/behave, init ................................. 0.50 0.19 0.18 0.02 0.71 0.70 XXX 

1233

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

96151 ......... ............ A Assess hlth/behave, subseq ........................ 0.48 0.18 0.17 0.02 0.68 0.67 XXX 

96152 ......... ............ A Intervene hlth/behave, indiv ......................... 0.46 0.17 0.16 0.02 0.65 0.64 XXX 

96153 ......... ............ A Intervene hlth/behave, group ....................... 0.10 0.04 0.04 0.01 0.15 0.15 XXX 

96154 ......... ............ A Interv hlth/behav, fam w/pt .......................... 0.45 0.17 0.16 0.02 0.64 0.63 XXX 

96155 ......... ............ N Interv hlth/behav fam no pt .......................... +0.44 0.18 0.17 0.02 0.64 0.63 XXX 

96400 ......... ............ A Chemotherapy, sc/im ................................... 0.17 1.12 NA 0.01 1.30 NA XXX 

96405 ......... ............ A Intralesional chemo admin ........................... 0.52 2.35 0.24 0.02 2.89 0.78 000 

96406 ......... ............ A Intralesional chemo admin ........................... 0.80 3.10 0.30 0.02 3.92 1.12 000 

96408 ......... ............ A Chemotherapy, push technique ................... 0.17 2.91 NA 0.06 3.14 NA XXX 

96410 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.16 NA 0.08 4.41 NA XXX 

96412 ......... ............ A Chemo, infuse method add-on .................... 0.17 0.74 NA 0.07 0.98 NA ZZZ 

96414 ......... ............ A Chemo, infuse method add-on .................... 0.17 5.22 NA 0.08 5.47 NA XXX 

96420 ......... ............ A Chemotherapy, push technique ................... 0.17 2.81 NA 0.08 3.06 NA XXX 

96422 ......... ............ A Chemotherapy,infusion method ................... 0.17 5.19 NA 0.08 5.44 NA XXX 

96423 ......... ............ A Chemo, infuse method add-on .................... 0.17 1.96 NA 0.02 2.15 NA ZZZ 

96425 ......... ............ A Chemotherapy,infusion method ................... 0.17 4.73 NA 0.08 4.98 NA XXX 

96440 ......... ............ A Chemotherapy, intracavitary ........................ 2.37 8.42 1.24 0.14 10.93 3.75 000 

96445 ......... ............ A Chemotherapy, intracavitary ........................ 2.20 8.54 1.19 0.08 10.82 3.47 000 

96450 ......... ............ A Chemotherapy, into CNS ............................. 1.89 7.32 1.10 0.07 9.28 3.06 000 

96520 ......... ............ A Port pump refill & main ................................ 0.17 3.94 NA 0.06 4.17 NA XXX 

96530 ......... ............ A Syst pump refill & main ............................... 0.17 2.86 NA 0.06 3.09 NA XXX 

96542 ......... ............ A Chemotherapy injection ............................... 1.42 4.43 0.66 0.06 5.91 2.14 XXX 

96545 ......... ............ B Provide chemotherapy agent ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96549 ......... ............ C Chemotherapy, unspecified ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

96567 ......... ............ A Photodynamic tx, skin .................................. 0.00 0.98 NA 0.04 1.02 NA XXX 

96570 ......... ............ A Photodynamic tx, 30 min ............................. 1.10 NA 0.37 0.05 NA 1.52 ZZZ 

96571 ......... ............ A Photodynamic tx, addl 15 min ..................... 0.55 NA 0.20 0.02 NA 0.77 ZZZ 

96900 ......... ............ A Ultraviolet light therapy ................................ 0.00 0.48 NA 0.02 0.50 NA XXX 

96902 ......... ............ B Trichogram ................................................... +0.41 0.25 0.16 0.01 0.67 0.58 XXX 

96910 ......... ............ A Photochemotherapy with UV-B ................... 0.00 1.07 NA 0.04 1.11 NA XXX 

96912 ......... ............ A Photochemotherapy with UV-A ................... 0.00 1.34 NA 0.05 1.39 NA XXX 

96913 ......... ............ A Photochemotherapy, UV-A or B .................. 0.00 1.78 NA 0.10 1.88 NA XXX 

96920 ......... ............ A Laser tx, skin < 250 sq cm .......................... 1.15 7.67 0.56 0.11 8.93 1.82 000 

96921 ......... ............ A Laser tx, skin 250-500 sq cm ...................... 1.17 7.74 0.57 0.11 9.02 1.85 000 

96922 ......... ............ A Laser tx, skin > 500 sq cm .......................... 2.10 8.48 1.04 0.19 10.77 3.33 000 

96999 ......... ............ C Dermatological procedure ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97001 ......... ............ A Pt evaluation ................................................ 1.20 0.73 0.45 0.06 1.99 1.71 XXX 

97002 ......... ............ A Pt re-evaluation ............................................ 0.60 0.43 0.24 0.02 1.05 0.86 XXX 

97003 ......... ............ A Ot evaluation ................................................ 1.20 0.86 0.40 0.06 2.12 1.66 XXX 

97004 ......... ............ A Ot re-evaluation ........................................... 0.60 0.60 0.20 0.02 1.22 0.82 XXX 

97005 ......... ............ I Athletic train eval ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97006 ......... ............ I Athletic train reeval ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97010 ......... ............ B Hot or cold packs therapy ........................... +0.06 0.05 NA 0.01 0.12 NA XXX 

97012 ......... ............ A Mechanical traction therapy ......................... 0.25 0.14 NA 0.01 0.40 NA XXX 

97014 ......... ............ I Electric stimulation therapy .......................... +0.18 0.19 0.19 0.01 0.38 0.38 XXX 

97016 ......... ............ A Vasopneumatic device therapy ................... 0.18 0.19 NA 0.01 0.38 NA XXX 

97018 ......... ............ A Paraffin bath therapy ................................... 0.06 0.11 NA 0.01 0.18 NA XXX 

97020 ......... ............ A Microwave therapy ....................................... 0.06 0.06 NA 0.01 0.13 NA XXX 

97022 ......... ............ A Whirlpool therapy ......................................... 0.17 0.22 NA 0.01 0.40 NA XXX 

97024 ......... ............ A Diathermy treatment .................................... 0.06 0.09 NA 0.01 0.16 NA XXX 

97026 ......... ............ A Infrared therapy ........................................... 0.06 0.06 NA 0.01 0.13 NA XXX 

97028 ......... ............ A Ultraviolet therapy ........................................ 0.08 0.07 NA 0.01 0.16 NA XXX 

97032 ......... ............ A Electrical stimulation .................................... 0.25 0.16 NA 0.01 0.42 NA XXX 

97033 ......... ............ A Electric current therapy ................................ 0.26 0.28 NA 0.02 0.56 NA XXX 

97034 ......... ............ A Contrast bath therapy .................................. 0.21 0.16 NA 0.01 0.38 NA XXX 

97035 ......... ............ A Ultrasound therapy ...................................... 0.21 0.11 NA 0.01 0.33 NA XXX 

97036 ......... ............ A Hydrotherapy ............................................... 0.28 0.33 NA 0.01 0.62 NA XXX 

97039 ......... ............ A Physical therapy treatment .......................... 0.20 0.10 NA 0.01 0.31 NA XXX 

97110 ......... ............ A Therapeutic exercises .................................. 0.45 0.28 NA 0.04 0.77 NA XXX 

97112 ......... ............ A Neuromuscular reeducation ......................... 0.45 0.30 NA 0.02 0.77 NA XXX 

97113 ......... ............ A Aquatic therapy/exercises ............................ 0.44 0.40 NA 0.04 0.88 NA XXX 

97116 ......... ............ A Gait training therapy .................................... 0.40 0.24 NA 0.02 0.66 NA XXX 

97124 ......... ............ A Massage therapy ......................................... 0.35 0.23 NA 0.01 0.59 NA XXX 

97139 ......... ............ A Physical medicine procedure ....................... 0.21 0.20 NA 0.01 0.42 NA XXX 

97140 ......... ............ A Manual therapy ............................................ 0.43 0.26 NA 0.02 0.71 NA XXX 

97150 ......... ............ A Group therapeutic procedures ..................... 0.27 0.18 NA 0.02 0.47 NA XXX 

97504 ......... ............ A Orthotic training ........................................... 0.45 0.33 NA 0.04 0.82 NA XXX 

97520 ......... ............ A Prosthetic training ........................................ 0.45 0.28 NA 0.02 0.75 NA XXX 

97530 ......... ............ A Therapeutic activities ................................... 0.44 0.32 NA 0.02 0.78 NA XXX 

97532 ......... ............ A Cognitive skills development ....................... 0.44 0.21 NA 0.01 0.66 NA XXX 

97533 ......... ............ A Sensory integration ...................................... 0.44 0.24 NA 0.01 0.69 NA XXX 

97535 ......... ............ A Self care mngment training ......................... 0.45 0.33 NA 0.02 0.80 NA XXX 

97537 ......... ............ A Community/work reintegration ..................... 0.45 0.27 NA 0.01 0.73 NA XXX 

97542 ......... ............ A Wheelchair mngment training ...................... 0.45 0.28 NA 0.01 0.74 NA XXX 

97545 ......... ............ R Work hardening ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1234

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

97546 ......... ............ R Work hardening add-on ............................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

97601 ......... ............ A Wound(s) care, selective ............................. 0.50 0.49 NA 0.05 1.04 NA XXX 

97602 ......... ............ B Wound(s) care non-selective ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97703 ......... ............ A Prosthetic checkout ..................................... 0.25 0.41 NA 0.02 0.68 NA XXX 

97750 ......... ............ A Physical performance test ........................... 0.45 0.30 NA 0.02 0.77 NA XXX 

97755 ......... ............ A Assistive technology assess ........................ 0.62 0.29 NA 0.02 0.93 NA XXX 

97780 ......... ............ N Acupuncture w/o stimul ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97781 ......... ............ N Acupuncture w/stimul ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97799 ......... ............ C Physical medicine procedure ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

97802 ......... ............ A Medical nutrition, indiv, in ............................ 0.00 0.47 NA 0.01 0.48 NA XXX 

97803 ......... ............ A Med nutrition, indiv, subseq ......................... 0.00 0.47 NA 0.01 0.48 NA XXX 

97804 ......... ............ A Medical nutrition, group ............................... 0.00 0.19 NA 0.01 0.20 NA XXX 

98925 ......... ............ A Osteopathic manipulation ............................ 0.45 0.33 0.14 0.01 0.79 0.60 000 

98926 ......... ............ A Osteopathic manipulation ............................ 0.65 0.42 0.25 0.02 1.09 0.92 000 

98927 ......... ............ A Osteopathic manipulation ............................ 0.87 0.51 0.30 0.04 1.42 1.21 000 

98928 ......... ............ A Osteopathic manipulation ............................ 1.03 0.60 0.35 0.04 1.67 1.42 000 

98929 ......... ............ A Osteopathic manipulation ............................ 1.19 0.68 0.37 0.05 1.92 1.61 000 

98940 ......... ............ A Chiropractic manipulation ............................ 0.45 0.24 0.12 0.01 0.70 0.58 000 

98941 ......... ............ A Chiropractic manipulation ............................ 0.65 0.30 0.18 0.02 0.97 0.85 000 

98942 ......... ............ A Chiropractic manipulation ............................ 0.87 0.36 0.24 0.04 1.27 1.15 000 

98943 ......... ............ N Chiropractic manipulation ............................ +0.40 0.24 0.16 0.01 0.65 0.57 XXX 

