# 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


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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


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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 nationalfile (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


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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

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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


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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


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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.


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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


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

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, thestatute 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 wasreceived 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 anagency 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


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

unnecessary. Moreover, because suchprocess 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).


# 1098 Federal Register / Vol. 69, No. 4 / Wednesday, January 7, 2004 / Rules and Regulations

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


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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) thatprovide 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.


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## 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.)


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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 Percentageused 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 ........................... 80DEXAMETHOSONE 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.


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(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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## V ALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 App ly.

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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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

A DDENDUM 

## B.

— R ELATIVE 

## VALUE 

## U NITS 

## (RVUS) AND 

## R ELATED 

## I NFORMATION



## — Continued

CPT 1 HCPCS 2 MOD Status Description Physician work RVUs 3 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 A pply.

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 App ly.

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

A DDENDUM 

## C.

— C ODES 

## W ITH 

## I NTERIM 

## RVU S

CPT 1 HCPCS 2 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 App ly.

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

A DDENDUM 

## C.

— C ODES 

## W ITH 

## I NTERIM 

## RVU S



## — Continued

CPT 1 HCPCS 2 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 App ly.

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

A DDENDUM 

## C.

— C ODES 

## W ITH 

## I NTERIM 

## RVU S



## — Continued

CPT 1 HCPCS 2 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

A DDENDUM 

## C.

— C ODES 

## W ITH 

## I NTERIM 

## RVU S



## — Continued

CPT 1 HCPCS 2 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 App ly.

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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