99000 ......... ............ B Specimen handling ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99001 ......... ............ B Specimen handling ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99002 ......... ............ B Device handling ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99024 ......... ............ B Postop follow-up visit ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99025 ......... ............ F Initial surgical evaluation ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99026 ......... ............ N In-hospital on call service ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99027 ......... ............ N Out-of-hosp on call service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99050 ......... ............ B Medical services after hrs ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99052 ......... ............ B Medical services at night ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99054 ......... ............ B Medical servcs, unusual hrs ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99056 ......... ............ B Non-office medical services ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99058 ......... ............ B Office emergency care ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99070 ......... ............ B Special supplies ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99071 ......... ............ B Patient education materials ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99075 ......... ............ N Medical testimony ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99078 ......... ............ B Group health education ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99080 ......... ............ B Special reports or forms .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99082 ......... ............ C Unusual physician travel .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99090 ......... ............ B Computer data analysis ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99091 ......... ............ B Collect/review data from pt .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99100 ......... ............ B Special anesthesia service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99116 ......... ............ B Anesthesia with hypothermia ....................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99135 ......... ............ B Special anesthesia procedure ..................... 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99140 ......... ............ B Emergency anesthesia ................................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99141 ......... ............ B Sedation, iv/im or inhalant ........................... +0.80 1.92 0.38 0.05 2.77 1.23 XXX 

99142 ......... ............ B Sedation, oral/rectal/nasal ........................... +0.60 0.99 0.31 0.04 1.63 0.95 XXX 

99170 ......... ............ A Anogenital exam, child ................................ 1.75 1.72 0.52 0.08 3.55 2.35 000 

99172 ......... ............ N Ocular function screen ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99173 ......... ............ N Visual acuity screen ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99175 ......... ............ A Induction of vomiting .................................... 0.00 1.40 NA 0.10 1.50 NA XXX 

99183 ......... ............ A Hyperbaric oxygen therapy .......................... 2.34 4.75 0.72 0.14 7.23 3.20 XXX 

99185 ......... ............ A Regional hypothermia .................................. 0.00 0.64 NA 0.04 0.68 NA XXX 

99186 ......... ............ A Total body hypothermia ............................... 0.00 1.79 NA 0.45 2.24 NA XXX 

99190 ......... ............ X Special pump services ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99191 ......... ............ X Special pump services ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99192 ......... ............ X Special pump services ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99195 ......... ............ A Phlebotomy .................................................. 0.00 0.44 NA 0.02 0.46 NA XXX 

99199 ......... ............ C Special service/proc/report .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99201 ......... ............ A Office/outpatient visit, new ........................... 0.45 0.50 0.16 0.02 0.97 0.63 XXX 

99202 ......... ............ A Office/outpatient visit, new ........................... 0.88 0.79 0.32 0.06 1.73 1.26 XXX 

99203 ......... ............ A Office/outpatient visit, new ........................... 1.34 1.13 0.48 0.10 2.57 1.92 XXX 

99204 ......... ............ A Office/outpatient visit, new ........................... 2.00 1.51 0.71 0.12 3.63 2.83 XXX 

99205 ......... ............ A Office/outpatient visit, new ........................... 2.67 1.80 0.95 0.14 4.61 3.76 XXX 

99211 ......... ............ A Office/outpatient visit, est ............................ 0.17 0.39 0.06 0.01 0.57 0.24 XXX 

99212 ......... ............ A Office/outpatient visit, est ............................ 0.45 0.54 0.16 0.02 1.01 0.63 XXX 

99213 ......... ............ A Office/outpatient visit, est ............................ 0.67 0.70 0.24 0.04 1.41 0.95 XXX 

99214 ......... ............ A Office/outpatient visit, est ............................ 1.10 1.05 0.40 0.05 2.20 1.55 XXX 

99215 ......... ............ A Office/outpatient visit, est ............................ 1.77 1.34 0.65 0.08 3.19 2.50 XXX 

99217 ......... ............ A Observation care discharge ......................... 1.28 NA 0.53 0.06 NA 1.87 XXX 

99218 ......... ............ A Observation care ......................................... 1.28 NA 0.43 0.06 NA 1.77 XXX 

99219 ......... ............ A Observation care ......................................... 2.14 NA 0.72 0.10 NA 2.96 XXX 

99220 ......... ............ A Observation care ......................................... 2.99 NA 1.03 0.13 NA 4.15 XXX 

99221 ......... ............ A Initial hospital care ....................................... 1.28 NA 0.45 0.06 NA 1.79 XXX 

99222 ......... ............ A Initial hospital care ....................................... 2.14 NA 0.74 0.10 NA 2.98 XXX 

1235

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

99223 ......... ............ A Initial hospital care ....................................... 2.99 NA 1.04 0.12 NA 4.15 XXX 

99231 ......... ............ A Subsequent hospital care ............................ 0.64 NA 0.23 0.02 NA 0.89 XXX 

99232 ......... ............ A Subsequent hospital care ............................ 1.06 NA 0.37 0.04 NA 1.47 XXX 

99233 ......... ............ A Subsequent hospital care ............................ 1.51 NA 0.52 0.06 NA 2.09 XXX 

99234 ......... ............ A Observ/hosp same date .............................. 2.56 NA 1.00 0.13 NA 3.69 XXX 

99235 ......... ............ A Observ/hosp same date .............................. 3.41 NA 1.29 0.16 NA 4.86 XXX 

99236 ......... ............ A Observ/hosp same date .............................. 4.26 NA 1.59 0.21 NA 6.06 XXX 

99238 ......... ............ A Hospital discharge day ................................ 1.28 NA 0.54 0.05 NA 1.87 XXX 

99239 ......... ............ A Hospital discharge day ................................ 1.75 NA 0.74 0.06 NA 2.55 XXX 

99241 ......... ............ A Office consultation ....................................... 0.64 0.65 0.22 0.05 1.34 0.91 XXX 

99242 ......... ............ A Office consultation ....................................... 1.29 1.05 0.46 0.11 2.45 1.86 XXX 

99243 ......... ............ A Office consultation ....................................... 1.72 1.39 0.63 0.12 3.23 2.47 XXX 

99244 ......... ............ A Office consultation ....................................... 2.58 1.83 0.92 0.16 4.57 3.66 XXX 

99245 ......... ............ A Office consultation ....................................... 3.42 2.29 1.24 0.19 5.90 4.85 XXX 

99251 ......... ............ A Initial inpatient consult ................................. 0.66 NA 0.25 0.05 NA 0.96 XXX 

99252 ......... ............ A Initial inpatient consult ................................. 1.32 NA 0.50 0.10 NA 1.92 XXX 

99253 ......... ............ A Initial inpatient consult ................................. 1.82 NA 0.68 0.11 NA 2.61 XXX 

99254 ......... ............ A Initial inpatient consult ................................. 2.64 NA 0.99 0.13 NA 3.76 XXX 

99255 ......... ............ A Initial inpatient consult ................................. 3.64 NA 1.35 0.18 NA 5.17 XXX 

99261 ......... ............ A Follow-up inpatient consult .......................... 0.42 NA 0.16 0.02 NA 0.60 XXX 

99262 ......... ............ A Follow-up inpatient consult .......................... 0.85 NA 0.31 0.04 NA 1.20 XXX 

99263 ......... ............ A Follow-up inpatient consult .......................... 1.27 NA 0.45 0.05 NA 1.77 XXX 

99271 ......... ............ A Confirmatory consultation ............................ 0.45 0.55 0.16 0.04 1.04 0.65 XXX 

99272 ......... ............ A Confirmatory consultation ............................ 0.84 0.82 0.31 0.07 1.73 1.22 XXX 

99273 ......... ............ A Confirmatory consultation ............................ 1.19 1.10 0.44 0.08 2.37 1.71 XXX 

99274 ......... ............ A Confirmatory consultation ............................ 1.73 1.36 0.64 0.11 3.20 2.48 XXX 

99275 ......... ............ A Confirmatory consultation ............................ 2.31 1.64 0.84 0.12 4.07 3.27 XXX 

99281 ......... ............ A Emergency dept visit ................................... 0.33 NA 0.09 0.02 NA 0.44 XXX 

99282 ......... ............ A Emergency dept visit ................................... 0.55 NA 0.15 0.04 NA 0.74 XXX 

99283 ......... ............ A Emergency dept visit ................................... 1.24 NA 0.31 0.10 NA 1.65 XXX 

99284 ......... ............ A Emergency dept visit ................................... 1.95 NA 0.47 0.14 NA 2.56 XXX 

99285 ......... ............ A Emergency dept visit ................................... 3.06 NA 0.72 0.23 NA 4.01 XXX 

99288 ......... ............ B Direct advanced life support ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99289 ......... ............ A Ped crit care transport ................................. 4.79 NA 1.91 0.17 NA 6.87 XXX 

99290 ......... ............ A Ped crit care transport addl ......................... 2.40 NA 0.83 0.08 NA 3.31 ZZZ 

99291 ......... ............ A Critical care, first hour ................................. 3.99 2.34 1.28 0.17 6.50 5.44 XXX 

99292 ......... ............ A Critical care, add’l 30 min ............................ 2.00 0.81 0.64 0.08 2.89 2.72 ZZZ 

99293 ......... ............ A Ped critical care, initial ................................. 15.98 NA 4.96 0.84 NA 21.78 XXX 

99294 ......... ............ A Ped critical care, subseq ............................. 7.99 NA 2.49 0.28 NA 10.76 XXX 

99295 ......... ............ A Neonate crit care, initial ............................... 18.46 NA 5.39 0.84 NA 24.69 XXX 

99296 ......... ............ A Neonate critical care subseq ....................... 7.99 NA 2.55 0.28 NA 10.82 XXX 

99298 ......... ............ A Ic for lbw infant < 1500 gm ......................... 2.75 NA 0.93 0.12 NA 3.80 XXX 

99299 ......... ............ A Ic, lbw infant 1500-2500 gm ........................ 2.50 NA 0.95 0.12 NA 3.57 XXX 

99301 ......... ............ A Nursing facility care ..................................... 1.20 0.67 0.40 0.05 1.92 1.65 XXX 

99302 ......... ............ A Nursing facility care ..................................... 1.61 0.95 0.54 0.06 2.62 2.21 XXX 

99303 ......... ............ A Nursing facility care ..................................... 2.01 1.16 0.67 0.07 3.24 2.75 XXX 

99311 ......... ............ A Nursing fac care, subseq ............................. 0.60 0.47 0.20 0.02 1.09 0.82 XXX 

99312 ......... ............ A Nursing fac care, subseq ............................. 1.00 0.65 0.34 0.04 1.69 1.38 XXX 

99313 ......... ............ A Nursing fac care, subseq ............................. 1.42 0.84 0.47 0.05 2.31 1.94 XXX 

99315 ......... ............ A Nursing fac discharge day ........................... 1.13 0.70 0.37 0.05 1.88 1.55 XXX 

99316 ......... ............ A Nursing fac discharge day ........................... 1.50 0.90 0.51 0.06 2.46 2.07 XXX 

99321 ......... ............ A Rest home visit, new patient ....................... 0.71 0.35 NA 0.02 1.08 NA XXX 

99322 ......... ............ A Rest home visit, new patient ....................... 1.01 0.46 NA 0.04 1.51 NA XXX 

99323 ......... ............ A Rest home visit, new patient ....................... 1.28 0.55 NA 0.05 1.88 NA XXX 

99331 ......... ............ A Rest home visit, est pat ............................... 0.60 0.32 NA 0.02 0.94 NA XXX 

99332 ......... ............ A Rest home visit, est pat ............................... 0.80 0.38 NA 0.04 1.22 NA XXX 

99333 ......... ............ A Rest home visit, est pat ............................... 1.00 0.45 NA 0.04 1.49 NA XXX 

99341 ......... ............ A Home visit, new patient ............................... 1.01 0.48 NA 0.06 1.55 NA XXX 

99342 ......... ............ A Home visit, new patient ............................... 1.52 0.68 NA 0.06 2.26 NA XXX 

99343 ......... ............ A Home visit, new patient ............................... 2.27 0.95 NA 0.08 3.30 NA XXX 

99344 ......... ............ A Home visit, new patient ............................... 3.03 1.18 NA 0.12 4.33 NA XXX 

99345 ......... ............ A Home visit, new patient ............................... 3.78 1.44 NA 0.14 5.36 NA XXX 

99347 ......... ............ A Home visit, est patient ................................. 0.76 0.39 NA 0.04 1.19 NA XXX 

99348 ......... ............ A Home visit, est patient ................................. 1.26 0.71 NA 0.05 2.02 NA XXX 

99349 ......... ............ A Home visit, est patient ................................. 2.02 1.04 NA 0.07 3.13 NA XXX 

99350 ......... ............ A Home visit, est patient ................................. 3.03 1.40 NA 0.12 4.55 NA XXX 

99354 ......... ............ A Prolonged service, office ............................. 1.77 0.75 0.66 0.07 2.59 2.50 ZZZ 

99355 ......... ............ A Prolonged service, office ............................. 1.77 0.73 0.62 0.07 2.57 2.46 ZZZ 

99356 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.62 0.07 NA 2.40 ZZZ 

99357 ......... ............ A Prolonged service, inpatient ........................ 1.71 NA 0.63 0.07 NA 2.41 ZZZ 

99358 ......... ............ B Prolonged serv, w/o contact ........................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99359 ......... ............ B Prolonged serv, w/o contact ........................ 0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

99360 ......... ............ X Physician standby services ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99361 ......... ............ B Physician/team conference .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99362 ......... ............ B Physician/team conference .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1236

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

99371 ......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99372 ......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99373 ......... ............ B Physician phone consultation ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99374 ......... ............ B Home health care supervision ..................... +1.10 0.70 0.41 0.05 1.85 1.56 XXX 

99375 ......... ............ I Home health care supervision ..................... +1.73 1.55 1.55 0.07 3.35 3.35 XXX 

99377 ......... ............ B Hospice care supervision ............................ +1.10 0.70 0.41 0.05 1.85 1.56 XXX 

99378 ......... ............ I Hospice care supervision ............................ +1.73 1.94 1.94 0.07 3.74 3.74 XXX 

99379 ......... ............ B Nursing fac care supervision ....................... +1.10 0.70 0.70 0.04 1.84 1.84 XXX 

99380 ......... ............ B Nursing fac care supervision ....................... +1.73 1.00 1.00 0.06 2.79 2.79 XXX 

99381 ......... ............ N Prev visit, new, infant .................................. +1.19 1.50 0.45 0.05 2.74 1.69 XXX 

99382 ......... ............ N Prev visit, new, age 1-4 ............................... +1.36 1.54 0.52 0.05 2.95 1.93 XXX 

99383 ......... ............ N Prev visit, new, age 5-11 ............................. +1.36 1.48 0.52 0.05 2.89 1.93 XXX 

99384 ......... ............ N Prev visit, new, age 12-17 ........................... +1.53 1.55 0.59 0.06 3.14 2.18 XXX 

99385 ......... ............ N Prev visit, new, age 18-39 ........................... +1.53 1.55 0.59 0.06 3.14 2.18 XXX 

99386 ......... ............ N Prev visit, new, age 40-64 ........................... +1.88 1.74 0.72 0.07 3.69 2.67 XXX 

99387 ......... ............ N Prev visit, new, 65 & over ........................... +2.06 1.87 0.79 0.07 4.00 2.92 XXX 

99391 ......... ............ N Prev visit, est, infant .................................... +1.02 1.02 0.39 0.04 2.08 1.45 XXX 

99392 ......... ............ N Prev visit, est, age 1-4 ................................. +1.19 1.09 0.45 0.05 2.33 1.69 XXX 

99393 ......... ............ N Prev visit, est, age 5-11 ............................... +1.19 1.06 0.45 0.05 2.30 1.69 XXX 

99394 ......... ............ N Prev visit, est, age 12-17 ............................. +1.36 1.13 0.52 0.05 2.54 1.93 XXX 

99395 ......... ............ N Prev visit, est, age 18-39 ............................. +1.36 1.16 0.52 0.05 2.57 1.93 XXX 

99396 ......... ............ N Prev visit, est, age 40-64 ............................. +1.53 1.25 0.59 0.06 2.84 2.18 XXX 

99397 ......... ............ N Prev visit, est, 65 & over ............................. +1.71 1.36 0.66 0.06 3.13 2.43 XXX 

99401 ......... ............ N Preventive counseling, indiv ........................ +0.48 0.62 0.19 0.01 1.11 0.68 XXX 

99402 ......... ............ N Preventive counseling, indiv ........................ +0.98 0.87 0.37 0.02 1.87 1.37 XXX 

99403 ......... ............ N Preventive counseling, indiv ........................ +1.46 1.09 0.56 0.04 2.59 2.06 XXX 

99404 ......... ............ N Preventive counseling, indiv ........................ +1.95 1.32 0.75 0.05 3.32 2.75 XXX 

99411 ......... ............ N Preventive counseling, group ...................... +0.15 0.18 0.06 0.01 0.34 0.22 XXX 

99412 ......... ............ N Preventive counseling, group ...................... +0.25 0.25 0.10 0.01 0.51 0.36 XXX 

99420 ......... ............ N Health risk assessment test ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99429 ......... ............ N Unlisted preventive service .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99431 ......... ............ A Initial care, normal newborn ........................ 1.17 NA 0.38 0.05 NA 1.60 XXX 

99432 ......... ............ A Newborn care, not in hosp .......................... 1.26 0.90 0.40 0.07 2.23 1.73 XXX 

99433 ......... ............ A Normal newborn care/hospital ..................... 0.62 NA 0.20 0.02 NA 0.84 XXX 

99435 ......... ............ A Newborn discharge day hosp ...................... 1.50 NA 0.50 0.06 NA 2.06 XXX 

99436 ......... ............ A Attendance, birth .......................................... 1.50 NA 0.46 0.06 NA 2.02 XXX 

99440 ......... ............ A Newborn resuscitation ................................. 2.93 NA 0.94 0.13 NA 4.00 XXX 

99450 ......... ............ N Life/disability evaluation ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99455 ......... ............ R Disability examination .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99456 ......... ............ R Disability examination .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99499 ......... ............ C Unlisted e&m service ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99500 ......... ............ I Home visit, prenatal ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99501 ......... ............ I Home visit, postnatal ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99502 ......... ............ I Home visit, nb care ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99503 ......... ............ I Home visit, resp therapy .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99504 ......... ............ I Home visit mech ventilator .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99505 ......... ............ I Home visit, stoma care ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99506 ......... ............ I Home visit, im injection ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99507 ......... ............ I Home visit, cath maintain ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99509 ......... ............ I Home visit day life activity ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99510 ......... ............ I Home visit, sing/m/fam couns ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99511 ......... ............ I Home visit, fecal/enema mgmt .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99512 ......... ............ I Home visit for hemodialysis ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99551 ......... ............ F Home infus, pain mgmt, iv/sc ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99552 ......... ............ F Hm infus pain mgmt, epid/ith ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99553 ......... ............ F Home infuse, tocolytic tx ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99554 ......... ............ F Home infus, hormone/platelet ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99555 ......... ............ F Home infuse, chemotheraphy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99556 ......... ............ F Home infus, antibio/fung/vir ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99557 ......... ............ F Home infuse, anticoagulant ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99558 ......... ............ F Home infuse, immunotherapy ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99559 ......... ............ F Home infus, periton dialysis ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99560 ......... ............ F Home infus, entero nutrition ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99561 ......... ............ F Home infuse, hydration tx ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99562 ......... ............ F Home infus, parent nutrition ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99563 ......... ............ F Home admin, pentamidine ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99564 ......... ............ F Hme infus, antihemophil agnt ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99565 ......... ............ F Home infus, proteinase inhib ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99566 ......... ............ F Home infuse, iv therapy ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99567 ......... ............ F Home infuse, sympath agent ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99568 ......... ............ F Home infus, misc drug, daily ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99569 ......... ............ F Home infuse, each addl tx ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99600 ......... ............ I Home visit nos ............................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99601 ......... ............ I Home infusion/visit, 2 hrs ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

99602 ......... ............ I Home infusion, each addtl hr ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1237

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

A4890 ......... ............ R Repair/maint cont hemo equip .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0150 ......... ............ R Comprehensve oral evaluation .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0240 ......... ............ R Intraoral occlusal film ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0250 ......... ............ R Extraoral first film ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0260 ......... ............ R Extraoral ea additional film .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0270 ......... ............ R Dental bitewing single film ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0272 ......... ............ R Dental bitewings two films ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0274 ......... ............ R Dental bitewings four films .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0277 ......... ............ R Vert bitewings-sev to eight .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0460 ......... ............ R Pulp vitality test ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0472 ......... ............ R Gross exam, prep & report .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0473 ......... ............ R Micro exam, prep & report ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0474 ......... ............ R Micro w exam of surg margins .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0480 ......... ............ R Cytopath smear prep & report ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D0502 ......... ............ R Other oral pathology procedu ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D0999 ......... ............ R Unspecified diagnostic proce ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1510 ......... ............ R Space maintainer fxd unilat ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1515 ......... ............ R Fixed bilat space maintainer ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1520 ......... ............ R Remove unilat space maintain .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1525 ......... ............ R Remove bilat space maintain ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D1550 ......... ............ R Recement space maintainer ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D2970 ......... ............ R Temporary- fractured tooth .......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D2999 ......... ............ R Dental unspec restorative pr ....................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D3460 ......... ............ R Endodontic endosseous implan ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D3999 ......... ............ R Endodontic procedure .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4260 ......... ............ R Osseous surgery per quadrant .................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4263 ......... ............ R Bone replce graft first site ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4264 ......... ............ R Bone replce graft each add ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4268 ......... ............ R Surgical revision procedure ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D4270 ......... ............ R Pedicle soft tissue graft pr ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4271 ......... ............ R Free soft tissue graft proc ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4273 ......... ............ R Subepithelial tissue graft ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4355 ......... ............ R Full mouth debridement ............................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D4381 ......... ............ R Localized chemo delivery ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5911 ......... ............ R Facial moulage sectional ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5912 ......... ............ R Facial moulage complete ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5951 ......... ............ R Feeding aid .................................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5983 ......... ............ R Radiation applicator ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5984 ......... ............ R Radiation shield ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5985 ......... ............ R Radiation cone locator ................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D5987 ......... ............ R Commissure splint ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D6920 ......... ............ R Dental connector bar ................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7111 ......... ............ R Coronal remnants deciduous t .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7140 ......... ............ R Extraction erupted tooth/exr ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7210 ......... ............ R Rem imp tooth w mucoper flp ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7220 ......... ............ R Impact tooth remov soft tiss ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7230 ......... ............ R Impact tooth remov part bony ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7240 ......... ............ R Impact tooth remov comp bony ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7241 ......... ............ R Impact tooth rem bony w/comp ................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7250 ......... ............ R Tooth root removal ...................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7260 ......... ............ R Oral antral fistula closure ............................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7261 ......... ............ R Primary closure sinus perf ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D7291 ......... ............ R Transseptal fiberotomy ................................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D7940 ......... ............ R Reshaping bone orthognathic ...................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9110 ......... ............ R Tx dental pain minor proc ............................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9230 ......... ............ R Analgesia ..................................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9248 ......... ............ R Sedation (non-iv) ......................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

D9630 ......... ............ R Other drugs/medicaments ........................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9930 ......... ............ R Treatment of complications ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9940 ......... ............ R Dental occlusal guard .................................. 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9950 ......... ............ R Occlusion analysis ....................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9951 ......... ............ R Limited occlusal adjustment ........................ 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

D9952 ......... ............ R Complete occlusal adjustment ..................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

G0001 ........ ............ X Drawing blood for specimen ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0008 ........ ............ X Admin influenza virus vac ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0009 ........ ............ X Admin pneumococcal vaccine ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0010 ........ ............ X Admin hepatitis b vaccine ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0027 ........ ............ X Semen analysis ........................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0030 ........ ............ C PET imaging prev PET single ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0030 ........ 26 ....... A PET imaging prev PET single ..................... 1.50 0.58 0.58 0.05 2.13 2.13 XXX 

G0030 ........ TC ...... C PET imaging prev PET single ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0031 ........ ............ C PET imaging prev PET multple ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0031 ........ 26 ....... A PET imaging prev PET multple ................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX 

G0031 ........ TC ...... C PET imaging prev PET multple ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0032 ........ ............ C PET follow SPECT 78464 singl ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1238

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0032 ........ 26 ....... A PET follow SPECT 78464 singl ................... 1.50 0.54 0.54 0.06 2.10 2.10 XXX 

G0032 ........ TC ...... C PET follow SPECT 78464 singl ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0033 ........ ............ C PET follow SPECT 78464 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0033 ........ 26 ....... A PET follow SPECT 78464 mult ................... 1.87 0.74 0.74 0.07 2.68 2.68 XXX 

G0033 ........ TC ...... C PET follow SPECT 78464 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0034 ........ ............ C PET follow SPECT 76865 singl ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0034 ........ 26 ....... A PET follow SPECT 76865 singl ................... 1.50 0.57 0.57 0.06 2.13 2.13 XXX 

G0034 ........ TC ...... C PET follow SPECT 76865 singl ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0035 ........ ............ C PET follow SPECT 78465 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0035 ........ 26 ....... A PET follow SPECT 78465 mult ................... 1.87 0.73 0.73 0.07 2.67 2.67 XXX 

G0035 ........ TC ...... C PET follow SPECT 78465 mult ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0036 ........ ............ C PET follow cornry angio sing ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0036 ........ 26 ....... A PET follow cornry angio sing ....................... 1.50 0.56 0.56 0.05 2.11 2.11 XXX 

G0036 ........ TC ...... C PET follow cornry angio sing ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0037 ........ ............ C PET follow cornry angio mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0037 ........ 26 ....... A PET follow cornry angio mult ...................... 1.87 0.71 0.71 0.07 2.65 2.65 XXX 

G0037 ........ TC ...... C PET follow cornry angio mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0038 ........ ............ C PET follow myocard perf sing ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0038 ........ 26 ....... A PET follow myocard perf sing ..................... 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0038 ........ TC ...... C PET follow myocard perf sing ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0039 ........ ............ C PET follow myocard perf mult ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0039 ........ 26 ....... A PET follow myocard perf mult ..................... 1.87 0.71 0.71 0.08 2.66 2.66 XXX 

G0039 ........ TC ...... C PET follow myocard perf mult ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0040 ........ ............ C PET follow stress echo singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0040 ........ 26 ....... A PET follow stress echo singl ....................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0040 ........ TC ...... C PET follow stress echo singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0041 ........ ............ C PET follow stress echo mult ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0041 ........ 26 ....... A PET follow stress echo mult ........................ 1.87 0.73 0.73 0.06 2.66 2.66 XXX 

G0041 ........ TC ...... C PET follow stress echo mult ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0042 ........ ............ C PET follow ventriculogm sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0042 ........ 26 ....... A PET follow ventriculogm sing ...................... 1.50 0.61 0.61 0.05 2.16 2.16 XXX 

G0042 ........ TC ...... C PET follow ventriculogm sing ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0043 ........ ............ C PET follow ventriculogm mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0043 ........ 26 ....... A PET follow ventriculogm mult ...................... 1.87 0.75 0.75 0.07 2.69 2.69 XXX 

G0043 ........ TC ...... C PET follow ventriculogm mult ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0044 ........ ............ C PET following rest ECG singl ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0044 ........ 26 ....... A PET following rest ECG singl ...................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0044 ........ TC ...... C PET following rest ECG singl ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0045 ........ ............ C PET following rest ECG mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0045 ........ 26 ....... A PET following rest ECG mult ....................... 1.87 0.72 0.72 0.07 2.66 2.66 XXX 

G0045 ........ TC ...... C PET following rest ECG mult ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0046 ........ ............ C PET follow stress ECG singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0046 ........ 26 ....... A PET follow stress ECG singl ....................... 1.50 0.59 0.59 0.05 2.14 2.14 XXX 

G0046 ........ TC ...... C PET follow stress ECG singl ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0047 ........ ............ C PET follow stress ECG mult ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0047 ........ 26 ....... A PET follow stress ECG mult ........................ 1.87 0.73 0.73 0.07 2.67 2.67 XXX 

G0047 ........ TC ...... C PET follow stress ECG mult ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0101 ........ ............ A CA screen;pelvic/breast exam ..................... 0.45 0.52 0.17 0.01 0.98 0.63 XXX 

G0102 ........ ............ A Prostate ca screening; dre .......................... 0.17 0.39 0.06 0.01 0.57 0.24 XXX 

G0103 ........ ............ X Psa, total screening ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0104 ........ ............ A CA screen;flexi sigmoidscope ..................... 0.96 2.20 0.52 0.06 3.22 1.54 000 

G0105 ........ ............ A Colorectal scrn; hi risk ind ........................... 3.69 6.04 1.58 0.24 9.97 5.51 000 

G0105 ........ 53 ....... A Colorectal scrn; hi risk ind ........................... 0.96 2.20 0.52 0.06 3.22 1.54 000 

G0106 ........ ............ A Colon CA screen;barium enema ................. 0.99 2.57 NA 0.18 3.74 NA XXX 

G0106 ........ 26 ....... A Colon CA screen;barium enema ................. 0.99 0.33 0.33 0.05 1.37 1.37 XXX 

G0106 ........ TC ...... A Colon CA screen;barium enema ................. 0.00 2.24 NA 0.13 2.37 NA XXX 

G0107 ........ ............ X CA screen; fecal blood test ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0108 ........ ............ A Diab manage trn per indiv ........................... 0.00 0.84 NA 0.01 0.85 NA XXX 

G0109 ........ ............ A Diab manage trn ind/group .......................... 0.00 0.48 NA 0.01 0.49 NA XXX 

G0110 ........ ............ R Nett pulm-rehab educ; ind ........................... 0.90 0.70 0.30 0.04 1.64 1.24 XXX 

G0111 ........ ............ R Nett pulm-rehab educ; group ....................... 0.27 0.29 0.14 0.01 0.57 0.42 XXX 

G0112 ........ ............ R Nett;nutrition guid, initial .............................. 1.72 1.20 0.66 0.06 2.98 2.44 XXX 

G0113 ........ ............ R Nett;nutrition guid,subseqnt ......................... 1.29 0.83 0.41 0.05 2.17 1.75 XXX 

G0114 ........ ............ R Nett; psychosocial consult ........................... 1.20 0.49 0.37 0.04 1.73 1.61 XXX 

G0115 ........ ............ R Nett; psychological testing ........................... 1.20 0.64 0.37 0.05 1.89 1.62 XXX 

G0116 ........ ............ R Nett; psychosocial counsel .......................... 1.11 1.01 0.34 0.05 2.17 1.50 XXX 

G0117 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.45 0.71 0.19 0.02 1.18 0.66 XXX 

G0118 ........ ............ T Glaucoma scrn hgh risk direc ...................... 0.17 0.52 0.07 0.01 0.70 0.25 XXX 

G0120 ........ ............ A Colon ca scrn; barium enema ..................... 0.99 2.57 NA 0.18 3.74 NA XXX 

G0120 ........ 26 ....... A Colon ca scrn; barium enema ..................... 0.99 0.33 0.33 0.05 1.37 1.37 XXX 

G0120 ........ TC ...... A Colon ca scrn; barium enema ..................... 0.00 2.24 NA 0.13 2.37 NA XXX 

G0121 ........ ............ A Colon ca scrn not hi rsk ind ........................ 3.69 6.04 1.58 0.24 9.97 5.51 000 

G0121 ........ 53 ....... A Colon ca scrn not hi rsk ind ........................ 0.96 2.20 0.52 0.06 3.22 1.54 000 

G0122 ........ ............ N Colon ca scrn; barium enema ..................... +0.99 2.57 2.57 0.18 3.74 3.74 XXX 

G0122 ........ 26 ....... N Colon ca scrn; barium enema ..................... +0.99 0.38 0.38 0.05 1.42 1.42 XXX 

1239

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0122 ........ TC ...... N Colon ca scrn; barium enema ..................... +0.00 2.19 2.19 0.13 2.32 2.32 XXX 

G0123 ........ ............ X Screen cerv/vag thin layer ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0124 ........ ............ A Screen c/v thin layer by MD ........................ 0.42 0.18 0.18 0.01 0.61 0.61 XXX 

G0125 ........ ............ C PET image pulmonary nodule ..................... 0.00 0.00 NA 0.00 0.00 NA XXX 

G0125 ........ 26 ....... A PET image pulmonary nodule ..................... 1.50 0.52 0.52 0.06 2.08 2.08 XXX 

G0125 ........ TC ...... C PET image pulmonary nodule ..................... 0.00 0.00 NA 0.00 0.00 NA XXX 

G0127 ........ ............ R Trim nail(s) ................................................... 0.17 0.25 0.07 0.01 0.43 0.25 000 

G0128 ........ ............ R CORF skilled nursing service ...................... 0.08 0.03 0.03 0.01 0.12 0.12 XXX 

G0130 ........ ............ A Single energy x-ray study ............................ 0.22 0.88 NA 0.06 1.16 NA XXX 

G0130 ........ 26 ....... A Single energy x-ray study ............................ 0.22 0.07 0.07 0.01 0.30 0.30 XXX 

G0130 ........ TC ...... A Single energy x-ray study ............................ 0.00 0.81 NA 0.05 0.86 NA XXX 

G0141 ........ ............ A Scr c/v cyto,autosys and md ....................... 0.42 0.18 0.18 0.01 0.61 0.61 XXX 

G0143 ........ ............ X Scr c/v cyto,thinlayer,rescr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0144 ........ ............ X Scr c/v cyto,thinlayer,rescr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0145 ........ ............ X Scr c/v cyto,thinlayer,rescr .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0147 ........ ............ X Scr c/v cyto, automated sys ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0148 ........ ............ X Scr c/v cyto, autosys, rescr ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0166 ........ ............ A Extrnl counterpulse, per tx ........................... 0.07 3.58 0.03 0.01 3.66 0.11 XXX 

G0167 ........ ............ D Hyperbaric oz tx;no md reqrd ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0168 ........ ............ A Wound closure by adhesive ........................ 0.45 1.92 0.16 0.01 2.38 0.62 000 

G0173 ........ ............ X Stereo radoisurgery,complete ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0175 ........ ............ X OPPS Service,sched team conf .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0176 ........ ............ X OPPS/PHP;activity therapy ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0177 ........ ............ X OPPS/PHP; train & educ serv ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0179 ........ ............ A MD recertification HHA PT .......................... 0.45 1.07 NA 0.01 1.53 NA XXX 

G0180 ........ ............ A MD certification HHA patient ....................... 0.67 1.29 NA 0.02 1.98 NA XXX 

G0181 ........ ............ A Home health care supervision ..................... 1.73 1.52 NA 0.07 3.32 NA XXX 

G0182 ........ ............ A Hospice care supervision ............................ 1.73 1.71 NA 0.07 3.51 NA XXX 

G0186 ........ ............ C Dstry eye lesn,fdr vssl tech ......................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

G0202 ........ ............ A Screeningmammographydigital ................... 0.70 2.79 NA 0.11 3.60 NA XXX 

G0202 ........ 26 ....... A Screeningmammographydigital ................... 0.70 0.23 0.23 0.04 0.97 0.97 XXX 

G0202 ........ TC ...... A Screeningmammographydigital ................... 0.00 2.56 NA 0.07 2.63 NA XXX 

G0204 ........ ............ A Diagnosticmammographydigital ................... 0.87 2.81 NA 0.12 3.80 NA XXX 

G0204 ........ 26 ....... A Diagnosticmammographydigital ................... 0.87 0.29 0.29 0.05 1.21 1.21 XXX 

G0204 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.52 NA 0.07 2.59 NA XXX 

G0206 ........ ............ A Diagnosticmammographydigital ................... 0.70 2.25 NA 0.11 3.06 NA XXX 

G0206 ........ 26 ....... A Diagnosticmammographydigital ................... 0.70 0.23 0.23 0.05 0.98 0.98 XXX 

G0206 ........ TC ...... A Diagnosticmammographydigital ................... 0.00 2.02 NA 0.06 2.08 NA XXX 

G0210 ........ ............ C PET img wholebody dxlung ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0210 ........ 26 ....... A PET img wholebody dxlung ......................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0210 ........ TC ...... C PET img wholebody dxlung ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0211 ........ ............ C PET img wholbody init lung ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0211 ........ 26 ....... A PET img wholbody init lung ......................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0211 ........ TC ...... C PET img wholbody init lung ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0212 ........ ............ C PET img wholebod restag lung ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0212 ........ 26 ....... A PET img wholebod restag lung ................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0212 ........ TC ...... C PET img wholebod restag lung ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0213 ........ ............ C PET img wholbody dx .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0213 ........ 26 ....... A PET img wholbody dx .................................. 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0213 ........ TC ...... C PET img wholbody dx .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0214 ........ ............ C PET img wholebod init ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0214 ........ 26 ....... A PET img wholebod init ................................. 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0214 ........ TC ...... C PET img wholebod init ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0215 ........ ............ C PETimg wholebod restag ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0215 ........ 26 ....... A PETimg wholebod restag ............................ 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0215 ........ TC ...... C PETimg wholebod restag ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0216 ........ ............ C PET img wholebod dx melanoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0216 ........ 26 ....... A PET img wholebod dx melanoma ............... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0216 ........ TC ...... C PET img wholebod dx melanoma ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0217 ........ ............ C PET img wholebod init melan ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0217 ........ 26 ....... A PET img wholebod init melan ...................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0217 ........ TC ...... C PET img wholebod init melan ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0218 ........ ............ C PET img wholebod restag mela .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0218 ........ 26 ....... A PET img wholebod restag mela .................. 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0218 ........ TC ...... C PET img wholebod restag mela .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ........ ............ N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ........ 26 ....... N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0219 ........ TC ...... N PET img wholbod melano nonco ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0220 ........ ............ C PET img wholebod dx lymphoma ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0220 ........ 26 ....... A PET img wholebod dx lymphoma ................ 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0220 ........ TC ...... C PET img wholebod dx lymphoma ................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0221 ........ ............ C PET imag wholbod init lympho .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0221 ........ 26 ....... A PET imag wholbod init lympho .................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0221 ........ TC ...... C PET imag wholbod init lympho .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0222 ........ ............ C PET imag wholbod resta lymph .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1240

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0222 ........ 26 ....... A PET imag wholbod resta lymph .................. 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0222 ........ TC ...... C PET imag wholbod resta lymph .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0223 ........ ............ C PET imag wholbod reg dx head .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0223 ........ 26 ....... A PET imag wholbod reg dx head .................. 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0223 ........ TC ...... C PET imag wholbod reg dx head .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0224 ........ ............ C PET imag wholbod reg ini hea .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0224 ........ 26 ....... A PET imag wholbod reg ini hea .................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0224 ........ TC ...... C PET imag wholbod reg ini hea .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0225 ........ ............ C PET whol restag headneckonly ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0225 ........ 26 ....... A PET whol restag headneckonly ................... 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0225 ........ TC ...... C PET whol restag headneckonly ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0226 ........ ............ C PET img wholbody dx esophagl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0226 ........ 26 ....... A PET img wholbody dx esophagl .................. 1.50 0.53 0.53 0.05 2.08 2.08 XXX 

G0226 ........ TC ...... C PET img wholbody dx esophagl .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0227 ........ ............ C PET img wholbod ini esophage ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0227 ........ 26 ....... A PET img wholbod ini esophage ................... 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0227 ........ TC ...... C PET img wholbod ini esophage ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0228 ........ ............ C PET img wholbod restg esopha .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0228 ........ 26 ....... A PET img wholbod restg esopha .................. 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0228 ........ TC ...... C PET img wholbod restg esopha .................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0229 ........ ............ C PET img metaboloc brain pres .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0229 ........ 26 ....... A PET img metaboloc brain pres .................... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0229 ........ TC ...... C PET img metaboloc brain pres .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0230 ........ ............ C PET myocard viability post .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0230 ........ 26 ....... A PET myocard viability post .......................... 1.50 0.53 0.53 0.05 2.08 2.08 XXX 

G0230 ........ TC ...... C PET myocard viability post .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0231 ........ ............ C PET WhBD colorec; gamma cam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0231 ........ 26 ....... A PET WhBD colorec; gamma cam ............... 1.50 0.51 0.51 0.05 2.06 2.06 XXX 

G0231 ........ TC ...... C PET WhBD colorec; gamma cam ............... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0232 ........ ............ C PET whbd lymphoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0232 ........ 26 ....... A PET whbd lymphoma; gamma cam ............ 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0232 ........ TC ...... C PET whbd lymphoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0233 ........ ............ C PET whbd melanoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0233 ........ 26 ....... A PET whbd melanoma; gamma cam ............ 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0233 ........ TC ...... C PET whbd melanoma; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0234 ........ ............ C PET WhBD pulm nod; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0234 ........ 26 ....... A PET WhBD pulm nod; gamma cam ............ 1.50 0.52 0.52 0.05 2.07 2.07 XXX 

G0234 ........ TC ...... C PET WhBD pulm nod; gamma cam ............ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0236 ........ ............ F Digital film convert diag ma ......................... +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

G0236 ........ 26 ....... F Digital film convert diag ma ......................... +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

G0236 ........ TC ...... F Digital film convert diag ma ......................... +0.00 0.00 0.00 0.00 0.00 0.00 ZZZ 

G0237 ........ ............ A Therapeutic procd strg endur ...................... 0.00 0.47 NA 0.02 0.49 NA XXX 

G0238 ........ ............ C Oth resp proc, indiv ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0239 ........ ............ C Oth resp proc, group ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0242 ........ ............ X Multisource photon ster plan ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0243 ........ ............ X Multisour photon stero treat ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0244 ........ ............ E Observ care by facility topt .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0245 ........ ............ R Initial foot exam pt lops ............................... 0.88 0.79 0.32 0.06 1.73 1.26 XXX 

G0246 ........ ............ R Followup eval of foot pt lop ......................... 0.45 0.54 0.16 0.02 1.01 0.63 XXX 

G0247 ........ ............ R Routine footcare pt w lops ........................... 0.50 0.51 0.21 0.06 1.07 0.77 ZZZ 

G0248 ........ ............ R Demonstrate use home inr mon .................. 0.00 6.75 NA 0.01 6.76 NA XXX 

G0249 ........ ............ R Provide test material,equipm ....................... 0.00 3.91 NA 0.01 3.92 NA XXX 

G0250 ........ ............ R MD review interpret of test .......................... 0.18 0.06 0.06 0.01 0.25 0.25 XXX 

G0251 ........ ............ E Linear acc based stero radio ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0252 ........ ............ N PET imaging initial dx .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0252 ........ 26 ....... N PET imaging initial dx .................................. +1.50 0.60 0.60 0.04 2.14 2.14 XXX 

G0252 ........ TC ...... N PET imaging initial dx .................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0253 ........ ............ C PET image brst dection recur ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0253 ........ 26 ....... A PET image brst dection recur ...................... 1.87 0.71 0.71 0.08 2.66 2.66 XXX 

G0253 ........ TC ...... C PET image brst dection recur ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0254 ........ ............ C PET image brst eval to tx ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0254 ........ 26 ....... A PET image brst eval to tx ............................ 1.87 0.71 0.71 0.08 2.66 2.66 XXX 

G0254 ........ TC ...... C PET image brst eval to tx ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ........ ............ N Current percep threshold tst ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ........ 26 ....... N Current percep threshold tst ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0255 ........ TC ...... N Current percep threshold tst ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0256 ........ ............ D Prostate brachy w palladium ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0257 ........ ............ E Unsched dialysis ESRD pt hos ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0258 ........ ............ E IV infusion during obs stay .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0259 ........ ............ E Inject for sacroiliac joint ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0260 ........ ............ E Inj for sacroiliac jt anesth ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0261 ........ ............ D Prostate brachy w iodine see ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0262 ........ ............ D Sm intestinal image capsule ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0262 ........ 26 ....... D Sm intestinal image capsule ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0262 ........ TC ...... D Sm intestinal image capsule ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1241

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0263 ........ ............ E Adm with CHF, CP, asthma ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0264 ........ ............ E Assmt otr CHF, CP, asthma ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0265 ........ ............ X Cryopresevation Freeze+stora .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0266 ........ ............ X Thawing + expansion froz cel ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0267 ........ ............ X Bone marrow or psc harvest ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0268 ........ ............ A Removal of impacted wax md ..................... 0.61 0.63 0.25 0.05 1.29 0.91 000 

G0269 ........ ............ B Occlusive device in vein art ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0270 ........ ............ A MNT subs tx for change dx ......................... 0.00 0.47 NA 0.01 0.48 NA XXX 

G0271 ........ ............ A Group MNT 2 or more 30 mins ................... 0.00 0.19 NA 0.01 0.20 NA XXX 

G0272 ........ ............ D Naso/oro gastric tube pl MD ........................ 0.00 0.00 0.00 0.00 0.00 0.00 000 

G0273 ........ ............ D Pretx planning, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0273 ........ 26 ....... D Pretx planning, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0273 ........ TC ...... D Pretx planning, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0274 ........ ............ D Radiopharm tx, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0274 ........ 26 ....... D Radiopharm tx, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0274 ........ TC ...... D Radiopharm tx, non-Hodgkins ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0275 ........ ............ A Renal angio, cardiac cath ............................ 0.25 NA 0.10 0.01 NA 0.36 ZZZ 

G0278 ........ ............ A Iliac art angio,cardiac cath ........................... 0.25 NA 0.10 0.01 NA 0.36 ZZZ 

G0279 ........ ............ C Excorp shock tx, elbow epi .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0280 ........ ............ C Excorp shock tx other than .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0281 ........ ............ A Elec stim unattend for press ........................ 0.18 0.11 NA 0.01 0.30 NA XXX 

G0282 ........ ............ N Elect stim wound care not pd ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0283 ........ ............ A Elec stim other than wound ......................... 0.18 0.11 NA 0.01 0.30 NA XXX 

G0288 ........ ............ A Recon, CTA for surg plan ............................ 0.00 10.66 NA 0.18 10.84 NA XXX 

G0289 ........ ............ A Arthro, loose body + chondro ...................... 1.48 NA 0.56 0.33 NA 2.37 ZZZ 

G0290 ........ ............ E Drug-eluting stents, single ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0291 ........ ............ E Drug-eluting stents,each add ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0292 ........ ............ E Adm exp drugs,clinical trial .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0293 ........ ............ E Non-cov surg proc,clin trial .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0294 ........ ............ E Non-cov proc, clinical trial ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0295 ........ ............ N Electromagnetic therapy onc ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0296 ........ ............ C PET imge restag thyrod cance .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0296 ........ 26 ....... A PET imge restag thyrod cance .................... 1.87 0.71 0.71 0.08 2.66 2.66 XXX 

G0296 ........ TC ...... C PET imge restag thyrod cance .................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0297 ........ ............ X Insert single chamber/cd ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0298 ........ ............ X Insert dual chamber/cd ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0299 ........ ............ X Inser/repos single icd+leads ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0300 ........ ............ X Insert reposit lead dual+gen ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0302 ........ ............ X Pre-op service LVRS complete ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0303 ........ ............ X Pre-op service LVRS 10-15dos ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0304 ........ ............ X Pre-op service LVRS 1-9 dos ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0305 ........ ............ X Post op service LVRS min 6 ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0306 ........ ............ X CBC/diffwbc w/o platelet .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0307 ........ ............ X CBC without platelet .................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0308 ........ ............ A ESRD related svc 4+mo<2yrs ..................... 12.74 8.54 8.54 0.42 21.70 21.70 XXX 

G0309 ........ ............ A ESRD related svc 2-3mo<2yrs .................... 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0310 ........ ............ A ESRD related svc 1 visit<2yr ...................... 8.49 5.68 5.68 0.28 14.45 14.45 XXX 

G0311 ........ ............ A ESRD related svs 4+mo 2-11yr .................. 9.73 4.72 4.72 0.34 14.79 14.79 XXX 

G0312 ........ ............ A ESRD relate svs 2-3 mo 2-11y ................... 8.11 3.92 3.92 0.29 12.32 12.32 XXX 

G0313 ........ ............ A ESRD related svs 1 mon 2-11y ................... 6.49 3.14 3.14 0.22 9.85 9.85 XXX 

G0314 ........ ............ A ESRD related svs 4+ mo 12-19 .................. 8.28 4.42 4.42 0.27 12.97 12.97 XXX 

G0315 ........ ............ A ESRD related svs 2-3mo 12-19 .................. 6.90 3.67 3.67 0.23 10.80 10.80 XXX 

G0316 ........ ............ A ESRD relate svs 1 vist 12-19 ...................... 5.52 2.94 2.94 0.17 8.63 8.63 XXX 

G0317 ........ ............ A ESRD related svs 4+mo 20+yrs .................. 5.09 2.86 2.86 0.17 8.12 8.12 XXX 

G0318 ........ ............ A ESRD related svs 2-3 mo 20+y .................. 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0319 ........ ............ A ESRD related svs 1 visit 20+ ...................... 3.39 1.90 1.90 0.11 5.40 5.40 XXX 

G0320 ........ ............ A ESRD related svs home under2 .................. 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0321 ........ ............ A ESRD related svs home mo<2ys ................ 6.90 3.67 3.67 0.23 10.80 10.80 XXX 

G0322 ........ ............ A ESRD relate svs home mo12-19 ................. 8.11 3.92 3.92 0.29 12.32 12.32 XXX 

G0323 ........ ............ A ESRD related svs home mo 20+ ................ 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0324 ........ ............ A ESRD related svs home/dy<2y ................... 0.35 0.24 0.24 0.01 0.60 0.60 XXX 

G0325 ........ ............ A ESRD relate home/dy 2-11 yr ..................... 0.23 0.12 0.12 0.01 0.36 0.36 XXX 

G0326 ........ ............ A ESRD relate home/dy 12-19y ...................... 0.27 0.13 0.13 0.01 0.41 0.41 XXX 

G0327 ........ ............ A ESRD relate home/dy 20+yrs ...................... 0.14 0.08 0.08 0.01 0.23 0.23 XXX 

G0328 ........ ............ X Fecal blood scrn immunoassay ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0338 ........ ............ X Linear accelerator stero pln ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0339 ........ ............ X Robot lin-radsurg com, first ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G0340 ........ ............ X Robot linear steroradio max5 ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G3001 ........ ............ X Admin + supply, tositumomab ..................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9001 ........ ............ X MCCD, initial rate ........................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9002 ........ ............ X MCCD,maintenance rate ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9003 ........ ............ X MCCD, risk adj hi, initial .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9004 ........ ............ X MCCD, risk adj lo, initial .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9005 ........ ............ X MCCD, risk adj, maintenance ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9006 ........ ............ X MCCD, Home monitoring ............................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1242

ADDENDUM B.—RELATIVE VALUE UNITS (RVUS) AND RELATED INFORMATION—Continued

CPT1

HCPCS2 MOD Status Description 

Physician

work

RVUs3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G9007 ........ ............ X MCCD, sch team conf ................................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9008 ........ ............ X Mccd,phys coor-care ovrsght ...................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9009 ........ ............ X MCCD, risk adj, level 3 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9010 ........ ............ X MCCD, risk adj, level 4 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9011 ........ ............ X MCCD, risk adj, level 5 ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9012 ........ ............ X Other Specified Case Mgmt ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

G9016 ........ ............ N Demo-smoking cessation coun ................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

M0064 ........ ............ A Visit for drug monitoring .............................. 0.37 0.34 0.12 0.01 0.72 0.50 XXX 

P3001 ......... ............ A Screening pap smear by phys ..................... 0.42 0.18 0.18 0.01 0.61 0.61 XXX 

Q0035 ........ ............ A Cardiokymography ....................................... 0.17 0.45 NA 0.03 0.65 NA XXX 

Q0035 ........ 26 ....... A Cardiokymography ....................................... 0.17 0.07 0.07 0.01 0.25 0.25 XXX 

Q0035 ........ TC ...... A Cardiokymography ....................................... 0.00 0.38 NA 0.02 0.40 NA XXX 

Q0091 ........ ............ A Obtaining screen pap smear ....................... 0.37 0.66 0.14 0.01 1.04 0.52 XXX 

Q0092 ........ ............ A Set up port xray equipment ......................... 0.00 0.32 NA 0.01 0.33 NA XXX 

Q3014 ........ ............ X Telehealth facility fee ................................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0070 ......... ............ C Transport portable x-ray .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0075 ......... ............ C Transport port x-ray multipl ......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

R0076 ......... ............ B Transport portable EKG ............................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

V5299 ......... ............ R Hearing service ............................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

1 1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3 + Indicates RVUs are not used for Medicare payment. 

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM C.—CODES WITH INTERIM RVUS

CPT 1

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

11400 ......... ............ A Exc tr-ext b9+marg 0.5 < cm ....................... 0.85 2.00 0.89 0.07 2.92 1.81 010 

11401 ......... ............ A Exc tr-ext b9+marg 0.6-1 cm ....................... 1.23 2.07 1.03 0.11 3.41 2.37 010 

11402 ......... ............ A Exc tr-ext b9+marg 1.1-2 cm ....................... 1.51 2.25 1.10 0.14 3.90 2.75 010 

11403 ......... ............ A Exc tr-ext b9+marg 2.1-3 cm ....................... 1.79 2.42 1.33 0.19 4.40 3.31 010 

11404 ......... ............ A Exc tr-ext b9+marg 3.1-4 cm ....................... 2.06 2.73 1.41 0.22 5.01 3.69 010 

11406 ......... ............ A Exc tr-ext b9+marg > 4.0 cm ....................... 2.76 3.10 1.67 0.30 6.16 4.73 010 

11420 ......... ............ A Exc h-f-nk-sp b9+marg 0.5 < ....................... 0.98 1.77 0.94 0.10 2.85 2.02 010 

11421 ......... ............ A Exc h-f-nk-sp b9+marg 0.6-1 ....................... 1.42 2.08 1.12 0.13 3.63 2.67 010 

11422 ......... ............ A Exc h-f-nk-sp b9+marg 1.1-2 ....................... 1.63 2.27 1.34 0.17 4.07 3.14 010 

11423 ......... ............ A Exc h-f-nk-sp b9+marg 2.1-3 ....................... 2.01 2.61 1.46 0.21 4.83 3.68 010 

11424 ......... ............ A Exc h-f-nk-sp b9+marg 3.1-4 ....................... 2.43 2.82 1.61 0.25 5.50 4.29 010 

11426 ......... ............ A Exc h-f-nk-sp b9+marg > 4 cm .................... 3.77 3.52 2.11 0.41 7.70 6.29 010 

11440 ......... ............ A Exc face-mm b9+marg 0.5 < cm ................. 1.06 2.28 1.33 0.10 3.44 2.49 010 

11441 ......... ............ A Exc face-mm b9+marg 0.6-1 cm ................. 1.48 2.40 1.51 0.13 4.01 3.12 010 

11442 ......... ............ A Exc face-mm b9+marg 1.1-2 cm ................. 1.72 2.59 1.58 0.17 4.48 3.47 010 

11443 ......... ............ A Exc face-mm b9+marg 2.1-3 cm ................. 2.29 2.97 1.83 0.22 5.48 4.34 010 

11444 ......... ............ A Exc face-mm b9+marg 3.1-4 cm ................. 3.14 3.54 2.19 0.30 6.98 5.63 010 

11446 ......... ............ A Exc face-mm b9+marg > 4 cm .................... 4.48 4.11 2.78 0.36 8.95 7.62 010 

11600 ......... ............ A Exc tr-ext mlg+marg 0.5 < cm ..................... 1.31 2.65 0.98 0.11 4.07 2.40 010 

11601 ......... ............ A Exc tr-ext mlg+marg 0.6-1 cm ..................... 1.80 2.72 1.23 0.14 4.66 3.17 010 

11602 ......... ............ A Exc tr-ext mlg+marg 1.1-2 cm ..................... 1.95 2.86 1.27 0.16 4.97 3.38 010 

11603 ......... ............ A Exc tr-ext mlg+marg 2.1-3 cm ..................... 2.19 3.11 1.33 0.19 5.49 3.71 010 

11604 ......... ............ A Exc tr-ext mlg+marg 3.1-4 cm ..................... 2.40 3.41 1.40 0.22 6.03 4.02 010 

11606 ......... ............ A Exc tr-ext mlg+marg > 4 cm ........................ 3.42 4.11 1.75 0.34 7.87 5.51 010 

11620 ......... ............ A Exc h-f-nk-sp mlg+marg 0.5 < ..................... 1.19 2.62 0.96 0.11 3.92 2.26 010 

11621 ......... ............ A Exc h-f-nk-sp mlg+marg 0.6-1 ..................... 1.76 2.73 1.25 0.14 4.63 3.15 010 

11622 ......... ............ A Exc h-f-nk-sp mlg+marg 1.1-2 ..................... 2.09 3.00 1.39 0.18 5.27 3.66 010 

11623 ......... ............ A Exc h-f-nk-sp mlg+marg 2.1-3 ..................... 2.61 3.36 1.59 0.24 6.21 4.44 010 

11624 ......... ............ A Exc h-f-nk-sp mlg+marg 3.1-4 ..................... 3.06 3.79 1.78 0.30 7.15 5.14 010 

11626 ......... ............ A Exc h-f-nk-sp mlg+mar > 4 cm .................... 4.29 4.70 2.40 0.42 9.41 7.11 010 

11640 ......... ............ A Exc face-mm malig+marg 0.5 < .................. 1.35 2.69 1.12 0.12 4.16 2.59 010 

11641 ......... ............ A Exc face-mm malig+marg 0.6-1 .................. 2.16 3.06 1.54 0.18 5.40 3.88 010 

11642 ......... ............ A Exc face-mm malig+marg 1.1-2 .................. 2.59 3.44 1.73 0.22 6.25 4.54 010 

11643 ......... ............ A Exc face-mm malig+marg 2.1-3 .................. 3.10 3.85 1.96 0.29 7.24 5.35 010 

11644 ......... ............ A Exc face-mm malig+marg 3.1-4 .................. 4.02 4.74 2.47 0.40 9.16 6.89 010 

11646 ......... ............ A Exc face-mm mlg+marg > 4 cm .................. 5.94 5.81 3.49 0.55 12.30 9.98 010 

20982 ......... ............ A Ablate, bone tumor(s) perq .......................... 7.27 105.35 2.99 0.69 113.31 10.95 000 

21030 ......... ............ A Excise max/zygoma b9 tumor ..................... 4.49 6.84 4.31 0.72 12.05 9.52 090 

21040 ......... ............ A Excise mandible lesion ................................ 4.49 6.87 4.14 0.23 11.59 8.86 090 

21685 ......... ............ A Hyoid myotomy & suspension ..................... 12.98 NA 10.09 1.52 NA 24.59 090 

21742 ......... ............ C Repair stern/nuss w/o scope ....................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

21743 ......... ............ C Repair sternum/nuss w/scope ..................... 0.00 0.00 0.00 0.00 0.00 0.00 090 

22532 ......... ............ A Lat thorax spine fusion ................................ 23.96 NA 14.82 4.56 NA 43.34 090 

22533 ......... ............ A Lat lumbar spine fusion ............................... 23.09 NA 13.48 3.84 NA 40.41 090 

22534 ......... ............ A Lat thor/lumb, add’l seg ............................... 5.99 NA 3.04 1.18 NA 10.21 ZZZ 

1243

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

31622 ......... ............ A Dx bronchoscope/wash ............................... 2.78 4.17 0.89 0.17 7.12 3.84 000 

31623 ......... ............ A Dx bronchoscope/brush ............................... 2.88 5.05 0.89 0.17 8.10 3.94 000 

31624 ......... ............ A Dx bronchoscope/lavage ............................. 2.88 4.28 0.90 0.16 7.32 3.94 000 

31625 ......... ............ A Bronchoscopy w/biopsy(s) ........................... 3.36 5.37 1.26 0.19 8.92 4.81 000 

31628 ......... ............ A Bronchoscopy/lung bx, each ....................... 3.80 5.53 1.34 0.17 9.50 5.31 000 

31629 ......... ............ A Bronchoscopy/needle bx, each ................... 3.36 NA 1.22 0.16 NA 4.74 000 

31630 ......... ............ A Bronchoscopy dilate/fx repr ......................... 3.81 NA 2.00 0.36 NA 6.17 000 

31631 ......... ............ A Bronchoscopy, dilate w/stent ....................... 4.36 NA 2.02 0.37 NA 6.75 000 

31632 ......... ............ A Bronchoscopy/lung bx, add’l ........................ 1.03 0.76 0.32 0.17 1.96 1.52 ZZZ 

31633 ......... ............ A Bronchoscopy/needle bx add’l ..................... 1.32 0.91 0.40 0.17 2.40 1.89 ZZZ 

31635 ......... ............ A Bronchoscopy w/fb removal ........................ 3.67 NA 1.67 0.25 NA 5.59 000 

31640 ......... ............ A Bronchoscopy w/tumor excise ..................... 4.93 NA 2.35 0.45 NA 7.73 000 

33310 ......... ............ A Exploratory heart surgery ............................ 18.48 NA 9.65 2.73 NA 30.86 090 

33315 ......... ............ A Exploratory heart surgery ............................ 22.34 NA 10.95 3.50 NA 36.79 090 

34805 ......... ............ A Endovasc abdo repair w/pros ...................... 21.85 NA 9.46 1.99 NA 33.30 090 

35510 ......... ............ A Artery bypass graft ...................................... 22.97 NA 10.17 2.10 NA 35.24 090 

35512 ......... ............ A Artery bypass graft ...................................... 22.47 NA 10.00 2.10 NA 34.57 090 

35522 ......... ............ A Artery bypass graft ...................................... 21.73 NA 9.74 2.10 NA 33.57 090 

35525 ......... ............ A Artery bypass graft ...................................... 20.60 NA 9.35 2.10 NA 32.05 090 

35697 ......... ............ A Reimplant artery each ................................. 3.00 NA 1.03 0.41 NA 4.44 ZZZ 

36511 ......... ............ A Apheresis wbc ............................................. 1.74 NA 0.71 0.07 NA 2.52 000 

36512 ......... ............ A Apheresis rbc ............................................... 1.74 NA 0.71 0.07 NA 2.52 000 

36513 ......... ............ A Apheresis platelets ...................................... 1.74 NA 0.71 0.07 NA 2.52 000 

36514 ......... ............ A Apheresis plasma ........................................ 1.74 NA 0.71 0.07 NA 2.52 000 

36515 ......... ............ A Apheresis, adsorp/reinfuse .......................... 1.74 NA 0.73 0.07 NA 2.54 000 

36516 ......... ............ A Apheresis, selective ..................................... 1.22 NA 0.51 0.07 NA 1.80 000 

36555 ......... ............ A Insert non-tunnel cv cath ............................. 2.68 6.00 0.82 0.21 8.89 3.71 000 

36556 ......... ............ A Insert non-tunnel cv cath ............................. 2.50 5.85 0.74 0.10 8.45 3.34 000 

36557 ......... ............ A Insert tunneled cv cath ................................ 5.09 13.56 2.58 0.59 19.24 8.26 010 

36558 ......... ............ A Insert tunneled cv cath ................................ 4.79 13.45 2.47 0.59 18.83 7.85 010 

36560 ......... ............ A Insert tunneled cv cath ................................ 6.24 29.19 2.96 0.59 36.02 9.79 010 

36561 ......... ............ A Insert tunneled cv cath ................................ 5.99 29.11 2.87 0.59 35.69 9.45 010 

36563 ......... ............ A Insert tunneled cv cath ................................ 6.19 38.09 2.98 0.68 44.96 9.85 010 

36565 ......... ............ A Insert tunneled cv cath ................................ 5.99 22.15 2.87 0.59 28.73 9.45 010 

36566 ......... ............ A Insert tunneled cv cath ................................ 6.49 22.95 3.04 0.59 30.03 10.12 010 

36568 ......... ............ A Insert tunneled cv cath ................................ 1.92 8.19 0.59 0.21 10.32 2.72 000 

36569 ......... ............ A Insert tunneled cv cath ................................ 1.82 7.39 0.57 0.16 9.37 2.55 000 

36570 ......... ............ A Insert tunneled cv cath ................................ 5.31 40.27 2.64 0.59 46.17 8.54 010 

36571 ......... ............ A Insert tunneled cv cath ................................ 5.29 35.64 2.63 0.59 41.52 8.51 010 

36575 ......... ............ A Repair tunneled cv cath ............................... 0.67 3.35 0.26 0.59 4.61 1.52 000 

36576 ......... ............ A Repair tunneled cv cath ............................... 3.19 7.71 1.76 0.59 11.49 5.54 010 

36578 ......... ............ A Replace tunneled cv cath ............................ 3.49 10.54 2.20 0.59 14.62 6.28 010 

36580 ......... ............ A Replace tunneled cv cath ............................ 1.31 6.76 0.41 0.16 8.23 1.88 000 

36581 ......... ............ A Replace tunneled cv cath ............................ 3.43 13.27 1.84 0.59 17.29 5.86 010 

36582 ......... ............ A Replace tunneled cv cath ............................ 5.19 26.63 2.76 0.59 32.41 8.54 010 

36583 ......... ............ A Replace tunneled cv cath ............................ 5.24 13.13 2.77 0.59 18.96 8.60 010 

36584 ......... ............ A Replace tunneled cv cath ............................ 1.20 7.23 0.54 0.16 8.59 1.90 000 

36585 ......... ............ A Replace tunneled cv cath ............................ 4.79 35.46 2.62 0.59 40.84 8.00 010 

36589 ......... ............ A Removal tunneled cv cath ........................... 2.27 2.20 1.41 0.25 4.72 3.93 010 

36590 ......... ............ A Removal tunneled cv cath ........................... 3.30 6.41 1.64 0.41 10.12 5.35 010 

36595 ......... ............ A Mech remov tunneled cv cath ..................... 3.59 19.71 1.46 0.28 23.58 5.33 000 

36596 ......... ............ A Mech remov tunneled cv cath ..................... 0.75 4.39 0.49 0.05 5.19 1.29 000 

36597 ......... ............ A Reposition venous catheter ......................... 1.21 3.18 0.43 0.07 4.46 1.71 000 

36838 ......... ............ A Dist revas ligation, hemo ............................. 20.60 NA 9.36 2.99 NA 32.95 090 

37765 ......... ............ A Phleb veins - extrem - to 20 ........................ 7.34 NA 4.55 0.48 NA 12.37 090 

37766 ......... ............ A Phleb veins - extrem 20+ ............................ 9.29 NA 5.26 0.48 NA 15.03 090 

37785 ......... ............ A Ligate/divide/excise vein .............................. 3.83 5.14 2.64 0.49 9.46 6.96 090 

38207 ......... ............ I Cryopreserve stem cells .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38208 ......... ............ I Thaw preserved stem cells .......................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38209 ......... ............ I Wash harvest stem cells ............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38210 ......... ............ I T-cell depletion of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38211 ......... ............ I Tumor cell deplete of harvst ........................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38212 ......... ............ I Rbc depletion of harvest .............................. 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38213 ......... ............ I Platelet deplete of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38214 ......... ............ I Volume deplete of harvest ........................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

38215 ......... ............ I Harvest stem cell concentrte ....................... 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

43235 ......... ............ A Uppr gi endoscopy, diagnosis ..................... 2.39 5.04 1.07 0.16 7.59 3.62 000 

43237 ......... ............ A Endoscopic us exam, esoph ....................... 3.98 NA 1.61 0.27 NA 5.86 000 

43238 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 5.02 NA 1.97 0.27 NA 7.26 000 

43242 ......... ............ A Uppr gi endoscopy w/us fn bx ..................... 7.30 NA 2.78 0.35 NA 10.43 000 

43259 ......... ............ A Endoscopic ultrasound exam ...................... 5.19 NA 2.04 0.27 NA 7.50 000 

43752 ......... ............ A Nasal/orogastric w/stent .............................. 0.68 0.26 0.26 0.02 0.96 0.96 000 

47133 ......... ............ C Removal of donor liver ................................ 0.00 0.00 0.00 0.00 0.00 0.00 XXX 

47140 ......... ............ A Partial removal, donor liver .......................... 54.92 NA 22.74 4.80 NA 82.46 090 

47141 ......... ............ A Partial removal, donor liver .......................... 67.40 NA 27.39 4.80 NA 99.59 090 

1244

——————————

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3+ Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

47142 ......... ............ A Partial removal, donor liver .......................... 74.89 NA 29.97 4.80 NA 109.66 090 

53500 ......... ............ A Urethrlys, transvag w/ scope ....................... 12.19 NA 6.19 0.89 NA 19.27 090 

57425 ......... ............ A Laparoscopy, surg, colpopexy ..................... 15.73 NA 6.69 1.74 NA 24.16 090 

58545 ......... ............ A Laparoscopic myomectomy ......................... 14.58 NA 7.19 1.75 NA 23.52 090 

58546 ......... ............ A Laparo-myomectomy, complex .................... 18.97 NA 8.98 1.75 NA 29.70 090 

58550 ......... ............ A Laparo-asst vag hysterectomy .................... 14.17 NA 7.31 1.74 NA 23.22 090 

58552 ......... ............ A Laparo-vag hyst incl t/o ............................... 15.98 NA 8.02 1.74 NA 25.74 090 

58553 ......... ............ A Laparo-vag hyst, complex ........................... 18.97 NA 8.97 1.48 NA 29.42 090 

58554 ......... ............ A Laparo-vag hyst w/t/o, compl ...................... 21.97 NA 10.46 1.48 NA 33.91 090 

59070 ......... ............ A Transabdom amnioinfus w/ us .................... 5.24 5.12 2.41 0.28 10.64 7.93 000 

59072 ......... ............ A Umbilical cord occlud w/ us ......................... 8.99 NA 3.13 0.68 NA 12.80 000 

59074 ......... ............ A Fetal fluid drainage w/ us ............................ 5.24 4.61 2.41 0.28 10.13 7.93 000 

59076 ......... ............ A Fetal shunt placement, w/ us ...................... 8.99 NA 3.13 0.68 NA 12.80 000 

59897 ......... ............ C Fetal invas px w/ us ..................................... 0.00 0.00 0.00 0.00 0.00 0.00 YYY 

61537 ......... ............ A Removal of brain tissue ............................... 24.96 NA 14.45 6.49 NA 45.90 090 

61538 ......... ............ A Removal of brain tissue ............................... 26.77 NA 15.38 6.49 NA 48.64 090 

61539 ......... ............ A Removal of brain tissue ............................... 32.03 NA 17.85 7.98 NA 57.86 090 

61540 ......... ............ A Removal of brain tissue ............................... 29.96 NA 17.48 7.98 NA 55.42 090 

61543 ......... ............ A Removal of brain tissue ............................... 29.18 NA 16.46 7.37 NA 53.01 090 

61566 ......... ............ A Removal of brain tissue ............................... 30.95 NA 17.42 6.49 NA 54.86 090 

61567 ......... ............ A Incision of brain tissue ................................. 35.45 NA 20.73 6.49 NA 62.67 090 

61863 ......... ............ A Implant neuroelectrode ................................ 18.97 NA 9.21 4.79 NA 32.97 090 

61864 ......... ............ A Implant neuroelectrde, add’l ........................ 4.49 NA 2.29 1.13 NA 7.91 ZZZ 

61867 ......... ............ A Implant neuroelectrode ................................ 31.29 NA 13.81 4.79 NA 49.89 090 

61868 ......... ............ A Implant neuroelectrde, add’l ........................ 7.91 NA 4.03 1.21 NA 13.15 ZZZ 

63101 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.34 5.69 NA 56.98 090 

63102 ......... ............ A Removal of vertebral body .......................... 31.95 NA 19.34 5.69 NA 56.98 090 

63103 ......... ............ A Remove vertebral body add-on ................... 3.89 NA 2.01 0.76 NA 6.66 ZZZ 

64449 ......... ............ A N block inj, lumbar plexus ........................... 3.00 NA 0.97 0.10 NA 4.07 010 

64517 ......... ............ A N block inj, hypogas plxs ............................. 2.20 2.70 0.87 0.13 5.03 3.20 000 

64680 ......... ............ A Injection treatment of nerve ......................... 2.62 5.97 1.28 0.18 8.77 4.08 010 

64681 ......... ............ A Injection treatment of nerve ......................... 3.54 8.71 2.10 0.18 12.43 5.82 010 

65780 ......... ............ A Ocular reconst, transplant ........................... 10.23 NA 9.94 0.35 NA 20.52 090 

65781 ......... ............ A Ocular reconst, transplant ........................... 17.64 NA 13.31 0.35 NA 31.30 090 

65782 ......... ............ A Ocular reconst, transplant ........................... 14.98 NA 11.66 0.35 NA 26.99 090 

67912 ......... ............ A Correction eyelid w/ implant ........................ 5.67 20.38 5.27 0.28 26.33 11.22 090 

68371 ......... ............ A Harvest eye tissue, alograft ......................... 4.89 NA 4.62 0.21 NA 9.72 010 

70557 ......... 26 ....... A Mri brain w/o dye ......................................... 2.90 0.98 0.98 0.08 3.96 3.96 XXX 

70558 ......... 26 ....... A Mri brain w/ dye ........................................... 3.20 1.08 1.08 0.10 4.38 4.38 XXX 

70559 ......... 26 ....... A Mri brain w/o & w/ dye ................................. 3.20 1.08 1.08 0.12 4.40 4.40 XXX 

75901 ......... 26 ....... A Remove cva device obstruct ....................... 0.49 0.16 0.16 0.02 0.67 0.67 XXX 

75902 ......... 26 ....... A Remove cva lumen obstruct ........................ 0.39 0.13 0.13 0.02 0.54 0.54 XXX 

75998 ......... 26 ....... A Fluoroguide for vein device ......................... 0.38 0.13 0.13 0.05 0.56 0.56 ZZZ 

76082 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76083 ......... 26 ....... A Computer mammogram add-on .................. 0.06 0.02 0.02 0.01 0.09 0.09 ZZZ 

76514 ......... 26 ....... A Echo exam of eye, thickness ...................... 0.17 0.08 0.08 0.01 0.26 0.26 XXX 

76937 ......... 26 ....... A Us guide, vascular access ........................... 0.30 0.10 0.10 0.05 0.45 0.45 ZZZ 

78800 ......... 26 ....... A Tumor imaging, limited area ........................ 0.66 0.22 0.22 0.04 0.92 0.92 XXX 

78801 ......... 26 ....... A Tumor imaging, mult areas .......................... 0.79 0.27 0.27 0.04 1.10 1.10 XXX 

78802 ......... 26 ....... A Tumor imaging, whole body ........................ 0.86 0.30 0.30 0.04 1.20 1.20 XXX 

78803 ......... 26 ....... A Tumor imaging (3D) ..................................... 1.09 0.38 0.38 0.05 1.52 1.52 XXX 

78804 ......... 26 ....... A Tumor imaging, whole body ........................ 1.07 0.37 0.37 0.04 1.48 1.48 XXX 

79100 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 1.32 0.46 0.46 0.06 1.84 1.84 XXX 

79400 ......... 26 ....... A Nonhemato nuclear therapy ........................ 1.96 0.67 0.67 0.10 2.73 2.73 XXX 

79403 ......... 26 ....... A Hematopoetic nuclear therapy ..................... 2.25 0.90 0.90 0.10 3.25 3.25 XXX 

85396 ......... ............ A Clotting assay, whole blood ......................... 0.37 NA 0.17 0.04 NA 0.58 XXX 

88112 ......... 26 ....... A Cytopath, cell enhance tech ........................ 1.18 0.51 0.51 0.06 1.75 1.75 XXX 

88342 ......... 26 ....... A Immunohistochemistry ................................. 0.85 0.37 0.37 0.04 1.26 1.26 XXX 

88358 ......... 26 ....... A Analysis, tumor ............................................ 0.95 1.23 1.23 0.12 2.30 2.30 XXX 

88361 ......... 26 ....... A Immunohistochemistry, tumor ...................... 0.94 0.41 0.41 0.12 1.47 1.47 XXX 

91110 ......... 26 ....... A Gi tract capsule endoscopy ......................... 3.64 1.30 1.30 0.02 4.96 4.96 XXX 

93784 ......... ............ A Ambulatory BP monitoring ........................... 0.38 1.55 NA 0.03 1.96 NA XXX 

93786 ......... ............ A Ambulatory BP recording ............................. 0.00 0.91 NA 0.01 0.92 NA XXX 

93788 ......... ............ A Ambulatory BP analysis ............................... 0.00 0.51 NA 0.01 0.52 NA XXX 

93790 ......... ............ A Review/report BP recording ......................... 0.38 0.13 0.13 0.01 0.52 0.52 XXX 

95990 ......... ............ A Spin/brain pump refil & main ....................... 0.00 1.50 NA 0.06 1.56 NA XXX 

95991 ......... ............ A Spin/brain pump refil & main ....................... 0.77 1.43 0.19 0.06 2.26 1.02 XXX 

96110 ......... ............ A Developmental test, lim ............................... 0.00 0.19 NA 0.18 0.37 NA XXX 

96111 ......... ............ A Developmental test, extend ......................... 2.60 1.07 NA 0.18 3.85 NA XXX 

97537 ......... ............ A Community/work reintegration ..................... 0.45 0.27 NA 0.01 0.73 NA XXX 

97755 ......... ............ A Assistive technology assess ........................ 0.62 0.29 NA 0.02 0.93 NA XXX 

G0308 ........ ............ A ESRD related svc 4+mo<2yrs ..................... 12.74 8.54 8.54 0.42 21.70 21.70 XXX 

G0309 ........ ............ A ESRD related svc 2-3mo<2yrs .................... 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0310 ........ ............ A ESRD related svc 1 visit<2yr ...................... 8.49 5.68 5.68 0.28 14.45 14.45 XXX 

G0311 ........ ............ A ESRD related svs 4+mo 2-11yr .................. 9.73 4.72 4.72 0.34 14.79 14.79 XXX 

1245

ADDENDUM C.—CODES WITH INTERIM RVUS—Continued

CPT 1

HCPCS2 MOD Status Description 

Physician

work

RVUs 3

Nonfacility

PE RVUs 

Facility

PE RVUs 

Malpractice

RVUs 

Nonfacility

total 

Facility

total Global 

G0312 ........ ............ A ESRD relate svs 2-3 mo 2-11y ................... 8.11 3.92 3.92 0.29 12.32 12.32 XXX 

G0313 ........ ............ A ESRD related svs 1 mon 2-11y ................... 6.49 3.14 3.14 0.22 9.85 9.85 XXX 

G0314 ........ ............ A ESRD related svs 4+ mo 12-19 .................. 8.28 4.42 4.42 0.27 12.97 12.97 XXX 

G0315 ........ ............ A ESRD related svs 2-3mo 12-19 .................. 6.90 3.67 3.67 0.23 10.80 10.80 XXX 

G0316 ........ ............ A ESRD relate svs 1 vist 12-19 ...................... 5.52 2.94 2.94 0.17 8.63 8.63 XXX 

G0317 ........ ............ A ESRD related svs 4+mo 20+yrs .................. 5.09 2.86 2.86 0.17 8.12 8.12 XXX 

G0318 ........ ............ A ESRD related svs 2-3 mo 20+y .................. 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0319 ........ ............ A ESRD related svs 1 visit 20+ ...................... 3.39 1.90 1.90 0.11 5.40 5.40 XXX 

G0320 ........ ............ A ESRD related svs home under2 .................. 10.61 7.10 7.10 0.36 18.07 18.07 XXX 

G0321 ........ ............ A ESRD related svs home mo<2ys ................ 6.90 3.67 3.67 0.23 10.80 10.80 XXX 

G0322 ........ ............ A ESRD relate svs home mo12-19 ................. 8.11 3.92 3.92 0.29 12.32 12.32 XXX 

G0323 ........ ............ A ESRD related svs home mo 20+ ................ 4.24 2.38 2.38 0.14 6.76 6.76 XXX 

G0324 ........ ............ A ESRD related svs home/dy<2y ................... 0.35 0.24 0.24 0.01 0.60 0.60 XXX 

G0325 ........ ............ A ESRD relate home/dy 2-11 yr ..................... 0.23 0.12 0.12 0.01 0.36 0.36 XXX 

G0326 ........ ............ A ESRD relate home/dy 12-19y ...................... 0.27 0.13 0.13 0.01 0.41 0.41 XXX 

G0327 ........ ............ A ESRD relate home/dy 20+yrs ...................... 0.14 0.08 0.08 0.01 0.23 0.23 XXX 

1 CPT codes and descriptions only are copyright 2003 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. 2 Copyright 2003 American Dental Association. All rights reserved. 

3 + Indicates RVUs are not used for Medicare payment. 

Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations 

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